medico108
TRANSCRIPT
Manthan Topic:
Healing Touch: Universalizing access to quality primary
healthcare
Lack of management
Inadequate utilization of managerial skills in primary health care.
Team details:-
Abhishek Job(team coordinator)
Mulakala Vikas
Sarimalla Vinod
Gundala Kiran
Donempudi Raja
From:-University of Hyderabad,
Gachibowli,hyderabad(dist)
Andhra Pradesh
Primary health care
Primary health care abbreviated as PHC defined as
“first step health care based on adequate practical,scientically sound
and socially acceptable methods and technology made universally
accessible to individuals and families in the community”.
Most of the primary health center lacks managers for sound decision
making on certain issues which is one the major drawbacks in Indian
primary health care .
“Being a doctor or a nurse does not qualify
you to hold a management position.” Source:-District health management team members ,kloto district,togo
“Solve the problem rather than being alarmist without action”
Characteristics of Indian health care management in primary health care:-
Less Govt opportunities
for health care
managers
Negligence in budgeting
and monitoring expenditure
Poor staffing pattern
Inadequate management of drugs and equipments
Hypotheses:-placements of healthcare managers are less. Only physician are placed as managers and empowering health care givers in managerial training
Hypotheses:_
Involvement of
corruptive
work ideas
Inadequate staff
and orientation
and perceptions
of trust areas of
the health care
may not utilize
the quality staff
at the community
level
Out of stock
drugs and
equipments
• ensuring adequate numbers and employment of managers throughout the health system.
• ensuring managers have appropriate competence.
• creating an enabling working environment.
• the existence of functional critical support systems.
Strengthening management
• Reaching the health related millennium development goals.
• Improves coverage and quality of health services using available and new resources efficiently to provide better health care for needy people.
• Enough competent managers.
Investment in management
improves the health of populations
• Control over money was generally very centralized.
• There were often multiple systems for budgeting
• Approved budgets often did not translate into actual expenditure.
• Lack of communication between those who wrote and implemented the plans and who managed the finances
Improving health system financing
Better managerial skills can enhance a good quality of primary health care
Ensuring an adequate number of managers
•Adequate numbers of managers in charge of the majority of critical service delivery units (e.g. Health Districts, Hospitals, Health Centers)
• Reduced vacancy rates for critical service delivery management posts (DMOH/Hospital)
Ensuring managers have appropriate
competences
• Managers and managed units that are able to increase coverage of basic services (e.g. immunization, birth by skilled birth attendants; TB low DOTS drop outs, etc.)
•Service delivery plans and budgets prepared and local health targets are reached
Creating better critical management
support systems
•Staff turnover rates at district (or other operational level) reduced or stable
•Stock-outs of essential drugs are avoided in the majority of service delivery units
•Annual accounts and audits of service units completed on schedule
Creating an enabling working environment
• Increased innovation by managers to attain results
•Managers are motivated to attain service delivery goals and are recognized for it.
•The focus of service managers is directed to customers and communities' needs.
Implementing managerial skills capacity trends
Ministry of Health Sub national health
organizations (e.g. in
Districts,
Provinces, NGOs)
National Training
Institutions(Universities,
Research
Insts.)
International
Development
Agencies
Adequate
Numbers
of managers
Needs and gaps identification
&
analysis with stakeholders;
Prioritization of needs
Participate in needs analysis
and
gaps assessments
Assist to determine
national
capacity to produce
managers
Assist with
needs/gaps
assessments and
definitions
Appropriate
Competencies
Lead the design of national
competency frameworks and
management standards;
Identify the strengths of local
training institutions and find
ways
to assist them deliver
appropriate
programs
Provide basis for “fit for
purpose”
competency framework and
management strengthening
strategies
Advocate for and build
local
trainers capacity;
Contribute expertise and
research
findings to needs
assessment
Share technical
experiences,
knowledge, and
evidence of
international good
practices
Functional
Support
systems
Set up monitoring and
evaluation systems to follow up
on progress;
Regular review and evaluation
of
support systems
M&E(monitoring and
evaluation ) partner in
collecting data and
assessing whether systems
are
producing results;
Sharing experience and
good
practice
Conduct studies and
evaluate
effectiveness and impact
of
management support
systems
Share technical
experiences,
knowledge and
evidence of
international good
practice
Enabling work
environment
Identify and access resources
needed to strengthen
management
Involve local clinicians in
management decision and
results
Conduct studies on ways
of
improving management
effectiveness (incentives,
rewards,
performance assessments,
etc.)
Facilitate
benchmarking of
good
management
performance and
incentives systems Sta
keh
old
ers
involv
emen
t in
th
is i
mp
lem
enta
tion
Management Inputs
Processes Outputs
Expected Outcomes
Purpose Sector Goals
E.g. resources/money for
training managers,
infrastructure, staff
development, software and
systems
E.g. training methods &
approaches, selecting &
preparing managers
E.g. numbers of managers
trained; improved
administrative efficiency.
Reaching the health related
Millennium
Development Goals
Improve coverage and
quality of health services
Enough competent
managers and critical
management
systems that function
Ste
ps
in i
mp
rov
ing
th
e p
rob
lem
so
luti
on
Staff Essential Desirable Essential Desirable
Medical Officer- MBBS 1 1 1#
Medical Officer –AYUSH 1* 1*
Accountant cum Data Entry Operator 1 1 1
Pharmacist 1 1 1
Pharmacist AYUSH 1 1
Nurse-midwife (Staff-Nurse) 3 +1 4 +1
Health worker (Female) 1* 1*
Health Assistant. (Male) 1 1
Health Assistant. (Female)/Lady Health Visitor 1 1
Health Educator 1 1
Laboratory Technician 1 1
Cold Chain & Vaccine Logistic Assistant 1 1
Multi-skilled Group D worker 2 2
Sanitary worker cum watchman 1 1 +1
Total 13 18 14 21
Indian Public Health Standards (IPHS) Guidelines for Primary HEALTH CENTRES
PHC government infrastructure lacks managers
Som
e fe
w p
osi
tio
ns
ca
n b
e a
dd
ed a
nd
so
me
sta
ff
can
ab
le to
get
tra
inin
g in
ma
na
ger
ial
po
siti
on
s
Qualified nurse
As a manager Advocate for client's and
family Counselor
Factor affecting the problem
1)identity
challenges in right
time
2)spreading
information at all
levels
3)Better
communication
4)competence in
implementing the
program
5)planning
Competition
Economy Information
Managerial basis
• Health care programmers should be need based, community based and accessible
Implementation
• Program implementation to be well planned, systematic and flexible
Evaluation
• Evaluation process should be continue and transparent
Accountability at every cadre
The team involved in health care program should include policy makers,adminsters managerial cadre
Sustainability and scalability of managerial skills
Sustainability is based mainly on the scope of the
continuative of the health care services
Health outcomes
Health leadership and management strengthening is a
critical ingredient in achieving the MDGs; leaders and
managers need to be held accountable for results.
Evidence based
Leadership and management development should draw
on available evidence and national and international
good practice; be practical and feasible, and progress in
performance be monitored over time.
Aligned
Leadership and management strengthening should not
take place in isolation;
Long term
Improvements have to be introduced sequentially,
flexibly and incrementally, starting on what can be
improved immediately; building on efforts that already
exist, and sustaining support over the long term.
Transformational
Addressing leadership and management challenges
requires a transformational approach
Harmonized
Greater effectiveness in leadership and management
development will be achieved through harnessing and
harmonizing of all available internal and external
resources involved
Yes … we can do it. Source –WHO management case study
References
• Egger D, Travis P, Dovlo D, Hawken L. Management
strengthening in low-income countries. Document
WHO/EIP/healthsystems/2005.1. Geneva, World
Health Organization. 2005.
http://www.who.int/management/Making%20HSWor
k%201.pdf
• World health organization
• Indian public health standards.
• National rural health mission.