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Sofia University, Sofia, Bulgaria: Creation of an on-line information system and improvement of the capacity of the administration, responsible for public health sector in the municipality of Radnevo, Bulgaria 
 

The project “Creation of an on-line information system and improvement of the capacity of the administration, responsible for public health sector in the municipality of Radnevo, Bulgaria” is focused on the management problems of the health care sector and the provision of funds for these activities at municipal level, as well as on the improvement of the interaction between the municipal administration and the management staff of the municipal hospital of Radnevo. The authors also have the ambitious aim to offer the results of this activity to serve as a base of new models for management at both municipal and national level.

Objectives of the project
The authors of the project have set the following main objectives:

1. The first objective of the project is to improve the interaction between the municipality and the managing body of the hospital, which will lead to improvement of the quality of the health care sector in the municipality as a whole.

2. The second objective is to improve the management skills of both the managing staff of the Municipal hospital – Radnevo and the municipal administration, responsible for the health care sector, so that they are able to cope with the new environment in which the health care sector in Bulgaria is managed and funded.

3. The third objective is to help the managing staff of the hospital and the municipal administration to work out alternative ways of funding the health care services provided by the Municipal hospital – Radnevo.

4. The fourth objective is to elaborate an on-line web based information system. The system has two main aims. First, it allows the individually specialists and participants in the process of managing the health care sector to exchange information, to directly contact each other, as well as representatives of educational institutions and NGOs involved, in resolving the problems of the health care sector. Second, after analyzing the data and the information gathered in this information system, the real needs and problems in the area of the health care sector could be suitably estimated and the use of the resources available could be optimized thus increasing the quality of the provided services. At a later stage, this system may serve as a base of a similar information system to be applied at national level.

5. The fifth main objective of the project is to place the fundamentals of along term collaboration among the Municipality of Radnevo, the Sofia University “St. Kliment Ohridski” and the non-governmental sector. The elaborated models of good practice of collaboration for solving similar problems of the health care sector management in a typical small municipality are applicable to other similar municipalities too and they can be also applied at national level. Based on this cooperation, particular case studies have to be developed in order to include them in the teaching program of the Public Administration Department. It is extremely useful for the future administrators to be familiar with real problems from the current practice of the Bulgarian municipalities. 
6. The sixth objective is to develop a multi annual strategy concerning the development of the public health sector in Radnevo municipality, as a result of the whole research and training activity under this project. This strategy include concrete steps and decisions for the specific needs of the local population in the area of the health care sector and it shall be a part of the annual budget of the Municipality. A long-term vision for the development of the health care system in the Municipality of Radnevo shall be developed in the strategy by focusing on two major aims: improvement of the services of the municipal hospital and development of a system for attracting highly qualified doctors and specialists in administration by developing systems for HR motivation.

Project implementation

 

Report on the activities

First stage

      The first stage of the project implementation is related to the identification of the problems.

      In order to identify the problems, the workshop: “Identification of the problems and management approaches for solving them” was held from 11th till 16th of April 2005.  Professor Tatiana Braikova led it.  Specialists from the individual practice – primary medical assistance, school doctors, and representatives of Zagora Cultural Centre took part in it. As a result of the discussions conducted and analysis of the empirical data about the status of the public health services in the municipality, which were gathered in advance, there were identified the major problems of the sector. The experts from the three organizations involved in the project traced out the main approaches for overcoming the outlined difficulties. Also, a working group of experts prepared a model of the information system that included the subjects, the data and the ways it may be accessed.

      Within the frames of the workshop „Identification of the problems and management approaches for solving them” professor Tatiana Braikova presented to the participants some new methods and approaches for estimation of the public policies including the health care sector, and some innovation steps to solve problems in management. 

Before the beginning of the workshop „Identification of problems and management approaches for solving them”, the specialists from the Public administration Department of the Sofia University elaborated tools for subjective estimation of the results from the training programs achieved – a closed ended questionnaire. The results from the data gathered show an undeniably high estimation of the quality of teaching given by the trained ones.

The effective work of the information system began in the end of April, too. The specialists of Zagora Cultural Centre have developed it. All matters of the workshop „Identification of problems and management approaches for solving them”, as well as the analyses of the information gathered, were immediately published on the web: http://radnevo.consult.bg. It makes them easily accessible for both the specialists who took part in the project and everyone interested in these matters. All the participants in the project received their user passwords which enable them to exchange information – either available to all the visitors of the site, or information of a more limited access.

In the beginning of May, there was published an article in the “Policies” magazine. It introduced to a larger public at a national level the major objectives and the received and expected project results. This is an extremely important precondition for implementing the most ambitious objective of the project authors– to make the good results a base for applying similar practices at a national level.

Based on the data summarized until that moment, case studies were developed and they have become a part of the teaching in a number of disciplines at the Public administration Department: “Analysis of the public policies”, “Management of the social programs”, “Leadership”, “Local authority and self-government” and others.

The experts from Radnevo Municipality, from Zagora Cultural Centre, from the Municipal hospital – Radnevo and from the Public Administration Department participated in discussions, seminars and focus groups aimed at elaborating the first part of the multi annual strategy for development of the public health care sector in Radnevo municipality which accentuates on the defining of models for better management and development of the Municipal hospital.

Second stage

The second workshop – “Resource assurance of public health centers and possibilities for use of alternative resources” – led by professor Tatiana Braikova, was held from 9 to 14 May. The participants were from the Municipal hospital – Radnevo, specialists from the individual practice – primary medical assistance, school doctors, and representatives of the municipality and of the Zagora Cultural Centre.  The experts’ work was focused on the financial problems of the health care sector. The participants concentrated on the development of models for alternative funding of the individual kinds of health care services provided in Radnevo municipality. Professor Tatiana Braikova presented to them the most successful European practices in that area.

Another test for subjective estimation of the training was held and the results show good organization and quality of the training fulfilled. It also shows that, in trainings takes part new participants, who had not participated and had no interest to increase their qualification, before. This may be reported as a serious success from point of view of the objective posed to increase the institutional capacity for managing the health care sector in the municipality.

The positive practice to publish all materials and results of the project activities in the information system continued, too. Also, based on the gathered and analyzed information, new case studies were developed to enrich and to improve teaching at the Public administration Department.

Experts from Zagora Cultural Centre trained the representatives of the Municipal administration to work with the information system which allows them not only to use the system but to independently participate in the further building and improvement of the already working information system. 

Led by Professor Tatiana Braikova, special discussions and focus groups were held, aiming at the elaboration of the second part of the multi annual strategy for development of the public health care sector in Radnevo municipality, which focuses upon the problems related to the attraction of highly qualified specialists for the health care establishments in the municipality. The activities fulfilled up to that moment led, in the end of May, to the elaboration of a generalized preliminary reading of the strategy.   

 

Third stage

The final workshop – “Improvement of the competency of the administrative personnel of public health centers” took place from 30 May to 4 June. It was led by Albena Taneva, assistant professor. And again, there were participants from the Municipal hospital – Radnevo, specialists from the individual practice – primary medical assistance, school doctors, and representatives of the municipality and of the Zagora Cultural Centre. The analysis of the data from the next test for subjective estimation shows that the participants highly estimate both the extent to which the training replied to their needs and its quality.

The last case studies were elaborated, based on the information from that workshop. They are already a part of the individual course programs taught at the Public administration Department. In the end of June all case studies were gathered in an online collection and this collection is already a main handbook for the professors from the Public Administration Department and it is also at the disposal of any educational institution interested.

There were a focus group and a number of discussions held between 1 and 4 June related to the elaboration of a final version of the multi annual strategy for development of the public health care sector in Radnevo municipality. All of them were led by Professor Tatiana Braikova.  There were participants from the Municipal hospital – Radnevo, specialists from the individual practice – primary medical assistance, school doctors, and representatives of the municipality and of the Zagora Cultural Centre. After the careful analysis, the experts agreed on the final version of the strategy which was officially introduced at the attention of the municipal body. The strategy was examined by the municipal body. After having had highly evaluated the advantages of the program document, the deputy mayor agreed that it shall turn in an official document in shortest terms and that it shall stay at the base of the municipal activity in the public health care sector. This is the best possible estimation for the experts’ work, and it guarantees, at a larger extent, the quality improvement of the public health care services in Radnevo municipality.

All documentary, data and analyses which are result of the 5-months-long hard work of the experts from the separate organizations involved in the project were published within the frames of the information system built. This way they are available for anyone interested.

During the whole project duration, the concrete activities were widely spread by the local media. This brought to the publicity of the results among the main beneficent – the citizens of the Radnevo municipality.

 By summarizing the results from the activities achieved under the project, we may make the following conclusions about the extent to which the objectives were reached. The team work on achieving the individual tasks during the working process and the common participation in training programs put the bases of a higher level of coordination in the activity of the municipal and of the hospital administering. The accord attained on the main priorities and measures in the multi annual strategy of the health care sector in Radnevo municipality guarantees also the synchronization of the activities between the both institutions in order to reach the common objectives. The functioning of the information system ensures the common and direct contact between both administrations.

The qualification of the hospital and of the municipal administration as well as the development of new management skills and of the abilities to work as a team, are definitely improved after the three training programs achieved.

As a result of the common work of the experts from the Public administration Department, Zagora Cultural Centre, the Municipal hospital in Radnevo and Radnevo Municipality, a number of alternative mechanisms for additional provision of funds for the health care services was established.

The on-line web-based information system built, has already worked for nearly four months. As it was mentioned before, it helps the more efficient contacts among the participants in the project. This is very important with a view to keep the already successfully built partnership among the Municipality, the health care centers, the non-governmental sector and Sofia University, too.  It is the basic source of collecting information in two directions. First, the experts and the researchers can collect data both for estimating the future development of the public health care sector in the municipality and for their own researching and teaching work. The students in Public administration can also use the provided information in order to face real problems of the public sector administrating.

A sustainable model of cooperation among Sofia University “St. Kliment Ohridski”, the non-governmental sector and Radnevo Municipality was created and its advantages have already been exposed time and again.

The proper fact that the Municipality intends to adopt the strategy for the multi annual development of the health care sector in Radnevo municipality just elaborated and to make it its own official document and to turn it into real policy, is the highly estimation possible. A very important advantage of this document we should not miss is that it is a result of the common work of the specialists from the Public administration Department of Sofia University “St. Kliment Ohridski”, from Radnevo Municipality and from the Municipal hospital of Radnevo. And a policy based on the consensus and on the significant expert potential, shall be supported by the citizens and it could not be unsuccessful.

 

Benefit analyses

Main results from the project


1. On-line information system

The information system was created in the end of the third month of the project implementation. Training was held to learn using it and the representatives of all the main participants in the project received passwords to access the system.

The information system is created based on the open source and each participant, according to his access level, is able to present his own information in the system.

The web-based information system built within the frames of the project is a DB which is organized by following the natural logical order of the real objects under the so- called “parent-child relations” scheme which allows to penetrate in the deep of the objects without any restraints. The system allows to every user registered, after entering his personal ID and password, to access the data base and to be able to operate with its content – to enter data, to upload files, photos and multimedia content. Each user’s access level is regulated by the administrator of the system. The access is organized in 4 levels and, based on these four levels, there may be given individual access permission to every object/article. Reading, writing and operating permissions in respect of the individual user, of a group of users, of all registered users or of all unregistered users may be defined for each of these levels;

- First level – owner (creator of the object or of the article) ‘s level

- Second level – level of the user groups, it disposes of 9 sublevels with a view to the stronger resilience of the permissions;

- Third level – level of all users registered in the system regardless of their group belonging;

- Fourth level – level of all unregistered visitors of the site (they have no access to the tools allowing to edit and to ad new data).

Another advantage of the system is that it ensures:

- a possibility to create an unlimited number of users with individual passwords and with their personal space within the system;

- a possibility to create an unlimited number of groups;

- a possibility for each user to be a member of an unlimited number of groups;

- a possibility to set the terms  of validity for every object/article;

- forum, the comments of the forum can be sent by e-mail to the users subscribed to the concrete topic;

- subject mailing lists for the registered ones;

- forms for the easier and faster entering of standardized content;

- statistics about the visitors;

- 30-days-long backup of information;

The information system has extraordinary significance for stabilizing the municipal public health care sector. As a unique communicational system, it creates a new community among providers of services, users and public institutions. To use it would have an extremely favourable influence on the sector functioning as it creates circumstances for:

  • Identification of the existing problems;
  • Defining the expectations of the community;
  • Defining the estimation of the community.

To put into operation such an on-line information system shall strongly increase the capacity for solving the problems of the municipal public health care sector and the ability of the municipal administration to respond to the citizens’ needs of health care services.

Its use, however, depends on additional factors which were not controlled within the frames of the current project:

  • The access to the hard- and soft-ware. Up to the moment the information system can be used by the municipal administration, the municipal hospital and the municipal public health centre. However, it is not possible to include the citizens and the NGOs from the municipality yet.
  • The awareness of the specialists to participate into the information system. The participants in the project highly estimate the possibilities of the system but they still avoid taking part in it. The information system supposes the active participation – sharing and defending of the personal opinions - which depends on getting over many stereotypes and mostly over the mistrust that there is anything depending on the individual person regardless his role in the particular sector.

Regardless the existence of these risk factors, the information system created has a high potential and it could be spread both in other municipalities and sectors.

 

2. Health strategy

The health strategy was developed as one of the main products of the project. It has the following advantages:

·        The strategy was developed as a result of three focus groups which included representatives of all the participants in the municipal public health care sector. Thus, new problems of the sector were identified and feasible solutions were elaborated;

·         There were representatives of the municipal administration participating in the elaboration of the strategy and they estimated it as an important document with significance for the development of the municipal policy. It will be discussed by the Municipal council and it will become an official vision for development of the health care sector when searching opportunities for projects funding;

·        There are only a few municipalities which have working strategies for developing the public health care. As a result of the project implementation, and mostly of the multi annual strategy developed, Radnevo municipality has obtained strong advantages among the other municipalities by its ability to reply to the citizens’ needs and to effectively get along with the existing problems;

Although the municipal level has more likely some additional significance in the system of the public health care sector, the municipal administrations should have their individual strategies for the sector development. This is the needed condition in order to overcome the aloofness among the individual participants and to rally them for identifying and solving the problems. Besides, the process of creating a municipal strategy for developing the public health care sector gets over the widely spread opinion that the state has not called it a day and it turns the municipality into an effectively working level in the system of the public governance. These are the main benefits of the health strategy created within the project.

 

3. Increasing the participants’ capacity in the public health care

Representatives of the prevailing part of the participants in the health care sector attended the workshops and trainings within the project:

  • Municipal administration
  • Commission about education and health care at the Municipal council
  • The managing staff of the Municipal health care establishment
  • GPs
  • Nurses
  • The local departments of the State health and social services
  • NGOs
  • The local structures of the unions of the people of specific health care needs

Their needs were more practical than informative ones and they were mostly related to their principal inability to adapt to the changed environment in which the health care sector has to develop.

The project got along with several main shortages:

  • The lack of awareness that the public health care sector depends on every individual participant;
  • The lack of awareness that everyone should adapt its behavior to the circumstances of the environment by maximizing its own and/or the public benefits;
  • Insufficient ability to identify concrete problems which may be solved at municipal level with the funds and human capacity available;
  • Insufficient ability to search alternative ways to fund the health care sector;
  • Limited abilities to act together.

There was a considerable progress reached in developing the ability to identify problems and to find their effective solutions. In the beginning of the project the prevailing opinions included the following theses:

  • “The system of the public health care sector is not properly constructed”;
  • “There is lack of resources”;
  • “There is nothing that we can do”;
  • “The state did not complete its’ work” etc.

As a direct result from the workshops and trainings held within the project, the participants in the health care sector in Radnevo municipality started thinking on the firsthand problems which may be, at least partially, solved. They made a step toward changing their way of thinking by observing the public health care system as an environment they have to adapt to. By changing their approach, they managed to identify by themselves the major problems of the health care sector in the municipality and to formulate acceptable solutions to overcome them.

In the beginning of the trainings there was some mistrust between the hospital administration and the municipal representatives. Such a mistrust is institutionally determined – the health care establishment is, by law, a self running business entity, the municipal administration has responsibilities toward the health care and the Municipal council is the owner of the hospital. We cannot say that the project has got over the existing tension in the relations caused by the regulated allocation of functions, responsibilities and powers. A significant progress was made, however, to the establishment of partner relations in the municipality public health care sector.

 

4. Improvement of the teaching quality at the Public administration specialty of Sofia University “St. Kliment Ohridski”

The programs in “Design and manegmant fo social programs”, “Policy analyses”, “Local authority and self-government” and “Leadership skills” were enriched as a result of the project work. Based on the problems of Radnevo municipality, there were cases developed by the professors of the specialty and they were included in the teaching.

Though referring to a concrete situation, these cases may be considered as typical ones and they may be widely applied in the Public administration teaching. The cases are available online.

 

Correspondence between objectives and outcomes          

The results attained satisfy the project objectives at a great extent:

  1. The interrelation between the Municipality and the administration of the hospital was improved as a result of the common trainings and workshops. The representatives of the both institutions learned to identify the problems and to search solutions to overcome them together. Within the third cycle of workshop and training they developed their team-working and team-leading abilities.
    Reaching this objective does not have a long-term effect as the regulation and institutional bases of the problems in this interrelation are not left away. These problems are related to the general structure and functioning of the health care sector in Bulgaria. However, there is some capacity for effective interaction of the people currently working in the administration of the hospital and of the municipality in Radnevo.
    The improved interaction between the Municipality and the hospital administration was also reached as a result of the changed way of thinking of the people currently working at the respective institutional positions. Before the trainings held they had unrealistic expectations towards the others and they were tending to shift responsibility to each other. As a result from the project they learnt to distinguish and to share their responsibilities what is basic to the establishment of an effective partnership.
  2. The hospital administration capacity was improved as a consequence from their involvement and active participation in the workshops and trainings. The progress made is mostly related to the development of their abilities to identify problems and to solve them by realizable measures.
  3. There were established circumstances to ensure alternative funding sources by developing the capacity for working out projects and by making a sector network as a main precondition for their effective realization.
  4. The information system was developed and, at some conditions determined, it may turn into a significant factor to identifying needs and to finding solutions. It was effectively used at the elaboration of the multi annual strategy for development of the public health care sector in the municipality. The information system will be used when discussing the strategy.
    The information system will be supported for at least one year after the project end.
  5. A strong and efficient cooperation was set up between Sofia University and the non-governmental sector represented by Zagora Cultural Centre. As a result of their good partnership, there was developed a new common project which is going to be implemented.
  6. Up to the moment this report was written, the multi annual strategy developed within the project has not become an official document approved by the Municipal council yet. There is, however, a strong wish from part of the municipal administration to realize it. And, besides, the multi annual strategy is already used in developing some projects through which there will be searched alternative funding sources for the municipal public health care sector.

Correspondence between needs and outcomes

Due to the state of the public health car sector in Bulgaria and to the prevailing general estimation about the chaos it is in, the direct needs are at a lower level – they are related to more funds and more supply of medical services. The project is directed to another kind of needs, mostly related to the ineffective use of the resources, which are governance in the public health care system and, most of all, to the needs of the administration in the health care sector at a municipal level. The results from the project respond to:

  1. the need of increasing the competencies for working in the individual institutions from the health care sector;
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