Management of health
Care Services
Prof. Utsuk Datta
NIHFW
Basic concept of Management
• Management Managers role to get the things done in Right way, At Right time and place,
with the help of Right personnel and with effective use of Resources.
• Pre requisite for effective management
• Sound policy directives.
• Mechanism for Information system.
• Availability of trained man power.
• Proper supply of logistics.
• Effective mechanism of monitoring and supervision during implementation and periodic
evaluation.
• Strategic plan for implementation to be followed.
Dimension of Health Care Management
• District – lowest unit of implementation of health care services
• Institutional Mechanism
• Health care managers.
• Role of local bodies
• Health Management Information System (HMIS)
• Program Implementation Plan (PIP).
• Finance assistances Central assistance, User charges, Public Private
Partnership.
• Logistics and supply management
• Quality assurance
• Capacity Building Comprehensive training plan, Training institutes,
Training Management Information System (TMIS)
• Monitoring and evaluation Common Review Mission (CRM)
At the district level
• Principal unit of administration in India
• District Health Societies Chairman (Administrative head),
other members (MLA / MP/PRI/ local eminent person/ Head
of the departments of all the health related departments)
and Head of the health department as member secretary
• Function To mobilize financial and non-financial resources
for complementing/supplementing the health and family
welfare activities in the district.
• District health Office District Health Office is entrusted
with two major roles; to deliver public health services and to
manage resources within a district. ... It is also responsible in
disease monitoring and surveillance and also the
achievement of specific health indicators for each activity.
Health Managers
• All health care programmes in a district are placed under a unified
control
• The district officer with the overall control is designated as the Chief
Medical and Health Officer (CM & HO) or as the District Medical and
Health Officer (DM & HO).
• These officers are popularly known as DMOs or CMOs, and are overall
in-charge of the health and family welfare programmes in the district.
• These DMOs/CMOs are assisted by Dy. CMOs and programme officers.
• District Hospital under control of Civil Surgeon.
• CHC Under control of Block Medical Officer
• PHC In charge Medical officer
ADMN IN URBAN AREA
1. Town area committee 5000 to 10,000
(equivalent to village population
panchayat)
2. Municipal Board (equivalent 10,000 to
to chairman panchayat 2,00,000
population
samiti)
3. Municipal Corporation Population Above
(equivalent to Zilla-parishad) 2,00,000
Mayor
ADMINISTRATION AND
MANAGEMENT
• ADMINISTRATOR LAYS DOWN THE POLICIES AND PROVIDED
LEADERSHIP ALSO CONCERN ABOUT THE RULES AND REGULATION.
* MANAGER IS MAINLY RESPONSIBLE FOR EXECUTION OF THE WORK.
WHERE TO MANAGE
• MANPOWER
• MATERIALS
• FINANCE
• LEGAL ISSUES
• MEDIA
• CLIENT
• BOSS
CONCEPT
INPUT
PROCESS
OUTPUT
OUTCOME
EFFICIENCY
EFFECTIVENESS
CONCEPT
• HOW SHOULD BE THE PERFORMANCE OF THE STAFF
BE CHECKED AND ASSESSED ?
• - SUPERVISION
• HOW SHOULD THE OUTPUT OF THE PLANNED
ACTIVITIES BE CHECKED AND ASSESSED ?
• - MONITORING
• HOW SHOULD THE OUTCOME OF THE PROGRAMME
AS A WHOLE BE CHECKED AND ASSESSED
• - EVALUATION
CONCEPT
• COOPERATION
• COLLECTIVE EFFORT PUT WILLINGLY.
• COLLABORATION
• SHARING SIMILAR RESPONSIBILITIES.
• COORDINATION
• INTEGRATION OF GROUP OF EFFORTS FOR ACCOMPLISHMENT OF
COMMON GOALS.
• CONVERGENCE
• PROCESS THAT FACILITATES DIFFERENT FUNCTIONARIES TO WORK
TOGETHER.
Managers and Levels of Management
Strategic Level
Top
Management
Middle Technical Level
Management
First-level Operations Level
Management
Operating
Employees
12
MANAGEMENT FUNCTION
• PLANNING
• ORGANISING
• STAFFING
• DIRECTING
• COORDINATING
• REVIEWING
• BUDGETING
STEPS OF PLANNING
• SITUATION ANALYSIS
• LISTING OUT THE PROBLEMS
• PRIORITISATION OF PROBLEMS
• SETTING GOAL AND OBJECTIVES
• DECIDE INDICATORS FOR MONITORING
• DEVELOPMENT OF STRATEGY
• ORGANISING RESOURCES
• IMPLEMENTATION OF STRATEGY
• SUPERVISION AND MONITORING
• EVALUATION
• PLAN - B
Management Techniques
E. 1. Management by Objective
2. Management by exception
3. Situation analysis
4. Current State Assessment
5. SWOT analysis
6. Log Frame Approach
Management by Objectives (MBO)
• It is a process of defining objectives within an organization so
that management and employees agree to the objective and
understand what they need to do in the organization order to
achieve them
• Emphasis on result rather than objectives
• Defining objective / expected result
• Objectives must be in quantifiable and measurement terms
• Participatory or joint objective setting
• Identification of KRA
• Establishment of periodic review system
Program Implementation Plan (PIP)
• PIP prepared based on decentralized planning.
• In the month of November each district prepared program plan for the next
financial year. It is based on previous year achievement and also felt need for
the future.
• Set format has been generated to collect the information related to all health
programs. Information collected from Block level.
• Collation, compilation and preparation of district PIP by the district health
office and submit to the State health office.
• After receipt of responses from the States, the revised Plans were laid before
the National Programme Coordination Committee (NPCC), for approval.
• Review of all the program plan by the respective unit at MOHFW and feedback
given to State for changes if required.
• Final document submit by the state to MOHFW in the month of January
followed by presentation by te state official.
• After the approval of the NPCC, the Record of Proceedings (ROPs), including the
activity wise financial approval, communicated to the States.
Financial packages under PIP.
• FMR code (Financial Management Report) related to each program.
• Ratio is 40%:60% (State share is 40% and Central share is 60%).
• For Northeastern state and UTs the share ratio is 10%:90%.
• The state has to utilize the state share in initial months of new
financial year first.
• On receiving utilization certificate Center will release their share for
expenditure.
• There is a provision of Supplementary PIP and financial assistance
from center in the month of October.
• State release the fund to the districts according to their claim.
• Challenge There is always some constrain to release entire fund
by both state and center as envisaged in the PIP.
New Initiatives
• Rogi Kalyan Samiti (Patient Welfare Committee) / Hospital Management Committee is a simple yet effective
management structure.
• Ensure compliance to minimal standard for facility and hospital care and protocols of treatment as issued
by the Government.
• Introduce transparency with regard to management of funds;
• User Charges A user fee is a sum of money paid as a necessary condition to gain access to a particular
service or facility. Examples of user fees could include highway tolls or parking garages. People pay user fees
for the use of many government-affiliated services and facilities as well.
• National Quality Assurance Standards (NQAS) have been developed keeping in the specific requirements for
public health facilities as well global best practices. Currently available for District Hospitals, CHCs, PHCs and
Urban PHCs.
• Public-Private Partnerships (PPPs) are contractual arrangements entered into by the government with the
private sector. Under a PPP scheme, the private sector can build, operate and maintain public infrastructure
facilities and provide services traditionally delivered by government.
• Community mobilization is the process of bringing together as many stakeholders as possible to raise people's
awareness of and demand for a particular programme, to assist in the delivery of resources and services, and
to strengthen community participation for sustainability and self-reliance.
Thanks
