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.