deoki nandan political feasibility and political strategies for hrh reforms puri
TRANSCRIPT
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Political Feasibility andPolitical Feasibility and
Political Strategies forPolitical Strategies for
HRH Policy ReformHRH Policy Reform
(Theory into practice(Theory into practice The Agra experience)The Agra experience)
Prof. Deoki Nandan,Prof. Deoki Nandan,
Doctor Honoris CausaDoctor Honoris Causa--Odessa State MedicalOdessa State Medical
University, MD, FAMS, FIAPSM, FIPHA, FISCDUniversity, MD, FAMS, FIAPSM, FIPHA, FISCD
DirectorDirector
([email protected], [email protected],([email protected], [email protected],
www.nihfw.org)www.nihfw.org)
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How to do it?How to do it?-- the Agrathe Agra
experienceexperienceDecember 2003December 2003 took over as Principaltook over as Principal
and Chief of Hospitaland Chief of Hospital
Pathetic state of hospitalPathetic state of hospital--wards, OPD,wards, OPD,OTOT
Demotivated staffDemotivated staff-- court cases, nocourt cases, no
promotional avenues, no recruitmentspromotional avenues, no recruitments
Patient load minimalPatient load minimal--most preferred themost preferred the
private sectorprivate sector
Image of the institution was not goodImage of the institution was not good
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Biggest question wasBiggest question was--how to garner politicalhow to garner political
commitment forcommitment for
enablingenablingenvironment?environment?
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Getting Political SupportGetting Political Support
Went through the process of political analysisWent through the process of political analysis --identifying the decision makers and theiridentifying the decision makers and theirconcerns (vote bank, publicity, image)concerns (vote bank, publicity, image)
Got the emergency block inaugurated by theGot the emergency block inaugurated by thechief minister (this was under construction forchief minister (this was under construction forthe last twenty years!!) within five weeks afterthe last twenty years!!) within five weeks aftertaking over as Chief of hospital.taking over as Chief of hospital.
Regular visits of political personages, judges etcRegular visits of political personages, judges etcto the hospital/medical college on differentto the hospital/medical college on differentoccasions as chief guests.occasions as chief guests.
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Got good media coverage and alsoGot good media coverage and also
political presence (of different parties!!)political presence (of different parties!!)
Could get more funds committed for theCould get more funds committed for the
hospitalhospital
Let politicians take the creditLet politicians take the credit
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Critical incident 1 :Critical incident 1 :
Accident of a large group (connected to aAccident of a large group (connected to a
political heavyweight)political heavyweight)
Did not have blankets (in winter )and foodDid not have blankets (in winter )and food
GotGot 5050 blanketsblankets donateddonated byby aa wellwell knownknownindustrialistindustrialist andand mademade arrangementsarrangements forfor foodfood forforthethe attendantsattendants ofof thethe patientspatients (got(got thethe supportsupport ofofthethe otherother partyparty too!)too!)
Worked on establishing political support
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Critical incident 2:Critical incident 2:
A patient from constituency of CM wasA patient from constituency of CM was
admitted. Got a call from CM.admitted. Got a call from CM.
Patient required pacemakerPatient required pacemaker--which waswhich was
not available in SNMC!not available in SNMC!
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Immediately got the pacemaker donatedImmediately got the pacemaker donated
by the company and requested a privateby the company and requested a privatecardiac surgeon to come and insertcardiac surgeon to come and insert
pacemaker!pacemaker!
THAT WAS IT!THAT WAS IT!-- started getting morestarted getting more
patients from these placespatients from these places-- not everybodynot everybody
required lot of extra resources!required lot of extra resources! mainlymainlyattentionattention
Benefit to the organisationBenefit to the organisation-- was able to getwas able to get
the faith and ear of the political persons!the faith and ear of the political persons!
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Policy Cycle 1Policy Cycle 1 SignalingSignaling
situation analysis of manpowersituation analysis of manpower-- technical, managerialtechnical, managerialand supportand support
Patient loadPatient load-- OPD, In patient, emergencyOPD, In patient, emergency BudgetBudget-- sanctioned, available and utilizationsanctioned, available and utilization
DrugsDrugs-- availability and shortagesavailability and shortages
Infrastructure and equipmentsInfrastructure and equipments
Made presentations about the progress and theMade presentations about the progress and therequirements of the organisation.requirements of the organisation.
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FormulationFormulation
NumberNumber ofof medicalmedical teachersteachers inin UPUP waswas muchmuch
lessless thanthan requiredrequired
Recruitment of medical teachers was a big problemRecruitment of medical teachers was a big problem
Held a series of meetings with faculty, associations,Held a series of meetings with faculty, associations,
bureaucrats and political playersbureaucrats and political players
Emphasized on the MCI requirementsEmphasized on the MCI requirements
Identified the recruitment problemIdentified the recruitment problem-- 3 years senior3 years seniorresidency was required for recruitmentresidency was required for recruitment
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Policy Cycle 2Policy Cycle 2
AggregationAggregationReservations issues, court cases, teachers,Reservations issues, court cases, teachers,
community dividedcommunity divided
Media clippings of shortage of teachers inMedia clippings of shortage of teachers in
medical collegesmedical colleges
Threat of derecognition by MCIThreat of derecognition by MCI
Problems faced by community and lack ofProblems faced by community and lack of
qualityquality
Political advocacy for doing away with this 3Political advocacy for doing away with this 3
year clauseyear clause
Expected benefits and scenario projectedExpected benefits and scenario projected
Endorsement from associations and bureaucratsEndorsement from associations and bureaucrats
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Policy Cycle 3Policy Cycle 3
RatificationRatification
Decision at the level of chief secretary,Decision at the level of chief secretary,
minister and chief ministerminister and chief minister
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Policy Cycle 4Policy Cycle 4
ImplementationImplementation Inertia of bureaucraciesInertia of bureaucracies
Active resistance by losersActive resistance by losers
Creating new institutionsCreating new institutions Start fresh and attract talentStart fresh and attract talent
Create political interest in reformCreate political interest in reform
Political, Social and Economic ConstraintsPolitical, Social and Economic Constraints
Unforeseen eventsUnforeseen events war, economicwar, economicdownturns, disastersdownturns, disasters
Donor supervision missionsDonor supervision missions threats ofthreats ofsuspension of funding (but limits to this)suspension of funding (but limits to this)
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AGRA ExperienceAGRA Experience
Discussion with bureaucratsDiscussion with bureaucrats-- initial refusal asinitial refusal asburden on exchequer and fear of other sectorsburden on exchequer and fear of other sectors
demanding the samedemanding the same
Discussed with political leadersDiscussed with political leaders-- creating ancreating anenvironment of consensusenvironment of consensus
TriedTried toto getget theirtheir commitmentcommitment forfor theirtheir support!support!
Got posts advertised & made recruitmentGot posts advertised & made recruitment
Resulted in change in service rulesResulted in change in service rules
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Policy Cycle 5Policy Cycle 5 FeedbackFeedback
AGRA ExperienceAGRA Experience -- monitoredmonitored
Always did complete homework beforeAlways did complete homework before
presenting case to the political bossespresenting case to the political bosses-- e.g.e.g.
promotional avenues of the medical collegepromotional avenues of the medical collegeteachers; arrears of the last many yearsteachers; arrears of the last many years
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Tools for Strategies (3)Tools for Strategies (3)
Create a change teamCreate a change team
Constituted a committee of external influential membersConstituted a committee of external influential membersto advise and oversee the work of the hospital. Itto advise and oversee the work of the hospital. Itincreased their ownership and helped in gettingincreased their ownership and helped in gettingdecisions madedecisions made
Made medical faculty and staff more involved in theMade medical faculty and staff more involved in thewhole process.whole process.
Kept good relations with bureaucrats and politiciansKept good relations with bureaucrats and politicians
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TAKE HOME MESSAGETAKE HOME MESSAGE
Be preparedBe prepared
Exploit opportunitiesExploit opportunities
Create opportunitiesCreate opportunities
Do your homeworkDo your homework
Be convincingBe convincing
Work at it!Work at it!
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