Strengthening management capacity in a decentralized public health system
The World Bank has recommended decentralization of the health sector for developing countries with large National Ministries of Health. Such a process, however, also poses challenges and might have negative effects. In Philippines, decentralisation of the health sector occurred in 1991 but not without problems, as local government units and their managers were unprepared for the sudden change in roles and responsibilities.
In a recently published study, the authors aimed to evaluate the Philippines Field Management Training Program (FMTP), a 10-month program that aimed to provide local health workers with skills they could use to carry out their management responsibilities in the new health system. This program was implemented by the National Epidemiology Centre and the CDC and included classwork, fieldwork and mentoring visits. Some of the topics covered in workshops were team development, leadership, process improvement, effective communication, conflict management, progam planning, effective supervision etc.
Between 2000 and 2010, 294 people graduated from this program, 44% of whom were physicians and 30% nurses. Two hundred and four applied management improvement projects were completed, 65% of which were process improvement projects and 27% of which were program planning and management projects. Many of the program participants were later promoted to more responsible positions. They have been documented improvements in service delivery, information systems, logistics, health insurance, policy and laboratory outcomes. Graduates have continued to use quality improvement and other tools to implement new projects after the initial mentored projects.
How is it in your country? Has decentralisation taken place and if yes what are the major challenges and achievements?