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Organizational Reforms
Gaston Sorgho, Harvard School of Public Health
Reproductive Health and Health Sector Reform
Organizational Reforms: Session Objectives
To identify key aspects of organizational reforms;
To discuss impact on reproductive health delivery;
To relate to country settings.
Types of Reform
Financial & Resources Allocation
Provider Payments, Incentives &
Motivation
Organizational Change Laws and Regulation
Promoting Healthy Behaviors
Reform Types - System Goals
Effi-ciency
Quality Equity Client response
Sustain-ability
Financing
Providers Payment
Organisa-tional Ch.
Regula-tion
Promoting H.B.
Organization Structure
decision making technical expertise
Functional Planning facilitiesequipmentcommoditiespersonnel
RH Goals: What was expected ?
Client centered Integrated services Efficient Response to changes Motivated providers ……
What is the Problem ?Results
Poor management of RH servicesServices not client-orientedLimited range or optionsPriority to providers convenienceDemotivated providers Insufficient responsiveness to client
needs……...
Organizational Vehicle
Optimal
service delivery
Accountabilityto clients
Performance oriented behavior
Organizational Reform Challenge - RH
Changes needed in providers organization & management performance oriented behavioraccountability to clients
Clients Clients Clients Clients Clients Clients
Service Providers Service Providers
District
Regional
HQ
Private
Sector
1
2
3
4
5
Running Health Business
MOH / HQ
Technical leadership
Procurement
Provis
ionInformation system
Financing
Regula
tion
Service ProviderService Provider
Staffing Training
Policy
Budgeting
Evaluation
Auditing
Reforming MOH Organization
3. Separation of financefrom provision
1. District model
2. New public-sector management
1. Health District Model
District hospital & staff
Satellite health clinics
handed over responsibilitieshanded over responsibilities
Ministry of Health
Health Centers Health Staff
District Administrator
District Health Team
Ministry of Education
District Education Directorate
Schools Teachers
Administration Staff
Ministry of Interior
Centralized Structure
Ministry of Health
Health Centers Health Staff
District Administrator
District Health Team
Ministry of Education
District Education Directorate
Schools Teachers
Administration Staff
Ministry of Interior
Deconcentrated MOH
Devolution
Health District Health Team
Other Ministry Services
Education District Directorate
Ministry of Interior
Ministry of Education
Ministry of Health
District Council
Discussion : what are the benefits and risks of deconcentration
and devolution
for reproductive health care?
Clients Clients Clients Clients Clients Clients
Service Providers Service Providers
District
Regional
HQ
Private
Sector
1
2
3
4
5
From: health system organization
Private Service Provision
Services meet client needs
rather than bureaucracy needs
rather than cripples providers
Organized structure so it supports
Micro - structure
resources/staff management targets setting managers accountability
impact from ‘ inside ’
results-oriented policy
New Public Sector management
Accountability for performance
Greater autonomy
performance monitoring and evaluation
annual personnel performance agreements
performance-related budgeting
Private For Profit Family Planning Services
For-Profit Sources
Latin American & Caribbean 46 %
Middle East & North Africa 44 %
Sub-Saharan Africa 27 %
Asia (non-China/India) 26 %
Organizational Reforms
Macro structure
impact from ‘ outside ’
Micro structure
impact fom ‘ inside ’
Performance
Acountability
Organization’s Authority
hire & fire staff
Authority
No authority
Typical Public
NGO, Mission, Private Profit
build new structureschange profile of servicesdecide on user charge policydrug/supply policy