World AIDS Day 2010 Slideshow Project

World AIDS Day 2010 falls on the 1^st of December 2010. Where is it celebrated and remembered? All over the world. HIV/AIDS has become a global crisis and an old friend to the human race. Who else will care, if not us and who else will act, if not us.

For this memorable day is no joking matter, we should always understand the role that we need to play and the mindsets about AIDS that we need to change. For every prejudice destroyed, comes with it the ultimate benefit. And that moment starts now.

Especially for this day, I’ve put together some photos easily accessible from Google and did some research on our national AIDS organizations (both Malaysia and Indonesia) before arranging it into a slideshow via windows moviemaker. Hopefully some of the info and words shared in the slideshow will spark a little bit (if not much) of understanding among us to combat this global enemy.

Enjoy.

Managing Donations for Disasters

Donations and relief aids for Tsunami Disaster Victims (2004)

“Uncoordinated, uncontrolled masses of donated goods and volunteers can interfere with disaster operations and cause a secondary disaster”

Innocent thoughts ran through my mind as I hear about the amount of generous donations that came from an insane number of parties all over the world as well as local NGOs every time a disaster strikes in Indonesia. Little that I know, these resources without the proper management and coordination between the organizations that are involved can impose severe effects later for the respective country or area. 

There are two problems that may arise regarding poor donations and national volunteer management. Too many, and too little.

A good example that I got from Prof. Sulanto’s lecture was how thousands of help or medical aids received by local and international organization during the Acheh Tsunami, indeed caused billions of rupiahs to be spent by the government to assist in waste disposal in result of this. From this example, we know that a balance or regulation regarding this occurrence needs to be developed.

The National Volunteer and Donations management strategies stressed on a few key elements:

1.   Donations activities may begin before a disaster declaration: Coordinative efforts needs to be made to prevent difficult problems and misunderstandings later. Donations planning, coordination and management are necessary to avoid chaos, waste of time and effort that large shipments of undesignated goods can cause. This is also necessary towards addressing spontaneous, unaffiliated volunteers who arrived on-site at a disaster, ready to help. Because they are not associated with any part of the existing emergency management response system, their offers of help are often underutilized and even problematic to professional responders.

2.   Shipment of undesignated goods may be affected by state policies: During a catastrophic disaster, the state may impose policies that affect the transportation of all vehicles include shipments of goods. These policies should facilitate and not interfere with the shipments of the designated goods.

3.   State and local governments are in charge of donations operations: The government should address critical issues such as what procedures should be established at weigh stations, toll booths and other point of entry. The government also has a role in addressing a massage to the public regarding donated goods and volunteer services.

4.   State should make full use of existing voluntary agency capabilities: State and local donations management personnel should be very familiar with the strengths and interests of the voluntary organization, and other non-governmental organizations have a wide variety of abilities that can be fully used during a disaster.

5.   Use flexible strategies: Flexibility must always be used in disaster operations. There is no single correct way to manage unsolicited goods and spontaneous volunteers for all disasters. Other factors determining the appropriate approach will depend on the types of working relationships that are made between government emergency management personnel and voluntary agencies prior to a disaster.

6.   Use a team approach: While the government is responsible for certain critical issues, the leading voluntary agency representatives can be involved actively in day-to day operations.

7.   Cash donations to voluntary agencies are preferred. Cash donations to the voluntary agencies experienced in disaster relief help the agencies purchase precisely what the affected community needs, such as food items for the food bank. Cash donations to voluntary agencies help the local economy affected by the disaster because money is spent in the local area. Cash donations also eliminate the difficult transportation and logistics requirements necessary for the donations of goods.

8.   Information management IS essential: During a large-scale or catastrophic disaster, several thousand calls can be anticipated. A phone bank us the backbone of a successful donations management operation. The public should know where to call to discuss and coordinate their offers before they collect and send goods and volunteers to the disaster area. A volunteer and donations phone bank must be adequately staffed to give the caller accurate and timely information about the need for donations of goods and volunteers.

These key elements needs to be of high attention during each phase of disaster management. The elements of the volunteer and donations management system establish a consistent flow of information and goods to help manage operational activities.

References:

1.   Points of Light Foundation & Volunteer Center National Network: Managing Spontaneous Volunteers in Times of Disaster:  The Synergy of Structure and Good Intentions  www.PointsofLight.org/Disaster

2.   FEMA Materials:  “When Disaster Strikes … How You Can Help” (L-217 English and Spanish – FEMA Publications

Human Resource in Health Care

Human resource is a term used to describe the workforce of an organization. It is one of the three major principle of health system input, the other two being physical capital and consumables.

The concept of human resource management has been a topic of wide debate. It basically means, the strategic and coherent approach to an organization most valuable assets, and that would be the people working together to achieve a similar cohesive goal. 

In general, human resource management function to employ people, develop their maximum capacity, utilizing, maintaining, and compensating their services in tune with the organizational requirements.

In health care, human resource can be defined as the different kinds of clinical and non-clinical staff responsible for public and individual health intervention. The target of human resources in health care not only comes from the direct caregivers of health services but also other individuals that are involved in working together to ensure a efficient working health organization, for example, administration, public relation, security, catering, laundry, electronics, civil, electrical and air conditioning maintenance.

In a hospital setting, the human resources can be divided to medic and non medic; technical and administrators, and all have a rather similar crucial role to ensure the accessibility and efficiency of an organization.

***

When we talk about human resource in health care, several issues easily comes to mind:

1.      Composition and distribution of health care workforce. This issue is considered one of the key indicators or a country’s capacity to provide delivery and intervention of health care services.

2.      Workforce training issues. Some of us may wonder, where actually some doctors get their medical certificate judging from their performance in the field and quality of care, thus stereotypes are often being put forward. Truthfully, in my opinion, prior education is as vital as the in service training for health care workforces. The HRM (short for human resource management) should really develop ideas on how they can provide new options for education to cater for the country’s current and future needs.

3.      Migration of health workers. An issue addressed like an old friend. A problem that has been on top of everyone’s concern. Research has indicated that regardless of any country, migrations to urban area are common. This coincides with globalization of health care and issues of brain drain both external and internal. With regards to this issue, actions and planning needs to be generated as there might be an imbalance in the human resource in the urban and rural areas, thus jeopardizing health care deliveries at places where the attraction is less (in a working environment perspective).

4.      Level of economic development. One must admit that the richer and more developed country (higher gross domestic product per capita), the more money is being spent on health care as compared to countries with lower gross domestic products per capita.

5.      Sociodemographic, geographical and cultural factors. An example for this is regarding the age distribution of the population in an area. Where there is an ageing population, there is a high demand for human resource regarding a certain particular field. Training should also be given to younger populations so that they can fill in the shoes of doctors which will soon be retiring.

The management of human resource certainly has its difficulties and challenges. We, as soon-to-be 'human resource' involved in an organization has a big role to play in order to maintain the balance and efficiency of the system, therefore should always be prepared for the challenges ahead of us. This is because the whole organizational operation depends crucially on it and any mistakes and flukes can indeed impose severe effects to the system.

References:

1. Lecture by Dr. Andreasta Meliala : Human resource management in health and Medical Doctor career.

2. Human Resource Management in Health Care, Principles and Practices by L.Fleming Fallon, Jr; and Charles R. McConnell.

3. Human Resource Planning in health Care, B. Ray.

Teguh, jangan roboh

No one can whistle a symphony.  It takes a whole orchestra to play it.

H.E. Luccock

One can never live alone and achieve great things just by himself no matter how superior he think he is.

To build a superb organization, one shouldn't neglect the fact that effective team work plays an important, if not a crucial role. Organizational success is commonly linked to all sorts of teams. According to Kreitner & Kinicki, there are 4 general types of team work:

1. Advice team: Created to broaden the information base for managerial decisions.

2. Production team: Responsible for performing day-to-day operations.

3. Project team: Created to solve a sentinel event and handling specific issues in a period of   time

4. Action team: Responsible for the running activities within the organization.

In health care, teamwork has been defined as a dynamic process involving two or more healthcare professionals with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care.

These concepts are beneficial when talking about teamwork in Primary Health Centres. To serve better service for the patients’ benefits, the healthcare institution must be well governed so that they can house a vast array of multi-professional team who can effectively handle numerous procedures and equipments relating to a health care problem. Therefore, these separate members in a professional team are each assigned individual ‘assignments’ and holistically complements each other for the betterment of the patient’s condition.

Freshman et. al. states:

Effective working teams must be created and maintained. But the members of the teams are typically trained in separate disciplines and educational setting, leaving them unprepared to practice in complex collaborative setting. The work of each individual may be efficient from the perspective of their own tasks, but overall the effort are suboptimal and may not serve the need of the patient.

From this statement, we can conclude that by having many professionals from different backgrounds and ‘mixing’ them to produce an effective ‘work team’ might not be such an easy task. Strategies need to be implemented so that professionals from these different backgrounds are able to work together despite their different educational, cultural and social background. We can start by producing a similar and main goal of the operation and enforce it fully. Just like how many subsystem work together in a system, this concept must also be adapted similarly so that the word ‘teamwork’ lives up to its full potential.

References:

1. Freshman, B., Rubino, L., Chassiakos, Y.R. 2010: Collaboration Across the Disciplines in Health Care. Jones & Bartless Publishers, Boston USA

2. Teamwork: A concept analysis by Ream E (2008)

Lets Talk Statistics!

To increase our knowledge in the current happenings regarding health in Malaysia, i have linked a website from UNICEF. Kindly click on the link and get educated! :)

Statistics

Health for All

The right for health is for everyone to embrace, no matter how geographically challenged and technology deprived your living environment can be. It does not choose race, religion or genetic makeup but the simple fact that one should always have the right to what is utterly fundamental – Health.

So to achieve this goal, primary health centres all over the world has been developed and enhanced. 

With WHO as the main guideline, there are certain goals that accompany every reformation been proposed.

• Reducing exclusion and social disparities in health (universal coverage reforms)
• Organizing health services around people's needs and expectations (service delivery reforms)
• Integrating health into all sectors (public policy reforms)
• Pursuing collaborative models of policy dialogue (leadership reforms)
• Increasing stakeholder participation

PUSKESMAS

A word often used by lecturers, students and even patients. But what does it really mean? Simply put, it stands for “Pusat Kesehatan Masyarakat” which plays a role as a functional organization no less than what is being proposed by the WHO. It serves as a centre for health care services which ensures to provide holistic, accessible and supported by community involvement for the people of Indonesia, mostly living in rural areas or villages. It provides health care at an affordable price, both for the patients and the government.

From past experiences visiting the primary health centres of Indonesia, what I can see is it is far from the perfect picture on how health care should be delivered. With lack of professional doctors and also medical equipments to provide sufficient health care for the villagers, there are so many things that need to be improved. However, they are certainly moving towards all of the right directions in efforts to improve their health care qualities.

Me and my buddies at PUSKESMAS Nglipar 1

Drug Management & Policy in Primary Health Care

The amount and adequacy of medicine and drugs is an important measure of quality in primary health care centres. We know that certain drugs need to be available at all times so that health care can be provided to the community efficiently and sufficiently.

The following picture is a logistic cycle chart on how drug supplies are managed

We go to the first component of the cycle. When it comes to drug selection, some of the problems faced are too many items of drugs, expensive preparations, non-essential drugs and too many options of drugs. The selection of drugs in primary health care centres highly depend on the amount needed, indication (from the most common disease in the community) and most importantly, cost.

Procurement is defined here as the process of acquiring supplies from private or public suppliers or through purchases from manufacturers, distributors or agencies such as the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), or bilateral aid programs. These sources may be used individually or in combination to meet the entire range of your drug needs.

An effective procurement process should:

• Procure the right drugs in the right quantities
• Obtain the lowest possible purchase prices
• Ensure that all drugs procured meet recognized standard of quality
• Arrange timely delivery to avoid shortages and stock-outs
• Ensure supplier reliability with respect to service and quality
• Set the purchasing schedule, formulas for order quantities, and safety stock levels to achieve the lowest total cost at each level of the system
• Achieve these objectives in the most efficient manner possible

The third component of the cycle is distribution.  At the health centre level, drug distribution concerns mainly dispensing drugs to patients. This requires an understanding of the patients (who may not speak or understand the language of the dispenser) and practical skills in dispensing and record-keeping. The other aspect of distribution of drugs at the health centre is the return of overstocked and nearly expired drugs to the medical store. 

A well-run distribution system has the following qualities:

• Constant uninterrupted supplies;
• Commodities stay in good condition until they are used;
• Minimizes losses due to spoilage and expiry;
• Prevents theft and fraud;
• Maintains accurate stock;
• Uses storage locations that allow for on-time delivery;
• Efficiently uses transport resources;
• Enables collection of Accurate information for forecasting (World Bank, 2004)

Last but not least is the use of drug. The rational use of drugs requires that the drug is prescribed for a particular patient after proper diagnosis of a health problem. Prescriptions should promote the rational use of drugs. Rational use of drugs requires that a particular patient with a specific health problem receives drugs according to the following:

• Appropriate dose
• Appropriate dosage form
• Appropriate route of administration
• Appropriate frequency of administration
• Appropriate duration of treatment
• Appropriate information to the patient
• Adequate follow up

The policies and management of drugs in primary health care centers highly depend on the mentioned aspects to ensure a smooth and reliable health care delivery. It depends on certain aspects such as intelligence, systematic structure, effective techniques and willingness of the provider, consumer and policy maker to ensure drugs are being managed appropriately and ethically in primary health care level.

References:

1. Drug management & policy in primary health care: Dr. Erna Kristin's lecture
2. Management of Drugs at Health Centre Level - Training Manual

P4P

What is performance and quality without motivation? Many incidences happen whereby performances are dominantly affected by the amount of money being paid for them to do the particular job. No matter how 'noble' one sees themselves to be, money is a subject of everyone's affection, whether they are ready to admit it or not. The question is, will they work better with bigger salaries and incentives?


Many studies have linked financial rewards to quality and performance. These links are made so that costs can be curbed optimally while maintaining the best level of quality, safety and access. Ever heard of the term, "pay for performance"? Also known as "value-based purchasing", this payment model rewards physicians, hospitals and medical groups based on their performance in delivering the best services in their respective fields. Financial incentives will motivate behavioral changes and this is thought to be transformed into delivery of desired and optimal performance. 


The emergence of systems to measure quality and also performance has made this payment method a feasible one. The US has over 100 private and federal medicare reward and incentive programmes, and Italy and New Zealand are beginning to reward performance in primary care. It has yet to be applied at other countries which still apply the capitation, and health social insurances as health provider payment mechanism.


When they mention "performance", it doesn't only revolves around curing the patient, but rather, a holistic approach to patient management which includes volume, equity, patient satisfaction, patient safety and also cost effectiveness.


There are (nevertheless) consequences or potential unintended effects of this Pay for Performance principle. Physicians and health care providers may have tunnel visions and only focus on aspects of clinical performance while neglecting other "unmeasured areas" for example doctor-patient communication and empathy. There might also be adverse selections of patients where severely ill patients are avoided in order to minimize the risk of incentive cutbacks. This method of doctor's payment will also diminish the fundamental intrinsic professional motivation as the key attribute of high quality health care delivery. Misreporting, gaming or fraud can also exist in order to get more income.


Money motivates, no doubt. However one must remember that it shouldn't be the ONLY THING that can serve as a motivation. What happens to a situation where one needs to treat without payment? If doctors are too used to being paid incentives for every single thing, their attitude towards their patient and the profession will also be gruesomely affected. A balance needs to be achieved so that all actions are not merely based only on "rewarded" things. That will just be plain annoying for everyone, wouldn't it?


References:
1. bmj.com: Payment for performance in health care
2. Basing Pay-for-Performance on outcomes, The New York Times 

Pay me up!

There are a few physician payment approaches and incentives they create:

Capitation: The physician agrees to deliver a specified list of health services for a fixed amount per person. The physician bears financial risk. Potential incentives created:

• The physician might act too aggressively in constraining service use, eliminating some “necessary” as well as some “unnecessary” services. The result could be lower quality of care for patients especially if there is no sharing of risks or surpluses, if the capitated contract is short-term in nature and if contract renewal does not depend on measures other than costs.
• Conversely, if physician organizations reimbursed by capitation payments care for an enrolled population over a period of time, they have an incentive to provide services that maintain or improve the health of that population, as this will be financially beneficial in the long term.

Fee for service: Physician are pain for each service of unit provided. Potential incentives created:

• This form of payment contains a powerful incentive for “over-provision” of services and necessitates a substantial amount of costly monitoring on the part of the payer.
• There is a risk to patient health associated with “over-treatment,” just as there is with “under-treatment”

Salary: The physician is paid a fixed amount per time period. Potential incentives created:

• There is no incentive to deliver unnecessary services, nor is there an incentive for “under-provision,” except to the degree that physicians may “shirk” under salaried arrangements.
• There is no particular incentive under a pure salary method of payment for physicians to deliver high quality care, so there typically is a heavy reliance on enforcement of rules and procedures thought to enhance quality.
• The result could be quality enhancing or, to the degree that rule enforcement limits physician ability to bring professional judgment to bear in treatment decisions, result in lower quality of care

Budgets: Physicians must be reimbursed through a negotiated budget process at the organizational level. This method of payment is most often observed internationally in government administered health care system. Potential incentives created:

• The nature of the incentives in this payment arrangement can resemble capitation, when the number of individuals served in a given period is relatively fixed, and the organization is at risk for budget over-runs and can keep savings.
• Or, the incentives can resemble those of salaried physicians when the organization serves patients who seek care, but does not assume responsibility to provide care to a fixed number, or enrolled group, of individuals for a specified time period.

References:

1. Provider payment mechanism in healthcare: Incentives,Outcomes, and organizational Impact in Developing Countries
2. Principles for Physician Payment Reform www.abimfoundation.org

Who's in charge here? (An Overview on Disaster Management)

The past few days had been such a rollercoaster ride, to say the very least. When trying situations like these happen, only we can see how much theory is being put into practical.

So far, there has been hundreds of thousands of people being evacuated to a safer place, not forgetting the countless scarred hearts of the family members of the departed. In trying time like these, a systematic approach towards disaster is utterly important. Merapi’s latest eruption has pushed the death toll to 156 and the number could’ve been higher if some measures were not taken earlier. Which brings to my title of discussion.

Disaster management in Indonesia

The word ‘disaster’ is no foreign matter for Indonesia. Natural disaster is a common phenomena in Indonesia which has caused loss of lives and countless destruction to the environment. Its very ‘unstrategic’ location has subjected it to high seismic activities. Indonesia has more than 500 volcanoes, 128 of which are active volcanoes occupying the zones of Sunda, Banda, Halmahera and Minahasa. The country is susceptible from drought to floods, and tsunami risks to earthquakes. 

The particular geographical and geological characteristics of the country place it among the most vulnerable one to natural disasters. Indonesia is placed on the third place by the Asian Development Bank, in its observation of 13 Asian countries most susceptible to natural disasters for the period of 1964 - 1986, after the Phillipines and India in terms of severity of the disasters and their cumulative frequencies of occurrence.

In conjunction to these very unfortunate circumstances, the Indonesian government has decided to act through its many policies regarding the importance of managing disasters that happen to their beloved country:

It started of in 1966 when the Indonesian government established Advisory Board for Natural Disaster Management where its activities were focused on the disaster victims. As a measure to increase efficiency and coordination in managing disaster, the Indonesian government developed a coordinating body for natural disaster management named Badan Koordinasi Nasional Penanggulangan Bencana Alam (BAKORNAS PBA) in 1979. The organization has undergone a lot of changes over the years but he most recent organization structure is developed in 2001.

When a disaster strikes, Bakornas PBP would convene an initial meeting and appoint a certain ministry to be the leading sector at the national level to support the relief responses by the local government. The prevailing guidelines on the tasks distribution among members of Bakornas PBP are the ones stipulated by Decree of Secretary of Bakornas PBP No 2 Year 2001 issued on 30 March 2001.

Home Affairs and Regional Autonomy Minister

Manages activities of regional development for empowering and protecting the population and community based activities on disaster and IDP management.

Health and Social Affairs Minister

Manages mitigation, preparedness, rescue, and rehabilitation activities on health and medical emergencies and assistance for medicines, paramedics, food and clothing for disaster victims and IDPs

Settlement and Regional Infrastructures Minister

Manages the activities and mobilisation of temporary shelters, water and sanitation, resettlement of disaster victims and IDPs and rehabilitation of damaged infrastructures

Transport Minister

Manages pre,during, and post-disaster activities of detection and information of weather, meteorology, search and rescue6, assistance for transport and telecommunication

Energy and Mineral Resources Minister

Manages mitigative measures on geological disasters

Manpower and Transmigration Minister

Manages the mobilisation and movement of disaster victims who need resettlement

Finance Minister

Financially supports the plan and implementation of Bakornas PBP and related agencies in

a coordinated manner

Forestry Minister

Manages mitigative and operational measures for forest and land fires

Environment State Minister

Manages rehabilitation of damaged environment, early warning, and advocacy in disaster Prevention

Armed Forces Chief

Manages assistance of resources and facilities from military

Chief of Police

Manages security and law enforcement

Governor of Affected Province

Heads the Satkorlak PBP to coordinate and synchronise the assistance into his/her province

Secretary of Bakornas PBP

Heads the Secretariat of Bakornas PBP to support and implement the dispositions of the Bakornas PBP and coordinates integrated measures for disaster and IDP management.

As you can see, in the making of an effective systematic organization to handle natural disaster, distribution of work roles needs to be done efficiently. Now we know what's the makeup of an organization that handles disaster management programs and policies. Maybe in my later posts we will discuss further on their policies and also strategies in ensuring smooth operating procedures (action plans).

***

References:

1. www.adpc.com (Asian disaster preparedness centre)

2. msnbc.com (Merapi eruption 2010 news)