Stakeholder views
Many clinical service providers involved with MSOAP are not directly involved with or exposed to the administrative aspects of the MSOAP. Just over 30% are not involved in the development of and approval of the service proposal or the funding agreement. Around 23% are not involved with submitting invoices or activity reports.
The majority of service providers involved with these processes generally found them reasonable relative to the funding involved. Between 11 and 14% of service providers find these processes onerous.

Table 71 - MSOAP service providers assessment of administrative processes

How well coordinated are the outreach services provided in this location Inner and Outer Regional Remote and Very Remote Total
1. Good coordination, problem are rare 64% 37% 55%
2. Adequate coordination, there are some problems, but these do not greatly affect the services provided 32% 49% 38%
3. Poor coordination, there are regular problems, which have a detrimental effect on the services provided 4% 14% 7%

Source: HPA survey of MSOAP service providers, 2011.

In commenting on the administrative arrangements between fundholders and DoHA, almost all of those interviewed found the administrative processes very problematic. Fundholders considered the program over-administered, with a focus on detail to the detriment of an understanding of strategic issues. They compared MSOAP unfavourably with other national health programs they managed. The level of reporting, as discussed above, is very high. Activity reporting (Attachment B) was singled out as one of the most significant burdens, because macros embedded in the reporting template often required manual entry of data, sometimes over a period of weeks. Several fundholders argued for a rationalisation of funding agreements and reporting.

DoHA officers at the state/NT level also considered the level of reporting excessive. In most instances they considered fundholders had performed reasonably. There were areas in performance of some fundholders that were highlighted as being problematic, such as delays in submission of annual plans and reports, and reports that did not comply with requirements.

Evaluation findings

Funding agreements with most fundholders have been for three years with a one year extension for 2011-12. In general the three year funding agreement period has not been considered a major problem.

Reporting requirements under MSOAP are excessive. Fundholders and state/Northern Territory DoHA offices spend a disproportionate amount of time managing these. Within any one financial year there are around 24 documents reported under these two programs, with additional reports at the commencement and end of funding agreements. MSOAP-MS will add to reporting requirements. Fundholders managing other programs (e.g. USOAP) have additional reporting requirements.

In jurisdictions with two fundholders, reporting is doubled. This adds to the administrative demands on DoHA staff.

Variations in service proposals over 10% require DoHA approval, creating additional administrative processes.

An additional set of administrative support work is generated by the Annual Plan process. Each year, the MSOAP advisory fora consider every MSOAP service proposal. This generates a significant volume of paperwork, often in relation to service proposals, which are reapproved every year.

The timing of approval of annual plans and service proposals (generally in May-June) occurs late in the financial year and coincides with other reporting requirements. Several stakeholders believed service proposals for the forthcoming financial year should be approved by April. This would allow greater certainty for service providers, less disruption in service provision and reduce potential underspends.

Fundholders have to manage contracts with all service providers. For most fundholders contracts have been made on an annual basis. However, a number of fundholders have moved to longer term contracts (up to three years) with appropriate provisions for review and termination.

Recommendations - streamlined administration

26. One set of guidelines should be developed for all the MSOAP programs, highlighting any differences in eligibility or other issues.
27. All MSOAP programs should be integrated into one funding agreement between DoHA and the relevant fundholder, with details of annual allocations specified for relevant subprograms, specified in an attachment to the funding agreement. Variations in funding allocations should be managed through an exchange of letters agreeing to a variation to the funding agreement.
28. Funding agreements between DoHA and fundholders should be for a three year period with an option to extend for a further three years following review.
29. Reporting under the funding agreement should be rationalised. The structure of reports should be integrated so that there is one report including all subprograms. Details of subprograms should be specified in the report. The following integrated reports should be required under the funding agreement:
      a. A three year service plan to be submitted prior to the commencement of each three year cycle, together with data extract on proposed services for the national database.
      b. Annual update plan to be submitted prior to the commencement of years 2 and 3 of the three year cycle, together with data extract on proposed services for the national database.
      c. Quarterly income and expenditure statements.
      d. Annual audited statement.
      e. End of year report (including final report).
      f. Continuous or monthly data extract to national database.
30. Service proposals should be able to be approved for a cluster of locations (or a circuit) for a single service provider. However, reporting on services should always be in terms of visits to individual locations.
31. A higher threshold for requiring approval by DoHA of a variation in a specific service proposal be set, specifically:
      a. Within any financial year, fundholders should have the capacity to approve a change in the mix of service locations visited within a service proposal, without referral to DoHA. (This does not include the addition of new locations.) However, an ongoing change in the mix of services at locations should be referred to the advisory forum for consideration in the next annual/triennial plan.
      b. Within any financial year, fundholders should have the capacity to approve an increase or decrease of up to three visits to the specified location(s) for a service proposal, without referral to DoHA. However, an ongoing change in the level of visits for a location should be referred to the advisory fora for consideration in the next annual/triennial plan.
      c. Three year and annual plans should specify reserve services. Fundholders should have the capacity to initiate funding for these services without further reference to DoHA, in order to ensure funds are expended within the year.
32. Fundholders should be encouraged to develop three year contracts with service providers where they have been approved under the three year plan. Appropriate provisions for managing non-provision of services or changes in circumstance should be included in the contract.
33. An approach to invoicing and reporting by service providers should be developed that involves a capacity to include multiple locations in one invoice (e.g. a circuits or cluster of visits). Associated reporting of activity should be disaggregated by individual locations visited, but with a capacity to report multiple locations in one form. Systems for on-line submission of reports and invoice should be developed.Top of page