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.