managing productive and profitable healthcare in nigeria
TRANSCRIPT
DAVID EBOH
BA (Hons) (Health Service Management) PGDipHE, LLB, MBA
Health Management Consultant
President: Nigerian Association of Health Service Managers and Consultants
(NAHSMAC)
Author: Two management books on healthcare
School Governor: St Peter’s R.C. Pri. Sch. London
• The market and competition
• Globalisation and technology
• Corporate failures and successes
• Data management and information research
• Understanding yesterday
• Dealing with today
• Planning for tomorrow (future)
• Public interest and National/State Image
Financial strategy
Business strategy
Human Resource Strategy
Clinical leadership and Medical Research
Staff education, training and development strategy
Branding and Marketing strategy
Estate and facility management
Security
• Over 10 episodes of doctors’ strike in 2 years
• Over 100,000 deaths following the strikes
• Each strike last consistently over 2 – 10 months
• Diversion of public drugs and equipment to private hospitals
• Redirection of patients from public to private hospitals
• Cash deposit overrides Hippocratic oath for saving lives
Uffot, E. (2010) ....They’re still at best consulting clinics Newswatch 50th
Birthday Special Edn. 29 Sept.
• Political rhetoric, no genuine commitment
• Public fund paying for overseas treatment of government
officials
• Foreign medical treatment cost Nigeria N30 billion
annually (Ngozi Okonjo-Iweala)
• Failure to manage the synergy across health related
agencies – food, road/transport, water etc
• Political indecision on interprofessional rivalry
• Subjectivity to external influences – Nigerians used as
guinea pig for clinical trials
(Eboh, D. (2008) The Politics of Healthcare in Nigeria, A Game of Lottery
1 million Nigerian children currently die per year at birth
compare to 9 million globally (WHO)
1,100 children die annually out of 100,000 births
53,000 women die annually from pregnancy related
conditions (WHO, see Uffot 2010)
1 in 5 children die before their 5th birthday in Nigeria
Estimate of 60% of the deaths are preventable
Low life expectancy, 48 years men, 49 years women
• About 80% of preventable deaths are due to clinical
negligence
• In 2007 N400 million health budget mismanaged by then
Minister of Health Prof Adenike Grange
• In 2003, N17.4 billion health loan from IDA, world Bank not
properly accounted for
• In 2009, N13 billion loan from IDA ,World Bank also
unsatisfactorily managed
• Present Health Minister, Prof. Chukwu asserts that N 4.47
trillion ($20 billion) is needed to achieve MDG by 2015 (Uffot
2010)
Patient centred care - clinical and administrative staff
Equality and diversity
Corporate culture and identity; Collective ownership
Absence of learning and development – status barrier
Mutuality in dignity and respect across all boundaries
Every stakeholder matters in healthcare setting
The gradual growth of foreign healthcare providers in
Nigeria – threat and opportunities
Under developed accident & emergency services
Poor primary healthcare system - Non-viable community
healthcare services
Continuing brain drain of medical, other clinical and
healthcare professionals
Dead or isolated prominent Nigerians in healthcare
institutions abroad– why???
Road accidents and other traumatic incidents
Extensive review of the key influencing factors
Proactive PEST analysis
Comprehensive SWOT analysis
Overhaul of institutions and organisational structure
Introduction of corporate leadership
Introduction of Socio - entrepraprenural health management
model
Training, development and mentoring of managers
Taking advantage of IT and modern technology
Establishment of dedicated Health Management Institute
Extensive and sustained investment in medical research
Clear distinction in roles between clinical and management
leadership
Managed and viable primary healthcare system
Universal registration with Community Health Clinics
Functional A&E and Ambulance services
Proactive disease prevention and chronic disease
management
21st Century Healthcare Corporate Boardroom
With Social-Entrepreneural Model for Service Delivery
This model enhances multi-talents approach to corporate priorities and unifies strategic vision for growth,
productivity and profitability. It centres on the public and consumers’ needs © David E. Eboh
Dir. of Allied Medical Services
Director of Nursing & Quality
Chief Med. Director(CMD) (Experienced Doctor)
Director of Finance
Chief Executive Officer (CEO) (Trained and Qualified Strategic Manager)
Director of Pharmacy
Dir. of Strategy, Business & Org. Dev.
Secretary (Legal Practitioner)
Director Corporate Affairs, Communication & IT
Dir. of Public Health (Any Graduate in PH)
Dir. of Human Resources
Director of Procurement
Service Users Representatives: Community and Religious Leaders
Chairman
(Successful Entrepreneur)
©D.E. Eboh
Ancient Historical Healthcare Management Boardroom
With Medical Model for Service Delivery
Chief Med. Dir. Prof. (Doctor)
Rep. of Public Interest (Doctor)
Chairman MAC (Doctor)
Director of Administration
Rep. of University (Doctor) Dir. of Public Health
(Doctor)
Chairman
(Doctor)
Rep. of other professions
Rep. Fed. Min. of Health (Doctor)
Rep. of NMA (Doctor)
Hospital Boardroom
This model obscures fundamental corporate priorities and constricts innovation and creativity in strategic leadership and management
Secretary to Board
Idea projection for innovation and creativity
Training
Mentoring
Project management
Consultancy
Championing specific corporate philosophy/ideology
Hands on in clinical practice & corporate strategic
leadership
Support clinical and management research
Standard and quality
Accountability
Respect for human lives
Dignity and respect for everyone
Value for equality and diversity
Profitability for the respective institutions
Research and Development
Workforce training and development
Policy development and active implementation
Building organisational culture and identity
Universal access to affordable healthcare services
Positive inter-professional relationship, collaboration and co-
operation
Journal development and publication of health specific
articles, news and general information
Maximising satisfaction level for patients / services users,
and other stakeholders
Wake up the law for Patients and public protection
Coroners investigation
Financial and clinical accountabilities
Customer care services
Complaint management and patient / customer satisfaction
Rewarding success for clinicians and other staff
Knowledge, skills and experience of IT use
Knowledge, skills and experience of modern equipment
National Association of Health Service Managers and Consultants (NAHSMAC)
©David Eboh (2011)
Fed
era
l H
ealt
h S
erv
ice
Au
tho
rity
(F
HS
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General Hospitals
CEO of Fed Health Service Authority
(FHSA)
Fed. Chief Nursing Officer (FCNO)
Fed. Chief Medical Officer (FCMO)
Corporate Management
/ Leadership
(
Clinical Management
and Leadership
Primary Health Care
(Community Health Centres) Universal Access for Locals
National Dir of Healthcare Procurement
Mental Health Hospital
Teaching Hospitals
National Dir., Allied Health
Professionals Director General, NAFDAC
Political
Corporate strategic and managerial
Clinical
Technical and technological
Federal: Minister of Health for the Government
National Health Flag: Chief Executive for Federal Health
Service Authority (FHSA) (proposed)
State: Commissioner for State Government
State Health Flag: Chief Executive for state Health Service
Authority (SHSA) (proposed)
Health Institutions – CEO for Corporate leadership
Directors for medical, nursing, pharmacy etc, directorates
Directors for Admin, technical & other directorates -
Finance, HR, Estate, Engineering etc
NAHSMAC