Autonomy to the teaching hospita ls in light of MTI 2015 reform act; way forward

The objective behind any health reform should be better quality,efficiency and sustainability of health care. reform of the system is needed to achieve this. one important aspect of the reform is greater autonomy to the major teaching hospitals,including selected district hospitals. there should be a major effort to agree what is the intention behind autonomy and exactly what is expected to be passed to the control of the major hospitals in terms of autonomy for management decisions,financial procedures and performance,planning and development,human resource management and clinical performance1. the principle of decisions made at the lowest level practical should prevail. this means that autonomy and decentralization should also be passed down within hospitals to departmental levels2. needless to mention that success of any reform agenda to be implemented rests on the agreement and full backing of the majority of the stakeholders yy implementation of the new legislation may be badly managed and create resentment. yy regulations if badly framed may contain unexpected consequences or perverse incentives so there is reluctance to implement. yy people may be feeling insecure in regard to their tenure,their practice and insecure about how legislation is supposed to be understood. four cs are urgently needed. these are; yy commitment to the process from the highest levels; yy confidence among the board of governors (bog) members,managers and clinicians that they should be acting autonomously; yy competence in regard to management skills among managers and senior clinicians; and yy guiding compassion amongst all levels for the health and wellbeing of the people of the province that moves beyond lip-service,self-protection and greed. © 2016,postgraduate medical institute. all rights reserved.