Capital investment and maintenance for hospitals and primary health care facilities

I have just finished uploading the files on capital investment and maintenance from the Hospital Strategy Project.  These include information on planning both hospitals and primary health care facilities.

For other work that I have done on facility planning, see the pages on this site on hospitals and District Health Systems.

The Hospital Strategy Project: Module 1

As discussed in an earlier post, in 1996 the Hospital Strategy Project produced a lengthy and detailed report based on year-long national consultations with government officials and other experts in South Africa.  The report, which was commissioned by South Africa’s National Department of Health and funded by the European Union, set out ‘A Vision and Strategy for South Africa’s Public Hospitals.’ 

Fifteen years later, many of the Hospital Strategy Project’s recommendations remain pertinent, although some need to be updated in light of current circumstances.

Although the report is technically in the public domain, it is very difficult to access hard copies, let alone electronic versions.  Over the coming weeks I will try to upload as many of the component parts of the report as I can access.  I have already uploaded Module 2 (which deals with strengthening hospital management).  Today I am starting with Module 1 which deals with national affordability guidelines for hospital service delivery (see links below).  Unfortunately some of the components are missing as the original electronic files have been damaged, or I am uncertain whether I have the final version.

If you use any information from these reports, please acknowledge the source: 

Monitor Company, Health Partners International, Centre for Health Policy and National Labour and Economic Development Institute.  1996.  Module 1:  Development of National Affordability Guidelines for Hospital Service Delivery.  In:  Achieving equity, efficiency and accountability: a vision and strategy for South Africa’s public hospitals. Final report of the Hospital Strategy Project.  Johannesburg:  Monitor Company.

– Contents of Module 1

– Development of National Affordability Guidelines for Hospital Service Delivery:  Final Report  1 Affordability Guidelines MOD1SU~1

Appendix 1:  Report on the first meeting of working group on national affordability guidelines for hospital services, September 1995

Appendix 2:  Planning hospital services:  the role of national affordability guidelines

Appendix 3:  Defining hospitals by level of care:  towards a consensus position

Appendix 4:  Priorities for restructuring referral hospitals in support of hospital reform

Appendix 5:  A measuring tool to determine the personnel expenditure per unit output in complex hospitals

Appendix 6:  Use of indicators of hospital service provision, utilisation and efficiency

Appendix 7:  Introduction to guidelines for district hospitals

Appendix 8:  Guidelines for organisational characteristics of patient care in a district hospital

Appendix 9:  Guidelines for site lay-out and inter-relation between various departments of district hospitals

Appendix 10:  Guidelines for health professional departments or services in a district hospital

Appendix 11:  Guidelines for support services in a district hospital

Appendix 12:  Level II care:  structure and function

Appendix 13:  Level III care

Appendix 14:  Guidelines for human resources planning of hospital services

Appendix 15:  Hospital performance indicators  APP15H~1

Appendix 16:  Improving the quality of care in public hospitals

Appendix 17:  Clinical guidelines and referral routes

Appendix 18:  Developing a capital investment and maintenance plan for hospitals:Strategy and Issues APP18C~1

    • Appendix 1:  Guiding principles for a capital development programme for PHC services APP18A~1
    • Appendix 2:  Criteria for determining priorities for capital developments at PHC facilities  APP18B~1
    • Appendix 3:  The use of criteria for the priority ranking of health facilities (including Tables 1-3)  APP18C~2 plus Table 4

The Hospital Strategy Project: Module 2

In 1996 the Hospital Strategy Project produced a lengthy and detailed report based on year-long national consultations with government officials and other experts in South Africa.  The report, which was commissioned by South Africa’s National Department of Health and funded by the European Union, set out ‘A Vision and Strategy for South Africa’s Public Hospitals.’ 

Fifteen years later, many of the Hospital Strategy Project’s recommendations remain pertinent, although some need to be updated in light of current circumstances.

Although the report is technically in the public domain, it is very difficult to access hard copies, let alone electronic versions.  Over the coming weeks I will try to upload as many of the component parts of the report as I can access.  Today I am starting with Module 2 which deals with strengthening hospital management (see links below).  Unfortunately some of the components are missing as the original electronic files have been damaged.

If you use any information from these reports, please acknowledge the source: 

Monitor Company, Health Partners International, Centre for Health Policy and National Labour and Economic Development Institute.  1996.  Module 2:  Strengthening Hospital Management.  In:  Achieving equity, efficiency and accountability: a vision and strategy for South Africa’s public hospitals. Final report of the Hospital Strategy Project.  Johannesburg:  Monitor Company.

– Contents of volume on Module 2:  HSP Module 2_Contents pages for folder

– Overview:  HSP Module 2_Overview

– Contents of main report:  HSP Module 2_Contents pages for main report

– Main report:  HSP Module 2_Main report

Appendix 1:  Role of stakeholders above hospital level in hospital personnel management:  HSP Module 2_App1_Role of stakeholders above hospital level in hospital personnel management

Appendix 2:  Hospital personnel management: delegations to hospital managers:  HSP Module 2_App2_Hospital personnel management_delegations to hospital managers

Appendix 3:  Procurement, Public Works and Transport:  delegation of authority to the PHA and hospital management (electronic version not available)

Appendix 4:  Decentralised financial management: delegation of authority to the PHA and hospital management (click here for this appendix which is a substantial report appearing in a separate post)

Appendix 5:  Interventions to relieve pressing needs of hospitals  HSP Module 2_App5_Interventions to relieve pressing needs of hospitals

– Framework for implementation:  HSP Module 2_Framework for implementation

– Review of hospital management in six countries:  HSP Module 2_Hospital management in 6 countries

– Community involvement in hospitals:  HSP Module 2_Community involvement in hospitals 

– Decentralised financial management (electronic version not available –  scanned version is being uploaded onto separate post entitled Decentralised financial management of hospitals)

South African research on hospital management

You can look on the relevant page on this site for my research on hospitals.  Other research in South Africa I’ve found useful includes the Hospital Strategy Project, a case study on hospital restructuring, a summary of problems faced by Chris Hani Baragwanath Hospital, an analysis of problems in public hospital management and an article on leadership in public hospitals.  Does anyone know of more recent reports on hospital planning and management?  Relevant work from other countries would be very useful.

Improving management at public hospitals

It is difficult to convince governments to commit more resources to the public health sector.  One of the reasons is the perceived inefficiency of government facilities. 

Well, perhaps it’s impossible to perform well when one’s under-resourced:  this is often the case in low- and even middle-income countries. 

It’s going to be hard to put this argument across, though.  So, one strategy is to develop some best-practice sites:  introduce innovative management approaches, get things working better, show that it can be done – and then highlight the obstacles to further progress  posed by insufficient resources!

Has anyone got case studies of successful management transformation projects, especially in public hospitals?  It would be great to have detailed reports – sometimes the ‘magic’ that makes things work might lie in the little things …