Dr. Vung Tau, one of the six District Health Officers in the country of Burinam, had recently become interested in the Nurse’s Time Reporting (NTR) and Patient Visit Reporting (PVR) systems developed for the Health Services Division of the Ministry of Health. These new systems had been implemented in July 2003, and following the initial introduction and transition phase were working smoothly. The systems outputs were detailed and numerous; they provided a rather complete picture of patient demographics and selected health characteristics. However, from a management perspective, the system appeared less helpful. He wondered if it would be possible to augment the systems’ output such that managerially-useful information regarding both program and personnel performance could be obtained. He felt that this additional information would not only be useful for management at the district level but at the national level as well.

HISTORY OF THE ORGANIZATION

Burinam, located in Southeast Asia, had become an independent nation in 1985. Shortly thereafter, the Ministry of Health (MOH) had been reorganized, and its focus became communicable disease control and sanitation, combined with preventive maternal and child health care and limited curative care. During the late 1990s, its health activities evolved into personal public health services. The principal goals became health promotion and disease prevention, which would be accomplished via preventive health services. As a consequence, the Ministry expanded its scope from maternal and child health services and communicable disease control to preventive services for adults. Moreover, beyond traditional clinics and home visits, emphasis had been placed on health education.

As the mix of services diversified and expanded so did the Ministry’s infrastructure. In conjunction with an increase in foreign assistance in the early 1990s, there was a similar increase in the number of new program mangers and support staff at the central level. The need for greater standardization in the delivery of services at the local level fit nicely with the new programmatic efforts.

ORGANIZATIONAL DESIGN

The Ministry was one of twelve cabinet departments. Its six divisions—Health Services, Environment Services, Laboratory Services, Behavior Services, Health Planning and Development, and Administrative Services—are shown in Exhibit 1. The Health Services Division (HSD), the division in which Dr. Tau worked, was staffed by 520 employees, and was divided into two subareas: Administrative/ Regulation and Health Promotion/Disease Prevention.

The Office of Health Promotion/Disease Prevention (OHPDP) had the responsibility for delivery of personal pubic health services through a national network of 44 field health offices. Five bureaus were contained within OHPDP, each of which was headed by a Bureau Chief who was assisted by program managers; the programs provided support and guidance to the district and field health offices. In addition, the programs conducted a variety of activities that were independent of field operations. All five bureaus in the OHPDP were located in the capital and collectively were known as the “central office.” The health districts and field health offices, which were under the Field Operations Bureau, were known as the “field.” The Field . . .

Assignment

1. Assess the way that the budgeting and programming process works. How, if at all, would you change it?
2. Assess the existing reporting system and discuss what additional reports, if any, Dr. Tau should receive? Please be as specific as possible in accordance with the constraints discussed in the last paragraph of the case.