1. Shita Dewi Capacity Planning

2. Harding-Montagu-Preker Framework: Overview Distribution (equity) Efficiency Quality of Care Source: Adapted from Harding & Preker, Private Participation in Health Services, 2003. PHSA Gather available information Identify additional needs In-depth studies PHSA Gather available information Identify additional needs In-depth studies Activities Hospitals PHC Diagnostic labs Producers / Distributors Ownership For-profit corporate For-profit small business Non-profit charitable Formal/ Informal Activities Hospitals PHC Diagnostic labs Producers / Distributors Ownership For-profit corporate For-profit small business Non-profit charitable Formal/ Informal Grow Harness Convert Strategy Assessment Goal Focus Private Sector Public Sector Restrict

3. Objectives To introduce the basic concepts underlying capacity planning To outline the key elements of capacity planning To review the key steps for policy makers and managers to implement capacity planning in a mixed health system

4. Outline of Session Introduction Key findings from developed countries Examples of capacity planning Discussion

5. Introduction What is it? Capacity planning is the process of organizing decisions and actions relating to the deliverability and distribution of health care. Why do it? Capacity planning is of crucial importance, as it determines to a large degree how health care resources are spent by shaping health service priorities, delivery systems and structures. Who does it? National, regional or local level authorities, reflecting the various tiers of government within health systems. The distinction between these levels is not always clearcut. What are the types of capacity planning? Strategic capacity planning Operational capacity planning

6. Health sector variations in developed countries Health care capacity planning devolved to regional level Active involvement of provider organizations in the planning process The extent to which planning applies to both public and private (for-profit and not-for-profit) providers usually reflects whether private providers qualify for public reimbursement of the services they provide

7. Country specific influences on capacity planning Capacity Planning The institutional, legislative and regulatory framework Decentralization in the health sector Financing reforms and new models of health care delivery

8. Trends in capacity planning in developed countries Using systematized care pathways as a means of characterizing the provision of health care services, including their linkage and integration with capital investment. Comprehensive planning systems and the use of new measures of hospital capacity. The need for linking the operation of hospitals with flexible financing models. Market approachPublic approach The introduction of market competition into the health sector might deliver the required innovations and improvements in terms of health care provision. Redefining priorities, structures and systems to enable health systems to move beyond a hospital-centric view and towards system-wide and integrated provision of health care services

9. Key elements Strategic Capacity PlanningOperational Capacity Planning Level of autonomy and decision-making power(s) Understand the extent to which strategic and operational plans are integrated e.g. links between the principles of the service model, the supporting physical infrastructure, and the structure of the decision-making agencies Require technical and political expertise: Skills in health service research, geography and modeling Try to involve the public and other stakeholders in any planning activity as early as possible Skill in developing a form of agreement on funding and on the conditions (and sometimes volume) for service provision Take into account suitable public and private: reconfiguration might be needed Whole system perspective Building flexibility into structures

10. Hospital capital investment Capital investment: spending money up front on new or modernized buildings, machinery and equipment Investment in service delivery and allocation of human and financial resources Investment in expensive equipment and technology (such as magnetic resonance imaging scanners) Capital investment in existing facilities and new developments

11. Challenges in hospital capital investment The long time periods involved in planning, financing, construction and operation The need for health facilities to be able to respond to changing health care needs and medical technologies, The asymmetry between the need for rapid changes to enable the delivery of optimal care and the slow pace of change in facilities from which care is delivered poses a major challenge to the long term sustainability and effectiveness of hospitals

12. Lesson learned from developed countries The critical nature of systematized care processes The importance of the people factor involvement of health professionals in decision-making the role of inspired leadership The steadily-growing role of marketization in health care including public–private partnerships The tension behind deciding on the proper setting of care The need to look at whole-system perspectives The unsolved question of measuring the true capacity of a hospital

13. Questions 1. How can capacity planning, including private sector involvement, increase coverage or quality for a specific health delivery objective in your country? 2. What are some of the main institutional or capacity constraints in your country that impede implementing capacity planning that includes the private sector? 3. What could be done in your country to address these constraints?

14. Key Messages To participate in capacity planning, it is important to identify and acknowledge the ownership form of the health system: public, private or mixed. In a mixed health system, it is important to take into account private sector capacity while planning health sector development. Capital investment can play an important role in designing a purchasing scheme for the private sector.

15. Background readings Ettelt, S., Nolte, E., Thomsons, S., & Mays, N., (2007). Capacity planning in health care: reviewing the international experience. Euro Observer 9:1. Rechel, B., Wright, S., Barlow, J. & McKee, M. (2010). Hospital capacity planning: from measuring stocks to modeling flows. Bulletin of the World Health Organization, 88632–636. doi:10.2471/BLT.09.073361.