Report Monitoring Progress made by the Honduras Ministry of Health’s 2016 Improvement Plan
About the chapter:
The Asociación para una Sociedad más Justa (Association for a More Just Society, ASJ) is the Honduras Transparency International Chapter - a nonprofit organization that promotes justice and peace through advocating for the transformation of the state system and the empowerment of the Honduran people in order to achieve a more just society, where the rights of the most vulnerable are guaranteed and satisfied. ASJ was founded in Honduras in 1998, and for the past 21 years has worked to fight corruption and strengthen public institutions in the health, education and security sectors while empowering civil society to claim their rights and carry out social accountability efforts. Since 2015 ASJ has done social oversight to 9 public institutions with special emphasis on health, educaction and security sectors and 3 management areas: purchases, human resources and statistics. Through a compliance review ASJ measures the institution's compliance with laws and best practices which has contributed to an average increase of 30 points, going from 33% to 63%. In the health sector, ASJ has also promoted integrity agreements and participates in a Technical Committee in charge of purchasing medications in addition to issuing some research documents.
CPI Score: 29
CPI Rank: 132
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Theory of Change
Policy & Insititutional ChangeBetter Institutional Processes
In January 2014, the Honduras government and TI/ASJ signed the “Collaboration and Good Faith Agreement for Promoting Transparency, Combatting Corruption and Strengthening Systems”. Since then, TI/ASJ has conducted independent monitoring and evaluation of the Ministry of Health’s performance in three areas: purchasing and contracts, human resources management, and data collection and evaluation.
Based on TI/ASJ’s recommendations, the Ministry of Health introduced an improvement plan in 2016, which covers different actions and commitments to enhance their performance.
This report seeks to provide information about the improvements made by the Ministry of Health in purchasing and contracts, human resources management, and data collection and evaluation. It highlights progress and provides policy recommendations.
Together with the Ministry of Health, TI/ASJ selected specific indicators for evaluating the three major areas on which the Agreement focuses.
In the area of purchases and contracts, TI/ASJ evaluated the Ministry of Health’s procedures and regulations based on specific instances of contracting and purchasing medicines, medical supplies, and insecticides.
In the area of human resources, TI/ASJ evaluated the Ministry of Health’s procedures of management planning, hiring of personnel, and firing of personnel.
In the area of data collection and evaluation, TI/ADK evaluated the different processes to generate certain indicators that are important to the evaluation, data collection, and management of the institution.
To monitor the Ministry of Health’s improvement plan, the following steps were taken:
- ASJ/TI elaborated a monitoring and follow up matrix.
- The Ministry of Health presented a report showcasing progress in the monitoring indicators.
- TI/ASJ compared the Ministry of Health’s responses in their improvement plan versus baseline data. TI/ASJ considered three levels of execution: 1) not accomplished, 2) in process, and 3) completed.
- The teams focused in each area (purchasing and contracts, human resources management, and data collection and evaluation) revised the quality of the data.
- These teams met with the Ministry of Health to validate their conclusions.
- TI/ASJ evaluated the Ministry of Health’s overall advancement in their improvement plan.
- TI/ASJ wrote the report.
- The Ministry of Health created a database registering the prices of more than 580 products from previous procurement processes. However, they still need to run a market study and conduct an analysis that assesses the value for money of purchasing these products.
- The Ministry of Health introduced a draft regulatory framework for technical processes at the National Store of Medicines and Supplies, which was socialised with relevant staff.
- The Ministry of Health has a draft national policy on human resources.
- The Ministry of Health needs to make the regulatory framework for technical processes at the National Store of Medicines and Supplies official, and ensure its implementation.
- The Ministry of Health should strengthen all processes related to contracting, and especially the procurement unit. This should cover proper budgetary, administrative and regulatory analyses, as well ensuring that the purchasing and contracting staff are well trained.
- The draft national policy on human resources is a positive outcome. However, the Ministry must improve this draft, ensuring that it contains mechanisms to determine future personnel demand; guidelines on how to systematize employees’ censuses, considering aspects of specialization and geographical location; a strategy for the redistribution of administrative staff; and measures of personnel control, fault monitoring and application of sanctions based on due process.
TI/ASJ conducted a third review/evaluation to measure whether the progress achieved through this monitoring process has an impact on users of the system. TI/ASJ found:
- Increased governance/civil society contribution to strengthen the Ministry of Health: The Ministry allows civil society to review their performance on a yearly basis. This creates a space for both sectors to discuss the challenges faced by the public institution and agree on solutions (improvement plans). TI/ASJ also participates as external observers or provides technical assistance in specific processes such as purchasing medications and hiring medical doctors, among others. The Ministry of Health has implemented 34% of the recommendations issued by TI/ASJ in their reports, a total of 22 recommendations.
- Increased transparency: The Ministry of Health provides access to files for TI/ASJ to review their procedures and compliance with the law and identify best practices. In the baseline report, the Ministry got a transparency score of 52%. This score measures information published (for purchases and human resources management) and information requested. In the third evaluation, their score went up to 76%. This represents an increase of 24 points in their transparency, measured by access to information, information published on their website and the public purchases platform.
- TI/ASJ has witnessed major changes in the Ministry of Health’s operations. These are:
- A competitive and merit based hiring process for 456 medical doctors that resulted in hiring 392 doctors who showed the best qualifications for the job. This is the first one in years since doctors would not apply because they needed political recommendations or needed to make a payment to get a position in the public health system. ASJ participated in the design and also as an observer in the whole process.
- They have started to do a national census, which has been a TI/ASJ recommendation since the baseline report.
- The Ministry of Health has created some tools for recording prices of 580 goods purchased by them and has regulated some procedures for distributing goods purchased.
- Work to strengthen the enforcement of policies should be accompanied with work to hold officials to account.
- Social monitoring is crucial to the sustainability of new processes and changes. Monitoring has proven to contribute to better performance of institutions. It must, however, keep its Independence at all times.
- Political will can be major determinant in the success of monitoring, evaluating and accompanying public institutions in their path to stronger, more transparent, accountable, efficient and effective institutions. Where possible, it is advantageous to seek commitments by senior politicians.
- Transparency and accountability can be seen by government officials as compliance to laws or policies, rather than an obligation to disclose and be accountable on how public resources are being used. It is helpful to advocate for the social outcomes of integrity work.