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Washington, D.C.: 2010. 43 p. 

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As a contribution to the task of building and strengthening managerial capacity in health systems and services, improving the use of information and evidence for decision-making and action, PAHO provides the Productive Management Methodology for Health Services (PMMHS) and its support tools as an option for health services managers. The PMMHS is presented as an alternative that provides information for analyzing the relevance, efficiency and quality of healthcare provision, negotiation of management agreements (contracts) and costing and financing of health care services. [Please click here for the document]


...¨Management of health services that is aimed at obtaining efficiency with quality requires methodologies and tools that respond to the needs of managers in their mission to improve the health status of the populations they serve. These managers typically face the negative effects of segmented health systems and fragmentation in the health services on a daily basis.¨...

...¨Managers of health facilities and services face equally critical situations, while shortcomings in their managerial capacity affect efficiency, efficacy, and effectiveness of the services provided. Foremost among these shortcomings is the poor use of management information for decision making, the lack of critical competencies for information analysis, execution of  anticipatory or corrective action, performance evaluation, and change management in institutions that are in constant evolution, moulded and driven by external realities, as well as the new exigencies and challenges of a globalised society.¨...

...¨This state of things requires that the health services vision be re-oriented to new models of health services organization that respond to the problems generated by fragmentation,  and to models of care centered on people, with emphasis placed on health promotion and disease prevention based on Primary Health Care Strategies and which are pro-equity. These models should necessarily hold health services networks responsible for the health care of a defined population and providing integrated management of the most appropriate care while decentralizing the provision of services from the hospitals. Moreover, the health services network should be comprised of multidisciplinary teams, have mechanisms in place for quality assurance and continuous improvement, ensure community participation and promote self-care, all within an environment of shared responsibility with other sectors.¨...

...¨Achieving the objectives of transforming health systems and services will demand strengthening of managerial capacity at all levels and will require of the managers new management competencies and the use of methodologies and tools that aid efficient performance.¨...


What is thePMMHS?

...¨The Productive Management Methodology for Health Services is a management methodology developed by the Pan American Health Organization as a response to new approaches and emerging practices in the management of health services,  that aims to optimize the organization and management of health services as they transition to PHC-based health systems. It provides fundamental and essential elements of information to facilitate analysis of the pertinence, efficiency, and quality of the facility’s productivity, negotiation and control of management agreements, and for the creation of a new institutional culture oriented around appropriate cost reduction to optimize efficiency and maximized productivity.¨...

...¨In summary, the PMMHS is an analytical process for decision-making based on evidence that does not generate new information needs, but selectively correlates the existing information in order to offer a strategic vision for the management of health services. It constitutes a managerial methodology oriented to productivity and transparent accountability since it displays the reality of the institution or network under clear concepts of efficiency and quality of care. Its basic objective is accordingly, to support the health services manager in making informed decisions that leads to optimized productivity and rational use of resources, helping to improve access to, and quality of care.¨...


The implementation of the PMMHS and its tools in health care facilities contributes to the achievement of four basic institutional objectives:

►Efficiency with Quality: Optimal use of resources does not imply diminished quality in the delivery of health services. On the contrary, it is the basic objective required to enable improvement of health services to the population, especially in the public sector

►Appropriate Distribution of Resources: Efficient delivery of services is attained through appropriate use of resources while permitting the greatest utilization of the same and optimizing the investment in health to reach higher levels of coverage and clinical effectiveness.

►Continuous Improvement: When a certain level of organizational development is attained, sustainable management allows integration of the methodology’s components in an autonomous process in which the health services benefit from continuous improvement and achieved goals can continually be improved upon with application of improvement process and plans based on current information on the situation.

►Dissemination of Successful Practices: Sharing of information from lessons learned from experiences in the management of health services networks or the efficient use of resources in independent health facilities, through the establishment of communities of practice, facilitates comparison of results from similar institutions that have used the methodology successfully, and thus contributing to the dissemination of good practices.



Conceptual Framework and PAHO’s Strategic Mandates

1. Current Challenges to Health Systems And Services
a. Segmentation and Fragmentation
b. Management Challenges
2. PAHO’S Mandates


What Is The PMMHS?

1. Evolution

Structural Elements of PMMHS

1. Optimal Management
2. Processes
3. Tools
4. Objectives
5. Objectives in The Management Of Integrated Health Services Delivery Networks 

Functions of the PMMHS and Products of the PERC Tool

PMMHS: Basic Concepts

1. Who are the Health Managers?
2. Management Function
A. Productive Approach
B. Institutional Analysis

Key Concepts In PMMHS

1. Fundamental Elements of the PMMHS
2. Product
3. Production
4. Efficiency
5. Resources
6. Costs

Methodological Characteristics of the PMMHS

1. Managerial Process Indicators

PMMHS and PAHO’s Technical Cooperation

1. The Scope of the PMMHS
2. Implementation of the PMMHS and its Tools
A. Conditioning Factors and Requirements for Success
B. Implementation Process
C. Getting Information on the PMMHS and Accessing PERC
D. The PERC Community





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