1. Human Resources Factors-Key to Sustainability Learning from the Example of Public and Private Health services Keerti Bhusan Pradhan Consultant-Health Systems Keerti.health@gmail.com

2. Outline of the presentation Definitions of Capacity Development. Conceptual history of capacity development. Shifts in capacity development strategies. Steps in capacity development. Traditional Vs Capacity oriented approaches. Future challenges

3. Individual skills Effective organizations Inter relationships Systems oriented approach Definitions of Capacity Development. A process that focuses on enhancing the skills, knowledge and social capabilities available to individuals, individuals, social and political systems (UN) The sustainable creation, utilization and retention of capacity, in order to reduce poverty, enhance skills, achieve growth, equalize opportunities and enhance peoples lives(UNDP)

4. Conceptual history of capacity development.

5. 9 components of systemic capacity building Source: Potter & Brough HPP

6. Technical Skills Sufficient staff Beds & clinics Labs Decentralized Equipment Sufficient staff Incentives Planning systems Source: Potter & Brough 2004. Shifts in capacity development strategies. `

8. Shifts in capacity development strategies. Require Enable effective use of Enable effective use of Enable effective use of Source: Potter & Brough 2004.

9. Steps in capacity development. Determining current capacities for health management at all levels. (Consider self and outsiders perspectives) Establishing goals with clear visions for all units of the department & at all levels of administration. Determine the capacities to be strengthened - Operational & Adaptive capacities. Decide strategies for achieving these capacities, Implement, Monitor, reassess and plan for the future based on the results.

10. Traditional Vs Capacity oriented approaches. Objectives of training is to improve performance of an organization and enhance its ability to function within a changing environment. Traditional approaches focused on building the skills, trainee already have than dealing with real organizational problems, its basically transferring knowledge to the individuals. Action based approach enhances the capacity to meet an organizations specific needs to bring required organizational change. It includes training plans for people who are often forgotten which is specific, short, appropriate and interdisciplinary.

11. Traditional Vs Capacity oriented approaches. No individuals can single handedly change the organization. Scientific training alone is insufficient to achieve sustainable change. Use of Non traditional approaches to capacity development is another possibility. It includes use of advisers, consultants and resource persons. Workshops, meetings, conferences and study tours are other options. Establishing networking with varieties of organization at all levels and making centers of excellence is an upcoming trend, Sabbaticals is another innovation.

12. Future challenges Policy makers to consider the enormous growth in knowledge about causes of ill health and the means of improving it. The new perspectives are frequently complex and traditionally not within the health care sector. The growth and changes in IT with its ethical issues in health. Globalization. HR management (isolated & under professionalized). Inter departmental, sectoral, organizational, national continental partnerships for a wider health system. Information and evidence from evaluation. Persuading politicians at a policy level.

13. Conclusion. CD is a not a simple cause effect process. Efforts should focus on what works at the level of individual, department, organization and system. Activities of the ministry might change but the objectives remains the improvement (development) of the populations health. A change from clinician managers to professional managers is inevitable. They will enable all individuals in organizations to function at their highest potential capacity – to create, in effect, a capacity releasing organization.

14. Eye care services-Example World Bank assistance of US$136 million was provided in 1994 to the NPCB for 7 states which accounted for more than 70% of the cataract work load. The program consisted of Infrastructure development, equipment, consumables, training and capacity building. States: AP, MP, MS, Orissa, Rajasthan, TN & UP

15. Conceptual model of factors Independent variables Dependent variable Individual related variables GenderAge Marital status Educational Level Employment status Income Utilisation of Healthcare Facility -Public-Private Provider related variables Location Waiting time/ALOS Working hours Equipment Specialised Doctors Correct information Trained and Skilled staff Reputation of facility Cleanliness Internal organisation and procedures Staff courtesy and friendliness Previous experience

16. Dhenkanal District Eye Hospital Orissa inaugurated July 2000 in district hospital campus

17. Govt. Eye Hospital- 9 years later Photo taken 2009

18. Ophthalmologist in the District Hospital OPD

19. Sitting in the open patient waiting area Does not use required equipment/instruments to check the eye Eye Examination equipment-slit lamp is lying inside without any use

20. District Hospital Eye Unit OT Big OT All equipment available Expensive eqpt. available Some are brand new but defunct Only 254 surgeries per year

21. Private (NGO) Eye Hospital in a rented building in the same district hq

22. Private (NGO) Eye Hospital OT Small size OT in comparison to Govt. eye unit Doing 5000 surgeries per year

23. Talking to the patient

25. What it needs to ensure in Capacity Building of HR? Not only knowledge and skills Not just additional manpower Not just organisational structures Not just regular salaries Not just regular training and capacity building But Strategies to keep the workforce motivated and a culture of teamwork in healthcare…………..

26. Thank you