The National Primary Health Care Development Agency (NPHCDA), formed in 1992, is responsible for the delivery of primary health care services and the construction of the new health centers. It establishes and trains local development committees to manage local health care. As local development committees are being established, health center and community outreach staff are trained and health centers constructed and equipped by NPHCDA.

In early 2003, the M&L Program carried out a management needs assessment and assisted the NPHCDA in strategic planning. Since then, M&L has worked to address NPHCDA's basic management needs as identified in its strategic plan. M&L's technical assistance includes:

1. reengineering and computerizing the financial management system,
2. reengineering and implementing basic human resources (HR) systems to include job descriptions and performance-based planning and evaluation,
3. implementing and expanding a pilot project for the collection of service statistics, which will include the installation of software developed by MSH
4. establishing guidelines for the phased decentralization of the NPHCDA.

In June 2003, the NPHCDA financial management system was assessed. Recommendations were made for improvement, including the identification of a software package, which was purchased in December after M&L secured additional funds. Staff training in the use of the financial management software is underway.

After a basic assessment, the human resources system was redesigned. Field staff duties and responsibilities have been reworked, new job descriptions have been written, performance standards have been established, and HR procedures drafted.

NPHCDA has successfully implemented a pilot program for the collection of service statistics, which can be expanded for use at all health centers overseen by the organization. Additionally, it is in the process of implementing a software package, originally developed by MSH in its Equity Project in South Africa, that will greatly enhance its ability to collect service statistics and use the data for decision-making.

M&L will continue to help NPHCDA improve financial and programmatic accountability at all levels. By February 2005 (when funding ends) M&L expects that the organization will have quality and timely financial and programmatic information for decision making. It will have a well-defined system for planning the work of field staff and assessing their performance vis-à-vis their individual plans. NPHCDA will also be able to determine the cost of primary health care services at the local and national level and calculate the cost-benefit of service provision.