Medico108
- 1. 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
- 2. 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
- 3. “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
- 4. • 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
- 5. 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
- 6. 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, Facilitate benchmarking of good management performance and incentives systems Stakeholdersinvolvementinthisimplementation
- 7. Management Inputs Processes Outputs Expected Outcomes PurposeSector 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 Stepsinimprovingtheproblemsolution
- 8. 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 Somefewpositionscanbeaddedandsomestaff canabletogettraininginmanagerialpositions
- 9. 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
- 10. 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
- 11. 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
- 12. 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.