Post on 13-Feb-2018
transcript
THE MDI: STRENGTHENING THE MANAGEMENT CAPACITY OF HEALTH CARE SYSTEMS IN SUB-SAHARAN AFRICA
Rene Kiamba, Johnson & Johnson
5TH BIENNIAL ACHAP CONFERENCE
Challenges Facing African Health Care Organizations
National and international health care reforms Decentralization of decision-making authority Acute shortage of resources including human
resources, drugs, other supplies and equipment Emerging health problems & growing disease
burden Increased demand for health services due to
population growth
The Capacity to Satisfy Health Care Needs Depends on Many Inputs
Effective Management is Essential and Frequently Overlooked
Scarcity Makes Good Management Essential
Managers in Health Care Are Seldom Trained in Management
“Acumen in clinical, surgical and community health care skills has been mistakenly equated with acumen in leadership and
management. It is therefore not surprising to find that the ‘Nurse of the Year’ is promoted to District Nursing Officer or the ‘Top
Cardiothoracic Surgeon’ is made Chief Medical Officer (Director of Medical Services) or even Permanent Secretary (Principal
Secretary) in the Ministry of Health, without any prior exposure, training and experience in leadership and management.”
Peter Ngatia: Director of Capacity Building, AMREF
(In a recent study conducted by AMREF and Management Sciences for Health (MSH) ( July 2009) in Kenya, Ethiopia, Tanzania and Uganda, 75% of managers vested with the responsibility of Human Resource Management (HRM) indicated that they lacked the knowledge and skills to
carry out the numerous HR management functions.)
Management Programs Can Have Health Outcomes In Guinea, vaccination coverage improved from
0% in December 2002 to 47% in June 2003 and to 62% in December 2003. This was attributed to skills gained in scanning, mobilizing, resolving
conflict, negotiating and delegating acquired from a management program. (Rachel & Goldenberg, 2003)
MSH implemented a four-month leadership development program for staff from health facilities, focusing on the capacity of managers to produce organizational results. The outcomes were a 12% decline in infant mortality 35% decline in maternal mortality and a 17% increase in contraceptive prevalence in a span of five (5) years.
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MDI Partners
• The Anderson School at The University of California at Los Angles
• African Medical and Research Foundation
• Funding: Johnson & Johnson • Implementing partners
• University of Cape Town Graduate School of Business
• Ghana Institute of Management and Public Administration (GIMPA)
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Key Features of the MDI
Seven day intensive emersion in management
Taught mainly by local faculty
Emphasis on practical, relevant management competencies
Examples drawn from relevant clinical and geographic context
Understanding of health issues by program designers and faculty
Focus on country’s unique implementation of national health priorities
Deployment of an action plan – called the Community Health Improvement Plan (CHIP)
Commitment to follow-on consultation and technical assistance during project implementation
Measurement of the impact of the program
The Mission of the MDI (Until 2011)
The mission of the MDI is to increase the scope, scale and quality of care, treatment, prevention and support services for people and their families living with HIV/AIDS by enhancing the management skills of executive directors and leaders of African organizations devoted to providing these services.
MDI Participants
138
45
40
39
32
31
25
19
16
15
12
10
6
6
6
4
4
4
3
0 20 40 60 80 100 120 140 160
Kenya
Ghana
Nigeria
Swaziland
Uganda
Tanzania
Ethiopia
Somalia
Sudan & So. Sudan
Cameroon
South Africa
Zambia
Liberia
Sierra Leone
Malawi
Burkino Faso
Lesotho
Zimbabwe
D.R.Congo
472 Graduates through 2010
14 Intakes through 2010
Most MDI Faculty Are From African Business Schools
The MDI Curriculum Builds Relevant Management Competencies
Organizational Challenges, Issues &
Obstacles
Requisite Management Competencies: Skills, Knowledge & Abilities
Curriculum
Planning
Monitoring & Evaluation
Financial Management
Health IT
Operations Management
Social Marketing
Leadership
Health Economics
Curriculum of the MDI
The uses for monitoring and evaluation
Types of evaluation; Formative. Monitoring & Summative
Conceptual framework design: Health and economic outcomes
Outputs, Outcomes and Impact
Evaluation approaches
Creating a vision and mission for the unit or organization
Identifying unmet community health needs
Creating solutions to solving service gaps
Setting goals and objectives
Action planning Budgeting
Organizational Planning Monitoring & Evaluation
Curriculum of the MDI
Collecting information related to health care operations, clinical outcomes and financial systems
Data analysis to support strategic, operational and financial decision making
Data analysis for program and services evaluations
Data reporting for accountability
Using computers and the Internet to collect, analyze and report information
Financial Management Health Information Systems
Concepts of finance and accounting in health services
Activity-based costing Budgeting & Forecasting Differences between financial
(external) and managerial (internal) accounting
Recording and reporting non-cash contributions (human resources, medication, supplies)
Compliance with funding agencies reporting requirements
Curriculum of the MDI
Social marketing versus commercial marketing: differences and similarities
Achieving desired outcomes and impact: social change at individual, group and society levels
Determining the target group for intervention (demographics/geographic segmentation and selection)
Developing & implementing a social marketing mix and strategy
Determining marketing effectiveness
Aligning operations with corporate mission and strategy
The importance of operations management in scaling up services
Service process analysis and re-engineering for effective operations management
Service-process matrix model for ensuring, effectiveness, efficiency and productivity in service delivery
Service demand forecasting, inventory systems and policies
Operations Management Social Marketing
Curriculum of the MDI
Creating alignment Motivation and goal setting Human resources management Leading and managing change Leading versus managing Teamwork and collaboration Negotiation Effective communication
Economic tools for allocating scarce financial resources across competing health programs
The identification of economic outcomes from health care interventions and programs
Creating maximum value from health care expenditures
Comparative effectiveness analysis
Cost effectiveness analysis Cost benefit analysis
Health Economics Leadership
Outputs
Our Graduates Organizational Effectiveness
Intermediate
Outcomes
Short Term
Management Skills
Impact
More and Better Care
Evaluating the MDI
From the Head of the Kenya Medical Society
“The Management Development Institute (MDI) Program helped me realize that we were not as efficient as we
initially thought we were. It helped me improve my time management skills both on an individual and
organizational level. Better management of time has helped us to cope with congestion by streamlining the internal systems and operational flow at the clinic”.
Dr. Andrew Suleh, Medical Director of Mbagathi District Hospital, Nairobi
Sample Community Health Improvement Projects
Coptic Hope Center for Infectious Diseases – Coptic Hospital: “Expanding its HIV/AIDS program to three new locations while maintaining high-quality services”
HEAL Africa: North Kivu, Democratic Republic of the Congo: “PMTCT Program in Rutshuru and Kayna”
John Snow International, Nairobi, Kenya: “JSI Making Medical Injections Safer”
Kenyatta National Hospital, Nairobi, Kenya: “Establishment of a Community-Based PMTCT Adherence System”
Konkola Copper Mines Community Medicine, Chingola, Zambia: “KCM Door-to-Door Family Health Check”
Liverpool VCT, Care and Treatment, Nairobi, Kenya: “LVCT Strategic Planning for Sustainability”
Nairobi Women’s Hospital, Nairobi, Kenya: “Capacity Building in Management of Sexual and Gender-Based Violence for Health Workers”
Tutulane AIDS Organization, Chitipa District, Northern Region, Malawi: “ART and Nutrition Access Improvement for PLWHIV in Underserved Traditional Authorities”
New Directions for the MDI in 2011
Emphasis on broad health systems rather than being disease-specific
To include chronic care in addition to communicable diseases
Multi-person teams to work collectively on National health care priorities NGO partners invited to participate with MOH
personnel
Management Is Essential to New Emphasis in Global Health
Through the Global Health Initiative (GHI) the United States will invest $63 billion over six years to help partner countries improve health outcomes through strengthened health systems
“Sustainable programs must be country-owned and country-driven.” (PEPFAR)
Sustainability & Systems Strengthening
The Redesigned MDI Reflects PEPFAR’S Goals Transition from an emergency response to promotion of
sustainable country programs. Strengthen partner government capacity to lead the
response to this epidemic and other health demands. Expand prevention, care, and treatment in both
concentrated and generalized epidemics. Integrate and coordinate HIV/AIDS programs with
broader global health and development programs to maximize impact on health systems.
Invest in innovation and operations research to evaluate impact, improve service delivery and maximize outcomes.
The U.S. President's Emergency Plan for AIDS Relief: Five-Year Strategy (December 2009)
The 2011 MDI Focuses on Addressing National Health Care Priorities
The Structure of the Community Improvement Project (CHIP)Process: Problem Identification to Evaluating the Solution
MISSION OR NATIONAL HEALTH
PRIORITY
POSSIBLE PROBLEM
POSSIBLE PROBLEM
SELECTED PROBLEM
POSSIBLE SOLUTION
POSSIBLE SOLUTION
OPTIMAL SOLUTION
GOAL
PROCESS & OUTCOME OBJECTIVES
ACTION PLAN EVALUATION
Pilot MDI in Swaziland
ELIMINATION OF MTCT
TRANSPORT UNRELIABLE SUPPLIES OF DRUGS
LACK OF TRAINING IN PMTCT
SOLUTION: TRAINING OF
NURSES
GOAL: COMPREHENSIVE PMTCT TRAINING
PROCESS OBJECTIVE: 2 NURSES PER
FACILITY BY 2011
OUTCOME OBJECTIVE: 90% OF
HIV+ WOMEN INITIATED ON AZT
ACTION PLAN
Implementing the WHO PMTCT Guidelines in
Swaziland
Three 2011 MDI Locations
East Africa
Southern Africa
West Africa
Nairobi, Kenya: May 2 – 7
Cape Town, South Africa: August 21 – 27
Accra, Ghana: August 28 – September 3
To apply: http://www.anderson.ucla.edu/mdi.xml
Candidates
We are seeking teams or clusters of individuals having related leadership responsibilities for implementing specific national health care programs and priorities in their country or region.
Director Project Manager Program Manager Executive director Program coordinator Public health coordinator Regional coordinator Chief Medical officer Chief nurse Medical superintendent Country coordinator
Questions