deoki_nandan_political_feasibility

8/7/2019 deoki_nandan_Political_Feasibility

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Political Feasibility andPolitical Feasibility and

Political Strategies for Political 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 Medical UniversityOdessa State Medical University,,

MD, FAMS, FIAPSM, FIPHA, FISCDMD, FAMS, FIAPSM, FIPHA, FISCD

Director Director

([email protected], [email protected],([email protected], [email protected],

www.nihfw.org)www.nihfw.org)



HOW TO DO IT?HOW TO DO IT?

December 2003December 2003 ±± took over as Principal andtook over as Principal and

Chief of HospitalChief of Hospital

Pathetic state of hospitalPathetic state of hospital--wards, OPD, OTwards, OPD, OT Demotivated staff Demotivated staff-- court cases, nocourt cases, no

promotional avenues, no recruitmentspromotional avenues, no recruitments

Patient load minimalPatient load minimal--most preferred themost preferred the

private sector private sector

Image of the institution was not goodImage of the institution was not good



Biggest questionBiggest questionwaswas- - how to garner how to garner

political political commitment for commitment for

enabling enabling environment? environment?



Getting Political SupportGetting Political Support

WentWent throughthrough thethe processprocess of of politicalpoliticalanalysisanalysis -- identifyingidentifying thethe decisiondecision makersmakersandand their their concernsconcerns (vote(vote bank,bank, publicity,publicity,image)image)

GotGot thethe emergencyemergency blockblock inauguratedinaugurated byby thethechief chief minister minister (this(this waswas under under constructionconstructionfor for thethe lastlast twentytwenty years!!)years!!) withinwithin fivefive weeksweeks

after after takingtaking over over asas Chief Chief of of hospitalhospital..

Regular Regular visitsvisits of of politicalpolitical personages,personages, judgesjudgesetcetc toto thethe hospital/medicalhospital/medical collegecollege onon

differentdifferent occasionsoccasions asas chief chief guestsguests..



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



CRITICAL INCIDENT 1CRITICAL 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

UsedUsed blanketsblankets availableavailable withwith thethe hospitalhospital andandmademade arrangementsarrangements for for foodfood for for thetheattendantsattendants of of thethe patientspatients (got(got thethe supportsupport of of thethe other other partyparty too!)too!)

Worked on establishing political

support



Critical incident 2Critical 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 pacemaker Patient required pacemaker--which waswhich was

not available in SNMC!not available in SNMC!



Immediately got the pacemaker arrangedImmediately got the pacemaker arranged

from the company and requested a privatefrom 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!



Policy Cycle 1Policy Cycle 1

SignalingSignaling

Situation analysis of manpower Situation analysis of manpower-- technical,technical,

managerial and supportmanagerial and 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 andMade presentations about the progress and

the requirements of the organisation.the requirements of the organisation.



FormulationFormulation

N umber N umber of of medical medical teachersteachers inin UP UP waswas muchmuchlessless thanthan required required

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 senior 3 years senior

residency was required for recruitmentresidency was required for recruitment




AggregationAggregationReservations issues, court cases, teachers,Reservations issues, court cases, teachers,community dividedcommunity divided

�� Media clippings of shortage of teachers in medicalMedia clippings of shortage of teachers in medical

collegescolleges

�� Threat of derecognition by MCIThreat of derecognition by MCI

�� Problems faced by community and lack of qualityProblems faced by community and lack of quality

�� Political advocacy for doing away with this 3 year clausePolitical advocacy for doing away with this 3 year clause

�� Expected benefits and scenario projectedExpected benefits and scenario projected

�� Endorsement from associations and bureaucratsEndorsement from associations and bureaucrats




ImplementationImplementation

Discussion with bureaucratsDiscussion with bureaucrats-- initial refusal as burden oninitial refusal as burden onexchequer and fear of other sectors demanding the sameexchequer and fear of other sectors demanding the same

Discussed with political leadersDiscussed with political leaders-- creating an environmentcreating an environmentof consensusof consensus

TriedTried toto getget their their commitmentcommitment for for their their support!support!

Got posts advertised & made recruitmentGot posts advertised & made recruitment

Resulted in change in service rules and better Resulted in change in service rules and better promotional avenues opened uppromotional avenues opened up




FeedbackFeedback

AGRA ExperienceAGRA Experience -- monitoredmonitored

AlwaysAlways diddid completecomplete homeworkhomework beforebefore

presentingpresenting casecase toto thethe politicalpolitical bossesbosses-- ee..gg..

promotionalpromotional avenuesavenues of of thethe medicalmedical collegecollege

teachersteachers;; arrearsarrears of of thethe lastlast manymany yearsyears



Tools for StrategiesTools for Strategies

Create a ³change team´Create a ³change team´

Constituted a committee of external influentialConstituted a committee of external influential

members to advise and oversee the work of themembers to advise and oversee the work of the

hospital. It increased their ownership and helped inhospital. It increased their ownership and helped ingetting decisions madegetting decisions made

Made medical faculty and staff more involved in theMade medical faculty and staff more involved in the

whole process.whole process.

Kept good relations with bureaucrats and politiciansKept good relations with bureaucrats and politicians



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!

deoki_nandan_political_feasibility

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