One immediate problem confronting the NHSO was how to exercise its purchasing
function in local areas, and what organizational infrastructure would be needed
to support this. Initially, the NHSO assigned the Provincial Health Office (PHO) to
run provincial branches, which meant that both purchaser and provider roles
were invested in a single organization. PHOs were accountable to the NHSO
and MOPH, but in reality, the primary allegiance of most PHOs was to the MOPH
because of the traditional lines of command and control in the MOPH organizational
hierarchy and the fact that the provincial chief medical officer is appointed
by the MOPH permanent secretary. These dual responsibilities led to conflicts in
UCS implementation. After 2006 the NHSO transferred the devolved purchasing
role to 13 regional branch offices, which then liaised with PHOs to formulate local