Decentralization of health systems aims to improve health outcomes by shifting decision-making powers to lower levels of government. This allows for better matching of services to local needs and preferences, increased innovation, accountability, and community participation. There are various approaches to decentralization, including public administration, local fiscal choice, social capital, and principal agent models. Case studies on decentralization in countries like Maldives, Myanmar, and Nepal show efforts to establish local health committees, provide equitable access to primary health care, and involve communities more in health activities through a decentralized approach.
This document discusses decentralization in health system development. It defines decentralization as the transfer of authority and decision-making from national to sub-national levels. Decentralization aims to improve efficiency, increase local participation, empower local governments, and increase innovation and accountability. There are different approaches to decentralization, including public administration, local fiscal choice, social capital, and principal-agent models. The document also provides case studies of decentralization efforts in Maldives, Myanmar, and Nepal and discusses strengths, weaknesses, and recommendations for effective decentralization.
Decentralization in Health Care – is there evidence for it?
Guest lecture at School of Public Health, National University of Kyiv-Mohyla Academy
by Axel Hoffmann, PhD
Swiss Tropical and Public Health Institute
The document discusses Pakistan's plan to devolve health care powers and responsibilities from the national to district levels. This is aimed to empower local communities and improve access to quality health services. However, challenges remain around political and financial capacity at district levels as well as defining administrative roles between provincial and district governments.
Decentralization in the provision of health care servicesAlexander Decker
This document summarizes a study on the decentralization of health care services through the implementation of the Regional Health Insurance (Jamkesda) program in Malang Regency, East Java, Indonesia. The study finds that Jamkesda implementation in Malang Regency was a response to provincial regulations rather than an initiative by the local government. As a result, the local government's commitment and consistency in implementing Jamkesda has been weak. This weak commitment and inconsistency are the main constraints on Jamkesda implementation in Malang Regency. The study aims to describe the decentralization process of Jamkesda in Malang Regency and identify the driving and constraining factors.
The document summarizes findings from a survey of District Health Management Teams (DHMTs) in Kenya that was conducted as part of the 2004 Kenya Service Provision Assessment. The survey aimed to evaluate the effectiveness of decentralizing health management to districts in meeting norms and standards. It found that while most DHMTs held frequent meetings, guidelines on their functioning were unavailable, limiting the assessment. Data was also missing for 20% of districts, potentially weakening validity. Additionally, most DHMTs had reproductive health plans but less than a quarter implemented them on time, citing lack of funds and transport. Continuing education for staff was accepted but needed strengthening. Infrastructure and communication facilities were generally available but funding for medicines, equipment and building maintenance
The document summarizes healthcare financing in India. It discusses that healthcare financing aims to ensure access to health services. The key principles are generating revenue, pooling funds for cross-subsidization between rich/poor and healthy/sick, and purchasing efficient services. In India, healthcare is financed primarily through out-of-pocket payments by households, while government expenditure is low compared to other countries. Reforms like NRHM and RSBY aim to increase public allocation to healthcare. Challenges include expanding coverage with limited resources and improving spending efficiency.
This document discusses social mobilization, which involves activating large groups of people to participate in social activities and processes to enact change. Social mobilization is not a single event but rather a long-term process that can take months or years. It enhances community capacity and participation, improves program quality and sustainability, and empowers communities. Effective social mobilization requires awareness creation, community participation, increasing ownership, and empowerment. It can be controlled, spontaneous, specific, or general. Pre-requisites include defining a purpose, leaders, symbols, messages, organizers, and funds. The process at the village level involves community engagement, forming groups, empowering individuals, promoting participation and leadership. Qualities of effective health professionals in
- Government health spending in India is very low at just over 1% of GDP, well below what is needed to meet the country's health needs. This has forced many people to rely on private healthcare, leading to high out-of-pocket costs that push many into poverty.
- Reforms are needed such as increasing public health spending to 3-5% of GDP, regulating the private sector, and implementing a universal health coverage program. However, challenges remain due to India's large population, infrastructure weaknesses, and need to balance fiscal priorities.
- Initiatives have been launched such as the National Rural Health Mission and health insurance programs, but more focus is needed on primary care, community participation, and direct
This document discusses decentralization in health system development. It defines decentralization as the transfer of authority and decision-making from national to sub-national levels. Decentralization aims to improve efficiency, increase local participation, empower local governments, and increase innovation and accountability. There are different approaches to decentralization, including public administration, local fiscal choice, social capital, and principal-agent models. The document also provides case studies of decentralization efforts in Maldives, Myanmar, and Nepal and discusses strengths, weaknesses, and recommendations for effective decentralization.
Decentralization in Health Care – is there evidence for it?
Guest lecture at School of Public Health, National University of Kyiv-Mohyla Academy
by Axel Hoffmann, PhD
Swiss Tropical and Public Health Institute
The document discusses Pakistan's plan to devolve health care powers and responsibilities from the national to district levels. This is aimed to empower local communities and improve access to quality health services. However, challenges remain around political and financial capacity at district levels as well as defining administrative roles between provincial and district governments.
Decentralization in the provision of health care servicesAlexander Decker
This document summarizes a study on the decentralization of health care services through the implementation of the Regional Health Insurance (Jamkesda) program in Malang Regency, East Java, Indonesia. The study finds that Jamkesda implementation in Malang Regency was a response to provincial regulations rather than an initiative by the local government. As a result, the local government's commitment and consistency in implementing Jamkesda has been weak. This weak commitment and inconsistency are the main constraints on Jamkesda implementation in Malang Regency. The study aims to describe the decentralization process of Jamkesda in Malang Regency and identify the driving and constraining factors.
The document summarizes findings from a survey of District Health Management Teams (DHMTs) in Kenya that was conducted as part of the 2004 Kenya Service Provision Assessment. The survey aimed to evaluate the effectiveness of decentralizing health management to districts in meeting norms and standards. It found that while most DHMTs held frequent meetings, guidelines on their functioning were unavailable, limiting the assessment. Data was also missing for 20% of districts, potentially weakening validity. Additionally, most DHMTs had reproductive health plans but less than a quarter implemented them on time, citing lack of funds and transport. Continuing education for staff was accepted but needed strengthening. Infrastructure and communication facilities were generally available but funding for medicines, equipment and building maintenance
The document summarizes healthcare financing in India. It discusses that healthcare financing aims to ensure access to health services. The key principles are generating revenue, pooling funds for cross-subsidization between rich/poor and healthy/sick, and purchasing efficient services. In India, healthcare is financed primarily through out-of-pocket payments by households, while government expenditure is low compared to other countries. Reforms like NRHM and RSBY aim to increase public allocation to healthcare. Challenges include expanding coverage with limited resources and improving spending efficiency.
This document discusses social mobilization, which involves activating large groups of people to participate in social activities and processes to enact change. Social mobilization is not a single event but rather a long-term process that can take months or years. It enhances community capacity and participation, improves program quality and sustainability, and empowers communities. Effective social mobilization requires awareness creation, community participation, increasing ownership, and empowerment. It can be controlled, spontaneous, specific, or general. Pre-requisites include defining a purpose, leaders, symbols, messages, organizers, and funds. The process at the village level involves community engagement, forming groups, empowering individuals, promoting participation and leadership. Qualities of effective health professionals in
- Government health spending in India is very low at just over 1% of GDP, well below what is needed to meet the country's health needs. This has forced many people to rely on private healthcare, leading to high out-of-pocket costs that push many into poverty.
- Reforms are needed such as increasing public health spending to 3-5% of GDP, regulating the private sector, and implementing a universal health coverage program. However, challenges remain due to India's large population, infrastructure weaknesses, and need to balance fiscal priorities.
- Initiatives have been launched such as the National Rural Health Mission and health insurance programs, but more focus is needed on primary care, community participation, and direct
Exploring perceptions and functioning of Rogi Kalyan Samiti in selected distr...IPHIndia
The document summarizes a formative research study conducted by CINI Regional Resource Center (RRC) to understand perceptions and functioning of Rogi Kalyan Samitis (RKS, or patient welfare committees) in West Bengal, with an emphasis on maternal and child health. The study involved semi-structured interviews and focus group discussions in three districts to analyze RKS members' awareness, functioning in meetings, and priority given to maternal and child health issues. Key findings included low awareness among many RKS members of their roles and responsibilities, irregular meetings, and greater focus in discussions on infrastructure than quality of health services.
Devolution of Healthcare Services Kenya_Conference ReportOwino Rita
This document summarizes a conference on devolving healthcare services in Kenya. It discusses several key topics:
1. Training and resourcing challenges in a devolved system, including the need for capacity building, understanding roles of national/county governments, and equitable resource distribution.
2. Innovations proposed for healthcare training, including e-learning, mobile training units, expanding residence programs, collaboration between national/county governments, and establishing a training center of excellence.
3. Addressing workforce retention issues through task-shifting programs, educating the public, and revising training curriculums to meet changing needs.
The document captures views from presentations and group discussions on ensuring a successful
Relationship Between Fiscal Decentralization and Health Care Financing in Uas...Triple A Research Journal
ABSTRACT
This study examined the relationship between fiscal decentralization and health care financing in Uasin Gishu County Kenya, the researcher sought to answer the following research questions; To what extend does the adequacy of decentralized funds influence health care financing in Uasin Gishu County Kenya? How effective was health management team in influencing health care financing in Uasin Gishu County Kenya? How does budgeting and allocation of decentralized funds affect health care financing in Uasin Gishu County Kenya? Lastly, what were the effects of decentralized fund expenditure on health care financing in Uasin Gishu County Kenya? The researcher used ex-post facto research design. Both stratified sampling and random sampling technique was used to select the respondents. The target population for the study was 98 employees working in health department with a sample size of 79 respondents whom comprised of permanent health workers working in the major hospitals in the county. Questionnaires were employed as the major data collection tools. Data were analysed through descriptive statistics and hypothesis is tested by use of chi square. The analysis of the data was done with Statistical package for social science (SPSS) version 20 and the data was presented though use of graphs and tables for clear understanding of the results. The findings from the study therefore rejected the null hypotheses and concluded that there exists statistically significant relationship between adequacy of decentralized funds, management effectiveness and budgetary mechanism and the level of health care financing. This means that whenever the health management team are effective in managing the decentralized funds well, there is an increase in the level of health care financing.
Keywords: Fiscal Decentralization and Healthcare financing
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
The HSFR/HFG project worked with the Government of Ethiopia from 2013-2018 to improve Ethiopia's health care financing system and expand access to health services. Key achievements included increasing the proportion of health facilities managing funds and services through boards representing communities, expanding revenue retention at health centers and hospitals, and piloting community-based health insurance. The project aimed to increase utilization of primary health services, enroll more people in insurance, and reduce out-of-pocket costs through technical support across Ethiopia's decentralized health system. Challenges remained in expanding reforms and improving health indicators, but the project strengthened sustainability by building local capacity and engaging stakeholders.
Can community action improve equity for maternal health and how does it do soHFG Project
Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health.
Importance of Community Health Strategy (CHS) in attaining health goals (MNCH...REACHOUTCONSORTIUMSLIDES
This document outlines Kenya's community health strategy. It discusses how community health units empower communities to take control of their health, hold leaders accountable, and improve health outcomes. The strategy aims to enhance access to healthcare through sustainable community services. Key points include:
- Community health units are a key part of Kenya's healthcare system and Vision 2030 goals.
- Over 4587 units had been established by 2015, serving over 40,000 communities.
- The strategy has contributed to improved maternal and child health indicators in Kenya.
- Continued support is needed to ensure resources, training, and data systems for community health volunteers and units.
- Research shows community health strategies can increase healthcare utilization and reduce childhood mortality.
Research and Understanding for Universal Health Care - #RU4UHCAlbert Domingo
Research priorities in support of universal health care (UHC) implementation in the Philippines. Delivered in plenary at the 3rd Western Visayas Health Research Conference, 6 Nov 2018, Iloilo City, Philippines.
Universal Health Care: The Philippine journey towards accessing quality healt...Albert Domingo
Presentation delivered by WHO Consultant for Health Systems Strengthening Dr Albert Domingo at the University of Santo Tomas, on the occasion of UHC Day 2018.
SUSTAINABLE HEALTH SERVICE DELIVERY-AlDamar-SShamiSaeed Shami
The document discusses health issues and proposed interventions in Al Damar Locality, Sudan. Poverty and lack of basic services have resulted in high rates of malnutrition, communicable diseases, and mortality. The proposed project aims to increase access to quality health care, strengthen local services and capacity, and reduce maternal and child health risks. It will rehabilitate and construct health centers, train workers, establish management systems, and improve health information. Implementing through a local approach with UNOPS support, the project aims to sustainably improve health and livelihoods in the region.
This document provides guidelines for contracting out public health services to private organizations in India. It discusses the concept of public-private partnerships (PPPs) in healthcare and contracting out as a model of PPP. The document outlines the necessary steps for initiating a contracting out process, including reviewing past experiences, assessing feasibility, identifying facilities, determining community needs, deciding what services to contract out, and establishing contract management procedures. The overall aim is to improve healthcare access, efficiency and quality by leveraging the strengths of both public and private sectors through collaborative partnerships.
This document discusses community systems strengthening (CSS), which promotes the development and sustainability of communities and community organizations to contribute to long-term health outcomes. CSS aims to improve access to and utilization of health services through increased community engagement in areas like advocacy, health promotion, and home-based care. For communities to effectively impact health, they must have strong, sustainable systems for activities, services, and funding. The core components of CSS systems include enabling environments, community networks, resources and capacity building, community activities, organizational strengthening, and monitoring and evaluation.
HSDPF Dr. Elizabeth Ogaja Presentation, ECM Health, Kisuu County-HRH and UHC ...Emmanuel Mosoti Machani
This document provides an overview of health reform in Kenya, with a focus on human resources for health (HRH) in Kisumu County. It discusses the country's constitution and health policies aimed at achieving universal health coverage. In Kisumu County, key challenges include poor health indicators, inadequate HRH, and low health financing. Opportunities for improving HRH include policies supporting county health sectors and partnerships between government and training institutions. Effective governance structures will be important for counties to optimize HRH as they work to strengthen primary healthcare and achieve health reform goals.
Improving the accessibility of heath services in urban and regional settings ...Dr Lendy Spires
This document discusses strategies for improving Indigenous access to health services in urban and regional areas. It finds that accessible services are those that are physically available, affordable, appropriate, and acceptable. Common barriers to access include lack of local services, cost, lack of cultural competence, and prior negative experiences. Effective strategies identified include making services more local, providing transportation, allowing flexible appointments, employing Indigenous health workers, and adopting a holistic, culturally-respectful approach. Strictly biomedical or fee-for-service models are found to be less effective. More evaluation of access programs is still needed.
The document proposes the National Urban Health Mission to address health issues of India's growing urban poor population. Key points:
1) India's urban population is growing rapidly and will reach 43.2 crores by 2021, increasing strain on infrastructure. The urban poor have poor access to healthcare due to inadequate public systems and high costs of private care.
2) The NUHM will cover all cities over 1 lakh people and state capitals. It will focus on the urban poor, especially those in slums, as well as other vulnerable groups. The mission aims to facilitate equitable access to available healthcare.
3) Components include strengthening public primary care, engaging private providers, promoting community involvement, organizing women into health
The document provides an overview of key provisions and implementation timeline of the Patient Protection and Affordable Care Act (ACA). It establishes health insurance exchanges by 2014 to facilitate the purchase of qualified health plans. The ACA also defines essential health benefits that must be covered and establishes different coverage levels (bronze, silver, gold, platinum). Health insurers must offer at least one silver and one gold plan on the exchanges.
34-63% of counties have maternal health tracer drugs but 18-39% of child health tracer drugs available
Large disparities in the availability of first line HIV drugs (0-50%)
Kisumu, Kisii, Vihiga, and Siaya consistently top third in drug availability
Transzoia, E-Marakwet, Nandi, Nyeri & T.River bottom
11 maternal health tracer drugs
11 child health tracer drugs
First-line drugs for HIV
ACT, first line treatment for malaria
4FDC, intensive treatment for tuberculosis
Metformin, preferred OGLA treatment for diabetes
Health care financing in Saudi Arabia is provided mainly through government revenues, accounting for approximately 80% of total health care spending. Government spending on health as a percentage of the national budget has risen from 2.8% in 1970 to 6.4% in 2004. The remaining sources of health care financing include private sources such as personal out-of-pocket payments and employer-sponsored health insurance programs.
The document summarizes the proceedings of a conference on renewing health districts in Africa 25 years after the Harare Declaration. It discusses how:
1) While health districts have defined African health systems, challenges remain in quality and access. The conference aimed to revisit implementation given changes in contexts.
2) Over 25 years, Africa has transformed through globalization, urbanization, and new health issues. A renewed vision is needed to cope with challenges through flexible, inclusive, and learning-focused district strategies.
3) The health district remains a valid strategy, but must better empower communities, acknowledge pluralism in the health sector, and shift to more flexible and open approaches at the district level.
The document summarizes key discussions from a regional conference on renewing health districts in Africa 25 years after the Harare Declaration.
Over the past 25 years, African countries have undergone significant political, economic, social and health changes that impact local health systems. While the health district strategy established important foundations, implementation challenges and changing contexts require revisiting the approach. The conference brought together 170 experts to discuss progress and identify implications of trends like urbanization, non-communicable diseases, and pluralistic health sectors. Participants concluded the health district strategy remains valid if adapted to modern realities through a more flexible, inclusive and innovative vision that empowers communities and stakeholders.
HEALTH SECTOR REFORMS- INDIA
Slides contain;
Reforms & Health System
Definition- HSR
Introduction
Financial reforms
Structural re-organization
Communication
Quality Assurance
Convergence
Public Private Partnership
Ways forward for effective HSR
Conclusion and points for Consideration
End
Exploring perceptions and functioning of Rogi Kalyan Samiti in selected distr...IPHIndia
The document summarizes a formative research study conducted by CINI Regional Resource Center (RRC) to understand perceptions and functioning of Rogi Kalyan Samitis (RKS, or patient welfare committees) in West Bengal, with an emphasis on maternal and child health. The study involved semi-structured interviews and focus group discussions in three districts to analyze RKS members' awareness, functioning in meetings, and priority given to maternal and child health issues. Key findings included low awareness among many RKS members of their roles and responsibilities, irregular meetings, and greater focus in discussions on infrastructure than quality of health services.
Devolution of Healthcare Services Kenya_Conference ReportOwino Rita
This document summarizes a conference on devolving healthcare services in Kenya. It discusses several key topics:
1. Training and resourcing challenges in a devolved system, including the need for capacity building, understanding roles of national/county governments, and equitable resource distribution.
2. Innovations proposed for healthcare training, including e-learning, mobile training units, expanding residence programs, collaboration between national/county governments, and establishing a training center of excellence.
3. Addressing workforce retention issues through task-shifting programs, educating the public, and revising training curriculums to meet changing needs.
The document captures views from presentations and group discussions on ensuring a successful
Relationship Between Fiscal Decentralization and Health Care Financing in Uas...Triple A Research Journal
ABSTRACT
This study examined the relationship between fiscal decentralization and health care financing in Uasin Gishu County Kenya, the researcher sought to answer the following research questions; To what extend does the adequacy of decentralized funds influence health care financing in Uasin Gishu County Kenya? How effective was health management team in influencing health care financing in Uasin Gishu County Kenya? How does budgeting and allocation of decentralized funds affect health care financing in Uasin Gishu County Kenya? Lastly, what were the effects of decentralized fund expenditure on health care financing in Uasin Gishu County Kenya? The researcher used ex-post facto research design. Both stratified sampling and random sampling technique was used to select the respondents. The target population for the study was 98 employees working in health department with a sample size of 79 respondents whom comprised of permanent health workers working in the major hospitals in the county. Questionnaires were employed as the major data collection tools. Data were analysed through descriptive statistics and hypothesis is tested by use of chi square. The analysis of the data was done with Statistical package for social science (SPSS) version 20 and the data was presented though use of graphs and tables for clear understanding of the results. The findings from the study therefore rejected the null hypotheses and concluded that there exists statistically significant relationship between adequacy of decentralized funds, management effectiveness and budgetary mechanism and the level of health care financing. This means that whenever the health management team are effective in managing the decentralized funds well, there is an increase in the level of health care financing.
Keywords: Fiscal Decentralization and Healthcare financing
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
The HSFR/HFG project worked with the Government of Ethiopia from 2013-2018 to improve Ethiopia's health care financing system and expand access to health services. Key achievements included increasing the proportion of health facilities managing funds and services through boards representing communities, expanding revenue retention at health centers and hospitals, and piloting community-based health insurance. The project aimed to increase utilization of primary health services, enroll more people in insurance, and reduce out-of-pocket costs through technical support across Ethiopia's decentralized health system. Challenges remained in expanding reforms and improving health indicators, but the project strengthened sustainability by building local capacity and engaging stakeholders.
Can community action improve equity for maternal health and how does it do soHFG Project
Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health.
Importance of Community Health Strategy (CHS) in attaining health goals (MNCH...REACHOUTCONSORTIUMSLIDES
This document outlines Kenya's community health strategy. It discusses how community health units empower communities to take control of their health, hold leaders accountable, and improve health outcomes. The strategy aims to enhance access to healthcare through sustainable community services. Key points include:
- Community health units are a key part of Kenya's healthcare system and Vision 2030 goals.
- Over 4587 units had been established by 2015, serving over 40,000 communities.
- The strategy has contributed to improved maternal and child health indicators in Kenya.
- Continued support is needed to ensure resources, training, and data systems for community health volunteers and units.
- Research shows community health strategies can increase healthcare utilization and reduce childhood mortality.
Research and Understanding for Universal Health Care - #RU4UHCAlbert Domingo
Research priorities in support of universal health care (UHC) implementation in the Philippines. Delivered in plenary at the 3rd Western Visayas Health Research Conference, 6 Nov 2018, Iloilo City, Philippines.
Universal Health Care: The Philippine journey towards accessing quality healt...Albert Domingo
Presentation delivered by WHO Consultant for Health Systems Strengthening Dr Albert Domingo at the University of Santo Tomas, on the occasion of UHC Day 2018.
SUSTAINABLE HEALTH SERVICE DELIVERY-AlDamar-SShamiSaeed Shami
The document discusses health issues and proposed interventions in Al Damar Locality, Sudan. Poverty and lack of basic services have resulted in high rates of malnutrition, communicable diseases, and mortality. The proposed project aims to increase access to quality health care, strengthen local services and capacity, and reduce maternal and child health risks. It will rehabilitate and construct health centers, train workers, establish management systems, and improve health information. Implementing through a local approach with UNOPS support, the project aims to sustainably improve health and livelihoods in the region.
This document provides guidelines for contracting out public health services to private organizations in India. It discusses the concept of public-private partnerships (PPPs) in healthcare and contracting out as a model of PPP. The document outlines the necessary steps for initiating a contracting out process, including reviewing past experiences, assessing feasibility, identifying facilities, determining community needs, deciding what services to contract out, and establishing contract management procedures. The overall aim is to improve healthcare access, efficiency and quality by leveraging the strengths of both public and private sectors through collaborative partnerships.
This document discusses community systems strengthening (CSS), which promotes the development and sustainability of communities and community organizations to contribute to long-term health outcomes. CSS aims to improve access to and utilization of health services through increased community engagement in areas like advocacy, health promotion, and home-based care. For communities to effectively impact health, they must have strong, sustainable systems for activities, services, and funding. The core components of CSS systems include enabling environments, community networks, resources and capacity building, community activities, organizational strengthening, and monitoring and evaluation.
HSDPF Dr. Elizabeth Ogaja Presentation, ECM Health, Kisuu County-HRH and UHC ...Emmanuel Mosoti Machani
This document provides an overview of health reform in Kenya, with a focus on human resources for health (HRH) in Kisumu County. It discusses the country's constitution and health policies aimed at achieving universal health coverage. In Kisumu County, key challenges include poor health indicators, inadequate HRH, and low health financing. Opportunities for improving HRH include policies supporting county health sectors and partnerships between government and training institutions. Effective governance structures will be important for counties to optimize HRH as they work to strengthen primary healthcare and achieve health reform goals.
Improving the accessibility of heath services in urban and regional settings ...Dr Lendy Spires
This document discusses strategies for improving Indigenous access to health services in urban and regional areas. It finds that accessible services are those that are physically available, affordable, appropriate, and acceptable. Common barriers to access include lack of local services, cost, lack of cultural competence, and prior negative experiences. Effective strategies identified include making services more local, providing transportation, allowing flexible appointments, employing Indigenous health workers, and adopting a holistic, culturally-respectful approach. Strictly biomedical or fee-for-service models are found to be less effective. More evaluation of access programs is still needed.
The document proposes the National Urban Health Mission to address health issues of India's growing urban poor population. Key points:
1) India's urban population is growing rapidly and will reach 43.2 crores by 2021, increasing strain on infrastructure. The urban poor have poor access to healthcare due to inadequate public systems and high costs of private care.
2) The NUHM will cover all cities over 1 lakh people and state capitals. It will focus on the urban poor, especially those in slums, as well as other vulnerable groups. The mission aims to facilitate equitable access to available healthcare.
3) Components include strengthening public primary care, engaging private providers, promoting community involvement, organizing women into health
The document provides an overview of key provisions and implementation timeline of the Patient Protection and Affordable Care Act (ACA). It establishes health insurance exchanges by 2014 to facilitate the purchase of qualified health plans. The ACA also defines essential health benefits that must be covered and establishes different coverage levels (bronze, silver, gold, platinum). Health insurers must offer at least one silver and one gold plan on the exchanges.
34-63% of counties have maternal health tracer drugs but 18-39% of child health tracer drugs available
Large disparities in the availability of first line HIV drugs (0-50%)
Kisumu, Kisii, Vihiga, and Siaya consistently top third in drug availability
Transzoia, E-Marakwet, Nandi, Nyeri & T.River bottom
11 maternal health tracer drugs
11 child health tracer drugs
First-line drugs for HIV
ACT, first line treatment for malaria
4FDC, intensive treatment for tuberculosis
Metformin, preferred OGLA treatment for diabetes
Health care financing in Saudi Arabia is provided mainly through government revenues, accounting for approximately 80% of total health care spending. Government spending on health as a percentage of the national budget has risen from 2.8% in 1970 to 6.4% in 2004. The remaining sources of health care financing include private sources such as personal out-of-pocket payments and employer-sponsored health insurance programs.
The document summarizes the proceedings of a conference on renewing health districts in Africa 25 years after the Harare Declaration. It discusses how:
1) While health districts have defined African health systems, challenges remain in quality and access. The conference aimed to revisit implementation given changes in contexts.
2) Over 25 years, Africa has transformed through globalization, urbanization, and new health issues. A renewed vision is needed to cope with challenges through flexible, inclusive, and learning-focused district strategies.
3) The health district remains a valid strategy, but must better empower communities, acknowledge pluralism in the health sector, and shift to more flexible and open approaches at the district level.
The document summarizes key discussions from a regional conference on renewing health districts in Africa 25 years after the Harare Declaration.
Over the past 25 years, African countries have undergone significant political, economic, social and health changes that impact local health systems. While the health district strategy established important foundations, implementation challenges and changing contexts require revisiting the approach. The conference brought together 170 experts to discuss progress and identify implications of trends like urbanization, non-communicable diseases, and pluralistic health sectors. Participants concluded the health district strategy remains valid if adapted to modern realities through a more flexible, inclusive and innovative vision that empowers communities and stakeholders.
HEALTH SECTOR REFORMS- INDIA
Slides contain;
Reforms & Health System
Definition- HSR
Introduction
Financial reforms
Structural re-organization
Communication
Quality Assurance
Convergence
Public Private Partnership
Ways forward for effective HSR
Conclusion and points for Consideration
End
The document discusses health care reforms in India. It defines key concepts like health systems and health care. It outlines the components and goals of health sector reforms, including improving efficiency, equity and effectiveness. Some key reforms in India include reorganizing the existing health care system, decentralization, increasing community involvement, and public-private partnerships. Challenges to reforms include unclear roles and responsibilities and balancing various stakeholder interests.
Elements of health services management.pptxCheriro
The document discusses elements of health systems and services management. It outlines six core components or "building blocks" that comprise health systems: service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. It then describes Kenya's decentralized health system, which is organized into four levels of care delivered by both public and private providers at the national, county, and community levels under the guidance of the national health policy. The roles and challenges of health services managers are also examined.
Decentralization of health services in Nigeria by Dr Daniel Gobgab, CHANachapkenya
Nigeria has a population of 173 million people governed across 36 states and 774 local government areas. Health services are decentralized across three levels of government - federal, state, and local. The new National Health Act aims to improve healthcare access and quality through a basic healthcare provision fund and universal health coverage. Key challenges to decentralization include a lack of political will, limited local capacity and resources, and inequities in service distribution across areas.
This document discusses community systems strengthening (CSS), which promotes the development and sustainability of communities and community organizations to contribute to long-term health outcomes. CSS aims to improve access to and utilization of health services through increased community engagement in areas like advocacy, health promotion, and home-based care. For communities to effectively impact health, they must have strong, sustainable systems for activities, services, and funding. The core components of CSS systems include enabling environments, community networks, resources and capacity building, community activities, organizational strengthening, and monitoring and evaluation.
This document provides an overview of a research project conducted by a civil society consortium to examine the interactions between global health initiatives (GHIs) and national health systems. The consortium conducted research in Kenya, Malawi, Uganda, and Zambia through interviews and focus groups. The research aimed to understand the roles of civil society in maximizing positive synergies between GHIs and health systems. The consortium found that civil society plays an important role across various components of health systems, but often lacks capacity. Strengthening community systems is key to empowering civil society to advocate for community needs and provide oversight of GHIs and health services.
What offers more choice? Budgets or human rights?shibley
My talk on how best to deliver choice in English dementia strategy - through the market, e.g. personal budgets, or international law, e.g. human rights.
The document summarizes healthcare reforms in India and their implementation. It discusses the key components of the health system and health sector reforms. Major reforms included reorganizing and restructuring the existing healthcare system, involving communities in health system delivery, establishing a health management information system, and focusing on quality of care. Key national health missions addressed in the reforms were the National Rural Health Mission and National Urban Health Mission. Five Year Plans from the 8th to 12th Plans shifted policies to encourage private sector initiatives, prioritize primary healthcare, address issues of equity, and work towards universal health coverage. Effective health sector reforms require increased public spending on health, regulating the private sector, risk pooling, and strengthening health management information systems.
This viewpoint paper is about rethinking the human resources (HR) strategy in the face of systematic failures in the devolved health sector in Kenya. The paper gives a background introduction of the health sector of Kenya as defined and established by the constitution of Kenya, explains the sharing of functions devolved in the health sector, and explains the history of devolution of the health sector. Under the identification and justification of the study, the paper highlights how specialized skills in health service provision are concentrated in urban centers and emphasizes a lack of inter-county transfer of services. The paper further explains the distribution of healthcare service provision, the current management of HR, and the statement of specific problems in Kenya; such problems minclude
outcry from healthcare providers, which is manifested by frequent strikes across the country over issues to do with salaries, promotions, and career development. The viewpoint of the authors is that the seven building blocks of the health sector in Kenya are vital. The six building blocks can be handled by county governments while one block that deals with the management of HR of the health sector should be reformed, strengthened, and handled by the national government, hence the paper proposes the introduction of a health service commission to manage human resource components of the health sector. Finally, boost the Ministry of Health’s effective control of the healthcare workforce by advancing and integrating policies relating to health systems, services, and cross sectorial collaboration to revive primary healthcare services and attain universal health coverage.
This document discusses community systems strengthening (CSS) as supported by the Global Fund. It defines community systems as structures made up of community members and organizations that are close to communities and understand their needs. CSS aims to build the capacity of these community groups to engage in service delivery, advocacy, accountability, and coordination efforts for health programs. The Global Fund recognizes CSS as critical for ensuring responses reach marginalized groups. It includes a CSS module in its measurement frameworks to track investments in strengthening community systems. This module contains four interventions: community monitoring, advocacy, social mobilization and networking, and institutional capacity building for community organizations. The Global Fund rationale is that strong community systems are essential for effective and equitable health programs.
This document discusses community systems strengthening (CSS) as supported by the Global Fund. It defines community systems as structures made up of community members and organizations that are close to communities and understand their needs. CSS aims to build the capacity of these community groups to monitor health services, advocate for change, deliver services, and coordinate their work. The Global Fund recognizes community systems as critical to ensuring access to health services for marginalized groups. It supports CSS through funding modules in its measurement frameworks for HIV/AIDS, tuberculosis and malaria. The modules include interventions for community monitoring, advocacy, social mobilization, and building institutional capacity of community sector organizations. The Global Fund's rationale is that strong community systems are essential for effective and sustainable responses to diseases
This document discusses existing and emerging health issues in Ethiopia. It notes that while Ethiopia has made improvements in health indicators, challenges remain like neonatal mortality, under-5 deaths, and maternal mortality. Emerging issues like COVID-19 also impact health. The building blocks of the health system are described, including health service delivery, workforce, information systems, access to medicines, financing, and leadership. National health policy in Ethiopia focuses on decentralization and developing preventive care. Strategies under the Health Sector Transformation Plan aim to improve quality, equity, and universal health coverage. Reforms introduced revenue retention and exemptions to improve access.
The district health system of Nepal is transitioning from a centralized system to a federal system organized around the federal, provincial, and local levels of government. This transition has led to confusion over the roles of district health offices and municipalities in managing health services and programs. Under the new system, municipalities have taken over management of many health facilities and programs from district health offices. However, the division of responsibilities between the different levels of government remains unclear, and local municipalities face challenges like limited staff and skills for managing health programs. Proper implementation of the new federal system and clear definition of roles across levels of government are needed to strengthen Nepal's health system during this transition period.
Innovative social enterprise, rural health, India Infrastructure Report 2014Poonam Madan
It is a moot issue just how much time and resources can get used up by social entrepreneurs in seeking public partnerships to scale their work, while it would be in the interest of the nation for governments to examine, identify and work with them.
INHIBITING FACTORS AND SUPPORTING FACTORS IN THE IMPLEMENTATION OF FINANCIAL ...AJHSSR Journal
ABSTRACT: This study aims to describe and analyze the supporting factors and inhibiting factors for the
implementation of BLUD financial management policies at Poso Hospital and the implementation model of
BLUD financial management policies at Poso Hospitals. In implementing the vision and mission, it was found
that in improving the quality of health services through the provision of medical personnel (specialist doctors,
special nurses) by building cooperation with universities. Provision of infrastructure for. Improving the welfare
of Poso Hospital employees. However, several problems were found in the form of improving employee welfare
in the form of medical services that do not yet have standard rules in the governance process so that they are
prone to irregularities. In addition, the Poso Hospital infrastructure, especially the availability of rooms and
some medical equipment, is still limited so that patients affect community services.
One of the supporting factors is the availability of the Poso Regional Hospital Development Location and the
availability of pediatric surgeons that are not owned by other hospitals in the Central Sulawesi region. The
inhibiting factor that makes it difficult to implement the BLUD RSUD Poso policy is the weakness of the
budget supervisor, which is proven by the corruption of Medical Devices in the 2013 fiscal year. In addition, the
evaluation of the local government towards the officials managing the BLUD RSUD Poso is very weak, even
especially in the quality assurance of health service activities.
Adjusting the need for medical medical devices that support the implementation of health services so as to
maximize human resources with health infrastructure. Evaluation of service performance (medical personnel)
and officials managing the Poso Regional Hospital on a regular basis so that from the results of the evaluation
by the local government action can be taken to determine budget needs and service quality
KEYWORDS: policy, management, supporters, barriers, hospital
This document provides an overview of health systems strengthening. It defines key concepts including health systems, health system strengthening, and the four main functions of a health system: stewardship, financing, human and physical resources, and service delivery. It then discusses each function in more detail, including how policies and programs can influence health outcomes through strengthening different parts of the health system. The goal is to help organizations and implementers understand health systems and how their work can benefit from health systems approaches.
This document outlines the Canadian Nurses Association's position on primary health care. It believes primary health care is integral to improving health outcomes for Canadians and that its principles, such as accessibility, health promotion, and intersectoral collaboration, are the most effective way to provide equitable healthcare. The CNA also believes primary health care and nursing are closely connected, and nursing standards and education should be grounded in primary health care principles. Adopting a primary health care approach could help address rising healthcare costs and improve Canada's performance on health indicators relative to other countries.
Alzheimer's disease is the most common form of dementia. It causes memory loss and cognitive decline and affects over 26 million people worldwide. The disease was first described in 1906 by Alois Alzheimer and was named Alzheimer's disease in 1910. Since then, research has made progress in identifying the biological markers of the disease, such as beta-amyloid and tau proteins, as well as genetic risk factors. Treatments have also emerged, with the first drug being approved in 1993. However, Alzheimer's remains a major public health issue and the number of people affected is expected to rise significantly in coming decades.
This document presents a research study on the knowledge of meditation among higher secondary students in Nepal. It discusses how meditation can help reduce stress, anxiety, and improve focus and academic performance. The study aims to assess the knowledge and perceptions of meditation among higher secondary level science students at Pinnacle College in Lalitpur, Nepal. An online survey will be conducted of 80 randomly selected students to understand their existing knowledge on the benefits of meditation and factors influencing it like education, health status, and media influences. The findings could help education policymakers incorporate meditation into the curriculum.
This dissertation examines the bacterial etiology of wound infections and the antibiotic susceptibility patterns of isolates from patients visiting B and B Hospital in Nepal. Cultures were taken from 1164 wound samples over one year. Common gram-positive isolates included Staphylococcus aureus (92.46%) and gram-negative isolates included E. coli (28.1%), Pseudomonas spp. (30.91%). Antibiotics like amikacin and vancomycin were effective against most isolates. The study concludes that wound infections are commonly caused by resistant bacteria, so alternative antibiotics need to be used for treatment.
This thesis report examines antibiotic resistance due to spices like garlic and turmeric. The objectives were to extract the spices using solvents, test their antimicrobial properties, and determine the minimum inhibitory concentration. Garlic, turmeric, and a combination were extracted using distilled water, ethanol, and chloroform. Extracts showed antibacterial effects against E. coli and Staphylococcus aureus, with ethanol and distilled water being most effective. The minimum inhibitory concentration of extracts was lower than standard antibiotics, indicating they may help reduce antibiotic resistance.
The document introduces Shreejeet Shrestha and his qualifications as an MPH and MSc in Medical Microbiology. It then asks a series of questions about the identity of different groups, including doctors, an actor, farmers, and software engineers. The document concludes by providing 25 tips for getting in good shape and advises taking care of yourself and your fat.
This document provides background information on the health situation in the community of Jamyka, located in the developing country of Jamyne. It finds that Jamyka residents face difficulties due to its isolated geography and lack of economic opportunities, resulting in high rates of poverty, illiteracy, and gender inequality. As a result, children in Jamyka experience high levels of malnutrition, diarrhea, and other diseases. The document proposes interventions to address underlying contributors to malnutrition like inadequate breastfeeding and weaning practices, lack of access to nutritious foods, and poor hygiene and sanitation. The goal is to reduce all forms of malnutrition among children under 5 by 50% through improving feeding practices, raising awareness, and providing supplementary
Shreejeet Shrestha provides an overview of sociology and its application in public health. Sociology developed from 19th century theoretical writings and emphasizes social structures and processes over individuals. Key concepts in sociology like social fabric, conflict, and social systems are highly relevant to public health. While psychology has traditionally dominated social sciences in public health, sociology is increasingly important for understanding large-scale social determinants of health like inequality, social capital, and health systems. Sociological methods involving both quantitative and qualitative data are valuable tools for public health research and evaluation.
The document discusses the harms of smoking tobacco. It notes that tobacco contains nicotine, which is highly addictive, as well as other toxic substances like carbon monoxide and benzapyrene. Regular tobacco use can lead to numerous health issues, including various cancers, bronchitis, cardiovascular disease, emphysema, and others. It recommends avoiding tobacco use and educating people about the health risks of smoking.
Alcoholism is defined as dependency on alcohol caused by regular consumption of alcoholic beverages like beer, wine, brandy, whiskey, rum, or gin. An alcoholic is someone who has become a habitual drinker. Alcoholism can be caused by social pressure, a desire for excitement, an attempt to escape problems, developing a taste for alcohol, or a family history of alcoholism. Alcohol is neither a food nor a stimulant, as it provides no nutritional value and reduces the body's efficiency. Alcoholism has many negative health effects such as liver damage, heart problems, impaired judgment and motor skills, and increased risk of disease. It also harms families financially and emotionally, and increases social problems like crime. Drinking alcohol
This randomized controlled trial examined the effects of a home-based exercise and caregiver behavioral management program on 153 patients with Alzheimer's disease. The intervention group received training over 12 hours in the first 3 months. Results found the intervention reduced functional dependence and depression at 3 months, with only SF-36 differences maintained at 24 months. However, the program did not delay institutionalization. The study suggests home-based programs may improve physical and mental health in the short-term but repeated training may be needed to sustain effects. Limitations included potential information bias and an outdated diagnostic criteria for Alzheimer's.
This document provides an overview of Myanmar (Burma). It notes that Myanmar has a population of over 54 million people and is located in Southeast Asia, bordering the Andaman Sea and Bay of Bengal. It is comprised of various ethnic groups, the majority religion is Buddhism. The document outlines Myanmar's climate, geography, natural resources, agriculture, industries and government. It also describes some important cultural festivals in Myanmar and provides dos and don'ts for proper cultural etiquette.
This document discusses common gynaecological problems including menstrual problems, vaginal discharge, pruritus vulvae, and vulval swellings. It provides details on the typical presentation, causes, diagnostic workup, and treatment approaches for each condition. Key conditions covered include dysmenorrhoea, abnormal vaginal bleeding, endometriosis, adenomyosis, uterine polyps, vaginal infections like bacterial vaginosis and candidiasis, and pruritus. It emphasizes taking a thorough history and performing examinations to arrive at the correct diagnosis and treat underlying causes.
This document summarizes a study on the prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) among surgical patients visiting hospitals in Kathmandu Valley, Nepal. The study found a MRSA prevalence of 9.9%. MRSA prevalence was higher in males, older patients, those with longer hospital stays, and those with wound or tissue samples. All MRSA strains showed resistance to multiple antibiotics and were considered multi-drug resistant. Vancomycin was found to be an effective antibiotic against MRSA.
This document discusses the importance of emotional intelligence for healthcare leaders. It defines emotional intelligence and its components, which include self-awareness, self-regulation, self-motivation, social awareness, and relationship management. These skills help leaders understand and engage their teams, handle conflicts, and solve complex problems. The document also outlines key leadership skills and competencies and presents an emotional intelligence model. It argues that emotional intelligence training should be provided to healthcare leaders to develop skills in areas like leadership style, relationship building, and emotional monitoring.
The document outlines the details of a community health project for St. Louis Community located in Bangkok, Thailand. It provides background information on the target community including demographics, health issues such as hypertension, and risk factors. The document also presents a logical framework for a proposed community health project aimed at reducing hypertension in the community.
More from Orion institute; Asian college for Advance studies (15)
Impact of Effective Performance Appraisal Systems on Employee Motivation and ...Dr. Nazrul Islam
Healthy economic development requires properly managing the banking industry of any
country. Along with state-owned banks, private banks play a critical role in the country's economy.
Managers in all types of banks now confront the same challenge: how to get the utmost output from
their employees. Therefore, Performance appraisal appears to be inevitable since it set the
standard for comparing actual performance to established objectives and recommending practical
solutions that help the organization achieve sustainable growth. Therefore, the purpose of this
research is to determine the effect of performance appraisal on employee motivation and retention.
Ganpati Kumar Choudhary Indian Ethos PPT.pptx, The Dilemma of Green Energy Corporation
Green Energy Corporation, a leading renewable energy company, faces a dilemma: balancing profitability and sustainability. Pressure to scale rapidly has led to ethical concerns, as the company's commitment to sustainable practices is tested by the need to satisfy shareholders and maintain a competitive edge.
Originally presented at XP2024 Bolzano
While agile has entered the post-mainstream age, possibly losing its mojo along the way, the rise of remote working is dealing a more severe blow than its industrialization.
In this talk we'll have a look to the cumulative effect of the constraints of a remote working environment and of the common countermeasures.
Org Design is a core skill to be mastered by management for any successful org change.
Org Topologies™ in its essence is a two-dimensional space with 16 distinctive boxes - atomic organizational archetypes. That space helps you to plot your current operating model by positioning individuals, departments, and teams on the map. This will give a profound understanding of the performance of your value-creating organizational ecosystem.
Enriching engagement with ethical review processesstrikingabalance
New ethics review processes at the University of Bath. Presented at the 8th World Conference on Research Integrity by Filipa Vance, Head of Research Governance and Compliance at the University of Bath. June 2024, Athens
Sethurathnam Ravi: A Legacy in Finance and LeadershipAnjana Josie
Sethurathnam Ravi, also known as S Ravi, is a distinguished Chartered Accountant and former Chairman of the Bombay Stock Exchange (BSE). As the Founder and Managing Partner of Ravi Rajan & Co. LLP, he has made significant contributions to the fields of finance, banking, and corporate governance. His extensive career includes directorships in over 45 major organizations, including LIC, BHEL, and ONGC. With a passion for financial consulting and social issues, S Ravi continues to influence the industry and inspire future leaders.
A presentation on mastering key management concepts across projects, products, programs, and portfolios. Whether you're an aspiring manager or looking to enhance your skills, this session will provide you with the knowledge and tools to succeed in various management roles. Learn about the distinct lifecycles, methodologies, and essential skillsets needed to thrive in today's dynamic business environment.
Colby Hobson: Residential Construction Leader Building a Solid Reputation Thr...dsnow9802
Colby Hobson stands out as a dynamic leader in the residential construction industry. With a solid reputation built on his exceptional communication and presentation skills, Colby has proven himself to be an excellent team player, fostering a collaborative and efficient work environment.
A team is a group of individuals, all working together for a common purpose. This Ppt derives a detail information on team building process and ats type with effective example by Tuckmans Model. it also describes about team issues and effective team work. Unclear Roles and Responsibilities of teams as well as individuals.
Designing and Sustaining Large-Scale Value-Centered Agile Ecosystems (powered...Alexey Krivitsky
Is Agile dead? It depends on what you mean by 'Agile'. If you mean that the organizations are not getting the promised benefits because they were focusing too much on the team-level agile "ways of working" instead of systemic global improvements -- then we are in agreement. It is a misunderstanding of Agility that led us down a dead-end. At Org Topologies, we see bright sparks -- the signs of the 'second wave of Agile' as we call it. The emphasis is shifting towards both in-team and inter-team collaboration. Away from false dichotomies. Both: team autonomy and shared broad product ownership are required to sustain true result-oriented organizational agility. Org Topologies is a package offering a visual language plus thinking tools required to communicate org development direction and can be used to help design and then sustain org change aiming at higher organizational archetypes.
Comparing Stability and Sustainability in Agile SystemsRob Healy
Copy of the presentation given at XP2024 based on a research paper.
In this paper we explain wat overwork is and the physical and mental health risks associated with it.
We then explore how overwork relates to system stability and inventory.
Finally there is a call to action for Team Leads / Scrum Masters / Managers to measure and monitor excess work for individual teams.
12 steps to transform your organization into the agile org you deservePierre E. NEIS
During an organizational transformation, the shift is from the previous state to an improved one. In the realm of agility, I emphasize the significance of identifying polarities. This approach helps establish a clear understanding of your objectives. I have outlined 12 incremental actions to delineate your organizational strategy.
2. WHAT IS HEALTH SYSTEM?
Health care system is the organization of
people, institutions, and resources to
deliver health care services to meet the
health needs of target populations.
A health system consists of all
organizations, people and actions whose
primary intent is to promote, restore or
maintain health.(WHO, 2007)
3. HEALTH SYSTEM DEVELOPMENT (HSD)
Necessitates For The Development Of Health Care
Systems
Continuous support to policy and managerial
practices for appropriate infrastructure and logistics
Use of technology, information collection and
dissemination, organization of health workforce
development at national and institutional levels,
Universal coverage and Sustainable financing, and
Assured quality and safety in health-care
4. MEASURES OF HSD
Identify and remove health-system bottleneck
Monitor the progress and programs in
coverage
Intervention packages and health-system
strengthening (Health Care Service Delivery)
Address the Human Resources Crisis
Strengthen the Health Systems
(Decentralization)
Efforts of improve harmonization
5. WHAT IS DECENTRALIZATION?
According to WHO in 1990, Decentralization is
transfer of authority or dispersal of public
planning, management and decision making from
the national level to sub-national levels
6. Decentralization shifts decision-making powers
to lower-levels of government and entails setting
legal and regulatory provision to ensure the:
Favorable political environment
Good coordinating and cooperating
mechanism
Initiatives are sustained and required
strong political permanence.
Entities act in conformity at national
standard
Citizens have access to local decision
making
7.
8. NEED FOR DECENTRALIZATION
At the past, many countries in the world, particularly the
countries in Asia and Africa strengthened the national and
regional administration by reducing the responsibility of the
local government
But now, many of these countries realized the need to
strengthen the peripheral and local authorities and have
adopted decentralization as one of the major means for
implementing the reforms.
9. NEED FOR DECENTRALIZATION (CONT:)
There are many complex reasons why
governments in various countries are beginning
to decentralize their services. For example
Demands for more regional autonomy have
played a major role in Papua New Guinea and
Spain
Political ideologies were important in Chile
and Yugoslavia
The need to rationalize over burdened and
outmoded administration plays a large role in
New Zealand and Srilanka
10. CONCEPTS OF DECENTRALIZATION
On philosophical and ideological level, decentralization
have been seen as an important political ideal, providing
the means of community participation, local self reliance
and ensuring the accountability of the government
officials to the population.
11. CONCEPTS OF DECENTRALIZATION (CONT: )
Decentralization policies are usually initiated by
central governments and only subsequently are
adopted by the health sectors. This means that the
central government has initiated a national policy by
adopting constitutional changes that set the pattern
for the reforms to be adopted by the different
ministries.
12. DECENTRALIZATION IN HEALTH SERVICES
Decentralization is one of the main concept for Health
system Development
Decentralization of health system structure and
management is a key issue for many countries in the
achievement of ―Health For All‖ and in the
development of Primary Health Care. (Health System
Decentralization; Concepts, Issue and Country
Experience, WHO, Geneva 1990)
13. In practice, health system decentralization takes many
different forms, depending not only in overall government
political and administrative structures and objectives, but
also on the pattern of health system organization prevailing
in the particular country.
Decentralization demands a holistic approach, and the
decentralization of health services cannot be looked into in
isolation. As a part of reforms in the health care delivery
system, decentralization is currently being promoted in
many countries as a means to improve the performance
and outcomes of national health care systems.
14. It is often imputed that health ministries in developing countries
have a reputation of being the most bureaucratic and least
effectively managed institutions. Such centrally managed health
care systems, by and large, are poorly structured, badly led and
inefficiently organized.
Failure of such systems spawned the need for "people centered"
health care systems that build on bottom-up approaches in
planning, allow wider participation of people in needs
assessment, ownership over there sources and facilities and
stewardship of the local bodies.
15.
16. OBJECTIVE AND RATIONAL FOR DECENTRALIZATION IN HEALTH SERVICES
Objective Rationale
1) To improve
technical efficiency
Through fewer levels of bureaucracy and
greater cost consciousness at the local level
Through separation of purchasers and
provide functions in market-type relations.
2) To increase
allocative efficiency
Through better matching of public services
to local preferences
Through improved patient responsiveness
3) To empower local
governments
Through more active local participation
Through improved capacities of local
participation
4) To increase the
innovation of service
delivery
Through experimentation and adaptation to
local conditions
Through increased autonomy of local
governments and institutions
17. Objective Rationale
5) To increase
accountability
Through public participation
Transformation of the role of the central
government
6) To increase quality
of health services
Through integration of the health services
and improved information systems
Through improved access to health care
services for vulnerable groups
7) To increase equity Through allocating resources according to
local needs
Through enabling local organizations to
better meet the needs of particular groups
Through distribution of resources towards
marginalized regions and groups (through
cross –subsidy mechanisms)
18. DIFFERENT APPROACHES TO DECENTRALIZATION:
Public administration approach
Local fiscal choice
Social capital approach
Principal agent approach
19. PUBLIC ADMINISTRATION APPROACH
focuses on the distribution of authority and
responsibility for health services within a national
political and administrative structure.
different forms of decentralization:
Deconcentration
Delegation
Devolution
Privatization
20. LOCAL FISCAL CHOICE
was developed by economists to analyze
choices made by local governments using their
own resources and inter-governmental transfers
from other levels of government.
It has been applied mainly in federal systems
where local governments have had a history of
constitutionally determined authority and
significant locally generated resources.
21. SOCIAL CAPITAL APPROACH
focuses on explaining why decentralized
governments in some localities have better
institutional performance than do governments
of other localities.
Applied to health care, this approach suggests
that those localities with long and deep histories
of strongly established civic organizations will
have better performing decentralized
governments than localities which lack these
networks of associations.
22. PRINCIPAL AGENT APPROACH
proposes a principal (individual or institution)
with specific objectives and agents who are
needed to implement activities to achieve those
objectives.
Agents also have an advantage allow them to
pursue their own interests at the expense of the
principal.
23. Decentralization policies are usually initiated by
central governments and only subsequently are
they adopted by the health sector by
adopting constitutional changes that set the
pattern for the reforms to be adopted by the
different ministries
making innovative choices within the decision
spaces of local authorities
using local governments own resources and
intergovernmental transfers from other levels of
government (local fiscal choice model)
24. HOW CAN WE MAKE DECENTRALIZATION?
equalization funds
allocation formulae for intergovernmental transfers
allocation rules that earmark funding for specific
purposes
training exercises for local authorities and
communities to achieve institutional performance
(social capital approach: Putnam, 1993)
27. MALDIVES AND DECENTRALIZATION
The Seventh National Development Plan states that “the
health policy of the government is targeted to ensure access
to primary health care to all citizens in an equitable manner”.
Health Master Plan for 2006-2015, the Government of
Maldives has committed itself to provide equitable access to
health care for all its citizens.
The government aims to achieve these goals primarily through
decentralization of health services and the primary health care
approach.
“Act on Decentralization of the Administrative Divisions of the
Maldives”, 2010.
This is the Act on the creation of offices, posts, island councils,
atoll councils and city councils and the determination of their
characteristics, jurisdiction and required principles or rules for
the purpose of decentralized administration of the Maldives as
stipulated in Chapter 8 of the Constitution.
28. DECENTRALIZATION IN MYANMAR
Growing the needs
to involve all relevant sectors at all administrative levels
to mobilize the community more effectively in health
activities health committees had been established in
various administrative levels down to the wards and village
tracts
These committees at each level were headed by the
responsible person of the organs of power concern and
include heads of related government departments and
representatives from the social organizations as members.
Heads of the health departments were designated as
secretaries of the committees.
29. CASE STUDIES OF NEPAL FOR DECENTRALIZATION
IN HEALTH SERVICES
During the past few decades, many countries have embarked
on the decentralization of public services. Nepal has also
tried to adopt decentralization as a key reform process.
During the 1990s there was significant progress in the
development of health systems under the framework of long-
term (1997–2017) health plans and policies, guided by a
vision of equitable access and the principles of community
participation, decentralization, gender equality, effective
services management, and a public–private partnership
approach.
Under the guidance of these plans and polices, Nepal has
made visible progress in health sector reform despite the
nature of difficult topography (hills, mountains).
30. The main drivers for decentralization in Nepal include:
socio-economic inequalities, multi-ethnicity and cultural
heterogeneity, poverty, low efficiency of centralized delivery
systems and the global phenomenon of decentralization.
As in other countries, two important factors—technical or
managerial, and political motives—are major contributing
factors behind the decentralization process.
In the governance system, decentralization and local self-
governance have been made operational in Nepal since the
1960s.
In 1999, Nepal enacted a Local Self-Government Act
(LSGA) and this Act, whose monitoring committee was
chaired by the Prime Minister, laid the foundation for
establishing a local self-governance system adopting a
broad-based and cross-sectoral approach.
31. This Act recognized the role of local self governance and
devolution of authority and responsibility to make local
authorities more responsive and accountable to people.
The rationale for this Act was both philosophical and
practical and involved legislation, institutional provision,
resources (both financial and human) mobilization and
considerations, i.e. autonomy and equality.
One of the major reforms in Nepal's health sector under
decentralization was the restructuring of health services.
In 1987, the centre (MoH) underwent change and as a
result—Regional Health Directorates were established in
five development regions in Nepal.
32. Restructuring of the district health services (preventive
and curative) was considered to be vital for meeting the
health needs of local populations.
A unique feature of the health sector in Nepal is that
there is a strong community-based health workforce
(more than 50 000 female community health workers
in addition to 28 000 public health staff) across the
country who are mainly responsible for preventive
care.
Since 2001/02, over 1435 primary health care facilities
(100% in the study district) devolve to the local
community management. Government is now in the
process of devolve other health care facilities i.e.
district hospitals, zonal and regional hospitals to the
management of local committees.
34. Decentralization is regarded as the
most important force in improving
efficiency as well as equity and
responding to local health conditions
and demands.
35. STRENGTH OF DECENTRALIZATION
Governance
Trained local and district managers
Formation of DMHT for inter-sectoral collaboration
Creation of new posts at sub district level for monitoring at
grass root level
Financing
Retention of taxes by district
Autonomy for need-based allocation
Resources and services
Outsourcing leading to regularity, punctuality and service
delivery
Procurement of drugs at district level
36. WEAKNESS OF DECENTRALIZATION
Governance
Lack of administrative capacity and accountability
Selection on personal and political choice
Lack of power delegation at sub-district level
Lack of practical planning at local level
Lack of focus on preventive side
Lack of evidence based policy making
Duplication of power between provincial and district
governments
Limited authority on vertical programs
Bureaucratic resistance
37. WEAKNESS OF DECENTRALIZATION
Financing
Allocation are not need-based
Late release of funds
Underpaid health care workers
Extra-burden of non-development funds
Resources and services
Lack of capable trained health care staffs and doctors
Lack of laboratory facilities
Transport for emergency referrals
Failure to deliver service practically
Tertiary service excluded
Non-functioning HMIS
38. Implementing decentralization in the health sector
has many advantages for the health system
development, primary health care and health for-
all strategies.
However, decentralization is very sensitive political
issue, for it concerns the distribution of power and
allocation of resources.
The adoption of a national policy on
decentralization is only the beginning of a lengthy
process that strong political commitment over
many years to achieve the good results.