Capacity Planning

1. Capacity Planning ShitaDewi

2. Harding-Montagu-Preker Framework: Overview Assessment Strategy Focus Goal • PHSA • Gather available information • Identify additional needs • In-depth studies • Distribution (equity) • Efficiency • Quality of Care Private Sector Grow Harness Activities • Hospitals • PHC • Diagnostic labs • Producers / Distributors Ownership • For-profit corporate • For-profit small business • Non-profit charitable Formal/ Informal Convert Restrict PublicSector Source: Adapted from Harding & Preker, Private Participation in Health Services, 2003.

3. Objectives • To introduce the basic concepts underlying capacity planning • To outline the key elements of capacity planning • To review the key steps for policy makers and managers to implement capacity planning in a mixed health system

4. Outline of Session • Introduction • Key findings from developed countries • Examples of capacity planning • Discussion

5. Introduction What is it? • Capacity planning is the process of organizing decisions and actions relating to the deliverability and distribution of health care. Why do it? • Capacity planning is of crucial importance, as it determines to a large degree how health care resources are spent by shaping health service priorities, delivery systems and structures. Who does it? • National, regional or local level authorities, reflecting the various tiers of government within health systems. The distinction between these levels is not always clearcut. What are the types of capacity planning? • Strategic capacity planning • Operational capacity planning

6. Health sector variations in developed countries • Health care capacity planning devolved to regional level • Active involvement of provider organizations in the planning process • The extent to which planning applies to both public and private (for-profit and not-for-profit) providers usually reflects whether private providers qualify for public reimbursement of the services they provide

7. Country specific influences on capacity planning

8. Trends in capacity planning in developed countries • Usingsystematized care pathways as a means of characterizing the provision of health care services, including their linkage and integration with capital investment. • Comprehensive planning systems and the use of new measures of hospital capacity. • The need for linkingthe operationof hospitals with flexible financingmodels.

9. Key elements

10. Hospital capital investment • Capital investment: spending money up front on new or modernized buildings, machinery and equipment

11. Challenges in hospital capital investment • The long time periods involved in planning, financing, construction and operation • The need for health facilities to be able to respond to changing health care needs and medical technologies, • The asymmetry between the need for rapid changes to enable the delivery of optimal care and the slow pace of change infacilities from which care is delivered poses a major challenge to the long term sustainability and effectiveness of hospitals

12. Lesson learned from developed countries • The critical nature of systematized care processes • The importance of the “people factor” • involvement of health professionals in decision-making • the role of inspired leadership • The steadily-growing role of “marketization” in health care • including public–private partnerships • The tension behind deciding on the proper setting of care • The need to look at “whole-system” perspectives • The unsolved question of measuring the true capacity of a hospital

13. Questions • How can capacity planning, including private sector involvement, increase coverage or quality for a specific health delivery objective in your country? • What are some of the main institutional or capacity constraints in your country that impede implementing capacity planning that includes the private sector? • What could be done in your country to address these constraints?

14. Key Messages • To participate in capacity planning, it is important to identify and acknowledge the ownership form of the health system: public, private or mixed. • In a mixed health system, it is important to take into account private sector capacity while planning health sector development. • Capital investment can play an important role in designing a purchasing scheme for the private sector.

15. Background readings • Ettelt, S., Nolte, E., Thomsons, S., & Mays, N., (2007). Capacity planning in health care: reviewing the international experience. Euro Observer 9:1. • Rechel, B., Wright, S., Barlow, J. & McKee, M. (2010). Hospital capacity planning: from measuring stocks to modeling flows. Bulletin of the World Health Organization, 88632–636. doi:10.2471/BLT.09.073361.