While considerable progress can be made in capacity-building at the national level, this usually ends up reinforcing existing centralized MOH management capacity. As a result, evaluations often find that a health district capacity-building project has had almost no impact the improvement of the provision and management of health services at the health center and community levels. Two examples of actual health systems logframes are provided. Financial sustainability of PHC will be increased through cost sharing and community financing of health services. The MOH authorizes testing of cost sharing for Districts.
Districts have and use the authority to prepare and manage their own budgets.
Research in priority diseases, including malaria, diarrhea and ARI, has improved prevention and control at the service provider level. The Mangochi research station is completed in '94. Research grants to NGOs are made in 1994. Village health committees are active in planning, managing and financing health and development initiatives. Pre-Service Training of District personnel has been strengthened in PHC management.