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

What is the problem ?

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 Effects

Process OutcomesOrganization-al structure

Process - Outcomes

PROCESS OUTCOMES

Facilities

Personnel

EquipmentCommodities

Process - Outcomes

Process Outcomes

Facilities

Personnel

EquipmentCommodities

Challenge

Organizational Reform

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

From the Big Elephant to…

Reforming MOH Organization

3. Separation of financefrom provision

1. District model

2. New public-sector management

1. Health District Model

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?

2. New Public-Sector Management

Clients Clients Clients Clients Clients Clients

Service Providers Service Providers

District

Regional

HQ

Private

Sector

1

2

3

4

5

From: health system organization

To: client-centered organization

Regional

Districts

Service Providers

HQ

CLIENTS CLIENTS1

2

3

4

5

What are the characteristics of NGO’s / private

organizational structures ?

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

3. Separation of

Financing

from Provision

Macro - structure

legal and market conditions monopoly / competition

impact from ‘ outside ’

Financing - Provision

Share Public PrivatePolicy

Financing

Provision

Regulation

Information

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

Organizational Reforms Decentralization

Power Transfer

W HO?

WHAT ?

HOW

NewNew

W HO?