The lack of basic management skills of district-level health teams is often described as a major constraint to implementation of primary health care in developing countries. To improve district-level management in The...
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The lack of basic management skills of district-level health teams is often described as a major constraint to implementation of primary health care in developing countries. To improve district-level management in The Gambia, a 'management strengthening' project was implemented in two out of the three health regions. Against a background of health sector decentralization policy the project had two main objectives: to improve health team management skills and to improve resources management under specially-trained administrators. The project used a problem-solving and participatory strategy for planning and implementing activities. The project resulted in some improvements in the management of district-level health services, particularly in the quality of team planning and coordination, and the management of the limited available resources. However, the project demonstrated that though health teams had better management skills and systems, their effectiveness was often limited by the policy and practice of the national level government and donor agencies. In particular, they were limited by the degree to which decision making was centralized on issues of staffing, budgeting, and planning, and by the extent to which national level managers have lacked skills and motivation for management change. They were also limited by the extent to which donor-supported programmes were still based on standardized models which did not allow for varying and complex environments at district level. These are common problems despite growing advocacy for more devolution of decision making to the local level.
The Welsh Health Planning Forum has developed a "Strategic Intent and Direction for the NHS in Wales." The aim is "to take the people of Wales into the 21st Century with a level of health on course to c...
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The Welsh Health Planning Forum has developed a "Strategic Intent and Direction for the NHS in Wales." The aim is "to take the people of Wales into the 21st Century with a level of health on course to compare with the best in Europe" (Welsh Office NHS Directorate, The Welsh Health Planning Forum, 1989). Gwent Health, one of the nine health authorities in Wales, provides a comprehensive health service to its population of 445,000 and was chosen to develop a prototype for the provision of cancer services. Gwent residents were invited to seminars to express their opinions of the health service that was provided and describe the type of service they would like to have in the future. The response was encouraging enough to engender the planning of future seminars.
Mental health administrators are always facing challenges and turning them into opportunities;this article has introduced an additional and possibly more complex opportunity. With an internal environment that deals wi...
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On 1 April 1991, the financial base of the NHS underwent its most dramatic change since its inception in 1948. All NHS services are now based on contracts and this has major implications for library services. This cha...
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On 1 April 1991, the financial base of the NHS underwent its most dramatic change since its inception in 1948. All NHS services are now based on contracts and this has major implications for library services. This change was perceived by the South West Thames Regional Library Service as presenting a unique opportunity and the paper outlines the background to the thinking and the strategy adopted to meet the challenges. Sources of library funding and precise spending details were identified by means of a survey and contracts agreed covering all NHS staff in each of the 13 districts. The contracts are operating as 'shadow contracts' for 1991-92 allowing a valuable period of evaluation and monitoring before any money actually changes hands. The survey form for collecting library budgetary information and the service agreement are included as Appendices to the article.
The Rural Hospital Project (RHP) appeared to make a meaningful difference in the six Northwest rural communities that participated in this integrated community development and strategic planning effort. Although the m...
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The Rural Hospital Project (RHP) appeared to make a meaningful difference in the six Northwest rural communities that participated in this integrated community development and strategic planning effort. Although the methodological approach used in the evaluation precludes us from attributing observed changes in outcomes solely to the project interventions themselves, several elements of the process appear to be useful in stabilizing or expanding local health care systems. These include: (1) the involvement of outside organizations in fostering community change, (2) a high degree of community commitment and investment in all stages of the process, (3) comprehensive identification of problems in the health care system by outside consultants, (4) the use of periodic meetings of communities confronting similar issues, (5) identification and development of local leadership, (6) enhancing teamwork among local health care providers, and (7) the development of conflict-resolution mechanisms within health care organizations. Future attempts to use this strategy to strengthen rural health care systems can be enhanced by broadening the range of participation in health services planning, enlisting involvement of medical staff throughout the strategic planning cycle, addressing the issue of physician recruitment, and clarifying responsibility for implementation of community plans. Rural communities will predictably need to identify and resolve a set of core issues. To the extent that external organizations such as medical schools can strengthen the ability of rural health professionals and community leaders to identify and address these issues, the quality and viability of rural health care systems will be enhanced.
Canada's healthcare system is the envy of many other countries and their citizens around the world. And like other members of the Organization for Economic Cooperation and Development, Canada is under pressure to ...
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Canada's healthcare system is the envy of many other countries and their citizens around the world. And like other members of the Organization for Economic Cooperation and Development, Canada is under pressure to reduce healthcare expenditures. One strategy being explored by Canadian provincial governments is to regionalize or decentralize the delivery of healthcare services. To ensure achievement of its goals for each region, the Ministry of Health requires each regional health authority to submit a business plan and annual report, including performance information and underlying performance indicators. Performance indicators are used to measure process and outcome as well;they are useful for generating questions about the behavior or the performance of a provider or organization. A system for defining systemic performance measures for a publicly funded healthcare system does not exist. However, the performance indicators described in this article provide a sampling of provider-based healthcare performance.
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