the Military Hospital of Antananarivo, Madagascar. Julien H

1

Making a difference Management of
the Military Hospital of Antananarivo, Madagascar
Julien Herizaka Nirina Hubert H. Humphrey Fellows
hip Program
Tulane University New Orleans
2
PRESENTATION PLAN

• The Country and the People
• The Health Structure
• The Management of the Military Hospital,
  Antananarivo (problems and solutions)

3
LOCATION The Red Island
4
LOCATION
The Big Island
5
MADAGASCARUnity in Diversity
People, language Malagasy (unique)
adj. Madagascan Population 18 millions (es
t. 2007) Migration V-VII century (Asia, Pacifi
c) Density 27 inhabitants/km 18 tribes/1 e
thnic group Common culture based on Famadihan
a, Circumcision, Monotheism Size of Texas 4th
world largest island Capital city Antananarivo (
1.2) Highlands (1,500 m altitude) Tropical humid
climate 5 to 7 annual cyclones
6
FAUNA FLORASanctuary of the nature

• The "alternate world" or a "world apart" of
  endemics
  
• 900 species of orchids
• 35 species of lemurs
• 32 species of chameleons
• 202/265 species of birds
• 6/8 species of baobabs
• 165/175 palm trees
• 80 of flora and 95 of reptiles are endemic

7
MADAGASCAR History
.Independent and organized Kingdom
.1881 Opening of the 1st Medical School
.1891 Inauguration of the 1st Hospital
.1896 French colonization .1947 Popular indepen
dence movement (100,000 died) .1960 Independenc
e .1975-1989 Socialist system, malagasization .
till 1991 ultraliberal political system
Ranavalona III
Trano Fitsaboana Isoavinandriana
8
Politics
Presidential system National Assembly, Senate Co
urts  Religion Christians (52), M
uslims (7), Indigenous beliefs Freedom o
f speech 120 political parties (250 radios, 1
2 dailies, 25 TVs) UN, AU, SADC, COMESA, COI
WTO, AGOA, MCA (1st)
Marc Ravalomanana
9
INDEXES

• Pop Growth Rate 2.6 (2007)
• LE birth 56
• IMR 57/1000
• Prim. School Enrol. 92
• Education index 66
• Adult Literacy Rate 70.7
• GDP growth rate 4.9
• Currency Ariary
• (1Ar1,800, floating)
• Inflation rate 12 (2007)
• GDP (PPP) 857/capita,
• FDI (net inflow) 6.1 GDP
• HDI 0.503 (153/177)
• Corrupt. index 3.1 (85/163)

43.9
10
FREEDOM COMPARISON
11
HEALTH ORGANIZATION
12
RATIOS
BUDGET
13
DISEASES
14
MAIN HEALTH ISSUES
15
(No Transcript)
16
ORGANIZATIONAL CHART
Board 8 Ministry representatives 2 personnel rep
resentatives

Cecile Manorohanta
DIRECTOR GENERAL
Medical Committee
TECHNICAL DIRECTOR
ADM FINANCIAL DIRECTOR
Nurse in chief
Tech. Sces
Adm. Sces
17
MANAGEMENT
.State owned, .Tutelage Defense and Fina
nce ministries Budget investment projects
approval .Finance Budget autonomy Not ad
ministrative personnel .My responsibilities
HR, ITIS, Logistic, Public relations
18
ACTIVITIES
19
REVENUE - EXPENSES
20
BUDGETING PROCESSActivity evaluation

• A medical activity is identified by a Key-letter
  and Coefficient. Ex chest radiology,
  
• R 42
• medical indicator (activity, fixed)
• administrative indicator (price in Ar,
  modifiable)
  
• Cost price of Key-letter (R) x Coefficient
  (42)
  
• Activity sum of coefficients of same
  Key-letter
  
• Other Key-letters B, C, K, E, O,

21
RECORDED ACTIVITIES

• 135,000 days of hospitalization stratified by
  kind of rooms and accommodation (75 occupation)
  
• K 250,000 for surgery
• B 725,000 for bioassay
• R 650.000 for radiology screening
• C 180,000 for consultation

22
BUDGETING PROCESSRevenue Assessment
23
BUDGETING PROCESSExpenses Assessment
24
INVESTMENT BUDGET(supplementary)

• Own funds
• Public Private Part.
• Direct cooperation
• State subsidies
• Gifts
• ?Construction, acquisition,

25
DETECTED PROBLEMS

• Poverty of the country
• Lack of acquisition of new technologies
• Sustainability of projects

26
AND PROPOSED SOLUTIONS

• LT develop good governance and freedom of
  economy to increase FDI and GDP
  
• MT develop copayment system and investment in
  new technologies by banking and insurance
  systems
  
• ST develop Information System to sustain
  investment projects
  

27
Links and References

• Economy and Political Freedom www.heritage.org/res
  earch/features/index/country.cfm?idMadagascar
  
• International Corruption Perception Index
  www.infoplease.com/ipa/A0781359.html
  
• Indicators UNDP HDR 2006 http//hdr.undp.org/hdr20
  06/statistics/countries/country_fact_sheets/cty_fs
  _MDG.html
  
• Population studies www.mapsofworld.com/madagascar/
  information/population.html
  
• People http//countrystudies.us/madagascar/16.htm
  
  
• http//www.indexmundi.com/madagascar/infant_morta
  lity_rate.html
  
• World Bank data http//web.worldbank.org/WBSITE/EX
  TERNAL/COUNTRIES/AFRICAEXT/MADAGASCAREXTN/0,,menuP
  K356362pagePK141132piPK141107theSitePK35635
  2,00.html
• Positive causal relationship FDI-GDP
  http//www.wider.unu.edu/publications/rps/rps2005/
  rp2005-26.pdf
  
• Government of Madagascar www.madagascar.gov.mg
• Ministry of Health Madagascar www.sante.gov.mg
• Military Hospital of Antananarivohttp//takelaka.d
  ts.mg/cenhosoa/
  
• Tourism reference www.natureholidays.com
• My personal contacts herizakanirina_at_yahoo.fr
  (261)33.11.326.07, (261)20.22.286.07

28
Welcome to Madagascar
nothing but 5 star nature
Baobab Avenue, Morondava, west of Madagascar
Misaotra Tompoko!