Healthcare Models for LGBTI

The Lesbian, Gay, Bisexual, Transgender, and Intersex communities face unique challenges in accessing healthcare services. These challenges can be worse especially in developing countries that have deeply-rooted cultures and prejudice against LGBTI. This article explores the various approaches and Healthcare Models that may enhance health service provision to the LGBTI community.

Institution-Wide Training Model

Assuming that LGBTI persons live around major urban centers, this model proposes the

training of health care workers in selected facilities favored by the LGBTI community. In the coastal region of Kenya, for example, three out of 54 health care facilities offering ARVs could be selected, in consultation with the local LGBTI community, and facility-wide sensitivity and competence training provided on a periodic basis. The main challenges of this model are the high costs of facility-wide training sessions and the need to offer continuous re-training due to high staff turnover.

Syndromic Reference Model

In this model, which replicates the Comprehensive Care Centre (CCC) model used in government facilities, only a few clinicians and counselors in selected health facilities are sensitized and

trained in the health needs of LGBTI persons. Through the use of syndromic algorithms, other health workers can then transfer patients displaying certain symptoms such as genital sores or anal infection, to competent health workers. At the same time, it can be assumed that knowledge and awareness is passed on informally among peers in selected health facilities, creating a spill-over effect. While this model has the advantage of being less costly as it does not require institution-wide training, institutional and external transfers of LGBTI-competent health workers remains a challenge. It is also dependent on the dissemination of information about the procedure among the LGBTI community. 

Referral Stand-Alone Facility

This model proposes the establishment of health care desks within LGBTI community facilities where, on selected days, locum clinical officers examine, diagnose and refer patients to government health facilities for laboratory, pharmacy and other services. To reduce costs, clinic officers will be drawn from government facilities. Over time, this approach will also contribute to attitudinal change and the build-up of competence within such facilities. With the increased integration of LGBTI health services in public health facilities, stand-alone centers will eventually become abundant.

Insurance Model

This insurance-driven model aims to create incentives for private health care facilities to train their staff in LGBTI health needs in order to be considered as referral health centers for LGBTI insurance holders. While promoting sustainability and on-going innovations, this private-sector-driven model also requires profitability. Such systems could be explored through a public private partnership (PPP) pilot scheme.

Best-Practice Clinic Model

Under this model, which is used by the Fenway Institute, independent clinics are established to serve the particular health needs of LGBTI persons. These clinics can either be completely stand-alone, or they can function as specialized clinics within private hospitals, thus saving costs for shared services, such as laboratories and pharmacies. While such clinics are a good way to build much needed local competence in the area of LGBTI health services, there is also a risk that they may become stigmatized and therefore avoided by their target group. They are also cost intensive and highly localized. In order to extend their reach they must be replicated in various parts of the country. This has substantial implications in terms of cost. 

Responsibility Sharing Model

In this model, responsibility for diagnosing LGBTI-specific health problems is shared between health service providers and the LGBTI community. For this to be feasible, the government must

first carry out legal and policy reforms, so that LGBTI persons are protected from discrimination in health care settings and have mechanisms for redress. Under this proviso, it becomes the responsibility of the service provider to treat LGBTI patients without stigma or discrimination. The patient, for their part, must support the health worker by speaking openly about their sexual

history and providing, where possible, additional information that can assist the clinician’s diagnosis. For example, IEC material might include a brochure or card with simple algorithms. This

could be distributed among members of the LGBTI community, who could then present it to their doctor to assist their diagnosis.

Internet Referral Model

In this model, an internet portal is set up through which LGBTI patients can consult doctors anonymously. These doctors can then issue referral notes as needed for physical examination in

selected health facilities with LGBTI-sensitized and competent health workers. A major benefit of this model is that it is simple and cost-effective to set up in the short term and could serve as

an interim solution. It could be rolled out in collaboration with one of the medical schools and consequently also provide a learning opportunity for medical students.

Ethical Implications on Business Success

Healthcare is a business. Some organizations have developed successful business empires based on unethical practices, while others have had significant business milestones in relation to their ethical corporate culture. The way an organization aligns itself on ethical matters is likely to have an influence on the success or failure of the business. This post attempts to capture various cases for business success in relation to ethical and unethical practices by organizations .

Customers

Ethical organizations tend to treat their customers in a fair manner in terms of pricing and product quality. Ethical businesses offer the customer the right quality of product and at the right price in order to satisfy the needs of their customers. The satisfied customers develop a good attitude of the organization and its products.  This good perception of the company in terms of quality and pricing of items encourages the customers to build their loyalty to the organization and widens the market of the organization leading to a strategic success in business.

Unethical organizations sell low quality products at exorbitant prices in order to maximize revenues. In the short-run, these unethical organizations manage to exploit the markets and gain high revenues from deceiving the public about the quality of its products. However, there are dire long-term implications of this deception on the business success. The customers will reject the organization’s products and even sue the organization for compromising on their safety.

Cost of ethics

Maintenance of ethics in business comes with its own costs. These costs may include costs of auditing, supervision, training, intelligence systems, hiring the right people among other related costs. These costs may form a significant part of the organization’s expenditure and minimize the profits of ethical organizations. However, the strategic implication of spending on ethical behaviors is positive and facilitates success of the business.

An unethical business may be unwilling to spend on improving its ethical practices and instead, maximize its current profits. In the long-term, an unethical organization, spend more on saving its diminishing corporate image, defending itself in lawsuits, and ultimately losing its customers to other organizations. The overall effect is reduced success in business.

Averting competition

In this era of increasing competition in business, many organizations devise strategies that will enable them to overcome business rivalry. Ethical businesses engage in morally acceptable practices in order to beat competition. These ethical organizations believe that the use of fair means to beat competition is essential to maintain the market share and the good reputation among the customers. These fair practices may lead to failure in competition especially where there is stiff competition. In situations of failure, the organization can restructure its strategy and gain back its market share.

Unethical organizations engage in unfair practices in order to win over market segments. The unethical organizations may tarnish the brands of the competitors, and engage in corruption to use the authorities in frustrating the businesses of the competitors. The organizations are likely to gain a significant market share and succeed in business as compared to ethical businesses. However, when these secret adverse tactics become public, the unethical organization is likely to lose its customers’ trust and ultimately lose the customers themselves.

State support

Organizations that engage in ethical practices are likely to receive state recognition in their activities, which is a plus in improving customer confidence in the organization. The state may invest in such ethical organizations and offer the organization privileges based on its contribution to societal welfare. This support by the state is fundamental to facilitate the success of the business.

Organizations that carry out unethical practices are subject to frequent government interference and investigations. These businesses are likely to fail since the government interruptions affect business operations and send an adverse message of trust to customers.

In conclusion, ethical businesses tend to have better chances of success in comparison to unethical businesses. 

Devolution Issues in Healthcare

The realization of the new constitution had been the dream of every Kenyan in the progress towards reforms and reconstruction of the public sector. One of the proposed restructures was the devolution of various government functions from the central government to the county governments. Health was one of the central government functions that were proposed for devolution. Technically, the move to devolve health functions was welcome, since it is a way of enhancing access to health care services to Kenyans. This move was also aimed to reduce inefficiencies that accompany centralization of services.

Right move or not

The much-anticipated benefits of devolution of healthcare to the counties seem to be a mirage. Devolution of healthcare has shown declining performance of the health systems, bringing in questions on whether the country needed a devolved system or not. The public health sector has been faced with numerous human resource unrests that have led to many deaths and disruptions in service delivery. Matters concerning unfair employee appraisal systems, poor working conditions, inconsistency in remuneration and benefits among other grievances, have triggered these strikes.

Structures for healthcare devolution

All these challenges point towards poor health management structures in counties. The counties lack adequate structures in management of human resources and health finances. These inefficient or non-existent structures have brought about delays and confusions in release of funds for health facilities and workers.

Capacity

Most counties lack health managers who have done health systems/services management. Most of the persons served in the previous centralized health system where they could maneuver around without the requisite skills, since they had fewer responsibilities. Now that healthcare has been devolved, they face greater responsibilities, which they may not handle due to inadequate skills in health services management.

What needs to be done?

Devolution of healthcare is a very beneficial aspect of service delivery, through enhancing access to care and increasing efficiency of health systems. However, these benefits are clearly not achievable since Kenya is inadequately prepared for this. Since this is an issue of law, a referendum is necessary to revert the functions back to the central government until counties are well equipped to handle the health functions. Counties also have to insist on recruitment of persons trained in health services/systems management to handle managerial responsibilities in healthcare.

Health Literacy on Healthcare Delivery

Health literacy is on the rise because of consumer empowerment initiatives aimed at creating awareness on healthcare options and services. These initiatives enable healthcare clients to have an understanding of how they can better their health status, and to have an upper hand in decision making on what services they receive. Increasing consumer empowerment on health issues has both positive and negative influences on healthcare delivery.

Improved population health

High health literacy has a long-term positive effect on the health status of the population. The people will be able to live desirable lifestyles that promote health and make proper use of available prophylactic measures. This reduces the morbidity of various health conditions, thus providing better health outcomes for health services delivered.

Reduced healthcare costs

An improvement in the health of the population results in reduced expenditure on healthcare services. The number of healthcare priorities will reduce and thus lower healthcare costs. 

Increased effectiveness of care

Proper treatment accompanied by proper management of a condition by a client, is likely to result to recovery or improvement of the health status of the client. Achievement of this is possible with a health literate client on the condition under care. Health illiteracy usually leads to mismanagement of health conditions by clients, making the conditions worse or recurring. With the increasing number of drug resistant infections, effectiveness of treatment is a very crucial element in healthcare delivery.

Quality of care

Client empowerment on health issues is very important in ensuring provision of quality healthcare services. With health literacy, clients have an understanding of what services they need and at what standards. This makes providers to strive to provide quality services.

Litigation issues

Client empowerment is making healthcare delivery more challenging when it comes to issues like patient autonomy and other ethical issues. There is increasing cases of litigation on healthcare providers on various aspects of care especially touching on healthcare ethics. These issues bring in a conflict of interest on whether to provide care at the interest of the client, at the interest of the public, or at the interest of the professional requirements.

Self medication

Health literacy has given some people the perception that they can handle several conditions on their own without consulting a physician. This attitude is increasing the cases of self medication which may result to negative outcomes as will be discussed here soon.

Health literacy is generally important in the generation of desirable healthcare outcomes. There is need for investment in health literacy for better long-term population health status, reduced healthcare costs, increased effectiveness, and quality of healthcare.

Healthcare Investments for Sustainability of Care

Rising healthcare costs are increasingly becoming a threat to the sustainability of healthcare. Many organizations have been passing the healthcare costs to the consumers, thereby increasing disparities in financial access to care. There is need for healthcare organizations and hospitals to find ways to finance their services without creating undesirable social effects on the access to care. Healthcare organizations can achieve this by making investment decisions that generate additional funds for sustaining healthcare services.

Aging population

With the increasing population of the aged, this population segment can offer opportunities for investment on their unique needs. This population segment needs more rehabilitative care. Health organizations can invest in nursing centers for the aged, providing a comprehensive range of services for the aged.

Cosmetic health services

Cosmetic health services have been facing a rising demand in the recent times. Reconstructive surgeries, dental formula restructuring, and other cosmetic services can be a good source of income for investors in healthcare. Health organizations can take advantage of these social needs, and invest in these to provide finance for core health services.

Funeral homes

Changing population needs and innovations can see funeral homes generating very good revenue for health organizations. This is an investment with a huge potential and many opportunities. An in-depth analysis of this investment option will be posted here soon.

Personalized medicine

Personalized care and home-care services are investment opportunities worth keen consideration. The provision of these services is done at premium rates. The Health Services Manager has to ensure a balance in provision of these services in order to offer core services without human resource constraints.

Technological innovations

Investment in technology has a positive influence on cost reduction. Although initial investment cost is usually high, the long run cost effect is desirable. These savings from application of advanced technologies can be reinvested back in sustaining healthcare services.

Sustainability of care is important. Achievement of this is possible in application of innovative healthcare related investment options without relying on donor or government funding. 

Occupational Health Hazards Facing Mortuary Attendants

Mortuary attendants play a crucial role in the health system, though they are in most cases put at the periphery in human resource matters. Their role in preparation of cadavers is very important in ensuring the safe disposal of human remains and helping the bereaved to send off their loved ones in an honorable way. Health Systems Mangers need to ensure fairness in treatment of all health workforce. Mortuary attendants have been overlooked in many policy issues and in resource allocation, which actually demotivates them. Researchers on occupational health and safety in hospitals have been keen to focus on the clinical staff, with very few reaching out to the morticians. The few who have done research on the occupational health of mortuary attendants, have put more emphasis on the exposures to biological hazards without consideration of other many hazards mortuary attendants are to face.

Needle pricks, cuts, and lacerations

Mortuary workers usually use needles and surgical blades in the process of embalming. These tools may result to pricks and cuts if not well handled. Proper training of the mortuary attendant especially in the developing countries is unsatisfactory, because of the poor perception of this job. Since most of these workers have no formal training, they are at a higher risk of handling these tools improperly, leading to injuries.

Formalin

Formalin is the main preservative used in most mortuaries. This liquid is highly volatile and therefore, most mortuaries have formalin vapor in the air. Poorly ventilated mortuaries, and use of high concentrations of formalin, results in more formalin concentration in the air. Inhalation of formalin has negative health effects on the nervous, reproductive, and circulatory/breathing systems. Formalin also has an irritating effect on the eyes and nasal membranes.

Musculo-skeletal conditions

Mortuary work usually involves movement of bodies from one place to another, sometimes involving movement in different heights. Most morgues have inadequate equipment to aid the attendants in moving these bodies. The mortuary attendants end up with back, neck, or arm pains because of moving these bodies. This can be made worse when the movements are done under wrong postures.

Spillage of body fluids

Cadavers usually come in different conditions, some with various leaking fluids. As the mortuary attendants work on these bodies, they face the risk of getting in contact with these fluids and that may contain disease-causing microorganisms. These fluids may lead to slips and falls if they spill on the floor and the floor is not cleaned to dry. Other hazards include psychological stress as a result of interaction with the bereaved, noise, electrical hazards, and ergonomic hazards.

Recommendations

Mortuary attendants of most mortuaries are faced with various occupational hazards, and there are inadequate preventive measures in place. The public mortuaries should institute surveillance systems for occupational risks and hazards. Mortuary attendants should be provided with safety devices of appropriate quality and quantity, and training on their safety. Managers should adequately supervise the work in the morgues, develop safety procedures, and adequately communicate such procedures to the mortuary attendants.

Proper Management Practices for Drugs and Other Health Commodities

Drugs, vaccines, and non-pharmaceutical commodities form a large percentage of most health organization's budgets, in most cases going up to half of the proposed annual expenditure. These costs usually go higher due to inadequate management practices of these commodities, leading to wastage. Wastage may result from poor handling of the health commodities, improper storage, improper usage, and fraudulent practices within the organization.

Quantification

The estimation of the annual demand for the commodities is the first point that determines the cost to be incurred. A careful analysis of the previous consumption data and morbidity patterns is important in developing estimates that are more accurate. Under or over estimation have their associated costs.

Procurement

In procuring these commodities, proper management starts with the proper choice of the supplier. There is a high tendency of selecting the lowest bidder in procurement, but this is not a sufficient basis of selection for a supplier. Other important variables to put into consideration are quality of product, reliability of a supplier, and volume of transactions the potential supplier can provide. Consideration of the offer price is key, but there also needs to be compliance checks on all the other variables since they affect the organization’s operations and costs.

Documentation

There needs to be adequate and accurate documentation of transactions.  These transactions include acquisition, acceptance, disposal, rejects, and dispensation of commodities. Proper documentation helps to avoid errors and fraudulent acts. The LPOs/LSOs, invoices, receipt notes, delivery notes, payments, CRIVs, bin cards, stock control ledgers, cash book, credit notes, debit notes, bank statements, and other records need to be reconciled to reflect the authenticity of the transactions done.

Transportation and delivery

Placement of orders is done well in advance, considering the lead-time and stock level. The ordered commodities need transportation under the right conditions with proper handling. Those that require cold chain maintenance need transport facilities that ensure maintenance of the cold chain. The delivered commodities are inspected in order to ensure they are in the right condition and quantity. The organization can return to the supplier, or accept damaged goods at a lower price depending on nature of the commodity under consideration. The relevant documents should accompany the goods on deliveries and returns.

Storage and dispensation

Right conditions are necessary in storage of health commodities based on their specific requirements on temperature, lighting, humidity, security, spacing among other conditions. This avoids further wastage because of damages, pilferage, and theft. The dispensation of commodities should consider demand of the user department. Application of the appropriate stocking system is also crucial in dispensation to avoid wastage as a result of expiries. The most commonly advocated stock management system is FIFO (First In First Out), although there also has been recent ideologies on FEFO (First to Expire First Out).

Careful consideration of these practices ensures cost saving strategies have been put in place to minimize wastage.

Preventive Health Taken Too Far

A proposal by some civil society groups to cub teenage pregnancy cases in Kenya spiraled into a national debate on the role of some preventive health initiatives on the societal well-being. The groups were proposing the distribution of contraceptives to school going children/teenagers in order to minimize the rising cases of early pregnancies. This proposal has led stakeholders in the health sector to assess the overall impact of some preventive health interventions and re-assessment of health priorities.

Behavioral characteristics of teenagers

Teenagers are in a stage of development characterized by curiosity and this can be destructive especially under peer pressure. These young people are in the process of discovering their bodies and yearn to be ‘adults’. Ease of access and approval by the government will ‘open’ the minds of those children who had no idea of these things, thereby developing interest among all the children. Gone will be the days when our children will be playing football, the focus will be more on the consumption of contraceptives. One can only imagine how peer pressure can accelerate consumption rates. Why should they expire anyway?

Health priorities

There is need for a review of our health priorities. A program on distribution of contraceptives among school going children will require sustainability since it cannot be a one-time intervention. Alternatively, many school going children from poor families lack sanitary towels and therefore end up using homemade materials that may be unhygienic and uncomfortable. This goes a long way to affect the health and education of the girl child. A program for distribution of sanitary towels also requires long-term sustainability, but it will be addressing a higher priority public health condition as compared to distribution of contraceptives.

Gap between knowledge and practice

Availability of the contraceptives is one thing; their proper usage is the other thing. Some crucial stakeholders (especially the teaching fraternity), are against this intervention. These people would have played the role of teaching the children on how to use these contraceptives properly. The resistance shown by the teachers will put the children at greater risk since these contraceptives will be experimental use. There was inadequate involvement of stakeholders in coming up with the proposal.

Reality of the modern society

Although most people are faulting the proposal, some practitioners defend the proposal as the best way to deal with the reality that children become sexually active at a lower age than before and therefore, there is need for their protection in their adventures. Unavailability of these prophylactic devices may expose them to obvious risks, and this justifies the need to avoid taking chances, by providing the contraceptives to the children.

Innovative Marketing of Health Services for Public Facilities

There has been growing demand for healthcare services in the recent past, and this has contributed to a growth in investments in the health sector. Healthcare services are increasingly being commercialized than it was the case some time back, and therefore an element of competition is becoming a reality in the health sector, just like in the general corporate world. Therefore, every health institution is striving to stand out in the provision of its services in order to maintain and grow its market segments. Public health institutions in Kenya and most other countries lack incentive to market the various services they offer. This can be attributed to their nature of operation as not-for-profit, as influenced by government policies to ensure affordable healthcare to its citizens. The hospitals therefore in most cases have insufficient funds not only to sustain their services, but also to market their services to the level of their private peers. Although successful marketing in any sector comes with a high financial cost, the element of cost is not a hindrance especially in marketing of health services. Public health institutions can still go ahead and compete effectively in the health sector by employing the following strategies at minimal or no cost;

Quality care

This may be seen as an obvious strategy, but public health facilities need to make quality of care and satisfaction of their clients a number one priority since this is really what drives their clients away. Quality is the most valued attribute in the health sector, and therefore it’s an area that needs careful consideration. Quality issues range from the effectiveness of treatment provided (the patient’s role being constant), suitability of materials used, client waiting time, courtesy, adherence to SOPs (Standard Operating Procedures) and the general ambiance of the institution. The institution can set up an active and functional committee to check on quality issues.

Point of convergence for corporate social responsibility

Public facilities play a crucial role in the lives of people in their respective catchment areas due to the high poverty levels especially in third world countries. Therefore, these facilities have a great influence on the local population. The facilities can take this as an advantage in reaching out to the population through other organizations and still gain an edge in marketing. The facilities can achieve this by seeking to carry out joint community health related projects with multinational companies (e.g. Coca-Cola) or other leading national companies. In most cases, the companies will be willing to provide all the resources for the outreach, while the hospital can provide expertise, site space and access to the population. As the company seeks to market its activities and products to the local population and beyond, the public hospital will also gain limelight as a contributor/partner to the success of the outreach. These outreaches may combine the efforts of several organizations, or they may be bilateral between the hospital and a company depending on the practicality, economic viability and willingness of the companies involved.

Specialization while ensuring diversification

Successful companies like Samsung, initially had specialized in making cell phones and was ranked lower than Nokia. On diversification to other household electronics (like televisions, refrigerators etc.), Samsung gained higher ranks than Nokia and became a market leader in 2012. There is need for health facilities in the public sector to identify their strengths in service delivery and put a keen focus on these in order to gain much authority in those categories, just the way Samsung focused initially on cellphones. On identification of this area of specialty (guided by feasibility of implementation and demand for the service), the hospital should also diversify its services to widen its market. For example, Mathari Level 5 Hospital has specialized in mental health which has made it gain popularity in Kenya and beyond, although it still offers other services like dental care and thus serving a wider market.

Collaborations with institutions of learning

Most hospitals miss out on the marketing opportunities that come along with collaborations with medical training schools. These collaborations are usually seen in an abstract manner without deeper insights on possible opportunities for marketing. Hospitals can gain a lot through joint researches with medical training institutions usually at no cost. In most cases, the hospitals usually provide access to the subjects but at the end of the day, the name of the hospital dominates the research work. Isn’t this marketing without a sweat that?

Publicity

In the year 2012, Webuye Level 4 Hospital was awarded as the best maternity services provider among all the public health facilities in Kenya. Hospitals should strive to seek positive publicity in various ways, outstanding performance being one of them. Public hospitals can also take part in celebrations like the World AIDS Day and do these in unique ways that elicit media/public admiration and interest.

In conclusion:

It is now quite clear that public health institutions need to be at par with the reality of commercialization of healthcare, and thereby strive to stand out against competition that is increasing with time. This calls for innovative marketing strategies since these institutions are faced with financial constraints.

Future Challenges for Health Systems Management

Healthcare/system management is one of the professional practices that are rapidly changing with time. This dynamic practice therefore has experienced various uncertainties and challenges with changing times in the past. Some of the future challenges healthcare managers are likely to face, are analyzed in the following sections.

Escalating healthcare costs

Health care management will be faced with the challenge of minimizing healthcare expenditure which has been brought about by the trend of rising health care costs annually (Walshe & Smith, 2011). Research has shown that, for example, in the year 2001, the United States of America (U.S.A) had 14.1% of its Gross Domestic Product (G.D.P.) committed to covering health care costs. Going by the upward trend, this expenditure had been predicted to rise to 17.7% of G.D.P.in the year 2012 and continued increase in the subsequent years. This poses a great challenge to healthcare management professionals on how to contain these rising costs and increase efficiency in health care delivery.

Social disparities/inequities in health

One of the goals in health care management is to increase the access to quality health care in a fair way. Health care management is faced with the challenge of enhancing fairness and access in healthcare provision, due to the rising pressure on the public to pay for the healthcare services as a cost containment measure. This has limited the financial access of the poor to quality health care services, thus creating disparities in health status on the basis of income/social status. These disparities are likely to increase in the future as long as the cost of care is still being passed on to the consumers.

New healthcare technologies

Development of new drugs and technologies has been instrumental in improving the health of the population, although, it has also had its share of challenges in the health care industry. Many of these new technologies are expensive and may receive partial insurance coverage (Geisler, Krabbendam, & Schuring, 2003). Insured persons are thus quite often required to cover the high costs of these new technologies and prescription drugs. As the number of new technologies increase with time, healthcare managers are likely to be faced in the future by a conflict of interest between the benefits of new technologies to the society, and the need to minimize coverage of such new technologies in a bid to reduce healthcare expenditure

Emergence and re-emergence of diseases

The increasing burden of disease is another challenge that is currently facing healthcare management and is likely to be worse in the future. This will put a lot of pressure on healthcare managers to continuously review their healthcare priorities for the population. Emerging and re-emerging of conditions is proving a challenge in relation to frequent diversion of attention and action, which is likely to negatively influence overall health outcomes. An initial focus on infectious diseases in the 1960s was diverted to an increased focus on non-communicable diseases in the 1990s. A rise of the number of drug-resistant bacterial infections has been experienced in the past, and the trend is set to continue in the future. Health care management is thus faced with an additional challenge of investing more in research under its already constrained budget.

Complex client-provider relationship

The increasing complexity of the relationship between patients/clients with providers of healthcare will present a great challenge in the future. This relationship has been shifting from patient-provider to customer-provider, where patients/clients are insisting on their choice of treatment/care, confidentiality of information and informed consent. This continued empowerment of clients on health matters may result in increased risks of litigation against providers. Health care management will therefore be faced with the challenge of enhancing ethical practices among its providers in order to minimize ligation costs, and enhance patient/client satisfaction.

In conclusion;

Health care management being a dynamic field, is likely to be faced with various challenges ranging from rising expenditure, increased disparities in access to care, introduction of new technologies, increased burden of disease, to developing complexities in patient-provider relationships. These challenges need careful strategic planning to achieve the desired health care outcomes in the future.