International J. of Healthcare and Biomedical Research , Volume: 03, Issue: 03 , April 2015 , Pages 07- 19
Original article:
Management inputs for strengthening healthsystem through public private partnership with referenceto cleaning services
Dr. R. R. Shinde1, Dr. B. S. Nagaonkar2
1Professor and Head, Department of Preventive & Social Medicine, Seth G. S. Medical College & K.E.M. Hospital, Parel, Mumbai
2Assistant Director, Rajeev Gandhi JeevandayeeArogyaYojna Society, Public Health Department, Government of Maharashtra, Mumbai
Corresponding author: Dr. B. S. Nagaonkar
Abstract:
Background: Public private partnership is a strategic management policy to improvestandards of health services in Government hospitals as envisaged in IPHS (Indian Public Health Standards. PPP demands meaningful introspective mutually beneficial negotiations of the terms of references between the private partner and the Government competent authorities. These negotiations have long-term impact to strike a balance between quality outcomes and optimal expenditure by the Government. The present study focuses on evolving evidence based appropriate terms of references for qualitative services in the domain hospital cleanliness through PPP.
Objectives: 1.To study the existing status of cleanliness management of Government hospitals and identify scope for sustainable qualitative improvement 2. To evolve evidence based, need based terms of referencesfor PPP for sustainable management of cleanliness in Government hospitals
Material & Methods: 20 hospitals were selected by random method representing Konkan, Marathwada, North Maharashtra and Vidharba region. Out of these six were selected as study groups and rest 14 as control group.The baseline situational analysis regarding hospital cleanliness management was assessed. A questionnaire was prepared based on this analysis and was validated by senior health administrators, Public Health experts and academicians. 300 key informers representing all levels of hierarchy and 300 patients together were interviewed. Focus group discussions were also held in each hospital in both study and control groups amongst health care providers and patients separately. The findings were further subjected to critical appreciation and extrapolation based on situational analysis, extent of patient satisfaction regarding cleanliness and mainstreaming of the study interventions in the cleanliness management policy.
Results: The findings indicated that the quality of cleanliness management was compromised due to lack of structured interventional policy. It also reinforced the need for PPP in Hospital cleanliness management.88 Patients expressed positive satisfaction in study group out of 90, where as it was 190 out of 210 in control group. The evolved terms of references for cleanliness management through PPP were accepted by Directorate of Health Services was circulated across the state as circular. Earlier Government Resolution dated 16.01.03 and 26.05.04 of the payment cost of contractor of nonclinical services was less than 50% of cost of salary if regular employees would have been appointed,was violating minimum wages act 1948, was modified. Modified Government Resolution3 dated 27.02.13 of Law and Judiciary and Finance department4 dated 02.02.13 mainstreamed the cost at more than 80% of cost of salary if regular employees would have been appointed.
Keywords: Public Private Partnership, cleaning services, Terms of references