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Need for Hospital Reform and Draft Road Map

Need for Hospital Reform and Draft Road Map. Malawi German Health Programme 04/2010. Outline. Current situation: demand, supply, results Challenges and possible solutions Improved decision making in CH Reorganisation of CH Additional Funding Roadmap. 1. Increasing demand.

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Need for Hospital Reform and Draft Road Map

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  1. Need for Hospital Reform and Draft Road Map Malawi German Health Programme 04/2010

  2. Outline • Current situation: demand, supply, results • Challenges and possible solutions • Improved decision making in CH • Reorganisation of CH • Additional Funding • Roadmap

  3. 1. Increasing demand QECH 2002-2007 + 56% +165%

  4. Increasing budgets

  5. Better results?! Medical Dptm KCH in 2007 Each and every day > 2 patients die in one single ward …

  6. Limits to Decision Making Lack of Human Resources Quality of Care Overcrowding/ High Workload Low Motivation Underfunding 2. challenges

  7. Increased Decision Power Limits to Decision Making Lack of Human Resources Quality of Care Overcrowding/ High Workload Low Motivation Underfunding solutions

  8. Increased Decision Power Reorganisation Limits to Decision Making Lack of Human Resources Quality of Care Overcrowding/ High Workload Low Motivation Underfunding solutions

  9. Increased Decision Power Reorganisation Limits to Decision Making Lack of Human Resources Quality of Care Overcrowding/ High Workload Low Motivation Underfunding Additional Sources solutions

  10. I. Strengthening adequate Decision Making within Hospital Management

  11. e.g. Financial Management…

  12. e.g. Financial Management…

  13. e.g. Financial Management… Financing inputs Financing outputs Result Based Financing

  14. II. Reorganisation of Central Hospitals

  15. Functions of the Central Hospitals in Malawi • Tertiary care • Training • Research • But also: Secondary care (district hospital) • And even: PHC (OPD)

  16. e.g. efficient use of resources Top 10 diseases for admissions, QECH, July 2007 – June 2008 (Total = 94,747) OPD becomes nested health center • Administrative separation within Wards (embedded District Hospital) Majority of patients = primary and secondary care

  17. III. Cost Recovery andAlternative Sources of Financing

  18. Use of Government health services by socio-economic group (L. Mangham 2006) e.g. Equity • Cost recovery in private wards • Private insurance • National Health Insurance ?!

  19. Increased Decision Power Reorganisation Limits to Decision Making Lack of Human Resources Quality of Care Overcrowding/ High Workload Low Motivation Underfunding Additional Sources

  20. IV. Road Map • Allocating responsibilities • Specifying the content of the reform measures • Identification of governing structure and board composition • Drafting legislation • Determining personnel policies and transition arrangements • Developing systems, procedures and plans • Communication to staff and the public • Preparation of service plans • Developing service level agreements and performance management systems • Selecting and training key managers and board members

  21. 2. Content of the reform

  22. Approach ?

  23. Thanks a lot !

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