Abstract
Health sector reforms motivated by the need for efficiency, effectiveness and equity in the delivery of services have interested authorities in the planning competencies of managers, because planning sets the stage for the effective management of health systems. The huge public and private cost of oral health makes planning an important dimension for health authorities when considering the allocation of funds. Productivity in the oral health service sector is not often reported on, despite the cost involved in rendering oral health services. This study explores and describes the management planning experiences of oral health managers in the public sector in Lesotho, Africa, which consists of clinics in 10 districts serving hundreds of rural and remote mountainous communities. The study used a qualitative research design. Of the purposive sample of 14 public sector dentists then available, seven dentists (2 female and 5 male) met the criteria for participation (> or = 1 year of experience in district oral health planning), and consented to and were available for participation. Data were collected by in-depth, one-on-one interviews with 6 participants, and textual data were collected from the seventh. Interviews were audiotaped and transcribed verbatim. Data were organised and analysed using the Tesch method, with themed topics coded and categorised by a researcher and an independent coder for analysis. One major theme emerged (the management planning of oral health services were experienced as inefficient) and four sub-themes: (1) the need to plan carefully to provide efficient clinical services; (2) constraints to promoting expansion of community based dental services; (3) a breakdown in communication hampered service delivery; and (4) internal and external stakeholder issues impacted strongly on management planning. The inefficiency (failure of the community to derive maximum curative, preventive and rehabilitative benefits from public expenditure on oral health in Lesotho), as described by participants, arose from factors that impair careful planning; constrained the expansion of community based oral health services; caused a breakdown in communication between dentists and their authorities leading to poor services delivery; and was impacted strongly by internal and external stakeholder issues.
Highlights
Health sector reforms motivated by the need for efficiency, effectiveness and equity in the delivery of services have interested authorities in the planning competencies of managers, because planning sets the stage for the effective management of health systems
This study focused on the planning of Lesotho oral health services, using the experiences of dentists in the public sector as the unit of analysis
The study was carried out using a qualitative research design implementing an exploratory, descriptive and contextual approach, with public sector dentists in Lesotho as the research population
Summary
Health sector reforms motivated by the need for efficiency, effectiveness and equity in the delivery of services have interested authorities in the planning competencies of managers, because planning sets the stage for the effective management of health systems. For the public sector, planning is considered a reasoning process about how an organisation will get where it wants to go[2] This position maintains that planning shapes the whole field of public administration, determining the limits of government responsibility, the allocation of resources, distribution of costs, division of labour and the extent of public controls. For public healthcare a hierarchical framework as proposed by Green[3], outlines broad-based objectives for the future of a health organization This framework incorporates the values the contextual government holds for the health of the population and the goals of the health sector, and encompasses available resources for health delivery and specific techniques for putting the plans into practice. These long-term objectives are translated into operational plans with detailed activities, responsibilities, budgets and timetables
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