Very high turnover of MOH (Ministry of Health) staff slowed policy reforms that required legislative approval and government commitment. Although government changes cannot be predicted, a longer-term assessment of overall political stability would be valuable, so as to prioritize project policy goals that are necessary for project implementation and sustainability. A key lesson is that reform ambitions need to match the actual capacity of government agencies and factor in turnovers. Also, high staff turnover has an eroding effect on the institutional capacity of MOH, particularly in areas of policy analysis, continuity of policy reforms, and institutional memory. Therefore, future health projects should instigate skills development, training on policy analysis, and regular briefings and information sharing for MOH staff to improve counterpart competence, both individual and organizational. The government should enforce the implementation of current legal acts, such as the Civil Service Law, to make professional staff appointments independent from political changes in government. Strengthening legal enforcement is a more sustainable approach, but would require consolidated efforts by all political parties.
Third Health Sector Development Project