MPH/HSMP 2007-2008: CC1: DHS: GI: Strategies to promote publicly oriented services

this topic is the part of CC1: General introduction by Professor JP Unger

    It depended on financing typology, health system typology. Henry Mintzberg divided the fundamental components of organization into 5 parts as Strategic apex, Middle line, Techno-structure, Support staff (Logistics), Operating core (Functional unit). He categorized organization into 5 features as following;

1. Simple structure: The dominant part is strategic apex with directly command.
2. Mechanic bureaucracy: The dominant part is techno-structure with standard procedure setting. E.g. programs for TB, AIDS, others
3. Professional bureaucracy: The dominant part is functional unit with standard professional procedure and ethics. E.g. health care organization in India, Belgium
4. Divisionalised forms: The dominant part is middle line with standard of outputs. E.g. health care in UK, Scandinavian country, Spain, Brazil
5. Divisionalised adhocracy: The dominant parts are functional unit and logistics with teamwork performance. (ideal?)

                Each features or structure are suitable in different situation, if we can change to divisionalised form or divisionalised adhocracy (ideal), it is very good. But it’s very difficult to change organization structure in developing country. Hence, strategies should adapt to organizations’ features, professionals’ ethos and identities.

              Strategies in Mechanical bureaucracy

1. Improve responsiveness with Family & Community Medicine
2. Enlarge scope of activities with integration of disease control programs
3. Improve democracy with co-management-a political look at community participation
4. Improve financing of health care systems (International support & technical assistance; Contracting-in (non for profit, publicly oriented health facilities & organization) with managerial contracts (as opposed to production contracts))

                 Strategies in professional bureaucracy

1. Develop local health systems from outside power structures
2. Introduce reflexivity
3. Develop health services’ responsibility for well defined populations

                  Strategies in divisionalised form

1. Develop bio-psychosocial care
2. Promote non managed care techniques to improve quality of care
3. Strengthen co-management of health services
4. Set up local health system

Phichet Banyati,

November 11, 2007

Antwerp