In search of failure: guidelines for ministries of health.

PIP: Experience indicates that while ministries of health presumably seek to improve service delivery and people's health status, they often seem to act as if they are actually trying to fail by providing few and inadequate services and in limiting improvements in health status. In order to assure failure, ministries of health can proceed as follows: select high-sounding, but unattainable goals; assure inadequate funding for the health sector; centralize all decision making; establish an unwieldy management information system; post untrained personnel and move them often; create an illogical organizational structure; assure the ineffective use of supervision; decentralize the administrative structure, but not authority; delegate as little authority over money and people as possible; limit communication; target the relatively well-off; and use donors creatively. Ministries of health which desire to succeed must acknowledge their fundamental system flaws and commit to correct them. No innovative program nor influx of resources will achieve the desired results until a given ministry creates rational policies and procedures as well as a sound organizational structure.^ieng