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Strategic Issues and
Challenges in Health Management
The book argues some of the important issues and challenges before the Indian health system. These ranges from basic issues related to planning and development to other important concerns such as equity, access, cost effectiveness, financing, capacity-building, public-private partnership and governance besides a discussion on different national health programmes. Jeffrey D. Sach, based on his contribution to the report of the Commission on Macroeconomics on Health, points out that financial management, implementation of close to the client system but with proper investments and recruitment of village health workers are three important ways to improve the Indian health system. Andrew Green discusses that during the early 1990s, reforms in health sector were initiated through greater involvement of private sector, levying of user charges and adopting a consumerist rather than a community view. However, all these reforms attracted criticism since they excessively focused on supply side issues without giving due attention to demand side. Listing his vision 2020, he focuses on the need for being creative in developing mechanisms for regulating emerging health care providers as well as pay particular attention to the effects of the international competitive framework of the WTO. Within the equity considerations, he points out that the health system should respond to general expansion of services, type of health care offered, ownership and role of health agencies, type of health professional, economic implications, community engagement models, management issues and multi-sectoral challenges. G.N.V. Ramana advocates strengthening direct accountability mechanisms and client-centered information base to improve access to essential social and health services for the poor. He points out that it would be difficult to achieve equity without accountability and monitoring. Meenakshi Dutta Ghosh, in a chapter on "Public Private Partnership in Health Care", suggests a shared use of available resources among public sector, private sector and people’s sector, including communities, households, community-based organisations, NGOs and PRIs. She also suggests a detailed micro-planning of all health facilities, especially at the primary level. Likewise, Muraleedharan et al also points out that public private partnership is not a model as an end in itself, but requires building creditability into the public health care system and policy making machinery. Two papers by S.R. Rao and H. Sudarshan point out the importance of good governance in the present health system by way of effective management and supervision, a strong health management and information system, proper training of health manpower and a check on corruption, which is rampant in India. The book has three papers on capacity building. While Joe Curian elaborates on leadership qualities that are required in the health sector, Nancy Gerein talks about top-down and bottom-up approaches. In his paper Capacity Development Model in Enhancing Health Care (Eye Care) Services—The Arvind Eye Care Model, K.B. Pradhan elaborates how this hospital is a unique example in India. With 4,000 beds, it performs 250,000 eye surgeries per year, out of which 65 per cent are performed free without compromise on quality. Besides these, the book also covers a discussion on different health programmes such as AIDS control programme, national rural health mission, achieving the millennium development goals for maternal and new born health and management of urban health through public-private partnership. While discussing the standards of medical care in communicable diseases, Michael Friedman points out that creating an accreditation system based on a set of standards of care is an effective tool for ensuring excellent service quality. A. Nandkumar discussing non-communicable diseases elaborates how cancer atlas can be an extremely useful tool for understanding cancer incidence and prevalence patterns. Finally, A. Vaidheesh highlights the importance of health policy makers and industry working together to update the educational curriculum and prioritise the diseases and states that need to be tackled immediately. On the whole, the book discusses some extremely important and useful dimensions of health care and health management system and can be useful for the students of health economics, health policy planners and other health professionals.
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studies have pointed out strong connection of health with human resource
development, productivity and economic growth, as health influences the
overall quality of life and economic performance of a nation. Mortality,
morbidity and malnourishment are serious barriers to the productivity
and, therefore, act as constraints on economic performance.