Health policy and management

Chalie Tadie (BSC, MPH)

Department of Health system and Health policy

Institute of Public Health
College of Medicine and Health Sciences
University of Gondar

April , 2021
Gondar , Ethiopia

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 THE SQUARE WHEEL

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 Leadership
“I am more afraid of an
army of 100 sheep led
by a lion than an army
of 100 lions led by a
sheep” Talleyrand

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 Leadership

Leading is a continuous process of directing/ influencing

and motivating the work related activities of group
members towards accomplishment /achievement of
organizational objectives.
Leadership is a set of practices, behaviors and values
that enable work groups and organizations to face
challenges and achieve results. 

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 Dimensions of leadership

• Leadership is exercised with others.

• Leadership is responsibility, not rank, title, 

privilege, or money. 
• Leadership is about enabling people to face 

challenges.

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 Important Characteristics of Leadership
 Goal Oriented
 Sees the bigger picture, and understands the
purpose of life and work of the group or
organization. The leader has foresight and a
sense of direction.

 Enablement
 Effective leaders seek to enable others to
develop their potential to the fullest through
coaching, mentoring, etc.

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 Important Characteristics of Leadership cont…
 Concern
 Leaders need to know that human beings are
the most important resources they have.
 Leaders care about others.
 Human beings have needs and feelings, likes
and dislikes and they can think for
themselves.

 Self-development
Leaders also need to develop a healthy
self-image and a positive, “I can win attitude.”
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 Manager Vs Leader

• Sometimes used interchangeably.

• A person emerges as a leader.

• A manager is put in to his position by

appointment.
• If a manager cannot influence others he is not a
good leader; though he is a manager.
• There are good leaders who are not managers.
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Managers Leaders

 Cope with system complexity  Seeks change

 Plan and budget  Set direction and shared values
 Organize and direct the staff  Align people with the organization &
 Control and solve problem empower them
 Motivate people

 Administer  Innovate
 Reactive  Proactive
 Control  Inspire
 Ask how and when  Ask what and why
 Have subordinates  Have followers
 Avoid conflict  Use conflict
 Do things right  Do the right things

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 Approaches  to leadership

1. The trait approach(Theory):

• It was assumed that some people are set apart from others by
virtue of their possession of some quality or qualities of
‘greatness’ and that it is these people who become leaders.

• This approach to leadership suggests that it is personal

characteristics, or traits, that differentiate leaders from those
they lead.
• “Leaders
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are born but not Chalie
made” T.(BSc,MPH) 11
 2. The behavioral approach(Theory):

• The behavioral theory of leadership focuses on the

relationship between what a leader does and how their staff
react
– Emotionally (their levels of satisfaction with work) and
– Behaviorally (their job performance).
• “ Leaders are made but not just born”

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 3. The contingency approach:

• Leadership could vary with the situation or circumstances.

• Focuses on task requirements.

• No single trait has been shown to be common to all effective

leaders and no single style has been found to be effective in
improving staff performance in all situations.
• The management technique that best contributes to the
attainment of organizational goals might vary in different
types of situations or circumstances.
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 Leadership styles

 It is the typical pattern of behavior that a leader uses to influence

their employees to achieve organizational goals.
1. Autocratic Leaders:

• Make decisions and announce them.

• There is also a clear division between the leader and the

followers.
• “ Do just what I say” or “ Don’t touch the hot iron”.

• Subordinates carry out orders.

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 Styles of Leadership

2. Democratic /participative Leaders:
• Democratic leaders, also known as participative leaders, encourage group
members to participate.
• Democratic leaders keep staff informed about everything that affects
their work and share decision-making and problem-solving
responsibilities.
• Group members feel engaged in the process and thus are more motivated
and creative.  
• Permit subordinates to make decisions

• Ideas are bilaterally proposed

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“Let’s do together” Chalie T.(BSc,MPH) 15
 Democratic /participative Leaders…

• This style is most successful

– when used with highly skilled or experienced staff or
– when implementing operational changes or resolving
individual or group problems.
• This is a popular style because when it is done well it
creates a harmonious, productive and developing work
force.

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 Styles….
3. Laissez – faire Leaders: The leader provides little or no

direction and gives staff as much freedom as possible.

• All authority is given to the staff and they determine
goals, make decisions, and resolve problems on their
own.
• The laissez-faire leader promotes a strong sense of
competence and expertise in team members and allows
others to rise to their performance potential.
• This style can lack accountability for team failures.
• Leaders have little or no  confidence in their ability
• “Do as you like”
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 LEADERSHIP SKILLS
• Visioning skill/Strategic Planning
• Communication Skill
• Negotiation Skill
• Technical Skill
• Conceptual Skill
• Time Management Skill
• Team Development Skill
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 The Leadership/Managerial Grid

 Leaders may be concerned for the people and they

also must have some concern for the work to be

done.
 The question is, how much attention to pay to one or the
other?
 This is a well known grid that uses the Task vs. Person
preference that appears in many other studies.
 The Managerial Grid was the original name. It later
changed to the Leadership
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 High Country Club Team
Management
Management

Concern Middle of the

Medium
for Road
people Management

Low Impoverished Authority

Management
Compliance

Low Medium High

05/23/2021 Concern for Production
Chalie T.(BSc,MPH) (Task) 21
 Leadership use of power and authority

• Leaders influence people to do things through the use

of power and authority.

• Power is the ability to influence decisions and control

resources.

• Powerful people have the potential to exercise

influence, and they exercise it frequently.

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 Leadership use of power and authority…

• ‘Authority’ is the formal right to get people to

do things or the formal right to control
resources.

• Factors within a person, such as talent or

charm, help them achieve power.

• Only the organization can confer authority.

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 Types of leadership powers
Legitimate power
• It is a result of the position a person holds in the organization
hierarchy.
• It is the authentic right of a leader to make certain types of
requests.
• It is the easiest type of influence for most staff to accept.

• For example, virtually all employees accept the manager’s

authority to conduct a performance evaluation.

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 Coercive power

• It is a leader’s control over with punishments.

• Organizational punishments include assignment to

undesirable working hours, demotion, and firing.

• Effective leaders generally avoid heavy reliance on

coercive power because it creates resentment and
sometimes revenge.
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 Reward power

• It results in people doing what is asked because they

desire positive benefits or rewards.
– Exercising this power includes increasing the salary
and recommending employees for promotion.
– Wealth leads to considerable reward power; being an
extremely wealthy leader has become almost
synonymous with power.

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 Expert power

• It derives from a leader’s job-related knowledge

as perceived by group members.
– This type of power stems from having specialized
skills, knowledge, or talent.
– Expert power can be exercised even when a person
does not occupy a formal leadership position.

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 Referent power

• It refers to control based on loyalty to the leader and

the group members’ desire to please that person.
• Having referent power contributes to being perceived
as charismatic, but expert power also enhances
charisma.
• Part of the loyalty to the leader is based on
identification with the leader’s personal characteristics.

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 Activity
• Mr. X is a highly qualified and experienced clinician who
works as Chief OPD team in one health facility.
• His team of ten staff work in shifts.
• Mr. X performs annual reviews with each member of the
team and recommends bonus payments, promotion, demotion,
additional training, etc. as necessary.
• He has worked in this role for eight years and is liked and
respected both generally and within his team.
• What types of power Mr. X exert has ?
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 Comment

• Mr. X is a highly qualified and experienced doctor [expert

power]
• His team of ten staff work in shifts [legitimate power].
• Mr. X performs annual reviews with each member of the team
and recommends bonus payments, promotion, demotion,
additional training, etc. as necessary [reward power and
coercive power].
• He has worked in this role for eight years and is liked and
respected both generally and within his team [referent power].
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 Any questions?

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