deoki nandan Political Feasibility and Political Strategies for HRH Reforms puri

8/7/2019 deoki nandan Political Feasibility and Political Strategies for HRH Reforms puri

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Political Feasibility andPolitical Feasibility and

Political Strategies forPolitical Strategies for

HRH Policy ReformHRH Policy Reform

(Theory into practice(Theory into practice The Agra experience)The Agra experience)

Prof. Deoki Nandan,Prof. Deoki Nandan,

Doctor Honoris CausaDoctor Honoris Causa--Odessa State MedicalOdessa State Medical

University, MD, FAMS, FIAPSM, FIPHA, FISCDUniversity, MD, FAMS, FIAPSM, FIPHA, FISCD

DirectorDirector

([email protected], [email protected],([email protected], [email protected],

www.nihfw.org)www.nihfw.org)


2/18

How to do it?How to do it?-- the Agrathe Agra

experienceexperienceDecember 2003December 2003 took over as Principaltook over as Principal

and Chief of Hospitaland Chief of Hospital

Pathetic state of hospitalPathetic state of hospital--wards, OPD,wards, OPD,OTOT

Demotivated staffDemotivated staff-- court cases, nocourt cases, no

promotional avenues, no recruitmentspromotional avenues, no recruitments

Patient load minimalPatient load minimal--most preferred themost preferred the

private sectorprivate sector

Image of the institution was not goodImage of the institution was not good


3/18

Biggest question wasBiggest question was--how to garner politicalhow to garner political

commitment forcommitment for

enablingenablingenvironment?environment?


4/18

Getting Political SupportGetting Political Support

Went through the process of political analysisWent through the process of political analysis --identifying the decision makers and theiridentifying the decision makers and theirconcerns (vote bank, publicity, image)concerns (vote bank, publicity, image)

Got the emergency block inaugurated by theGot the emergency block inaugurated by thechief minister (this was under construction forchief minister (this was under construction forthe last twenty years!!) within five weeks afterthe last twenty years!!) within five weeks aftertaking over as Chief of hospital.taking over as Chief of hospital.

Regular visits of political personages, judges etcRegular visits of political personages, judges etcto the hospital/medical college on differentto the hospital/medical college on differentoccasions as chief guests.occasions as chief guests.


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Got good media coverage and alsoGot good media coverage and also

political presence (of different parties!!)political presence (of different parties!!)

Could get more funds committed for theCould get more funds committed for the

hospitalhospital

Let politicians take the creditLet politicians take the credit


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Critical incident 1 :Critical incident 1 :

Accident of a large group (connected to aAccident of a large group (connected to a

political heavyweight)political heavyweight)

Did not have blankets (in winter )and foodDid not have blankets (in winter )and food

GotGot 5050 blanketsblankets donateddonated byby aa wellwell knownknownindustrialistindustrialist andand mademade arrangementsarrangements forfor foodfood forforthethe attendantsattendants ofof thethe patientspatients (got(got thethe supportsupport ofofthethe otherother partyparty too!)too!)

Worked on establishing political support


7/18

Critical incident 2:Critical incident 2:

A patient from constituency of CM wasA patient from constituency of CM was

admitted. Got a call from CM.admitted. Got a call from CM.

Patient required pacemakerPatient required pacemaker--which waswhich was

not available in SNMC!not available in SNMC!


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Immediately got the pacemaker donatedImmediately got the pacemaker donated

by the company and requested a privateby the company and requested a privatecardiac surgeon to come and insertcardiac surgeon to come and insert

pacemaker!pacemaker!

THAT WAS IT!THAT WAS IT!-- started getting morestarted getting more

patients from these placespatients from these places-- not everybodynot everybody

required lot of extra resources!required lot of extra resources! mainlymainlyattentionattention

Benefit to the organisationBenefit to the organisation-- was able to getwas able to get

the faith and ear of the political persons!the faith and ear of the political persons!


9/18

Policy Cycle 1Policy Cycle 1 SignalingSignaling

situation analysis of manpowersituation analysis of manpower-- technical, managerialtechnical, managerialand supportand support

Patient loadPatient load-- OPD, In patient, emergencyOPD, In patient, emergency BudgetBudget-- sanctioned, available and utilizationsanctioned, available and utilization

DrugsDrugs-- availability and shortagesavailability and shortages

Infrastructure and equipmentsInfrastructure and equipments

Made presentations about the progress and theMade presentations about the progress and therequirements of the organisation.requirements of the organisation.


10/18

FormulationFormulation

NumberNumber ofof medicalmedical teachersteachers inin UPUP waswas muchmuch

lessless thanthan requiredrequired

Recruitment of medical teachers was a big problemRecruitment of medical teachers was a big problem

Held a series of meetings with faculty, associations,Held a series of meetings with faculty, associations,

bureaucrats and political playersbureaucrats and political players

Emphasized on the MCI requirementsEmphasized on the MCI requirements

Identified the recruitment problemIdentified the recruitment problem-- 3 years senior3 years seniorresidency was required for recruitmentresidency was required for recruitment


11/18

Policy Cycle 2Policy Cycle 2

AggregationAggregationReservations issues, court cases, teachers,Reservations issues, court cases, teachers,

community dividedcommunity divided

Media clippings of shortage of teachers inMedia clippings of shortage of teachers in

medical collegesmedical colleges

Threat of derecognition by MCIThreat of derecognition by MCI

Problems faced by community and lack ofProblems faced by community and lack of

qualityquality

Political advocacy for doing away with this 3Political advocacy for doing away with this 3

year clauseyear clause

Expected benefits and scenario projectedExpected benefits and scenario projected

Endorsement from associations and bureaucratsEndorsement from associations and bureaucrats


12/18


RatificationRatification

Decision at the level of chief secretary,Decision at the level of chief secretary,

minister and chief ministerminister and chief minister


13/18


ImplementationImplementation Inertia of bureaucraciesInertia of bureaucracies

Active resistance by losersActive resistance by losers

Creating new institutionsCreating new institutions Start fresh and attract talentStart fresh and attract talent

Create political interest in reformCreate political interest in reform

Political, Social and Economic ConstraintsPolitical, Social and Economic Constraints

Unforeseen eventsUnforeseen events war, economicwar, economicdownturns, disastersdownturns, disasters

Donor supervision missionsDonor supervision missions threats ofthreats ofsuspension of funding (but limits to this)suspension of funding (but limits to this)


14/18

AGRA ExperienceAGRA Experience

Discussion with bureaucratsDiscussion with bureaucrats-- initial refusal asinitial refusal asburden on exchequer and fear of other sectorsburden on exchequer and fear of other sectors

demanding the samedemanding the same

Discussed with political leadersDiscussed with political leaders-- creating ancreating anenvironment of consensusenvironment of consensus

TriedTried toto getget theirtheir commitmentcommitment forfor theirtheir support!support!

Got posts advertised & made recruitmentGot posts advertised & made recruitment

Resulted in change in service rulesResulted in change in service rules


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Policy Cycle 5Policy Cycle 5 FeedbackFeedback

AGRA ExperienceAGRA Experience -- monitoredmonitored

Always did complete homework beforeAlways did complete homework before

presenting case to the political bossespresenting case to the political bosses-- e.g.e.g.

promotional avenues of the medical collegepromotional avenues of the medical collegeteachers; arrears of the last many yearsteachers; arrears of the last many years


16/18

Tools for Strategies (3)Tools for Strategies (3)

Create a change teamCreate a change team

Constituted a committee of external influential membersConstituted a committee of external influential membersto advise and oversee the work of the hospital. Itto advise and oversee the work of the hospital. Itincreased their ownership and helped in gettingincreased their ownership and helped in gettingdecisions madedecisions made

Made medical faculty and staff more involved in theMade medical faculty and staff more involved in thewhole process.whole process.

Kept good relations with bureaucrats and politiciansKept good relations with bureaucrats and politicians


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TAKE HOME MESSAGETAKE HOME MESSAGE

Be preparedBe prepared

Exploit opportunitiesExploit opportunities

Create opportunitiesCreate opportunities

Do your homeworkDo your homework

Be convincingBe convincing

Work at it!Work at it!


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deoki nandan Political Feasibility and Political Strategies for HRH Reforms puri