Yet, merely 3 percent of the water on Earth is fresh —
and most of that is locked up in glaciers or deep underground. Imagine all of
the world's water — oceans, rivers, lakes, glaciers — was represented by
something the size of a standard globe; its fresh water would be just a
marble-sized drop.
Fresh water also harbors the greatest concentration of
life on Earth — greater than either terrestrial or marine biomes. Though it
covers less than a fraction of 1 percent of the Earth's surface, fresh water
provides habitat for more than 10 percent of known animals and about one-third
of all known vertebrate species. And, more than 40 percent of all fish species
are found in fresh water — even though it is, relatively speaking, a drop in
the bucket.
The
health and abundance of these species is a crucial indicator of the health of
freshwater ecosystems. These ecosystems, in turn, play an important role in
moderating the location, distribution, and timing of freshwater flows, ensuring
that we receive a multitude of benefits and services.
Americans
consume 99 gallons of water daily. And one out of six gallons served by U.S.
water utilities finds its way back to the ground, leaking out of pipes or
otherwise wasted. We protect only 35 percent of the upland areas that secure
delivery of freshwater services downstream.
An
ever-worsening water crisis demands that we respond with combined water
efficiency and ecosystem management solutions to maintain freshwater species
and services. Failure is simply not an option — at the current rate, we will
degrade the remaining 11 percent of ecosystems that provide us with fresh water
services by 2050.
Importance of
water:
Agriculture uses a huge
amount of water, more than 70 percent of available surface water each
year.
Nearly 40 percent of the
rivers in the U.S. are too polluted for fishing and swimming.
Nutrient runoff from
agriculture has created algal blooms that deplete oxygen from the water
and result in dead zones.
Nearly every major river
in the world has been dammed, altering natural freshwater flows, cutting
off migration routes and depleting fisheries downstream.
We have already lost more
than half of our planet's wetlands and an estimated 30 percent of freshwater species.
Sixty-nine percent of
river catchments, responsible for the capture and provision of our
freshwater supply, remain unprotected — putting more than two-thirds of
the source areas of our rivers at risk.
Declines in native
species and changes in freshwater food webs have been estimated to exceed
US $100 million in lost income revenues.
In the next few decades,
more than half of the world's people are expected to live with severe
water scarcity.
Climate change, a growing
global population, and increasing demands on water due to higher standards
of living threaten to further burden our planet's freshwater systems.
Freshwater
Ecosystem Services:
drinking water
water for
bathing/sanitation
water for food productionhydroelectric power
generation
3.1 Alternative strategies to increase effective resources levels:
A variety of technique and policies have been suggested in various contexts to do this, including the following:
Appraisal: techniques such as cost-effectiveness analysis may suggest alternative approaches to particular health problems which are more efficient.
Contracting out: buying –in of services from outside sources (such as catering or cleaning), where these are shown to be more efficient than internal provision.
An internal market: development of internal budget systems within an organization which is constituted as a quasi-market, with difference budget or cost centers selling services to each other. The assumption behind such a strategy is that such a simulation of the market will improve efficiency.
Information dissemination: dissemination of comparative information on the performance of different parts of the health services or of an organization, in the expectation that either peer-group pressure or management incentives will lead to changes in practice.
Involvement of clinicians in management: clinicians are typically the individuals who, through their decisions, have most influence on how resources are spent. Increasing their involvement in budgeting and management may be important as a means of developing greater awareness of cost and greater efficiency.
3.2 Criteria for choosing a financial system:
Viability and ease of use of the system
Revenue-generating ability
Effects on health-care supply
Demand-side effects including equity
Participation in decision-making
Multisectoralism
3.3 Alternative approaches to financing health-care:
Fees for service and private insurance
Tax revenue and social insurance
Community financing
Loans and grants
Methods of Health Care Financing
1. Government Financing (Revenue)
2.Health Insurance:
- Social Health Insurance (SHI)
- Private Health Insurance (PHI)
3. User Fee
4. Community Financing
- Community Health Insurance (CHI)
- Micro- Health Insurance: Special form of CHI
- Community drug programme (CDP)
5. Public-Private Collaboration
6. External Development Partners (EDPs)
1. Government Financing
•General Taxation:
- General Tax Revenue may be a stable source of financing
•Earmark Tax:
- particular taxfor health care
- e.g., Cigarette/Liquor Tax for Health Tax fund
2. Health Insurance
What is Health Insurance?
Health insuranceis a means of financial protection against the risk of unexpected and expensive health care.
• Social Health Insurance ( SHI) was first introduced in Germany in 1883
•In Chili, SHI was introduced in 1920s
•In Asia, China, Indonesia, the Philipines, Mongolia, Malaysia, Thailand, Vietnam, Taiwan, Singapore have already introduced SHI
Health Insurance (HI)
HI is stable source of health care financing
Health Insurance serves two principal Functions – for economic welfare of nation
Insurance pools together the financial risks facing a large group of people – (Risk Sharing)
Insurance enables individuals to transfer their risks to an insurance plan
Social Health Insurance (SHI)
Social Health Insurance: for formal Sector
Two characteristics that distinguish from PHI
- Social Health Insurance is compulsory in an eligible group,
- SHI can not be voluntary
Voluntary insurance markets fail, because of adverse selection and cream skimming
SHI premiums and benefits are described in social compact (laws)-legislation
Social Health Insurance is not right to all
Benefits are usually related to contribution
Contribution rates and benefits can not be unilaterally changed
Contributions (premiums) SHI are earmarked
Government, employers and employees – tripartite based
Private Health Insurance
PHI is offered by non-profit or for-profit insurance companies
Consumers voluntarily chose insurance package
Private insurance are offered on an individual basis and group basis
3. User fees
User fees: patients pay a fee to the provider at the point of service use
The amount of user fee can be determined:
a) The amount can be the full charge
b) As co-payment: a flat amount preset for each visit
c) Coinsurance: Patients responsible to pay a percent of full charge
Cost-Recovery
Break-Even Point:
At this point, Costs = Revenue
Profit making organizations always try to keep Revenue > Cost
Public facilities in a state of
Cost > Revenue
Cost Sharing, User charges, CDP etc minimizes the difference between Cost and Revenue
If price elasticity of demand is little, User fee would be good method
If price elasticity is high, User fee could not serve very well
Low income people are likely to consume less health care
From equity ground, user fee is notpreferred
Cross-subsidization: charge more who can afford and subsidies to poor and vulnerable groups
4. Community Health Financing (CHF)
Community financing is based on two Principles
- Community cooperation
- Self reliance
CHF may be encouraged and supported by the government through its polices, regulations and financial and technical support
It is thought as a cost recovery tool
11 countries Experiences on CHF China,Vietnam,Mongolia, The Philipines, Indonesia, Laos, Cambodia, PNG,Myanmar, Thailand and Malaysia
Five categories of community level health financing mechanisms:
•Voluntary Health insurance
•Compulsory Health Insurance
•Pre-payment Health Accounts
•User fees
•Revolving Drug funds
5. Public-Private Collaboration
Health care systems are also financed by Public-Private Collaboration
One way to tap resources that have moved away from the public sector
Private beds in public hospitals
Services contracted to private providers
Contract private general practitioners/Brain drain problem
Payment Mechanism
vAllocation of resources to health sector organizations and individuals in return for some activities.
vPayment encompasses both funding and remuneration
Some payment mechanisms are:
•Fee-for-Service
- Payment is made to health care organization only after a service has been provided
Planning is needed everywhere. Everyone makes plan for their daily life. It is fundamental. Planning is one of five major processes of management.
Planning
Organizing
Leading
Staffing
Controlling
Therefore being a health care manager one must have clear understanding of planning especially health care planning. Health is a state of complete mental, physical and social well-being not merely the absence of disease or infirmity. Therefore there are basically three components of health and while planning health care one should have to consider all these things. Health care planning can be disintegrated into two:
Health care services provided to individuals or community by agents of the health services or professionals for the purpose of promoting, maintaining and restoring health.
Planning – process of making decision in the present to bring about an outcome in the future. It involves determining appropriate goals and means to achieve them stating assumptions, developing premises and reviewing alternative course of action.
Health care Planning: making decisions and choosing alternative course of action in the present for effective and efficient health care services to be provided in the future. Health care planning is a fundamental management function which includes decision making and commitment. It is cyclic or continuous process. Health care planning basically consists of following elements:
What (resources)
How (to do)
Who (will do)
When (it should be done)
Characteristics of effective health care planning:
Flexibility
Tine table and sequence
Not too vague
Adaptability
Neither too idealistic nor too limited
Health care planning is a part of national Development Plan
Need of health care planning
Scenario in health care:
Limited health resources to meet unlimited health needs and demands
High wasteful expenditure
Quality is major consideration
Why health care planning?
To match the limited resources with many problems
To eliminate wasteful expenditure in health sector
To avoid duplication of work
To develop best course of action to accomplish predetermined objectives
1.1Planning Models
Planning models are those models that are used for doing planning for any of the works in advance for the future purpose. There are different types of planning models in management
1.1Planning model:
Planning models are the planning practice that is practiced by any organization for the planning purpose to fulfill their needs and demands for the fulfillment of the organizational goals and objectives through the optimum utilization or the available resources in an effective and efficient way.
Different planning models are used in a planning process by the organization. They are:
Comprehensive rationalism
Mixed scanning
Incrementalism
Comprehensive rationalism:
An explicit activity that attempts to determine how resources are used to further the specific goals of an organization. Common sense might suggest that any such decisions about the future required a sequence of broad logical steps such as those set which includes; what is the situation?, where do we want to go?, which possible alternatives are there for action?, which alternative is best?, take action. Such series of steps is often depicted as a continuous cycle. The first stage analyses the current position or problem to be solved. Next the aims (where we want to be) are decided. All the possible alternative courses of action are listed, and assessed as to their feasibility and capability to achieving the aims. Lastly, having decided on the most appropriate alternative, action is taken to implement it. The cycle then starts again with a reassessment or evaluation of the situation.
Mixed scanning:
The difficulties of operating such comprehensive system are recognized by proponents of mixed scanning. Here a deliberate decision is taken to narrow down the area of maneuverability by focusing planning attention on selected areas of interest. An early stage in the modified cycle involves determining the priority or problem areas for planning, and it is within these that the examination of options occurs. Mixed scanning is so called because it advocates a broad sweep or scan of the whole health sector, which then forms the basis for the more detailed examination of selected areas for planning action. Such an approach is less costly in terms of time and information resources. Its selection of priority areas for alternatives certainly reflects the reality of much planning. However, it raises a fundamental question: on what basis is such screening to occur?
Increamentalism:
The third approach to planning, incrementalism, recognizes the political nature of planning in a far more overt manner than either of the previous approaches. The term ‘political’ is used here in a wide sense, and , through inclusive of ideology and party politics, is by no means confined to these. It is used to cover analysis and action that recognizes the nature and effect of different interest groups in society, whether based on class, employment or business, area of residence, professional or trade union association, religion, ethnicity, gender, or any of the other variables which determine an individual’s values, loyalties, and actions.
Planning, as it is seen in this third approach, has been described as a process of ‘muddling through’ or as a series of ‘disjointed steps’ moving in an incremental manner towards the set goal, the degree of movement at any time being determined by the political context
1.2 Realistic Rational Planning:
It is perhaps more accurate to describe the realistic rational planning as a planning spiral, with the end-point of each cycle forming the start of the next cycle, but at a higher plane.
Situation Analysis:
The first step in such a process involves an assessment of the present situation. This is often referred to as a situation analysis. This analyses the present situation from various perspectives:
It examines the current and projected characteristics of the population including its demography
It looks at the physical and socio-economic characteristics of the area and its infrastructure
It analyses the policy and political environment including existing health policies
As essential part is the analysis of the health needs of the population
It would also look at the services provided both by the non-health sector and by the health sector itself. The latter would focus on facilities provided, their utilization and service gaps, together with organizational arrangements
The situation analysis would also examine the resources used in the provision of services and their current efficiency, effectiveness, equity and quality of services.
Priority setting:
The second stage of the planning spiral involves the determination of hierarchy of goals, objectives and targets of an organization- in other words, what it wants to achieve. This will be influenced by the situational analysis, especially the health needs, and by the broad policy objectives of the organization or state. Any realistic planning system must ensure that the priorities set are feasible within the social and political climate, and within the context of available resources. In practice this is likely to mean that within any one planning period only some problems are addressed. Clear criteria for the selection of these priority problems are needed. Such criteria should include political feasibility.
Option appraisal:
The third stage involves the generation and assessment (often called option appraisal) of the various options for achieving the set objectives and targets. For any target there may be a number of ways of achieving it. Although it is often worth while and productive at this stage to allow a wide variety of creative ideas to emerge, it is important that this set of option is quickly reduced, without too sophisticated analysis, to a reasonable shortlist. Such preliminary criteria are in practice often applied subconsciously.
Each of remaining options on the shortlist is looked at in turn, and is assessed in three ways:
The impact of each is examined to see its effects on the health target set.
The resources implications will ne examined, both to look at the efficiency with which each alternative could meet the targets (known as its cost-effectiveness) and to determine whether overall option can be afforded, given resource constraints.
The feasibility of each approach will be examined to see whether there are other barriers to its success.
Programming and budgeting:
The option appraisal stage will result in preferred option, which will then form part of the plan. This process will be carried out for each priority areas and its associated set of targets. The programming stage translates the results of the earlier decision into a series of programmes, each with a budget. The result of this is the plan document, which is a statement of intent concerning the activities over the plan period.
Implementation and Monitoring:
The penultimate stage involves the implementation of the plan, a neglected yet essential part of planning. This involves transforming the broad programmes into more specific timed and budgeted sets of task and activities, and involves the drawing up of a more operational plan or a work plan. This is the type of planning that we have described earlier as activity planning. An essential part of this process is the monitoring of the implementation of these activities.
Evaluation:
Lastly, a process of evaluation of the plan provides the basis for the next situational analysis, and hence afresh leads in to the planning spiral just described. Evaluation shares many of the characteristics of appraisal.
1.3 Public and Private Sector Planning:
The preceding sections described general approaches to allocative planning. The general principles and stages of planning outlined above are as valid for a private health-care provider as for a public sector provider. Planning for institutions within the private sector requires a similar combination of technical skills and political analysis. The parameters and values judgments which form the planning framework are however, bound to be different contents for their plans.
Comparison between the business and public sector planning
Private(Business) sector planning
Public sector planning
Determination of mission statement
Setting of goals
Analysis of strengths, weakness, opportunities, and threats (SWOT analysis) (including marketing)
Situation analysis (including needs assessment)
Determination of strategy
Option appraisal and monitoring
Operational plans
Operational plans
Implementation
Implementation
Feedback
Evaluation and monitoring
·The situational analysis needs to be far broader than that of a pure service provider, such as the private sector organization. It needs to look at the sector as a whole, rather than just at the ministry’s own activities and resources. It also needs to assess the broad causes of ill health, so as to allow the possibility for wider intersectoral strategies to be developed.
·The option appraisal must include the potential contribution that other sector can be encouraged or required to make to the state’s overall health goals. Thus options for health promotion must not be restricted to health service activities, but can include regulatory activity, legislation, and collaboration with other non-health agencies.
1.4 Level of planning:With in three groups of organizations – public, private-for-profit, and NGO – there are likely also to be different levels of planning within the organization. Although the principles and broad processes will be similar at each level, as one moves down to the lower levels plans will be more specific with the central plans providing the broad strategies envelope into which they are placed. Each level therefore needs to take account of plans being developed both in other organizations working at the same horizontal level and also plans of both higher and lower levels in the system the vertical dimension.
