Bytheendoftherole-Playing Exerciseitishopedthatparticipants Willachievethe Following

FACILITATOR’SNOTESON: “DecentralisationandHumanResourcesDevelopment”

1. Objectivesofroleplay:

BytheendoftheRole-Playing Exerciseitishopedthatparticipants willachievethe following:

•Understandtheimportanceofeffectivecentralgovernmenttoadecentralisation programme.

•Understandthatdecentralisationisnotjustaonce-offtransferofpowerbuta processofcontinualdevelopmentofanewsystem.

•Evaluate the appropriate roles and responsibilities of different levels of governmentinhumanresourcedevelopmentinthedecentralisedhealthsector.

2. Keyissuestocoverbeforeusingcasestudy:

Itisusefultocoverabitofbackgroundinformationonhowdecentralisationaffects therolesandresponsibilitiesofdifferentlevelsofgovernment. Itmaybeparticularly useful to highlight the fact that decentralisation initiatives often focus on developments innewlyformeddecentralisedunits,withverylittleattentionpaidto redefiningtheroleofhigherlevelsofgovernment(whicharehavingtogiveupsome oftheirpreviousresponsibilitiestolowerlevels).

3. Overviewofroleplay:

Theroleplaytakesabout1.5-2hourstoundertake. However, ifreadingofthe background materialsistooccurinthe‘classroom’ session,afurtherhourwillbe required. Ifpossible,6groupsshouldbecreated(withabout3-4peoplepergroup). Ifthenumberofparticipantsistoosmalltoallowforthisnumberofgroups,5groups shouldbesetupandtheonerole(thatoftheTreasuryTeam)shouldbeomitted.

Therolesthatareusedare:

•MinistryofHealth-DirectorofHumanResourcesandtheHRDteam

•President’sOffice-ChiefExecutiveTeamtothePresident

•PublicServiceCommission-DirectorofPostsandPackagesandcolleagues

•NorthernProvince-DirectorHRDandcolleagues

•EasternProvince-DirectorHRDandcolleagues

•NationalTreasury–DeputySecretaryandcolleagues

4. Introductiontogroupwork:

Thiscasestudyreportisgiventoallparticipants. Ifpossible,participants shouldbe requestedtoreadit beforethesession(e.g.overnight).

Wheninitiatingthegroupwork,thefacilitator shouldpresenttheproblemtothe participants andreinforcethekeyissuescontained inthesummaryparagraph ofthe backgroundreport(seepage2oftheroleplay).

Thefacilitatorthendiscusses,briefly,themainteamsof actors,beforeinvitingpeople tosayinwhichteamtheywouldliketobe. Eachteamisthenpresented withan envelopecontainingtheir“confidential” briefings(includedinthissetoffacilitator’s notes).Thefacilitatorshouldstressthatthesebriefingsareconfidential (i.e.onlyfor the eye’softhe teamtowhichtheyare given)asthe notescontainsomethoughtson strategy as well as gossip about other teams/actors. Each team should also presented withanamecard(whichjusthelpspeopleremember who’swhosothat theycantrytoformalliancesbeforethemeeting).

Teamsaregiven45minutes toreadthrough theirbriefing, andtoworkouttheir strategiesforthemeeting. Itisusefulforthefacilitator(s)tovisitthedifferent groups tohelpthemstrategise andtosuggestotherteamswithwhichtheymayconsider tryingtoformalliances.

Itwouldbeusefultohaveashortbreak(e.g.fortea)aftergroups havecompleted theirdiscussions.Thiswillallowdifferentteamstoattempttoformalliances.

TheteamfromthePresident’sOfficeisresponsibleforopening, chairingandclosing themeeting. Itislikelytotake30-45minutes forallteamstobeabletoputtheir viewpointsforward. Ifthemeetingisdraggingontoolong(beyond45mins)the facilitatorcaninterveneandputatimelimitonthemeeting(“thePresidenthas called anEmergencyCabinetmeeting”orthelike). Thechairshouldformallyclosethe meetingwithadecisiononthefuturehumanresourceplanninganddevelopment rolesandresponsibilitiesofdifferentstakeholders.

Apartfromthis‘timekeeper’role,thefacilitatorshouldkeepasmuchofabackseat aspossibleinthe meetingitself. Instead,the facilitatorshouldtakenoteson someof theissuesthatarise.Inparticular,itisworthnotingthefollowingissues:

• theagendasthatarepushed(recentralisationvs.improveddecentralisationetc.);

• thealliancesthatareformed;

• thelinesofargumentsthataredeveloped,and

• the technical roles and responsibilities for different role-players that are suggested.

Afterthemeetinghasclosed,itisworthwhilediscussingsomeoftheseissueswith theparticipants andgettingtheirreactions. Itisalsointerestingtoseewhetherthey think,fromatechnicalperspective,themeetingreachedtherightdecision. Key messagesshouldbereinforcedinthefinalsummary(suchastheimportance of clearlydefiningrolesandresponsibilities ofeachlevelofgovernmentwhen decentralisation isimplemented,aswellastheneedtonotonlyfocusonthenew decentralised unitsbutalsotopayattentiontoredefiningtheroleofmorecentral levelswhoareexpectedtogiveuppowerandresponsibility).

1. Directorof HumanResourcesDevelopmentand HRD Team,Ministryof

Health

ThecentralMinistryof Health(MOH)hasrecentlyappointedyouas anewDirectorof HumanResourcesDevelopment andyouhavewastednotimeinhiringateamof hotshotplannerstostrengthenyourweakDepartment. ThepreviousDirectorwas sackedafterprovingtobeineffectual inhisposition.Hepresidedoverhealthsector humanresourceswhilethecountryunderwentdecentralisationbutwasincapableof realisinganewrolefortheMOHinhumanresourcesdevelopment.Indeed,itis widelythoughtthathumanresources arenotbeingappropriatelyallocated underthe decentralisedsystem.

Belongingtothe“oldschool”ofcentralisedplanning,yourpredecessorspentmuch ofhistimemoaning aboutthelossofpoweroftheMinistryandpouringscornonthe newsystem.AsaresulttheMOHwassidelined inthedecisionmakingprocessand hashadlittleimpactonplanningormanagement ofhumanresourcesinthehealth sectoreversince.

YouandyourteamareawarethattheMOHneedsamuchlargerroleinplanning andtraininginhumanresources.Nevertheless,areturntocentralplanningmightnot betheanswer. Whatmightbeneeded isfortheMOHtobegivenanoverallroleof coordinator whilstprovidinghelptothoseprovinceswhichhavelimitedcapacityand resources.Nevertheless,youwillhavetogetsupportfromtheothersforthis.

YouhavebeenmovedfromthePublicServiceCommission (PSC)togivesome valuedexpertisetotheMOH.YouknowthePublicServiceCommissionwell.They arenothappyaboutyourmoveandprobablywillseeyouasaturn-coat. Youalso knowtheDirectorofPostsandPackagesfromUniversity. (S)heisaveryambitious personandyoususpect(s)hewilltryandundermineyourteamatthemeeting.

2.President’sOffice

As Chief Executive Team to the President your job is to follow up with other Ministrieson mattersof technicalconcernto thePresident.Recently,decentralisation hasbeeninthespot-light.LastMondaytheResidentRepresentative (RR)ofthe WorldDevelopmentBankvisitedthePresidentfortheirmonthlydiscussionofthe stateoftheeconomy. Thethirditemontheagendawastheprogress of decentralisation andinparticularthepoorrecordofthehumanresourceplanningin thehealthsector.ThePresident’s attentionwasdrawntoarecentevaluation. Itis clearthatthereisnorationalplanninggoingoninthesector:manyprovinces donot seemcapableofgoodplanning,especially thepoorerones,andtheMOHseemsto havenocoordinatingrole.ThePresidentwasnotpleased.TheRRsuggestedthat theproblemneededtobesolvedquicklybysacking keypeopleintheMinistry of Healthandbringingeffectivehumanresourceplanningbackintotheprocess. Ifthis doesnothappen,vitalaidtothecountrymightbelessforthcoming innextmonth’s negotiationswithdonors.

ThePresidenthasputyouon thetaskto “sortit out”andhasaskedyoutoconvenea meetingofthekeystakeholders.Theagendaforthemeetingisasfollows:

1. WelcomeandIntroduction(geteachstakeholdertointroducethemselves)

2. Assesswhatactionisneededtoimprovetheplanningandtrainingofhealth

sectorhumanresourcesunderdecentralisation(geteveryone’sopinion)

3. Assignnewrolesandresponsibilities(thisisthemostimportantpartofthe meeting)

4. Agreenextsteps

Youareawarethat,ontheordersofthePresident, theformerheadoftheHuman ResourcesDivisionintheMOHhasbeensackedandanewDirectorhasbeen posted(previouslyfromthePublicServiceCommission). Oneofyourtasksinthe meeting willbetodecidewhether thenewDirector isuptothejob.If(s)heis,then MOHcouldleadthecoordination ofrationalplanningofhumanresourcesinthe system.If notthentheresponsibilityneedstobegiventothePSC.

Whateverhappensthecurrentad-hocsystemcannotremaininplaceandyouwillnot takeanynonsensefromtheProvincialGovernmentRepresentatives aboutlossof control.Thereisclearlyaneedforinformedplanningofhumanresources atthe centrallevel.

3.PublicServiceCommissionTeam(PSC)-DirectorofPostsandPackages andcolleagues

Youareresponsibleforoverseeingtheadministrationofthegovernment bureaucracy. Youarecareerbureaucratsandhavenotbeenveryhappyaboutthe factthatyouhavelostsomepowertotheprovincesthroughdecentralisation.

Youhavebeensummoned toameetingtoresolvetheproblemsinhumanresource planninginthehealth sector. Itisquitecleartoyouthattheprovinceshavenotbeen doingagoodjobofplanningtheirpersonnel positionsandtrainingtheirstaff.You, nevertheless, feelthatthePSCcangetontopoftheproblem.Indeed,thereisno needfordesperate action-acoupleofhealthsectorplannersplacedintothePSC couldhelpcoordinatethesectorandresolvesomeofthepresentinefficiencies in allocatingresourcesandtraining.Indeed,aquietreturntocentralised planningand trainingisneeded(thoughyouwouldbewisenottotrumpet thistooloudlyinthe meeting)whereresourcescanbedistributedtowardneedandwheretheallocationof humanresourcesisnothostagetolocalpolitics.

Indeed,youhavedrawnupsomeplansforanew “HealthPostsPlanningUnit”under yourMinistry.ThiswouldonlycostanextraUS$75,000ayearandevenifthe MinistryofFinancewon’tfundit,youhaveheardthattheWorldDevelopment Bank hassomeslushfundsforimportantprojects.

YouknowthenewDirectorofHumanResourceDevelopment intheMOH,as(s)he wasaformercolleague ofyoursinthePSC.(S)heisabittoocleverforhis/herown good.Youhavealsoheardthatteamofplannersthat(s)hehashiredareknownto beflashyopportunists.TheDirectorofPostsandPackageswenttoUniversitywith theDirector ofHRD,MOHandcanvouchthat(s)heisjustasirritating asever. Actuallyyouthoughther/hispredecessorwasn’tallthatbad.

4.ProvincialHRDTeam:NorthernProvince

Comingfromtherichestprovinceinthecountry youhavebeenquitehappywiththe decentralisation process.Youbelievethatithastakenpowerawayfromacentral conservative eliteandhelpedtransferpowertothepeopleofthecountrywhoreally matter.Youareawarethattherearemovesafoottotransferpowerbacktothe centralministriesandyouhaveheardrumoursthattheWorldDevelopmentBank (theinternational donoragency)isbehindamovetorecentralise humanresource planning.

You havedevelopedgoodcapacityatthe locallevelfor planninghumanresourcesin yourprovince.Admittedly, thishastakentimebutyouarenowconfidentofthe expertiseofyourstaff.Youhavebeenabletohiregoodcalibrepersonnelbypaying

25%abovethemarketrate.Youhavealsoexpanded yourstaffatkeyfacilitiesand thishasgreatlybenefitedtheserviceprovidedto yourcustomers.Indeed,inarecent survey,74%ofrespondentsintheNorthernprovincethoughtthatdecentralisationin the healthsectorwasagoodthing.Youhavealsobeenabletofundandorganisean in-servicetrainingprogrammeformedicalpersonnel.

Decentralisation hasgivenyoualotofgainsandyouareveryreluctanttogiveup yourpowers.Itisveryimportant thatyouareallowedtoconduct mostofyourown humanresourceplanningand managementwiththe minimumofcentralinterference. Thingsmustnotbeallowedtoreturntothebadolddays.Nevertheless,yoususpect itwillbeanuphill battle inthemeetingandneed toforge allianceswith organisations whowillpreserveyourpowerbase.

Youshouldholdoutforlocalcontroloverplanninghumanresources, linkedtolocal fund-raisingability.Afterall,youhavesomeimportanttertiaryfacilitiesthatprovide for patients from other provinces. You need staffing to mirror your enhanced provincial role.Indeed,perhapsotherprovinces shouldbehelpingyouprovidesuch services!

5.ProvincialHRDTeam:EasternProvince

TheEasternprovinceisthepoorestinthecountry.Although youlikedtheideaof decentralisation, inpracticeithasnotbeenbackedupbythenecessaryfundsfrom theMinistryofFinance. TheProvince issimplynotrichenoughtohireskilledstaffto conducthumanresourceplanningatalocallevel.Furthermore, thecentral government hasnothelpeddevelopcapacityatthelocallevel.Thishasbeenvery frustrating andinprotestyoudecided tostoptheMOHusinghealthfacilities for traininginyourprovince. TheMinistryofHealthwaslividandafterseveralthreats forcedyoutoretractyourmove(seetheevaluationreport).Nevertheless, MOHhas stillnotofferedyouanyhelpincapacitydevelopment.

Whatmakesyoumoreangryisthatotherprovinces whoarerichenoughtomanage theirownaffairshavebeendoingwelloutof thedecentralisation.Thepresent systemisclearlyinequitable andunfair!Ideally,theMinistryofHealthwouldneedto allocatefinancesforhealthcarehumanresourcesinlinewithneed.Itisclearthat theEasternProvincehasthegreatestneedandyetcurrently itisgettingtheleast fundsforhumanresources!

YouhaveheardthatthereisanewDirectorofHumanResourcesDevelopmentin theMOH.(S)heissaidtobemoresympathetic thanthepreviousone.Itmightbe worthseeingif MOHorPSCaresympathetictoyourconcernsbeforethemeeting.

6.DeputySecretaryToTheTreasuryAndTeam

You have technical responsibilityfor coordinatingthe annual Budget. The next Budgetcyclelookslikebeingtougher thannormal. Thedonorsaregivingnegative signalsthattheremightbelessfundingthananticipated innextmonth’svitalaid negotiations.Decentralisation isbeingspot-lightedasanareawhereimprovements mustbemade,particularlyintermsofefficiencyofthereformsandperceivedequity oftheresults.Acommitmentfromthegovernmenttoredresstheinefficienciesinthe currentplanningofhumanresources inthehealthsectormaywellbuyvaluable credibilityandaid.

Anyfreshdemandsforresourcesfromtheprovinceswillnotbeconsidered, unless theyaretargetedsolelyatimproving efficiency inHRDplanninginthehealthsector. ThetotalamountofGovernmentmoneygoingintothedecentralisation process cannotbeallowedtorisefurther.(However, shorttermdonorgrantsmaybe consideredwheretherecurrentcostimplicationsareminimal.)

Youareabitannoyedathavingtoattendthismeeting.You havelittle respectforthe

MinistryofHealthandaresickandtiredofmoaningprovinces.

Youwould prefer amore centralisedsolutiontothehealthsectorproblem.Compiling provincialplansandbudgetshasbeenahead-ache fromstarttofinish.Thereis clearlynotthecapacityinthecountry,atthemomenttodecentraliseasfarasyou areconcerned. Havingsaidthis,aslongasasolutionisreachedwhichisfiscally prudentyouareprobablynotgoingtoworrytoomuch.Youcanthenparadethisto thedonorsandgetonwiththerealbusiness, preparing fornextmonth’said negotiations.

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