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Analytical summary - Leadership and governance

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Descriptive summary

Since the end of the socialist era in 1991, the Government of Zambia has developed complex mechanisms of leadership and governance. The National Health Policies and Strategies published the same year set the starting point for the development of far reaching health reforms in the following years, including the decentralization policy, the introduction of the Basic Health Care Package (please check the NATIONAL HEALTH STRATEGIC PLAN 2006-2010 for more information), and the early steps of Sector Wide Approaches in coordination with Cooperating Partners.


  • There is strong political will and commitment
  • There is clear and limited mandate of the MOH (Ministry Of Health) to provide oversight
  • Leadership structures are in place
  • Fiduciary responsibility over financial and other resources have been enhanced
  • Partners goodwill
  • Improved institutional capacity at all levels to provide oversight
  • Existing of policy and strategic environment to support service delivery - FNDP (Fifth National Development Plan ), NHSP (NATIONAL HEALTH STRATEGIC PLAN), MDG (Millenium Development Goal), PRSP (Poverty Reduction Strategy Paper), Vision 2030


  • Policies are largely donor influenced
  • Lack of policy direction with the existing policy on secondary and tertiary services delivery management
  • Weak documentation of the definition of the scope of the Health sector
  • Long term reliance on vertical programmes
  • Donor government creating parallel departments in the name of NGO (Non Government Organisation) creating unhealthy competitions
  • Inadequate human resources to support leadership and oversight at all levels
  • Inadequate oversight and quality assurance
  • Limited implementation of health policy
  • Inadequate capacity for leadership and management at various levels
  • Poor compliance with government guidelines and regulations


  • Revamp leadership management training MOH staff at appropriate level
  • Induction of Health workers must be enhanced with regulations and guidelines
  • Annual Performance Appraisal system should broaden to capture appropriate government regulations and guidelines
  • MOH to provide leadership and ownership in policy formulation and implementation
  • New engagement framework with cooperating partners and CSO (Central Statistical Office) should be developed-paris declaration and the three ones principle strengthened
  • MOH to put in place policies and strategies that can strengthen secondary and tertiary health service management
  • Promote integration of programmes
  • Revise National Policy

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