1. REDESIGNING ORGANIZATION & MANAGEMENT SYSTEMS (IHSDNs Attributes # 7, 8, 9,10, 11, 12, 13) (IHSDNs Attributes # 7, 8, 9,10, 11, 12, 13) July 28 - 30, 2015 Belize REYNALDO HOLDER Health Services and Access Unit Department of Health Systems and Services

2. Overview Definitions: Governance, Social Participation and Intersectoral Action Integrated management systems Human Resources for Health Integrated Information Systems Results-based management

3. Governance, Social Participation and Intersectoral Action Governance: is the interaction and processes through which system’s stakeholders (formal and informal) interact for the achievement of common purposes.

4. Integrated Health Services Delivery Networks

5. Governance, Social Participation and Intersectoral Action Levels of Intersectoral Action: – Information sharing – Consultation – Collaboration – Adoption of healthy public policies – Advisory committees and intersectoral working groups.

6. Governance, Social Participation and Intersectoral Action Levels of Social Participation: – Information sharing – Consultation – Involvement – Collaboration – Empowerment

7. Integrated Management Systems Attribute 10 Integrated management of clinical, administrative and logistical support systems

8. Integrated Management Systems Administrative Depends on size and complexity of network Multi-disciplinary management team responsible for the continuum of care Economies of scale in centralized management and support systems

9. Integrated Management Systems Clinical Depends on size and complexity of network Centralized and integrated clinical support systems – Laboratory – Radiology – Other diagnostic systems Medical technology assessment and rationalization

10. Integrated Management Systems Logistical support Depends on complexity of network Organized and centralized for the whole network – Appointment system – Medical transport – Other transport – Maintenance Centralized purchase, storage and delivery of drugs and medical supplies

11. Integrated Management Systems Attribute 11 Sufficient, competent and committed human resources for health that are valued by the network

12. Integrated Management Systems Human Resources for Health Quantity, distribution and competencies for appropriate services to cover population needs Defining composition of basic health teams Defining requirements for specialized care based on population health needs New positions and new competencies Development plan Organizational culture National Human Resources for Health policies

13. Integrated Management Systems Attribute 12 An integrated information system that links all network members with data disaggregated by age, sex, place of residence, ethnic origin, and other pertinent variables.

14. Integrated Management Systems Information System Links all network members Not only Electronic Medical Record Nor only an Epidemiological Information system

15. Integrated Management Systems Information System Should include: – Unique personal identifier – Health status of population (including social determinants) – Demand and utilization – One Health Record Personal, Family and Community Health Information Clinical Information (personal medical record) – Information on population satisfaction – Other clinical support information: Call Centers PDR/Vademecum Universal definitions of terms and standards Clinical Guidelines & Treatment Protocols – Operational information: Admissions, discharges, visits/consultations, referrals, etc. Appointment System – Visits and consultations – Procedure Planning (Surgeries, labs, imaging) Management & Financial Information (Balanced Score Card, Daily Management Dashboards, PERC, etc.) The question of Confidentiality

16. PERC Management Dashboards

17. Integrated Management Systems Attribute 13 Results-Based Management

18. Integrated Management Systems Results-Based Management (RBM) A strategy or approach through which an organization ensures that its processes, products and services contribute to achievement of clearly defined results.

19. Integrated Management Systems Results-Based Management (RBM) Strategic planning and management framework; Strategy to achieve change in the way institutions operate; Improve performance and achievement of results; Accountability

20. Integrated Management Systems Results-Based Management (RBM)

21. Integrated Management Systems Results-Based Management (RBM) HOW? – National strategic plan and central goals ✔ – National – Region: Management Agreements on expected results – Region – Network – Health Facilities: Service Level Agreements – Network – Personnel: Personal Performance Evaluation systems

22. Integrated Management Systems Results-Based Management (RBM) HOW?

23. Integrated Management Systems Results-Based Management (RBM) HOW? – Define realistic expected results – Monitor and assess progress – Reporting & Accountability processes – Evaluate results and re- programming – Operations research

24. Integrated Management Systems Results-Based Management (RBM) HOW?

25. Lessons Learned Integration process: – Are complex and take a long time. – Require wide systemic changes – Require the commitment of health workers, managers and policy makers Integration is not a one-fit-all. There can be different modalities and levels of integration in one systems. Evidence suggest that clinical integration, integrating information systems and staff buy-in are the most challenging changes to achieve. Integration is not a cure for lack of resources.

26. Custome Slide 26 Thank you!