Health activity planning
The MoH actively undertakes planning for the public health sector, including the CHAZ institutions. The planning cycle follows the Medium Term Expenditure Framework (MTEF) approach over a 3-year period but with a detailed activity budget for each following fiscal year. In addition to this, the national level HQ prepares a 5-year National Health Strategic Plan which guides MTEF planning and feeds into the 5-Year National Development Plans.
Health planning activities are placed under the authority of the Directorate of Planning and Development at MoH-HQ. It organizes and manages the activity on behalf of the MoH and is also the link unit to the National Development Plan. Within the Planning Directorate is also a Policy Unit, which is charged with formulating and processing policy recommendations into national health policies.
Planning and budgeting for primary health care in Zambia takes the form of “bottom-up planning” along an indicative planning figure: first health facilities develop their individual yearly planning ; then their proposals are submitted and consolidated into a district plan by the District Health Office; the provincial health office receives and scrutinises all district health plans for compliance to national level guidelines and compiles these into a provincial health plan; this plan is further scrutinized at national level for compliance to guidelines and set ceilings; finally the national level consolidates all provincial plans and budget into a national; level data for onward transmission to Ministry of Finance & National Planning.
Nevertheless, budget restrictions and ceilings often results in discrepancies between planning and disbursement as discussed in section 1.3.4. Also a study conducted by Equinet in 2005 on planning and budgeting for PHC revealed that some challenges still remain regarding the actual influence of local actors in the planning and budgeting processes at their health facility.