10.04.23 Seite 1

TA Mangement within the Health SWAp

- achievements,challenges and perspectives

Dr. Dieter Koecher, Malawi German Health Programme

10.04.23 Seite 2Page 2

TA-Strategy: achievements and gaps

done

Not done

o Comprehensive picture

o Most effective and efficient approaches

o Identify priority areas

o mangement procedures, costing, funding, timing (exit plan)

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Draft of TA-Strategy: 1. situational analysis

Bilateral funding

Variable quality of TA

Insufficient CP

Weak cost-effectiveness of LATH-intervention

Level service area positionCentral MoH DoPP 1 advisor to the DoPP (JICA), 1

advisor to the deputy (ded)

PAM 2 advisors to the Head of PAM (JICA)

Disease control 2 advisors to Head of HIV-unit (USAID)

HR 1 advisor to follow up on HRMIS (VSO), 1 advisor to support PB-Mgmt (GTZ)

CMS ? Advisors (USAID)

Central hospitals Internal medicine CIM: 1 KCH, 1 ZCH, 1 QECHChina: ? KCH, ? MCHvarious foundations and NGO’s: ? KCH, ?QECH

Surgery CIM: 1 ZCH, 2 QECHChina: ? KCH, ? MCHvarious foundations and NGO’s: ? KCH, ?QECH

Obs and gyne CIM: 2 KCH, 1 ZCH, 1 QECH, China: ? KCH, ? MCH various foundations and NGO’s: ? KCH, ?QECH

Ped CIM: 1 KCH, 1 ZCH, 1 QECHChina: ? KCH, ? MCHvarious foundations and NGO’s: ? KCH, ?QECH

Anaesthesia CIM: 1 KCH, 2 QECHChina: ? KCH, ? MCHvarious foundations and NGO’s: ? KCH, ?QECH

Peripheral MoH ZHSO Ded: 4 PH Specialists

District hospitals UNV: 30?

District management VSO: 25?MSF France:?MSF Belgium: 2?

>10

40-50

>60

1. Myopia and ambiguity towards TA

2. Biased understanding + poor strategic orientation

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Draft of TA-Strategy: 2. RE DESIGNING TA

Control of Performance Management,

Coordination and M+E by MoH

Review service delivery and

funding modalities for TA

Identify Suitably Qualified and Experienced Senior

Staff as Counterpart Personnel and motivate

them

Elaborate an Exit Plan with a phased withdrawal of long term TA Support

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Draft of TA-Strategy: 3. funding options

One pool Separate TA pool observations

Use of existing resources and structures *

Flexibility (integration of various resources **)

*Insufficient** GTZ (and ??) could add additional resources harmonisation+alignment

Less transaction costs (theoretically *); government develops its own Mgmt capacities **

Effective management (easy oversight; out sourcing of certain Mgmt tasks improves quality)

* + ** Existing structures overburdened lost opportunities = hidden costs and limited impact of TA

Politically correct (“on budget”); fragmented TA (at least “short term”-TA mainly “ad hoc” based and bilaterally provided

Pragmatic solution (“off budget”) *; comprehensive approach to TA

* What about accountability?!

Integration of short term consultants, possibly some trainings for counterparts, etc.

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Way forward… Finetune and disseminate TA-Strategy Discuss it with special emphasis on different

funding options and come to a common position Move rapidly towards implementation