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(18) WHO’s Madeleine De Rosas-Valera MD on international hospital reform

Madeleine De Rosas-Valera MD
Dr. Madeleine De Rosas-Valera speaks on hospital reform.

25 August 2011 - Madeleine De Rosas-Valera MD, Technical Officer for Quality and Patient Safety of the World Health Organization (WHO) Western Pacific Region, presented various country experiences in international hospital reform at the Development-At-Work forum on August 25 2011. The event entitled  "Forum on International Hospital Reform" gathered together various stakeholders and practitioners from the health sector, and provided relevant insights into the crucial aspects of hospital reform in the countries of Brazil, Malaysia, Germany and the Philippines, given WHO findings and recommendations.

Looking into the different strategies employed by these countries in mitigating and solving problems faced by public hospitals, Dr. Valera highlighted the importance of contextualizing reform in the big changes in demographics and medical technology, as well as the demands for increased cost efficiency and hospital staff and patient satisfaction. There is as well the bigger and most urgent task of ascertaining universal health care for all.

There are of course many steps towards hospital reform. As far as the WHO is concerned, it is important that hospital services are first of all matched with a given community’s needs, where hospital performance will necessarily be affected by external influences. Meanwhile an important possibility for hospital governance is seen to be hospital autonomy where it is (1) not an end goal (2) not equal to privatization (3) not absolute because it falls under government health policies and regulation. This is the best model as it allows the hospital to be partially self-governing, self-directing and self-financing (Hildebrand and Newbrander 1993). Dr. Valera clarifies though, that autonomy comes hand in hand with regulation, and that the process of autonomization varies across different contexts.

Hospital workforce numbers across the four countries meanwhile prove that the shortage of physicians is one of the more urgent problems, which might be solved by looking into migration patterns, salary upgrades and continuing education. Health financing and quality assurance and patient safety for each country are differ greatly across the countries, as does the responses to the development of health technologies and informatics.

Dr. Valera also highlights that what works in hospital reform may be divided among policy stewards, providers, and patients where each one is given more responsibility as they are better educated and trained in their tasks within the hospital system. Policy stewards must look into: (1) the poor having access to healthcare, (2) better performance and accountability, (3) collaborative management, (4) incentive structures, and (5) the reduction of the budgetary burden of government. Providers must: (1) shift to patient-centered healthcare, (2) look into community-based access, and (3) link and communicate with primary level care. Lastly, patients must: (1) become involved in the planning and monitoring of reform, (2) ascertain their own satisfaction, (3) be more informed and educated about their health, (4) move from being patient to becoming health consumer, and (5) be aware of his/her rights.

For the Philippines, reforming public hospitals happens through: (1) a territorial health care strategy that aligns hospital services to community needs, (2) a hospital frontline service strategy that will make efficient emergency room, out patient and basic care services, and (3) a hospital choke point strategy where areas with high expenses, wastage, high activity and patient complaints are identified and dealt with appropriately.

In the end, Dr. Valera asserts that hospital reform needs to match an individual country’s goals for universal access to health care, where hospital planning and operations are flexible in scope and scale, and is not isolated from the larger health system.


Click here to know more about the World Health Organization (WHO) Western Pacific Region.


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