Establishment of Shishu
Bikash Kendra at 14MCHs

Operational Plan of
Hospitals Services Management

For details, click below linked sentences.

Introduction & Background
Aims and objectives
Strategies
Component Activities
Problems faced during implementation
Suggestions to reduce problems
Lessons learned
Challenges for work

Health, Population and Nutrition Sector Program (HNPSP)

Line Director - Hospitals Services Program

Introduction & Background: ▲

The development of human capital has strong poverty reducing effect in Bangladesh. Health is the major element of human development. Hospital services are the most visible and major component of the health care delivery system and mainly focused at primary secondary and tertiary level. The strategy of comprehensive approach for the poverty reduction already visualizes some target to be achieved by the year 2015 in respect of health and nutrition. Better hospital services can effectively contribute for the achievement of this target.

Service delivery is the ultimate outcome of the health sector activities. Hospital services are the most visible and major component of the health sector delivery system. Appropriately equipped hospitals at all level will provide efficiently the expected services with quality of care and equity of access. Line Director Improved Hospital services Management is looking after the development activities of the secondary and tertiary level hospital. To improve he hospital services it is needed to address some important issues like proper allocation of resources, more delegation of administrative and financial powers to local authority, timely maintenance of hospital building and equipments use of user fees, decentralized procurement, improvement of the accessibility of women, children and poor. With all these concepts the OP- Improved Hospital Services Management was designed.

Aims and objectives: ▲

To ensure the accessibility of hospital services to women, children and specially to the poor.
To reduce the maternal mortality by strengthening the existing EOC services.
To introduce structured hospital referral linkage for the improvement of patient care.
To strengthen and upgrade secondary and tertiary level hospital services for improvement of patient care.
To equip secondary and tertiary level hospital services for provision of the expected range of services with quality of care.
To improve the quality of care for the private sector and NGOs hospitals/ clinics/Laboratories through monitoring/ supervision and also strengthen the regulatory framework.
To introduce Standard waste management (phase wise) for the reduction of the diseases amongst the service providers and community people and also to improve the hospital environment.
To provide access for the poor to specialize clinical service i.e reconstructive surgery.
To improve hospital based eye care by GO and NGO collaboration.
To strengthen the capacity of some selected institution and hospital both in the public and private sector.

Strategies: ▲

Ensure better hospital services to reduce morbidity and mortality by:

· Upgrading and modernization of hospitals

· Development of different systems in hospitals

· Allocation of resources in the different hospitals for better services

· Introduction and continuation of some important activities like EOC, Women and baby friendly hospital and strengthening of MCH at secondary and tertiary level hospital for the improvement of maternal and child care

B. Ensure quality of patient care by:

· Improving accessibility of poor women and children

· Improving standard of hospital waste management

· Ensuring proper referral system

· Introduction of the concept of clinical governance and other QA activities

Ensure strong regulatory mechanism for the private sector hospitals/clinics and pathological lab:

· Proper application of 1982 clinic ordinance.

· Decentralization of supervision and monitoring for the private clinics hospitals and pathological laboratories

· Proper capacity development

Component Activities: ▲

1. Continuation of the Public sector hospital services

2. Capacity development of Line Director-Improved Hospital Services Management

3. Introduction of standard waste management

4. Action plan for Hospital based EOC and gender sensitivity

5. Strengthening of Baby and Women friendly hospitals

6. Piloting and rollout of hospital Referral system

7. Hospital Accreditation and medical audit

8. Strengthening of National Electro Medical Workshop (NEMEW)

9. Specialized clinical services (Reconstructive surgery); DMCH -Burn unit

10. Specialized clinical services (Reconstructive surgery); NITOR

11. Strengthening of existing artificial limb replacement workshop at NITOR

12. Strengthening of National Center for Rheumatic Fever & Heart diseases

13. Construction of Diabetic Hospital at Barishal & Rajshahi

14. Strengthening of TEMO

15. Hospital Based Eye care-SSI

16. Hospital Improvement Initiative (HII)

17. Strengthening of the Postmortem services at Secondary and Tertiary level hospitals

18. Establishment of Medical Gas Pipe line & Suction unit at secondary and tertiary level hospitals

19. Strengthening of poisoning management at secondary and tertiary level hospitals

20. WHO-BAN program

21. Strengthening of BSMMU,

22. Support to National Heart Foundation,

23. Support to Ahsanea Mission Cancer Hospital

24. Strengthening of MCH at secondary and tertiary level hospitals

Problems faced during implementation: ▲

Dual funding revenue and development in a single institution creates complication
Deficiency of skilled manpower is very much evident
Lack of standardized chart for procurement items
Lengthy administrative steps to be crossed for procurement
Lack of coordination between construction of building and procurement
Lack of fund in repair and maintenance
EOC facilities difficult to operate due to absence and no stay of trained manpower
The outhouse management of hospital waste is not working well because local govt. functioning is not yet proper
Fund release process for women friendly hospital initiative is complicated

Suggestions to reduce problems: ▲

Funding from a single source reduces administrative constraints
For procurement institutional package may be introduced to reduce hassle
If repair and maintenance can be done by supplier there may be more accountability
Decentralized procurement is needed
Skilled manpower recruited properly eases the whole work
Proper placement strategy for EOC trained manpower is lacking
Fund release process for women friendly hospital initiative should be made easier

Lessons learned: ▲

1. Funding from a single source reduces administrative constraints

2. If repair and maintenance can be done by supplier there may be more accountability and precision

3. For procurement institutional package may be introduced to reduce hassle

4. Centralized procurement delays the whole process

5. Skilled manpower if recruited in time reduces workload and saves time

6. Proper utilization of user’s fee in repair and maintenance reduces administrative delay

7. Proper posting guideline for EOC trained manpower should be ensured by the authority

8. If Women friendly hospitals can be made effective then VAW management may be expedited

9. Healthcare waste management issue should be properly addressed

Challenges for work: ▲

To establish accountability framework in all spheres.
Mobilization of proper resources according to need.
Introduction of structured performance appraisal system.
Ensuring the 100% accessibility of child, women and poor to the hospital.
Regular maintenance of equipment and building.
Timely procurement of equipment, installation and maintenance.
Providing quality of care in the hospital.
Introduction of structured referral system for patients.
Retention and utilization of user fees in the hospitals.
Introduction of hospital autonomy for big hospitals.
Community involvement in the management process of hospitals.
Change of attitude of the service providers is required.
Development of proper deployment system with incentives for the hard to reach areas.

Operational Plan of Hospitals Services Management