Table 4 Leadership, coordination, and control

Competing agendas

“[M]ost of the organizations that arrive in the province, they already have their own plan, they come with the kind of activities they want to implement, they come with districts already identified that they want to support, independently of what priorities the provincial directorate has.” (Provincial health manager)

“There are partners that have their own agenda….they never discussed it with us, they simply arrive and say, I propose to work in community A, B, C with X disease preventive programs, because it’s convenient for me to work in province D, E, F. You don’t know if it’s convenient for the disease program to leave them there, or if it would be more helpful if they went to province G.” (Provincial health manager)

“[B]ecause there were cases that in the same districts we had 2 or 3 organizations, this was always an issue of discussion, the reallocation of NGOs, because the NGOs liked to go to districts more attractive, with good transport means, water, electricity or other kinds of attractive things. And we always argued that there were prioritized districts that we should pay more attention.” (National director)

Parallel Systems

“We already have a recording and reporting system in place, that is also recommended by WHO, but there is a partner that is always asking for other information that we don’t regularly collect although we know that it’s happening in the field, it becomes difficult…so they have to introduce new forms and they are not taking into account that in some health facilities we just have a nurse that has to collect all this information in addition to his/her regular job.” (National director)

“[D]ifferent NG0s have different methods of financial management, most of the time we end up identifying other people to manage these funds. For example, I have people to manage funds for X disease program, another person to manage funds for NGO Y, another person to manage another fund…it’s very time consuming and a lot of papers…if we had the same management fund rules it would save time and human resources.” (Provincial manager)

“[D]uring the two years that I stayed in district M, home based care for HIV was happening only in 4 neighborhoods, I mean, 3 organizations working in the same place, we had a dispute between them, with so many other areas uncovered…it also had implications in numbers that they used to send to us for statistics…maybe their numbers are referring to the same people.” (District program manager)

Accountability

“[B]ut in terms of financial report, this is where we have a big constraint, because there are few NGOs that are transparent and openly state the budget they have for certain activities…even for district planning its difficult since you don’t know how much are you going to be supported.” (District manager)

Capacity for negotiation

“[T]his NGO is based outside Africa. Requests for funds need permission from the NGO headquarters. Well, the request leaves this province, goes to Maputo and from there to headquarters. Meanwhile there are some errors in the request and it comes back again to be corrected and after that it’s submitted again. By the time the permission arrives in this province if it was an emergency, many people would have died without the support. And then I ask, is it useful to have this NGO working with me? Is there an option for more flexibility?” (Provincial manager)

Source: 41 interviews of Mozambique Ministry of Health managers 2008