10359.pdf
Media
- extracted text
-
-
-
■
•
Bll^
■
■
<
>
■
■■
Regional Strategic Plan
for Strengthening
Health Service Management
in the South-East Asia Region
OwW Wor,d Health
Organization
Regional Office for South-East Asia
SEA/HSD/301
Regional Strategic Plan
for Strengthening
Health Service Management
in the South-East Asia Region
World Health
Organization
Regional Office for South-East Asia
© World Health Organization 2007
This document is not a formal publication of the World Health Organization
(WHO), and all rights are reserved by the Organization. The document may,
however, be freely reviewed, abstracted, reproduced or translated, in part or in
whole, but not for sale or for use in conjunction with commercial purposes.
The views expressed in documents by named authors are solely the responsibility
of those authors.
Printed in India
pH - mo
/
/■i: r
ft z
H&
(\Q
)*
'
t/
J
-A
J. '7
Contents
Page
1.
Background
1
2.
Current management gaps and responses
2
3. Goal and strategic objectives
6
4.
Guiding principles
7
5. The strategic framework
7
6.
Strategic areas of actions for Member countries
Strategic area 1:
Strategic area 2:
Strategic area 3:
9
Assessment and monitoring of health service
management gaps........
11
Development of national plan for management
strengthening.....................
13
Increase production and equitable deployment
of managers.........................
15
Strategic area 4:
Ensure competency of individual health managers
17
and teams................................
Strategic area 5:
Development of functional support systems
19
Strategic area 6:
Working environment for better management
21
7.
WHO role
22
8.
Implementation of the Strategic Plan
22
9.
Monitoring and evaluation
23
10. References
23
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
1. Background
There has been a significant improvement in the health status of the people of the World
Health Organization's (WHO) South East Asia (SEA) Region in the last few decades1, however,
there is concern regarding the capacity of Member countries to achieve national and
international health targets such as Millennium Development Goals (MDGs) in the stipulated
time frame.
The reason is on many folds. They include:
(1)
Low health service outputs even in areas with reasonably good availability of
resources has made it imperative to look for ways to improve managerial capacity
at the national and sub-national levels of operation of health systems,
(2)
The need to ensure good management capacity, especially at the sub-national levels
have been felt as never before, as many countries operate on decentralized health
systems or undertaking delegation of responsibility to sub-national levels at increasing
pace.
(3)
Recital deteriorating services that push people, even the poor, to seek care at
private facilities as shown by the increasing out of pocket expenditure in many
countries in the South East Asia Region.
Weak health services delivery management has resulted in, for examples, low absorption
of the health sector budget, shortage of essential drugs, inadequate maintenance of medical
equipment and health facilities, and shortages of motivated and competent health workforce.
All Member countries of the Region are aware of the management related challenges in
the health sector and have made considerable attempts to improve the situation. The WHO
South-East Asia Regional Office has also implemented many interventions to strengthen the
management of health services in Member countries, mostly through training programmes on
management and by developing and advancing the use of manuals and strengthening
supervision systems.
In spite of several activities, the management of health services in some countries has
not improved significantly. Many countries have felt that a new initiative needs to be designed
and implemented to strengthen the management of overall health systems to improve the
health of the population. This strategic plan is intended to provide directions for Member
countries and the WHO to develop comprehensive interventions to strengthen the management
of health systems in a coherent and systematic manner.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
2. Current management gaps and responses
At the Regional Workshop on "Strengthening Management Capacity of Health Managers at
the Sub-National/District Levels" held in Jakarta, Indonesia, in February - March, 2007, the
main causes of the problems were identified. These are shortage of managers, inadequate
competencies, lack of functional support systems, and inadequate working environment to
support good management, as described below:
2.1
Shortage of managers
Most countries in the South-East Asia Region are coping with a paucity of competent managers,
particularly in the remote districts.
Supply situation
In many countries the production or supply of trained health managers does not meet the
demand due to limited number of education and training institutions, limited budget to support
training programmes, and limited opportunity to attend post-graduate study in health service
management. To rectify this situation some universities in India, Indonesia, Sri Lanka and
Thailand have developed postgraduate programmes in health services management.
Governments in smaller countries like Bhutan, Maldives and Nepal often send their officers to
universities overseas to study health services management.
Increasing demand
Proliferating health facilities in the cities and the establishment of newer peripheral units in
the districts, as a result of decentralization of the health services has in some countries, has led
to a spurt in demand. Internal migration from the government facilities to more lucrative
private institutions in bigger cities has added to the problem of paucity of managers in public
health facilities, particularly in India, Indonesia and Thailand. In Bhutan, in line with its good
governance policy, the Ministry of Health and Education was split into two separate ministries
in July 2003 leading to the creation of more managerial posts. Decentralization has increased
the demand for managers by two to three times in Bhutan. In line with the spirit and guidelines
of the Local Self-Government Act 1999, of Nepal, 1424 health facilities were handed over to
local administrative bodies in 28 districts in 2002-2003 and 2004-20052. Decentralization has
necessitated higher standards of managerial competence in the health service organizations
that have been decentralized. Bridging the gap between existing standards and demand has
been difficult in most countries.
Difficulty in deployment
Social unrest, armed conflicts and political instability in parts of some countries in South-East
Asia act as a disincentive to competent managers to seek a posting in those areas. Indonesia
and Maldives for example have found it difficult to deploy competent managers in their remote
islands or atolls. In Maldives, managerial posts are filled up by the community health workers
2
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
who are trained to practice preventive, promotive, and curative health-care activities at the
island level. Since decentralization was implemented in Indonesia in 2001 more and more
puskesmas (public health centres) have been headed by less qualified personnel. In response,
Indonesia, Myanmar and Thailand have created special motivational packages, which include
mostly non-monetary incentives like a years' of overseas posting for fellowship, to attract qualified
managers for deployment in remote areas. On the whole, tangible improvement is urgently
needed in areas of proper recruitment, career development and incentives for deployment of
competent managers to fill the gap between demand and supply.
2.2 Inadequate competencies managers
Though many health service managers in Member States have a background in managerial
education and many have participated in various management training sessions, particularly
on public health programmes - the feedback from the countries reveals the gaps in competency
levels, especially in managing complex health problems in the districts.
Some of these problems that percolate to the sub-national/district levels are:
>
Lack of capacity to address complex managerial problems that arise, such as,
managing health services in conflict situations
>
Aversion on the part of managers to practicing evidence-based decision-making.
>
Lack of competency in negotiation skills that are required to negotiate competitive
demands from the political leadership
>
Limited accessibility of public health managers stationed in the field to recent
management techniques and updated expertise, and
>
Lack of practical skills to solve problems in the practical arena. Most of them were
trained in class room setting and had not had the opportunity of doing a reasonable
period of apprenticeship after graduating.
During the Regional Workshop on Strengthening Management Capacity of Health
Managers at Sub-National/District Level, participants also identified several key areas in
management competency needing improvement. These are:
(D
Competency to engage and build consensus among relevant stakeholders in health.
(2)
Competency to manage decentralization.
(3)
Competency to manage budgets, human resources, and health infrastructures.
(4)
Competency to monitor and evaluate health service delivery.
2.3 Lack of functional support system
Many management issues are beyond the purview of individual managers. Weaknesses
in planning and budgeting systems, accounting systems, human resources management systems,
and procurement and logistics management systems could only be overcome at the systems
level. There are several areas of weaknesses in health service management support systems.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
Some of these have been identified as: organization and management of health service delivery
systems, management of human resources, health management information systems and
management of health finances.
Organization and management ofhealth service delivery systems
In some Member countries, there is no clear delineation of responsibilities between central,
provincial and district health services. Essential health-care services and public health functions
for each administrative level are not clearly defined and funded. There is no clear positioning
of government health-care services among health service providers (private for profit, private
not for profit, and NGOs). Quality control and assurance systems are not in place.
Human resource management
Improvement in human resource management systems is an urgent need in some Member
States to minimize or rectify problems of maldistribution, skill-mix imbalances, internal and
international brain drain, and low motivation levels. Recruitment and deployment systems,
performance management systems, job description and payroll systems and career development
systems are mostly needed to be strengthened at the system level. There is an array of low-cost
and practical mechanisms such as clear job description, supportive regular supervision, as well
defined levels of authority, roles and responsibilities and regular feedback on performance to
improve this situation to a desirable extent. These, however, are not always practiced.
Health management information system
Non availability of timely and reliable data to support evidence-based decision-making have
affected the capacity of the national health systems in decision making in many of the Member
countries. Data to support a competent annual health planning and budgeting suffers from
those gaps. To and fro flow of available information is also very slow and unproductive in field
situations. Consequently, many decisions related to health services are taken not on the basis
of evidence and scientific merit but on account of political demands and opinions.
Management ofhealth finances
Instruments for financial management, especially to monitor the availability and flow of funds,
are not made available on time to health managers in the field. Practical tools to manage
medical supplies and equipments are mostly non-existent. Many new management techniques
have been introduced but some that continue to remain in use are sees to be outdated.
Conflict of authority over available funds, especially in the partly or semi-decentralized units,
creates further difficulty in making use of the funds productively. Though policies, rules and
regulations have been laid down they are mostly not practiced nor implemented.
Other profound problems are weakness in supervision and evaluation systems and the
mechanisms to monitor the performance of managers. There are also palpable gaps in essential
functional support system attributes such as well defined guidelines, forms and procedural
details.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
2.4 In adequate working environment to support good management
Many factors beyond the premier of the health sector also tend to heavily influence the
performance of health managers.
Governance
Lack of human security and the armed conflict and terrorism, along with poor governance;
favoritism and nepotism have a direct impact on the performance of the health managers.
Good governance leads to a better organizational effort and better management of public
funds and programmes leading to holistic public engagement and more desirable outcomes.
Poor governance has been shown to foster an unfavorable work environment on account of
lack of clear roles, performance standards, procedural transparencies and accountability. Other
weaknesses found related to how local managers are held accountable for results and the lack
of incentives for a service manager to perform better.
Service conditions
Service conditions such as salary and other incentives adequate to sustain reasonable living
standards are also equally important and poor attention to these has weakened the management
system. Unpredictable, unbalanced or inflexible funding and staffing have also led to the
weakening of the health services management system in some countries of the Region.
All Member countries are aware of management problems existing in their countries
and responding in many ways. Several counties such as Bhutan, India, Indonesia and Thailand
have set standards for core competencies required in several levels of managers, including
health managers. In keeping with the current managerial challenges and also the policy of
decentralization, the governments of Bhutan, Indonesia, Maldives and Nepal have also revised
previously set standards to meet current needs. Most Member countries have adopted many
management manuals and techniques and enhanced the managers1 ability to access the
knowledge database on health service system management. They have tried to implement
result-based management techniques and integrated health planning and budgeting.
Some Member countries have developed and implemented standardized management
training programmes for their health managers by collaborating with their respective educational
and training institutions. Seminars and workshops have been held in most of these countries in
an effort to enhance managerial capacities in health-care delivery.
A list of select specific actions undertaken by some of the Member States as reported by
participants at the Regional Workshop on Strengthening Management Capacity of Health
Managers at the Sub-National/District Level held in Jakarta, Indonesia, is given below:
(1)
Maldives has created specific managerial posts for the peripheral hospitals and
developed and implemented an advanced level course in health service management
in collaboration with the Faculty of Health Sciences.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
5
(2)
Myanmar carried out a pilot programme on Management Effectiveness Programme
(MEP) in six townships of six states in 2004-2005 and expanded the programme to
another 6 townships in 2006-7. Myanmar has also developed a new motivational
package by offering one-year postings abroad and overseas fellowship training as
an incentive.
(3)
Indonesia has implemented a Mind Setting Programme for all health managers of
various levels at the central Ministry of Health and Strategic Leadership and Learning
Organization. Indonesia has also started implementing a Performance- Based
Budgeting and Medium-Term Expenditure Review to improve national planning
and financial management.
(4)
The Royal Civil Service Commission of Bhutan developed a new Position
Classification System (PCS) following a merit-based system.
(5)
Bangladesh, Bhutan, Indonesia and Thailand have implemented a new productoriented approach to programme implementation which emphasizes on the outputs
rather than inputs.
3. Goal and strategic objectives
3.1 Vision
The overall vision of the WHO in this area is for Member countries of the South East Asia
Region to achieve optimum health outcomes by ensuring availability and accessibility of
effective health service through strengthened health management.
3.2 Mission
Cognizant of its role and responsibilities, WHO to support Member countries of the SEA Region
to strengthen capacity in the management of health services delivery at the individual and
team, organizational and systems levels to meet increasing health demands.
3.3 Goal
The goal is to build capacity of Member States in strengthening management of health service
delivery, particularly at the sub-national/ district.
3.4 Strategic objective
The objectives are to contribute to strengthening management capacity of the Member
Countries by:
6
(1)
Developing management strengthening plan based as an integral part of national
health development plans of the Member countries.
(2)
Increasing production of health managers
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
(3)
Improving the managerial competencies, at the individual and team level, of health
sector managers, particularly at the sub-national/district level.
(4)
Improving functional support systems of national health systems
(5)
Creating an enabling work environment for good management.
4. Guiding principles
The guiding principles based on good practices to achieve management development are
given below3:
(D
Good management development should address barriers to achieve adequate
number of managers, with appropriate competencies, supported by effective
operational systems and functioning in an enabling work environment.
(2)
In all aspects and stages of the management development process, decisions will
be based on sound evidence and good practices, whenever available.
(3)
In addressing management development needs to aim at maximizing the
performance of sub-national/district level management; particular attention will be
focused at the more critical management functions that are likely to influence service
improvement and coverage, such as district health systems management, health
services delivery management, human resources management, etc.
(4)
Ensuring health services delivery to the unreached, the poor and the underprivileged
should be the main focus of the management development plans.
(5)
In developing managerial capacity, Member countries will be urged to consider
the socio-cultural context with a view to recognizing the local political and economic
circumstances.
(6)
Gender imbalances will be minimized in implementing all aspects of management
development.
(7)
Improvements will be introduced sequentially, flexibly and incrementally soon after
assessment and identification of gaps, by building on what already exists, and keeping
in view the long-term perspective.
(8)
Greater effectiveness will be achieved through harnessing and harmonizing all
available internal and external resources involved in management development.
5. The strategic framework
The WHO has identified that in building leadership and management capacity at the operational
level requires a balance among four inter-related dimensions4:
(1)
Adequate number and distribution of managers.
(2)
Appropriate competencies of managers.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
(3)
Functional support systems of the national health systems.
(4)
Enabling working environment.
It is imperative for WHO and Member countries to ensure that in strengthening
management system, efforts are directed towards the availability of effective managers, and to
improve managerial capacity of existing managers at individual and team levels through
continuous professional development, and improve managerial capacity at the organizational
level through strengthening functional support systems and creating a good enabling working
environment.
Strengthening management systems is a cyclical process. It consists of four core activities.
These are:
(1)
Assessment and planning to identify specific managerial problems and to suggest
interventions. It entails assessing the current situation and identifying problems,
analyzing their causes, and prioritizing and outlining solutions. This is a critical but
often neglected step. In the past, the approval to seek solutions to management
problems was to depute managers for management courses or apply a new
management technique without a thorough understanding of the underlying causes
that, in many cases, were embedded in the systems.
(2)
Pilot testing (Small-scale experimental testing): The implementation includes
piloting or small-scale experimental testing of the proposed change in management
processes. This minimizes the risk of disrupting the regular process and allows the
management to test whether the change will actually make a positive impact. In
identifying workable solution to current management problems, managers may
seek practices or interventions that have enabled others to solve similar problems
and to identify the cause of the problem and provide solutions. However, it is
important to note that in many situations, these piloted intervention are not
institutionalized though found to be effective and never reach to a scale to have
impact on the population's health.
(3)
Evaluation: Evaluation after the interventions would allow an estimation of the
impact made by the intervention. This is done by using certain tools decided during
the "assessment" phase. It entails evaluating key performance indicators after the
intervention in a practical setting.
(4)
Scaling-up: Scaling-up implies system-wide applications of the interventions proven
successful after evaluation of the piloting process. This phase transforms the proposed
changes into integral practice within the health management process.
The Strategic Framework on Health Service Management Srengthening is given in
Figure 1. It shows four dimensions of good management (in the centre), to be strengthened
through four steps - assessment and planning, implementing, evaluating and scaling up of a
cyclical management strengthen process. The expected output of those continuous activities
would be an effective and equitable health service delivery.
8
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
Figure 1: Strategic Framework on Health Service Management Strengthening*
Adequate
number of
managers
Appropriate
competency
Effective &
quitable
Q.
□
CD
Ith servi
.£
•co
Q
(P
Functional
support
systems
Enabling
working
environment
^a/uation
This strategic framework is derived from the WHO Strategic Framework for Management
Strengthening in low- and middle-income countries.
6. Strategic areas of actions for Member countries
At the country level, management development involves a set of interrelated interventions to
develop management capabilities of individuals and teams, in combination with management
support systems development and creation of an enabling work environment to improve their
organizational performance. The Strategic plan identifies six strategic areas that need urgent
attention. They are on assessment and monitoring of health service management gaps,
development of national plans for management strengthening, production and equitable
deployment of managers, ensure competency of individual health managers and teams,
development of functional support systems, and creation of enabling working environment to
support effective management.
The strategic areas of actions for Member countries are organized around six areas
which provide the foundation for the development of effective health management in the
Region. They are described below under each strategic area:
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
9
Strategic area 1: Assessment and monitoring ofhealth service
managementgaps
Though it is agreed that there is a shortage of managers and a deficiency in their competencies
at various levels of management, country specific reliable data on the overall gaps in health
service management for each country is still lacking. The gap in this context is the difference
between what is already available and what is needed. What is needed would be answered
by determining the standards and norms for health systems.
It is critical that management gaps are identified and analysed regularly. All managementrelated information, especially those that highlight management gaps, should be collected in a
timely and uniform manner with standardized definitions for different categories of management
functions and support systems.
Strategic activities include:
(1)
Adapt/develop methodologies and tools for assessing, analyzing and monitoring
management gaps to local situations.
(2)
Conduct assessment of health service management gaps.
(3)
Identify causes leading to health service management problems/gaps.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
*
ft 2.
Strategic area 2: Development of national plan for
management strengthening
Country specific comprehensive management development plan needs to be developed by
each country to overcome the existing managerial gaps. The plan should include a set of
interrelated interventions to develop management capabilities of individuals and teams, in
combination with management support systems development and creation of an enabling
work environment to improve their organizational performance. The plan should cover a
medium-term period of about three to five years.
CZ)
q-
njqs.
C)
Strategic activities include:
(1)
Develop guidelines or manual for the development of health service management
strengthening.
(2)
Organize workshops to develop national and/or sub-national/district management
strengthening plan.
(3)
Provide technical support, tools and guidelines to sub-national/district health
offices to develop a sub-national/district health service management strengthening
plan.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
13
Strategic area 3: Increase production and equitable
deployment ofmanagers
Integrated efforts are needed to produce adequate numbers of skilled health workers with
high managerial competencies. Their language, social background and attributes should make
them accessible to the user groups and they should be able and willing to reach diverse clients
and populations. This requires active planning and management with a focus on building
strong training institutions, strengthening professional regulation and revitalizing recruitment
capabilities.
Essential management subjects need to be included in the curricula of health professionals
at undergraduate and postgraduate levels. Standardized management training programmes
for various levels of managerial positions in the health sector need to be developed. In the era
of decentralized health management, posting effective managers in rural areas requires
coordinated efforts by several key players, such as ministry of health, ministry of education,
civil service commissioners and the local governments.
q*
5 Si
Strategic activities include:
w<*9.
n
(1)
Increase training opportunities through providing fellowships and increase budget
for health service management education and training.
(2)
Strengthen capacity of the health service management courses in medical schools
and educational institutions.
(3)
Develop policy to ensure equitable deployment of health service managers
through providing motivational packages to attract effective managers for
deployment in remote areas.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
15
Strategic area 4: Ensure competency ofindividual health
managers and teams
Health managers need to have access to adequate knowledge, techniques and tools to enable
them to keep improving their competencies at all times. They need to be continuously supported
by effective supervision and mentorship. Most management techniques and tools used in the
Region were developed in countries with a very different work environment. The local
management culture needs to be understood and its key elements identified and are made
part of the process of development of managers. Techniques hitherto applied including
mentorship, coaching and soft skills such as negotiation and political skills remain as important.
These may need modifications to suit local conditions and will have to be disseminated in the
local languages.
The pursuit of management-related knowledge, understanding and personal development
needs to be encouraged across the Region, particularly through strengthening of regional and
national capacity in knowledge generation and dissemination.
All approaches in enhancement of competency, such as self-learning, mentoring,
supervision and, on- the-job-training and classroom training need to be used in a balanced
and concerted manner.
Strategic activities include:
(1)
(2)
Develop and categorize standards of core competencies for managerial positions
at different levels.
CZ)
3
Design benchmark standards for health management training institutions.
n‘
(3)
Create tools for developing a generic competency framework for managers that
the countries of the Region can adapt.
(4)
Create a network of management institutions to share experiences and results
and also establish uniformity of criteria for accreditation by accrediting bodies of
repute.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
17
Strategic area 5: Development offunctional support systems
Functional support systems need to be in place, particularly with regard to management of
human resources, finance, logistics, programmes, and delivery of health services. Several
countries in the Region continue to use outdated management techniques and tools. This
needs to be addressed rather urgently.
Efforts to improve management competencies need to be implemented in tandem with
the development of better management support systems. New management techniques and
tools proven to be effective need to be incrementally applied to make management support
systems more effective. This would, therefore, require the following:
Strategic activities include:
(1)
Develop and implement practical tools to support financial management.
(2)
Develop and implement practical tools to support human resource management
tools, such as performance assessment coupled with reward and punishment
provisions, closer scrutiny and attractive incentives in the recruitment for
management positions.
(3)
Strengthen and continually use the health management information system.
(4)
Develop and implement practical tools to support drugs and medical supplies
management.
(Z)
q*
uiorc.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
19
Strategic area 6: Working en vironment for better
management
Creating an enabling environment for better management is very critical, but is mostly beyond
the control of health ministries alone. However, WHO and the ministries of health in
collaboration could influence the policy-makers to sequentially and incrementally develop
policies to create an enabling environment for better management. Member countries need
to be encouraged to apply evidence-based decision-making processes and to invest more on
health services management development. This would, therefore, require the following:
Strategic activities include:
(1)
Promote the implementation of good governance in public services, particularly
in the health sector.
(2)
Promote higher investment on public health services and government-owned
health facilities.
(3)
Better monitoring of performance and a renewal scheme for good managerial
performance league tables.
o (
(Z)
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
P.HJ
00
po9—
0 3 d’ J
21
cr'ZS.
r
7. WHO role
In strengthening health service management in member countries in the Region, the WHO
needs to play a vital role which is listed below:
(1)
Providing technical leadership to Member countries for strengthening management
through bridging the managerial competency gaps, training of trainers, technical
assistance and similar measures.
(2)
Strengthening knowledge management, particularly on knowledge acquisition
through learning from the experience of others, as well as disseminating good
practices on health management through, among others, commissioning case
studies, operational research.
(3)
Applying its normative function to work on health management strengthening. This
will include but not be limited to developing tools and guidelines, defining service
standards, assessment and other approaches to ensuring effective management for
better health.
(4)
Advocating for global resource mobilization through existing networks and
partnerships as well as their expansion to support management strengthening
(5)
Monitoring and reporting progress on management strengthening initiatives in the
Member Countries and the Region.
8. Implementation of the Strategic Plan
The Regional Strategic Plan for Strengthening Management was developed following a Regional
Workshop on Strengthening Management Capacity of Health Managers at the Sub-National/
District Levels, in Jakarta, Indonesia from 28 February to 2 March, 2007. The responsibility for
implementing the Regional Strategic Plan lies with two key players, the national governments
of the Member countries and the WHO. Using the strategic framework as a guide and
considering country priorities and the levels of management development, countries may
wish to further elaborate their strategic areas for action.
The roles of national governments in implementing country activities are critical as they
collectively, contribute to the regional actions. At the same time, the Regional Office of WHO
in close collaboration with Country Offices will play facilitating and catalytic roles in extending
support to Member countries whenever necessary. Partnerships and coordination at the global,
regional and country levels play an important role in the effective implementation of the
Strategic Framework.
The role and responsibilities entrusted to WHO would form the basis for the Regional
Office's budget plans for the 2008-2009 and 2010-2011 biennium. The biennium plans would
be based on the strategic areas of actions already reflected in the Strategic Plan.
22
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
9. Monitoring and evaluation
The entire process of management development requires regular monitoring and evaluation
to ascertain if the development process or the scaling up of the interventions that have been
proven successful is on track and moving forward and also to determine if the development
process being implemented is producing the desired results and bringing about the desired
benefits to the targeted population. Only monitoring and evaluation can provide the final
proof of the success or failure of the process.
Monitoring and evaluation mechanisms need to be designed and conducted by a
participatory approach and in particular, by involving the relevant stakeholders. Such
participation can encourage stakeholders to become involved in management issues and will
also make them aware of the extent of improvement in services and their delivery.
Monitoring and evaluation involves collection of data. Data collection can be similar as
in the assessment and evaluation phases but sometimes special tools need to be developed to
measure the results. They will include, for instance, opinion questionnaires, focus group
discussions and surveys.
The ultimate yardstick of successful national management development is better health
outcomes and better delivery of health services. Overall progress of the national management
strengthening exercise within the countries of the South-East Asia Region will be demonstrated
by the number of Member States that show progress against some select dimensions of
management capacity.
Indicators to monitor progress would include:
(1)
Number of countries having health service management strengthening strategic
plan.
(2)
Number of countries having conducted periodicevaluation of management capacity
gaps.
(3)
Number of countries having put in place standardized management training.
(4)
Number of countries having developed practical management tools (human
resources management, financial management, etc.).
10. References
(1)
Plianbangchang S. Healthcare in South East Asia Region: Situation and Challenges,
International Hospital Federation Reference Book 2005/2006
(2)
Lal Kama U N: Report on Review of Decentralization Process Particularly with
Regard to Health Services, Ministry of Health and Population, Policy, Planning and
International Cooperation Division, Ram Shah Path, Kathmandu, 2006.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
23
24
(3)
World Health Organization. Towards Better Leadership and management in Health:
Strengthening Health Leadership and Management in Low Income Countries:
Report on an International Consultation on Strengthening Leadership and
Management in Low-Income Countries, 29 January -1 February 2007, Accra, Ghana,
Geneva, 2007.
(4)
Egger D., Travis R, Dovlo D., Hawken L. Strengthening Management in Low-Income
Countries, Making Health Systems Work: Working Paper no. 1, Department of
Health System Policies and Operation, Evidence and Information for Policy, WHO,
Geneva, 2005.
Regional Strategic Plan for Strengthening Health Service Management in the South-East Asia Region
Position: 1758 (3 views)