International forum discusses health care delivery

Healthcare
Targeted training of community health workers can aid better management practices, however when funding is scarce, training programs are often given a low priority.

Perhaps one of the greatest challenges of the 21st century, when it comes to the field of global health care, is health care delivery management. Over the past ten years there have been a number of medical and technological advances, however, there has been less success in finding ways to efficiently implement these advances in developing countries. Simple things such as badly designed paperwork and inefficient use of medical employees’ time hamper the effectiveness of any health care system. Accordingly, major institutions have begun to fund programs dedicated to managerial innovation for health care delivery.

Recently, the Global Health Delivery Project at Harvard University sponsored an expert panel titled “Managing Health Care Delivery.” The panel featured a diverse group of some of the top academics within the emerging field of health care management science as well as an international assortment of health care delivery professionals from around the world.

The discussion focused mainly on the development of core skills needed in those who manage health care delivery, the factors that impact the health systems they work in and what kinds of resources would be the most helpful to those in that line of work.

According to the panel, one challenge that is faced is that managerial innovation is inherently undervalued when compared to medical advancements. For example, efforts focused on educating local physicians on the latest treatments for lung cancer in Vietnam are very inefficient when nearly all other steps of the health care chain are in need of improvement.

“Much of the work that people do in order to make the system better is unrecognized and is assumed to take place ‘on the side of the desk,’ in addition to the real, regular work,” Dr. Anjali Sastry, Senior Lecturer in System Dynamics at the MIT Sloan School of Management, said.

What must be recognized is that medical advancements are only as effective as the system that implements them. This undervaluation results in a scarcity of resources allocated to developing better management practices for many organizations.

“Formal management training, as opposed to training in health delivery … is treated as low priority when funding is scarce,” Abigail Wetzel, the Health Program Coordinator of the Ghana Health and Education Initiative, said

Political institutions can also be obstacles to managerial innovation. Those institutions with a substantial level of corruption will tend to resist change, especially any efforts aimed at increasing the transparency of health systems. In Mexico, the Mayan tradition of having midwives deliver babies is suppressed by a medical establishment rife with “double-dipping” doctors – doctors who collect two different salaries by having a public sector job and running a private practice on the side.

Midwives are blamed for the failings of the system, but as Sabrina Speich, a midwife in southeastern Mexico, remarks, “The problem is a corrupt political system laying the ground rules for work. Total incompetence for conflict resolution and very little work ethics.” She continued, saying “when a woman dies in third level care hospital and [the doctors] immediately call the midwives, even though the [death of the] woman had nothing to do with midwives. We are treated like scapegoats for everything wrong in the system.”

Throughout the panel’s discussion, many experts commented on what international institutions could do to encourage the development of better management techniques throughout the world. There was much support for the development of standardized training curriculums and education on the importance of managerial techniques. The efforts of mainly western institutions to develop curriculum oriented towards “Global Health Delivery Science” were praised, however, some complained that there needed to be more of a focus on offering such courses in developing c

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