That's depends of the main structure of the health care system, in the caribbean for example, the principle constraint for resources is the law, so, for this case following the literature the model of constraints will be explained by a social determinant in health

Thank you for answering Heriberto. It makes sense. I will go over the literature to find common constraints.

Follow this attachment, I think you will find your answers.

Usually main constraints are due to different level of commitment of multiple actors to project and their working habits. Strategic work with them and clarification of their needs and expectations with good plan should avoid problems with outputs on time, content and budget problems.

Multiple projects have multiple objectives, several stakeholders with their own expectations, often different time frames. All these will be competing for the same health system resources. Hence the major constraints are coordination, realignment to the health system goals and objectives and achieving efficiencies.

Thank you for sending source of information Mizanur. I appreciate that.

Thanks for answering Milena and Erasmus. You have provided me good insights.

I appreciate that.

The Five Steps of the Theory of Constraints management

1. Identify the System Constraint

The part of a system that constitutes its weakest link can be either physical or a policy.

2. Decide How to Exploit the Constraint

Goldratt instructs the change agent to obtain as much capability as possible from a constraining component, without undergoing expensive changes or upgrades.

An example is to reduce or eliminate the downtime of bottleneck operations.

3. Subordinate Everything Else

The non-constraint components of the system must be adjusted to a "setting" that will enable the constraint to operate at maximum effectiveness. Once this has been done, the overall system is evaluated to determine if the constraint has shifted to another component. If the constraint has been eliminated, the change agent jumps to step five.

4. Elevate the Constraint

"Elevating" the constraint refers to taking whatever action is necessary to eliminate the constraint. This step is only considered if steps two and three have not been successful. Major changes to the existing system are considered at this step.

5. Return to Step One, But Beware of "Inertia"

The constraints for managing multiple projects in healthcare system varies with refference -If you are a part of National health care system then you may face1. a system constraint I.e a policy.2.commitmentt of the providers  3. regularity in supplies or resources .

But you are a part of NGO/VO then your first constraint is of resources-money ,man &materials.here policy & commitment are of no issues.

overall in constraint management  we have to follow the planning cycle meticulously.-1.assigning priorities

2.assessment of resources

3.fixing priorities

4.writeup of formulated plan

5.programming & implementation

6.monitoring &evaluation.

I agree with the theory of constraints when this signfique that is underway a proper identification and priroizacion of the problems to be solved.With scarce resources is not possible to meet all the needs of the health systems, and performing many projects at the same time can also signify that resources are diluted and are not obtained good results in any of the lines of work.

Dear Denis, My answer is based on practical experience. Good Governance, Accountability, Transparency, Corruption free environment back by Strong IT Tools essential for Monitoring and Evaluation is required to manage multiple health programs. Usually the health system these days are good in Policy processes, evidence based high impact programs. Factors such as Outsourcing may also have an impact e.g. Outsourcing helps to distribute work to "ideal handlers" but lack of monitoring mechanisms or clear cut terms of references may worsen the situation. Do read this article published by Peyvand Khaleghian & Monica Das Gupta on Public Management and Essential Public Health Functions.

http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2004/04/21/000009486_20040421095725/Rendered/PDF/wps3220Publicmgt.pdf