For an efficient, decentralised, transparent and inclusive health system

Recommendations: 1. On planning and budgeting, greater coordination is recommended between planning (setting priorities) and budgeting (financial apportionment). Transformation of all District Health Services, Women and Social Action (SDSMAS) into Management Beneficiary Units (MBU) is necessary. 2. Stakeholders should bet more on application of national public financial management systems (PFM). The use of parallel financial systems instead of enabling the National Health System (NHS) to be more e cient hinders the enhancement of the sector’s PFM systems. 3. With regard to budgeting, zero-based budgeting implementation is recommended, replacing the incremental budgeting system. Zero-based budgeting is more realistic in so far as the health sector operation costs are concerned. 4. On the decentralisation and citizen participation component, the establishment of a national plan for decentralisation in the health sector is recommended. This plan would allow systematise local citizen participation mechanisms in the health system management and monitoring. 5. On revenue collection, the sector authorities need to explore areas of potential revenue already identified in Intellica’s 2013 research report, such as drug prescription, outpatient, medical certificate rates; and comply with the Decree 11/2007 of 30 May, which regulates tobacco consumption and sale, which has great potential to generate revenue for the health sector at the district level, by means of fines on the lawbreakers. 6. A Policy Brief drawn from the Public Expenditure Tracking Survey (PETS) in the Health Sector in Angoche, Bilene, Magude and Xai-Xai districts, and Chamanculo and José Macamo General Hospitals On expenditure performance, more and better coordination among stakeholders at district levels and Health Centres is recommended in order to avoid expenditure implementation costs in a fragmented and uncoordinated manner. 7. On procurement, accuracy improvement is recommended for the current legal framework implementation. This is to ensure that Procurement Management Units (PMUs) are practical; they can perform their tasks with independence, impartiality and professionalism. The direct award should always be treated as provided for in the law (an exception) and not deemed as the rule like what we have noticed occur in the researched cases. The document disorderliness of the Procurement Management Units portfolios can be solved with portfolio digitisation, ensuring more and better file and document handling, more control and additional transparency. 8. On transparency, recommendation to the Ministry of Health (MoH) is on the establishment of mechanisms which may ensure that sector o cials, who handle equal duties, should have the same understanding about procedures, not only in the health sector, but also in liaison with other sectors and society in general. When applying the Right to Information Act, Civil Society Organizations (CSOs) should now carry out awareness raising sessions and dialogue with sector o cials in order to reach mutual understanding on the added value that represents transparent public service management, with accountability and civil society influence, through monitoring and evaluation.