Political Feasibility and Political Strategies for HRH Policy Reform

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• Political Feasibility and Political Strategies
  for HRH Policy Reform
• (Theory into Practice The Agra Experience)

Prof. Deoki Nandan, Doctor Honoris Causa-Odessa
State Medical University, MD, FAMS, FIAPSM,
FIPHA, FISCD Director (director_at_nihfw.org,
dnandan51_at_yahoo.com, www.nihfw.org)
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HOW TO DO IT?

• December 2003 took over as Principal and Chief
  of Hospital
• Pathetic state of hospital-wards, OPD, OT
• Demotivated staff- court cases, no promotional
  avenues, no recruitments
• Patient load minimal-most preferred the private
  sector
• Image of the institution was not good

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Biggest question was- how to garner political
commitment for enabling environment?
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Getting Political Support

• Went through the process of political analysis -
  identifying the decision makers and their
  concerns (vote bank, publicity, image)
• Got the emergency block inaugurated by the chief
  minister (this was under construction for the
  last twenty years!!) within five weeks after
  taking over as Chief of hospital.
• Regular visits of political personages, judges
  etc to the hospital/medical college on different
  occasions as chief guests.

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• Got good media coverage and also political
  presence (of different parties!!)
• Could get more funds committed for the hospital
• Let politicians take the credit

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Worked on establishing political support

• CRITICAL INCIDENT 1
• Accident of a large group (connected to a
  political heavyweight)
• Did not have blankets (in winter )and food
• Used blankets available with the hospital and
  made arrangements for food for the attendants of
  the patients (got the support of the other party
  too!)

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• Critical incident 2
• A patient from constituency of CM was admitted.
  Got a call from CM.
• Patient required pacemaker-which was not
  available in SNMC!

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• Immediately got the pacemaker arranged from the
  company and requested a private cardiac surgeon
  to come and insert pacemaker!
• THAT WAS IT!- started getting more patients from
  these places- not everybody required lot of extra
  resources! mainly attention
• Benefit to the organisation- was able to get the
  faith and ear of the political persons!

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Policy Cycle 1

• Signaling
• Situation analysis of manpower- technical,
  managerial and support
• Patient load- OPD, In patient, emergency
• Budget- sanctioned, available and utilization
• Drugs- availability and shortages
• Infrastructure and equipments
• Made presentations about the progress and the
  requirements of the organisation.

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• Formulation
• Number of medical teachers in UP was much less
  than required
• Recruitment of medical teachers was a big problem
• Held a series of meetings with faculty,
  associations, bureaucrats and political players
• Emphasized on the MCI requirements
• Identified the recruitment problem- 3 years
  senior residency was required for recruitment

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Policy Cycle 2

• Aggregation
• Reservations issues, court cases, teachers,
  community divided

• Media clippings of shortage of teachers in
  medical colleges
• Threat of derecognition by MCI
• Problems faced by community and lack of quality
• Political advocacy for doing away with this 3
  year clause
• Expected benefits and scenario projected
• Endorsement from associations and bureaucrats

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Policy Cycle 3

• Ratification
• Decision at the level of chief secretary,
  minister and chief minister

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Policy Cycle 4

• Implementation
• Discussion with bureaucrats- initial refusal as
  burden on exchequer and fear of other sectors
  demanding the same
• Discussed with political leaders- creating an
  environment of consensus
• Tried to get their commitment for their support!
• Got posts advertised made recruitment
• Resulted in change in service rules and better
  promotional avenues opened up

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Policy Cycle 5

• Feedback
• AGRA Experience - monitored
• Always did complete homework before presenting
  case to the political bosses- e.g. promotional
  avenues of the medical college teachers arrears
  of the last many years

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Tools for Strategies

• Create a change team
• Constituted a committee of external
  influential members to advise and oversee the
  work of the hospital. It increased their
  ownership and helped in getting decisions made
• Made medical faculty and staff more involved
  in the whole process.
• Kept good relations with bureaucrats and
  politicians

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TAKE HOME MESSAGE

• Be prepared
• Exploit opportunities
• Create opportunities
• Do your homework
• Be convincing
• Work at it!

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THANK YOU