Unit One

Health Policy and

Management
for Medical students

By: Mebrate Degefu (BSc, MPH)

Email: [email protected]

Dec., 2024
30/12/24 L/col Mebrate D. Addis Ababa, Ethiopia1
 Health Policy and
Management..
Module Description
• This SPH module is designed to equip
medical students with the knowledge, skills
and attitude needed to lead and manage
health services and organizations.
Module Objective
• At the end of this module, medical
students will be able to apply principles
and methods of management and
leadership for effective and efficient
management of the Ethiopian healthcare
system.
30/12/24 L/col Mebrate D. 2
 CONCEPTS OF HEALTH

HEALTH
 Is widely used in public communication and
yet its meaning looks simple.
 Definitions:
 Lay point of view

Persons are healthy when they are doing their

activities with no apparent symptoms of disease
in them.

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 CONCEPTS OF HEALTH…
Professional

- Is defined as a measure of the state of the

physical bodily organs and the ability of

the body as a whole to function.

- Refer to freedom from medically defined

diseases.
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 CONCEPTS OF HEALTH…
Holistic Definitions:
WHO
 In 1948, in the Constitution.
 “A State of complete physical, mental, and social
well-being and not merely the absence of disease
or infirmity”.
 Having these health definitions, values,
conceptualization by different people/professionals,
is it easy to manage the health sector/service?

30/12/24 L/col Mebrate D. 5

 CONCEPTS OF HEALTH…

Health Care:
It is the total societal effort, undertaken
in the private and public sectors, focuses on
pursuing health.
Health Services:
are specific activities undertaken to
maintain or improve health or to prevent
decrements of health. These services can be:
preventive, acute/chronic, restorative,
palliative, etc.
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 CONCEPTS OF HEALTH…
H/Service Organizations:
 are entities that provide the organizational
structure within which the delivery of H/services
is made directly to consumers, whether the
purposes of the services is preventive, acute,
chronic, etc.

Health System:
 is defined as the sum total of all organizations,
people, resources and all activities whose primary
purpose is to promote health, to restore or maintain
health (WHO).
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 Scope of health service
management
• Assisted Living Administrator. ...
• Clinical Manager. ...
• Health Information Manager. ...
• Healthcare Compliance Manager. ...
• Healthcare Consultant. ...
• Healthcare Financial Manager. ...
• Healthcare Management Researcher. ...
• Hospital Administrator.
30/12/24 L/col Mebrate D. 8
 Public health
Public health is defined as the
science and art of preventing
diseases, prolonging life, promoting
health and efficiencies through
organized community effort.
It is concerned with the health of the
whole population and the prevention
of disease from which it suffers

30/12/24 L/col Mebrate D. 9

 Organizations and The Need for
Management

Organization
•Collections of people who work together and
coordinate their actions to achieve a wide variety of
goals
– Two or more people who work together in
a structured way to achieve a specific
goal or set of goals.
What does goal mean ?

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Goal : The purpose that organization strives
to achieve.

•Goals are the fundamental elements of an

organization. Why?

•Goal is the reason to exist and an

organization can not exist without a goal

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 What do all organizations need to achieve
goals?
To achieve goals all organizations
should
Have a method and
Have to acquire and allocate
resources
Thus the need for management.

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 What is Management?
• It is impossible to provide a single,
comprehensive , universally accepted
definition of management.
• Has been defined in ways that appear
different but with a strong underlying
similarity

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 Some common
definitions
 It is the process of reaching organizational goals by
working with and through people and other
organizational resources.

 Is a process of efficient utilization of available

resource to achieve organizational goals.
 Is the process of planning, organizing, staffing,
leading, and controlling efforts of organizational
members, and using all available organizational
resources to reach predetermined goals.
 The practice of consciously and continually
shaping organizations.
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 Common points in
Management
This definition incorporates several important
ideas.
•A process – a set of interactive and interrelated
ongoing functions and activities
•It involves accomplishing of organizational
objectives
•It involves achieving these objectives through people
and the use of other resources
•It occurs in formal organizational settings, where
a single, independent organization or a system of
organizations; or organizations invariably exist in the
context of larger external environment.
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 Rational for Learning
Management

• Management is universal and essential function in

all organizations.

• Proper health planning and health services

management skill is an important tool to bring
about change in the health care system.

• Resources are scarce urging the need for proper

skills in planning and management for efficient
utilization.

• Difficulty to address all health problems at a time

demands prioritize problems.
 Characteristics of
Management

 Universal : It applies every where

 Continuous process: Carried out through

out the budget year.
 Dynamic: Changes from one form to
another
 Pervasive: practiced in every organization
 What is manager?
• A manager is a person who plans, organizes,
leads and controls human, financial, and
other resources to meet organizational goals.

• who coordinates and oversees the work of

other people so that organizational goals can
be accomplished.

• A manager’s job is not about personal

achievement-it’s about helping others
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 Efficiency Vs
Effectiveness
Efficiency (Doing things right)

The ability to minimize the use of resources in

achieving organizational objectives.

Is about reaching ends by only the necessary

means or by the least wasteful use of resources.
 Effectiveness (“ Doing the right
thing”).

 The degree to which a stated objective is

being or has been achieved.

 Doing the right things in the right way at the

right times
 Efficiency and Effectiveness in
Management

Efficiency (Means) Effectiveness (Ends)

Resource Goal
Usage Attainment
Low Waste High Attainment

Management Strives for:

Low Resource Waste (high efficiency)
High Goal Attainment (high effectiveness)

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 Types of Managers
• Classification by level in the hierarchy
• Generally managers are categorized into three
levels.

Top
Top
Managers
Managers
Middle Managers
Middle Managers
First-Line Managers
First-Line Managers
Nonmanagerial Employees
Nonmanagerial Employees

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 1. First-line (first/ low level),Supervisory
managers
 Responsible for the work of operating staff and do not
supervise other managers.

 Direct non management employees and have authority

and responsibility for overseeing a specific type of work
and a particular group of workers.

 Lowest level of managers in the organizational hierarchy.

 They report to middle managers

 E.g. team leaders and team facilitators who oversees the

work
30/12/24
of non-management people
L/col Mebrate D. 23
 2. Middle level managers
 Managers in the midrange of the organizational
hierarchy.

 They are responsible for other managers and sometimes

for some operating employees.

 They report to more senior managers.

 Responsible for managing the performance of a particular

org’nal unit and for implementing top managers’
strategic plans.

30/12/24
example, director of human resources
L/col Mebrate D. 24
 3.Top / Senior
managers
 Mangers responsible for the overall
management of the organization.
 They establish operating policies and guide
the organization’s interaction with its
environment.
 Small in number

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Different names of manager :
 Executive Administrator
 Leader, Boss, Principal
 Chief, Supervisor, Senior Manager
 Superintendent, Commissioner
 Overseer, Officer, Coach
 President, Executive, Prime Minister etc.

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• The primary differentiation between levels
of managers is :
The degree of authority
 Scope of responsibility and
 Organizational activity.

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 Common Attributes to all managers
regardless of their title and level

• Formally appointed to positions of authority by the

organization.
• Directing work efforts of other subordinates.

• Responsible for utilization of organizational resources.

• Accountable to superiors for work results.

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 Classification based on scope of activities

 Functional Manager: Responsible for one

organizational functional area/activity e.g.
finance

 General Manager: Responsible for all

functional activities e.g. a company

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 Managerial Skills

• Are competencies a manager holds to undertake the

roles effectively.
• A manager should posses Three major skills for
successful management

1. Technical Skill

2. Human Relation Skill

3. Conceptual Skill

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 Managerial Skills…
1.Technical Skill

• The ability to use procedures, techniques and

knowledge of a specialized field.

• using specialized knowledge and expertise in

executing work related techniques and procedures.

• Such skills can be acquired through training,

education and work experience

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 Managerial Skills…
2.Human skill
 The ability to work with, understand and
motivate other people as individuals.

 The ability to understand, alter, lead, and

control the behavior of other individuals and
groups.

 Builds cooperation among the team.

30/12/24 L/col Mebrate D. 32

 Managerial Skills…
3. Conceptual skill
• Ability to see the organization as a whole.
• A manager with this skill has the ability or
better understand how various functions of
the organization complement one another.
• The relationship of the organization to its
environment.
• How changes in one part of the
organization affects the rest of the
organization.
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 Managerial Skills…
Which skill is equally needed by all managers?
Answer: Human skill
•Because the common denominator are people at all
levels,
•an inability to work with people, not a lack of
technical skills, is the main reason some managers fail
to reach their full potential.
A manager with human skill:
•Knows weaknesses and strengths,
•Knows how feelings harm others.
NB- Do not make wrong judgments about people
without studying contents of information.
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 Management Level and
skills

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 Managerial Roles
•Managerial roles refers to specific actions
or behaviors expected and exhibited by a
manager.
•Henry Mintzberg defines 10 roles that
managers are expected to play and group
them in to 3 categories.
1. Interpersonal role
2. Informational role
3. Decisional role

30/12/24 L/col Mebrate D. 36

 Mintzberg’s Managerial
Roles

Interpersonal roles
Decisional role 1.Figurehead
1.Entrepreneur 2.Leader
2.Disturbance /influence
handler 3.Liaison
3.Resource
allocator
4.Negotiation
Informational role
1.Monitor
2.Disseminator
3.Spokesperson

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 1. Interpersonal Roles:
A. Figureheads: engage in activities that are
ceremonial and symbolic in nature; as a symbol of legal
authority, attending ceremonies, signing documents,
receiving visitors etc

B. Leaders/influencer: providing guidance and

motivating subordinates to get the job done properly.

C. Liaison: involves formal and informal contacts beyond

the vertical chain of command (inside and outside).

•Links in horizontal as well as vertical chain of

communications.
30/12/24 L/col Mebrate D. 38
 2. Informational
Roles
A. Monitors/ Nerve Center: receiving all types of
information. filter, evaluate and choose to act or react
to that information.

B. Disseminators: involves communicating selected

information to subordinates.

C. Spokesperson: represent and speak on behalf of the

organization; Transmitting selected information to
outsiders.
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 3. Decisional Roles
A. Entrepreneurs: designing and initiating changes
within the organization

B. Resource allocators: managers decide who gets

what based on priority setting.

C. Negotiators: managers choose how to interact

with their superiors, peers, and subordinates.

•Negotiating with other parties representing

organizational interests.

D. Disturbance handlers: They handle both

internal and external disturbances. They anticipate
disturbances and resolve conflicts.
30/12/24 L/col Mebrate D. 40
 Principles of management (WHO)

1. Management by Objective

Management sees that objectives are specified then that

they are achieved.

The objectives should state:

What is to be accomplished?

How much of it?

Where it is to be done.

When it is be completed.

30/12/24 L/col Mebrate D. 41

 Principles of
management…
2. Learning from Experience

• Analysis of the results between the objectives and

achievement made.

• For better performance there should be feedback to

learn from experience.

3. Division of Labour

• Management attempts to bring about balance of work

among the different work and the different people
concerned.
30/12/24 L/col Mebrate D. 42
 Principles of
management…
4. Substitution of Resources

• Often when the resources that are normally used to

provide service became scarce or too expensive,
different resources may be used to provide the
intended results.

5. Convergence of Work

• Working relations should contribute to the success of

each activity and so to general effectiveness.

30/12/24 L/col Mebrate D. 43

 Principles of
management…
• These working relations of activities are:
 The logical relations with each other

 Time relations or sequence

 Spatial relations between activities

 Functional and structural working relations between people.

6. Functions Determine Structure

• When the work is defined i.e. the function and duties of the
individual members of the team are clearly defined and known
to all, the working relations (structure) follow.
• The exact nature of authority will be clearly delineated on the
structure.
30/12/24 L/col Mebrate D. 44
 Principles of
management…
7. Delegation

• Delegation is the downward transfer of formal

authority from superior to subordinate.

Factors to consider in delegation

• Experience, ability, urgency, availability, past

performance, motivation, risks/rewards

30/12/24 L/col Mebrate D. 45

 Principles of
management…
8. Management by Exception

Do not be overloaded with the routine and

unnecessary information, be selective and make BIG
decision first.

In short management by exception means:

 Selectivity in information and priority in

decision

30/12/24 L/col Mebrate D. 46

 Principles of
management…
9. Shortest Decision-path
This principle deals with issues like:
 Who should make which decision?
 When and where?
 Decision must be made as closely as possible in time and
place to the object of decision and to those affected by it.
10. Management by walking Around

 The practice of managers interacting with the workforce

by visiting the work area where the general staff work.

30/12/24 L/col Mebrate D. 47

Management functions
 Managers just don’t go out and haphazardly
perform their responsibilities.
 Good managers discover how to master
five basic functions:
1. Planning --------------- Planning
2. Organizing
3. Staffing -------- Implementation
4. Leading(directing,
motivating)
5. Controlling --------------- Evaluation

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 Planning
 It is the process of establishing goals and charting out
suitable course of action to achieve these goals.
 Helps to deal with the present and anticipate the
future.
 It involves what to do, how to do, when to do, who is
to do it,…
• Planning is a primary management function. Why?

Because:
 Through planning managers clearly put and outline
exactly what organizations must do to be successful.

30/12/24 L/col Mebrate D. 49

 Organizing
 Creates a mechanism to put plans into action. How?
 Through Assigning the tasks developed
during planning to individuals/groups within
the organization.
 Is the process of arranging and allocating work,
authority and resources among organization members
to achieve goals.

 involves establishing authority - responsibility

relationships among people working in groups and
creating a structural framework.

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 Staffing
• Staffing is filling and keeping filled with qualified
people all positions in the HSO.

• Recruiting, hiring, training, evaluating and

compensating are the specific activities
included in the function.

30/12/24 L/col Mebrate D. 51

 Leading
 Primarily concerned with people in the
organization.
 It is the process of directing and influencing
the task-related activities of group members
or an entire organization.
 The process of guiding the activities of
organization members in appropriate
direction.
 Influencing, directing , motivate
Controlling
 The process of ensuring the actual activities
in relation to planned
30/12/24 activities.
L/col Mebrate D. 52
Management theories
 Development of management
thought
Pre-Scientific Management Era

 The history of management thought can

be traced as 300 years before Christ when
people started forming group which
needed somebody to organize and
coordinate the activities of the people it
may be traced back to when people
started first to and work as a group
 e.g. the construction of the pyramid Egypt
and the Babylonians era

30/12/24 L/col Mebrate D. 54

 Pre-Scientific Management Era
 The study of management as a separate and
distinct subject with different theories and
techniques is a product of the beginning of
the twentieth century most writers agree the
origin of these discipline was the work of
Frederic Winslow Taylor during the scientific
management that developed around 1900.
 However the problem of organizing men to
achieve the desired objectives is not new it
is old as civilization itself.
 Introduction of management and planning
into health care system is even a very recent
story i.e. 3-4 decades.
 There are five types of management
theories as described below
30/12/24 L/col Mebrate D. 55
Development of management thought
Modern Management theory
1. Classical Management

A. Scientific management (1800-1914)

 Emphasized scientifically determined changes
in management practices as a solution to
improving labor productivity.
 The basic idea is managers should use and
develop standard methods developed support
workers and eliminate interruption and
provide wage incentives e.g. surgical teams.

 Neglected the social aspects of workers needs.

30/12/24 L/col Mebrate D. 56

 A. Scientific Management:
Taylor
1. Frederick W. Taylor (1856-1915)
- Father of “Scientific Management.
• attempted to define “the one best way” to
perform every task through systematic
study and other scientific methods.
• believed that improved management
practices lead to improved productivity.
- Three areas of focus:
• Task Performance
• Supervision
30/12/24
• Motivation L/col Mebrate D. 57
 Task Performance
• Scientific management incorporates
basic expectations of management,
including:
• Development of work standards
• Selection of workers
• Training of workers
• Support of workers

30/12/24 L/col Mebrate D. 58

 Supervision
• Taylor felt that a single supervisor could
not be an expert at all tasks.
• As a result, each first-level supervisor should
be responsible only workers who perform a
common function familiar to the supervisor.
• This became known as “Functional
Foremanship.”

30/12/24 L/col Mebrate D. 59

 Motivation
• Taylor believed money was the way to
motivate workers to their fullest
capabilities.
- He advocated a piecework system in which
worker’s pay was tied to their output.
• Workers who met a standard level of
production were paid a standard wage
rate.
• Workers whose production exceeded the
standard were paid at a higher rate for all
30/12/24
of their production output.
L/col Mebrate D. 60
 B) Administrative
Management: Fayol
• Henri Fayol (1841–1925)
• First recognized that successful
managers had to understand the basic
managerial functions.
• Developed a set of 14 general principles
of management.
• Fayol’s managerial functions of planning,
leading, organizing and controlling are
routinely used in modern organizations.
30/12/24 L/col Mebrate D. 61
Table 2.1 Fayol’s General Principles of Management

1. Division of work 8. Centralization

2. Authority and 9. Scalar chain
responsibility 10. Order
3. Discipline 11. Equity
4. Unity of command 12. Stability
5. Unity of direction 13. Initiative
6. Subordination of 14. Esprit de corps
individual interest to
the common good
7. Remuneration of
personnel Source: Based on Henri Fayol, General and Industrial
Management, trans. Constana Storrs (London: Pittman
& Sons, 1949).
30/12/24 L/col Mebrate D. 62
Fayol’s Principles of Management

Henri Fayol (1841-1925)

He has proposed that there are six

primary functions of management and
14 principles of management,
Forecasting, Planning, Organizing,
Commanding, Coordinating,
controlling
There are 14 Principles of
Management described
30/12/24 L/col by Henri
Mebrate D. 63
14 Principles of Henri Fayol

1. Division of Labor
Work of all kinds must be divided & subdivided and allotted to various
persons according to their expertise in a particular area.

2. Authority & Responsibility

Authority refers to the right of superiors to get
exactness from their sub-ordinates.

Responsibility means obligation for the performance of

the job assigned.

Note that responsibility arises wherever authority is

30/12/24 L/col Mebrate D. 64
exercised
14 Principles of Henri Fayol Cont’d

3. Unity of Command
A sub-ordinate should receive orders and be accountable to one and only one boss
at a time.

He should not receive instructions from more than one person

4. Unity of Direction
People engaged in the same kind of business or same kind of activities
must have the same objectives in a single plan.
Without unity of direction, unity of action cannot be achieved .

30/12/24 L/col Mebrate D. 65

14 Principles of Henri Fayol Cont’d

5. Equity
Equity means combination of fairness, kindness & justice.
The employees should be treated with kindness & equity if devotion is
expected of them.

6. Order

This principle is concerned with proper & systematic

arrangement of things and people.

Arrangement of things is called material order and placement of

people is called social order.
30/12/24 L/col Mebrate D. 66
14 Principles of Henri Fayol Cont’d

7. Discipline
Discipline means sincerity, obedience, respect of authority &
observance of rules and regulations of the enterprise.
Subordinate should respect their superiors and obey their order.

8. Initiative
Initiative means eagerness to initiate actions without being asked to
do so.
Management should provide opportunity to its employees to suggest
ideas, experiences& new method of work.

30/12/24 L/col Mebrate D. 67

14 Principles of Henri Fayol Cont’d
9. Remuneration
Remuneration to be paid to the workers should be fair, reasonable,
satisfactory & rewarding of the efforts.
It should accord satisfaction to both employer and the employees .

10. Stability of Tenure

Employees should not be moved frequently from one job
position to another i.e. the period of service in a job
should be fixed.

30/12/24 L/col Mebrate D. 68

14 Principles of Henri Fayol Cont’d

11. Scalar Chain

Scalar chain is the chain of superiors ranging from the ultimate authority to
the lowest.

Communications should follow this chain. However, if following the chain

creates delays, cross-communications can be allowed if agreed to by all
parties and superiors are kept informed.

12. Sub-ordination of Individual Interest to common goal

An organization is much bigger than the individual it constitutes
therefore interest of the undertaking should prevail in all
circumstances.

The interests of any one employee or group of employees should not

take precedence over the interests of the organization as a whole.
30/12/24 L/col Mebrate D. 69
14 Principles of Henri Fayol Cont’d

13. Espirit De’ Corps

It refers to team spirit i.e. harmony in the work groups and mutual understanding among the
members.

Espirit De’ Corps inspires workers to work harder.

14. Centralization
Centralization refers to the degree to which subordinates
are involved in decision making. Whether decision
making is centralized (to management) or decentralized
(to subordinates) is a question of proper proportion.

The task is to find the optimum degree of centralization for

each situation.
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 1c) Bureaucratic Management
• Focuses on the overall organizational
system.
• Bureaucratic management is based
upon:
– Firm rules
– Policies and procedures
– A fixed hierarchy
– A clear division of labor

30/12/24 L/col Mebrate D. 71

 Subfields of the Classical Perspective on
Management
Focuses on the
individual
worker’s Focuses on
productivity the overall
organization
al system

Focuses on
the functions
of
management

30/12/24 L/col Mebrate D. 72

 Classical Management

C. Bureaucratic organization
(administration theory)
• Sub- field of classical theory that
emphasizes management on an
impersonal rational basis through
such elements as clearly defined
authority and responsibility etc.
Command the strict rules disciplines
and control

30/12/24 L/col Mebrate D. 73

 Bureaucratic Management:
Weber
• Max Weber (1864–1920)
- A German sociologist and historian who
envisioned a system of management
that would be based upon impersonal
and rational behavior—
- the approach to management now
referred to as “bureaucracy.”
Division of labor
Hierarchy of authority
Rules and procedures
Impersonality
Employee selection and promotion
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 Weber’s Forms of Authority
• Traditional authority
- Subordinate obedience based upon custom or
tradition (e.g., kings, queens, chiefs).
• Charismatic authority
- Subordinates voluntarily comply with a leader
because of his or her special personal qualities
or abilities (e.g., Martin Luther King, Gandhi).
• Rational-legal authority
- Subordinate obedience based upon the position
held by superiors within the organization
(e.g., police officers, executives, supervisors).

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 Modern Management theory

2. Behavioral theory (1900-1940)

• Focus changed from job to people who
perform it
• Dissolve hierarchy between
management and workers
( subordinate)
• Treat people as special and meeting
their needs frequently results in
increased performance
• They feel that happy employees would
be productive
30/12/24 L/col Mebrate D. 76
 2) Behavioral Perspective
• Followed the classical perspective in
the development of management
thought.
- Acknowledged the importance of human
behavior in shaping management style
- Is associated with:
Mary Parker Follett
Elton Mayo
Douglas McGregor

30/12/24 L/col Mebrate D. 77

 Mary Parker Follett
• Concluded that a key to effective
management was coordination.
• Felt that managers needed to coordinate
and harmonize group effort rather than
force and coerce people.
• Believed that management is a
continuous, dynamic process.
• He felt that the best decisions would be
made by people who were closest to the
situation.

30/12/24 L/col Mebrate D. 78

 Follett on Effective Work Groups

•Four principles of coordination to

promote effective work groups:
Coordination requires that people be in direct
contact with one another.
Coordination is essential during the initial stages
of any industry.
Coordination must address all factors and
phases of any endeavor.
Coordination is a continuous, ongoing process.

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 Elton Mayo
• Conducted the famous Hawthorne
Experiments.
- “Hawthorne Effect”
• Productivity increased because attention was
paid to the workers in the experiment.
• Phenomenon whereby individual or group
performance is influenced by human behavior
factors.
• His work represents the transition from
scientific management to the early human
relations movement.
30/12/24 L/col Mebrate D. 80
 Douglas McGregor
• Proposed the Theory X and Theory Y
styles of management.
- Theory X managers perceive that their
subordinates have an inherent dislike of
work and will avoid it if at all possible.
- Theory Y managers perceive that their
subordinates enjoy work and that they
will gain satisfaction from performing
their jobs.
30/12/24 L/col Mebrate D. 81
 Table 2.3 Comparison of Theory X and Theory Y
Assumptions

Factor Theory X Assumptions Theory Y Assumptions

Employee attitude Employees dislike work and
Employees enjoy work and
toward work will avoid it if at all possible. will actively seek it.

Management view Employees must be directed,

Employees are self-motivated
of direction coerced, controlled, or threatened and self-directed toward
achieving
to get them to put forth adequate effort. organizational goals.

Employee view Employees wish to avoid responsibility; Employees seek

responsibility;
of direction they prefer to be directed and told what they wish to use their
creativity,
to do and how to do it. imagination, and ingenuity in
performing their jobs.
Management style Authoritarian style of
management
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L/col management
D. 82
Classical versus Behavioral Perspective

vs
.

Classical Behavioral
Perspective Perspectiv
Focused on e
Acknowledged the
rational importance of
behavior human
behavior
30/12/24 L/col Mebrate D. 83
 3)The Contingency
Perspective
• A view that proposes that there is no
one best approach to management
for all situations.
- Asserts that managers are responsible
for determining which managerial
approach is likely to be most effective in
a given situation.
- This requires managers to identify the
key contingencies in a given situation.
30/12/24 L/col Mebrate D. 84
 4.Quantitative Theory of
Management

• The quantitative management

approach is given by the
mathematical school that
recommends the use of computers
and mathematical techniques to
solve complex management issues
and assist in the managerial
decision-making process.

30/12/24 L/col Mebrate D. 85

 Quantitative Theory of
Management
The quantitative approach to
management includes the application
of statistics, optimization models,
information models, and computer
simulation to assist in the
managerial decision-making process.
More specifically, this approach focuses
on achieving organizational
effectiveness through the application of
mathematical and statistical concepts.

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 Quantitative Theory of
Management
The three main branches of the
quantitative approach are:
•Management Science,
•Operations Management
•Management Information System

30/12/24 L/col Mebrate D. 87

 5) The system Approach
• Views the organization as a unified,
directed system of interrelated parts.
• The systems sees each change in a
part of the system as having an
impact on all others parts.
• The system helps managers to
realize that every action has
consequences somewhere inside as
outside the organization.
30/12/24 L/col Mebrate D. 88
 Comprises of two systems
Open system
- characterized by interaction with
external environment

Closed system
- interaction with internal
environment (do not interact with
external)
30/12/24 L/col Mebrate D. 89
 External environment

Input Conversion Output

(the physical, (comprise the (the original
human, tech used to inputs as &
material, convert changed by
financial & inputs to transformation
info process) outputs process

Feedback
(info about a system’s
30/12/24
status & performance
L/col Mebrate D. 90
 Modern Management theory

5. System (integrative theory) 1940+

• This group of theorists view productivity as a
function of the interplay among structure
people technology and environment they
defined system as an interrelated party
arranged in a unified whole system can be
open (interact both internally and with its
environment ) or closed (self contained and
usually found only in the physical sciences )
• in general open system view focuses taking
organization as a whole and as the
interrelationship of its part.
30/12/24 L/col Mebrate D. 91
 Chronological
Development of
Management Perspectives

L/col Mebrate D. 92
 Figure 2.1 Chronological Development of Management
Perspectives

30/12/24 L/col Mebrate D. 93

 Thank you !!

30/12/24 L/col Mebrate D. 94

 Unit Two

Planning

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 Planning
• “if you do not know where you are going no road will
get you there?”
• Planning is intellectual process which is concerned with
deciding in advance what, when, why, how, and who
shall do the work.
• Planning is concerned with ends (what is to be done) as
well as with means (how it is to be done)
• Planning bridges a gap between from where we are to
where we want to go”
• It involves establishing goals and a suitable course of
action to achieve the goals
30/12/24 L/col Mebrate D. 96
 Purposes of Planning
– Provides direction to managers and employees

– Reduces uncertainty by forcing managers to look

ahead, anticipate change, consider the impact of
change, and develop appropriate responses
– Minimizes waste and redundancy

– Sets the standards for controlling

Disadvantages
– Incorrectly planned, overambitious plans have negative
impact

Planning takes place at all level of an organization

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 Types of Plans

30/12/24 L/col Mebrate D. 98

 Types of planning

• Short-term plans

– Plans with time frames on one year

or less
• Long-term plans

– Plans with time frames extending

beyond three years
30/12/24 L/col Mebrate D. 99
• Strategic plans

– Apply broadly to the entire organization

– Establish the organization’s overall

goals/objectives
– Seek to position the organization in terms of its
environment
– Provide direction to drive an organization’s
efforts to achieve its goals
– Serve as the basis for the operational plans

– long term, and single use

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• Components of strategic plan

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 Mission Statement – why we exist/ who
are we

• A Mission is defined as 'Purpose, reason for being'

• Defined simply "Who we are and what we do"

• Here is an example of a mission statement:

– The mission statement of a small community hospital may
indicate that its purpose is “to serve the health care needs of
the immediate community and provide care for commonly
occurring illnesses”
– A large university hospital may have a mission statement
that encompasses research, teaching, and care for complex
problems
30/12/24 L/col Mebrate D. 102
 Vision - What we want to be/ where do we
want to go

• A Vision is defined as ‘An Image of the future we

seek to create’
• Best picture of organization in the future

• A vision is not true in the present, but only in the

future.
 Example
– A Hospital aspire to be the best hospital in Ethiopia in
2025
30/12/24 L/col Mebrate D. 103
 Benefit of visioning
• Breaks the manager out of boundary
thinking
• Provides continuity of action
• Alerts stake holders to need change
• Promote interest and commitment

Vision killers
Traditions
Fatigue leaders
Short term thinking
30/12/24 L/col Mebrate D. 104
Goal
The purpose that organization strives to
achieve
Goal is the reason to exist and an
organization can not exist without a goal
Goals are clearer statement of the mission
specifying the accomplishment to be achieved if
the mission is to become real
30/12/24 L/col Mebrate D. 105
 Operational plans
– Apply to specific parts of the organization

– Specify the details of how the overall objectives

are to be achieved
– Are derived from strategic objectives

– Cover shorter periods of time

– Must be updated continuously to meet current

challenges
– The specific results expected from departments,
work groups, and individuals
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30/12/24 L/col Mebrate D. 107
• Specific plans
– Plans that have clearly defined objectives and
leave no room for misinterpretation
• “What, when, where, how much, and by
whom” (process-focus)
• Directional plans
– Flexible plans that set out general guidelines,
Provide focus but don’t lock managers into
specific courses of action
– “Go from here to there” (outcome-focus)

30/12/24 L/col Mebrate D. 108

• Single-use plans
– A plan that is used to meet the needs of a
particular or unique situation
– Apply to activities that do not recur or
repeat in the same form in the future - Non
repetitive

Examples:
Single-day sales advertisement
 Program: Covers relatively large set of
activities
 Projects: Smaller, separate portions of
programs- Limited in scope
 Budgets : Financial resources allocated for
certain activities in a given time
30/12/24 L/col Mebrate D. 109
• Standing plan
– A plan that is ongoing and provides guidance for
repeatedly performed actions in an organization
– Usually made once and retain their value over a
period of years while undergoing periodic revisions
and updates
Examples:
• Customer satisfaction policy
• Policy - A broad guideline for managers to follow
when dealing with important areas of decision
making- HR policy
• Procedure - A set of step-by-step directions that
explains how activities or tasks are to be carried out
- Procedures for purchasing drugs ,supplies and
equipment
30/12/24 L/col Mebrate D. 110
 Strategic Management

• Understanding the strategic position of an

organization
 Where we are?

• Making strategic choices for the future

 Where we want to be?

• Turning strategy into action

 How to get there?

30/12/24 L/col Mebrate D. 111

 Where you are now

To determine where you are now, you have to analyze the

organization’s situation

 How well is the present strategy working?

 What are the organization’s strengths, weaknesses,

opportunities, and threats?

 How strong is the organization’s competitive position?

 What strategic issues does the organization face?

30/12/24 L/col Mebrate D. 112

 SWOT Analysis
• SWOT is an acronym for Strengths,
Weaknesses, Opportunities and Threats
• Strengths (S) and Weaknesses (W) are
considered to be internal factors over
which you have some measure of control
• Opportunities (O) and Threats (T) are
considered to be external factors over
which you have essentially no control

30/12/24 L/col Mebrate D. 113

 SWOT Analysis…..
Strengths
 What organizations are well-versed in or what they
have expertise in,
 The traits and qualities employees possess
(individually and as a team) and
• Strengths are divided into two categories:
 Resources (what you have) and
 Capabilities (what you do well).

• Both resources and capabilities can be tangible or

intangible
• In the health sector, strengths may be considered
availability of resources and trained human power
30/12/24 L/col Mebrate D. 114
 SWOT Analysis……
Weaknesses
• are the qualities that prevent organizations from
accomplishing mission and achieving their full
potential
• negative influences on the organizational success
and growth
 Weaknesses are controllable. They must be
minimized and eliminated

 Weakness include lack of managerial talent and

obsolete facilities.

30/12/24 L/col Mebrate D. 115

 SWOT Analysis ….
Opportunities
• are presented by the environment within which
organizations operate.
• arise when an organization can take benefit of
conditions in its environment to plan and execute
strategies that enable it to become more profitable.
• Positive external environmental factors
 Organizations can gain competitive advantage by
making use of opportunities
 Organization should be careful and recognize the
opportunities and grasp them whenever they arise
• Include clear and supportive government polices and
the presence of a functional health committee in the
communities

30/12/24 L/col Mebrate D. 116

 SWOT Analysis
Threats
• arise when conditions in external environment
jeopardize the reliability and profitability of the
organization.
 Threats are uncontrollable. When a threat comes,
the stability and survival can be at stake.
• Negative external environmental factors

• Include adverse cultural believes towards modern

medical practice and growing cost of essential drugs

30/12/24 L/col Mebrate D. 117

 SWOT Analysis ……
• The main objective of analyzing the strengths,
weaknesses, opportunities and threats is
 to identify strategic issues which are key for
success or which will be obstacles to the achievement
of the missions and objectives

The SWOT Matrix

• The SWOT analysis serve for
 refinement of current strategies or generation of new
possible alternative strategies by illustrating how the
external opportunities and threats can be matched
with the internal strengths and weaknesses
 to result in four sets of possible strategic
alternatives.
30/12/24 L/col Mebrate D. 118
 SWOT Matrix

Strengths Weaknesses

Opportunitie S-O W-O

s strategies strategies

Threats S-T W-T

strategies strategies

30/12/24 L/col Mebrate D. 119

 SWOT Matrix
Strengths Weaknesses

Opportuniti S-O strategies W-O strategies

es Internal strengths Internal weaknesses
matched with relative to external
external opportunities
opportunities

Threats S-T strategies W-T strategies

Internal strengths Internal weaknesses
matched with relative to external
external threats threats

30/12/24 L/col Mebrate D. 120

 SWOT Matrix
Strengths

Opportunitie S-O strategies

s Pursue opportunities that are a good fit
to the organization's strengths.
 Use organization’s internal strengths
to take advantage of external
opportunities

30/12/24 L/col Mebrate D. 121

 SWOT Matrix
Weaknesses
Opportunities W-O strategies
Overcome weaknesses to pursue
opportunities.
Improving internal weaknesses by
taking advantage of external
opportunities
Outsourcing

30/12/24 L/col Mebrate D. 122

 SWOT Matrix

Strengths

Threat S-T strategies

s Identify ways that an
organization can use its strengths
to reduce its vulnerability to
external threats.
 Use organization’s strengths to
avoid or reduce the impact of
external threats
campaign emphasizing superior
30/12/24 L/col Mebrate D. 123
customer service or competitor's
 SWOT Matrix

Weaknesses
Threats W-T strategies
Establish a defensive plan to prevent
organization’s weaknesses from making it
highly susceptible to external threats.
Defensive tactics aimed at reducing
internal weaknesses & avoiding
environmental threats

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124
 Formulate Strategies
• how to do?
• Ways and means to achieve objectives
• Major course of actions
• Every objectives should have at least one
strategy

30/12/24 L/col Mebrate D. 125

 HEALTH PLANNING

30/12/24 L/col Mebrate D. 126

 Health planning

Health Planning - Is the process of defining

community health
problems, Identifying needs and resources,
establishing priority goals, and setting out the
administrative action needed to reach those goals.

30/12/24 L/col Mebrate D. 127

 Steps in health planning
1. Situation analysis
2. Analyzing and selecting critical (priority)
problems
3. Setting objectives and targets
4. Identifying potential obstacles
5. Designing the strategies
6. Writing up the plan

30/12/24 L/col Mebrate D. 128

 Step 1: Situational Analysis
Population characteristics
•Study size, composition and distribution of the population
•Identify target groups
Socio-economic characteristics & health infrastructures & pattern
of health services of the country/region/ district/area.
Policy and political environment
•Consider national health policy and programs and relate it to
actual situation in your own area

30/12/24 L/col Mebrate D. 129

Analysis of present & future health
needs/situation of the population
•information may come from different
sources: surveys
•Morbidity rates (Incidence and
Prevalence)
•Morality rates (IMR , MMR)
•Disability rates

30/12/24 L/col Mebrate D. 130

Analyze health services:
•Analyze organizational structure and functions of
health services ,
•Service facilities, Service utilization, Service gaps,
•Identify limitations/bottle necks in organizational
structure
Analyze resources:
•Financial resources, Personnel, Material/equipment
and Time
Review past implementation experience:
•Find out information or experiences from activities
implemented in the past (Success and Short comings )

30/12/24 L/col Mebrate D. 131

 Step 2: Selecting Critical
Problems (Priority)
Identification of Problems: - gaps between what should be
and what is
a problem is a difficulty or obstacle seen to exist between a
present situation and desired future
Prioritization of the identified problems:
•In the light of competing needs and limited resources. Setting
priority is, perhaps the most critical and hardest planning
stage and yet cannot be avoided.
•Establish criteria for selection

30/12/24 L/col Mebrate D. 132

• It is useful to group problems under
common headings example:-

• Environmental problems

- Poor sanitation

• Disease or Health problems

- Malaria
• Health service problems
- Insufficient drugs and materials

30/12/24 L/col Mebrate D. 133

The selection criteria for priority setting are:

•Magnitude of the problem

•Degree of severity (consequent suffering and disability)

•Feasibility-in terms of cost effectiveness

•Political and social acceptability of intervention.

•Sustainability in terms of resources and organizational

capacity
Community concern

•Consistence with multi - sectoral approach

30/12/24 L/col Mebrate D. 134

• Ranking which health problems they
think were most important. This can
be done by using criteria on five
point scale
– 5 -very high,
– 4 -high,
– 3 -moderate,
– 2 -low,
– 1.-very low

30/12/24 L/col Mebrate D. 135

 Step 3: Setting Objective
and Target
• Every plan has the primary purpose of helping the
organization succeed through effective management.
• Success is defined as achieving organizational
objectives.
• Objectives are desired end states (outcomes) of a
program
– Example: By the end of 2017 90% of eligible children will be
vaccinated against six target disease in Omo Nada woreda

• Well-defined objectives have several Characteristics.

They are: SMART
– S –Specific
– M –Measurable
– A –Achievable
– R –Realistic/ relevant - fits with health policy
– T -Time specific/Time frame

30/12/24 L/col Mebrate D. 136

Step 4: Identifying Potential Obstacles and
limitations
• Why objectives could not be
attained?
• Which are the limitations &
obstacles?

30/12/24 L/col Mebrate D. 137

 Resources:-
People
- Lack of interest, No skilled people
Equipment
- Not available, Expensive (if available)
Money
- No budget
Time
- People may not have time
Information
- Hard to find, Statistics not available

30/12/24 L/col Mebrate D. 138

 Environmental obstacle : When making a plan the
environment should be reviewed to see whether it
presents any specific difficulties, such as:
• Geographical
• Climate - type of diseases - type of building
• Technical difficulties –electricity
• Social factors - traditions may operate against your
plan

30/12/24 L/col Mebrate D. 139

After identification – Analyze the obstacle
ƒ
•obstacles might be modified,
ƒ
•obstacles might be removed or
ƒ
• can not be removed but has to be clear

30/12/24 L/col Mebrate D. 140

30/12/24 L/col Mebrate D. 141
 Step 5: Designing the Strategies

The potential strategies often include:

•Technology to be applied,

•procedures to be used and

•Defining the role of communities and other sectors

30/12/24 L/col Mebrate D. 142

• Determine resources required in terms of proposed
strategy
- time
- staff - who will do the activities
- facilities/materials
- money

• Estimate strategy costs & assess adequacy

30/12/24 L/col Mebrate D. 143

 Step 6: Writing up the Plan
• The purpose of writing the plan

• to request funds or resources

• for monitoring and evaluating the implementation

process by all
concerned

30/12/24 L/col Mebrate D. 144

 Writing the Plan (summary)
• An outline of writing the plan may include:
Summary
A problem statement - Why are we doing this?
Objectives and targets - What is to be done?
Strategies and activities - How will it be done?
Resources needed - Who will do it and what are The things
that we need? (money, time, personnel, where, when
Monitoring and evaluation - By Whom and How will it be
controlled?

30/12/24 L/col Mebrate D. 145

 Approaches to planning
There are three distinct approaches for formulating plans:
1. Centralized top down planning:
• is the traditional approach to planning
• a centralized group of executives or staff assumes the primary
planning responsibility.
2. Bottom-up planning:
• is an approach that delegates planning authority to division
and department managers, who are expected to formulate
plans under the general strategic umbrella of organizational
objectives.
3. Team planning:
• is a participative approach to planning
• planning teams comprising managers and staff specialties
initiate plans and formulate organizational objectives.

30/12/24 L/col Mebrate D. 146

 Seminar presentations
1. PHC and MGDs with relation to
Ethiopian condition
2. Historical development Health care
and Health policy in Ethiopia
3. Health transformation plan in
Ethiopia
4. HSDP 1 up to 4

30/12/24 L/col Mebrate D. 147

The Organizing function

Unit -three
 Organizing
 Next step after planning.
 A key issue in accomplishing the goals
identified in the planning process.
 structuring the work of the organization.
 Is a process of deciding what work needs
to be done,
 Is the process of arranging and
allocating work, authority and
resources among organization
members to achieve goals.

30/12/24 L/col Mebrate D. 149

 The Importance of Organizing

• It is the primary mechanisms managers use

to activate plans
• It creates and maintains relationships
between all organizational resources by
indicating which resources are to be used
for specified activities and when, where, and
how they are to be used.
• managers minimize costly weakness, such
as duplication of effort and idle
organizational resources.
30/12/24 L/col Mebrate D. 150
 The steps in the organizing
process include:
1. Review plans,

2. List all tasks to be accomplished,

3. Group related jobs together in a logical and

efficient manner,

4. Assign work to individuals,

5. Delegate authority

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 Organization

Two or more people who work together in a

structured way to achieve a specific goal or set of
goals.

Types of Organizations
- Many types: manufacturers, associations,
political parties, community associations,
hospitals, etc.
 formal and informal
• In both people are kept together
 believing there is a benefit working together to
achieve a common goal
30/12/24 L/col Mebrate D. 152
 Characteristics of organizations:

Whatever their purpose, all organizations have

four characteristics:

1. Coordination of effort

2. Common goal or purpose

3. Division of labor, and

4. Hierarchy of authority.

30/12/24 L/col Mebrate D. 153

 Organizational Structure
• The way, in which an organization’s activities
are divided, organized and coordinated.

• Is the formal decision-making framework by

which job tasks are divided, grouped, and
coordinated. Why formal?

• It is the official organizational structure built by

top management.

• Formalization is an important aspect of

structure.
30/12/24 L/col Mebrate D. 154
 Organizing….
Organization charts/high level maps/
The formal organization can be seen and
represented in chart form.
The chart represents channels through which
authority, power and responsibilities flow.
Displays the organizational structure
and shows job titles, lines of authority,
and relationships between departments.
Is helpful for managers as it is an
organizational blue print for deploying
human resource.
30/12/24 L/col Mebrate D. 155
 MoE

University Board
Gender &HIV issue
University Senate
Ethics&anti-corrupn
Offic. Legal affairs President Audit
Special ass. To Presid Direc. Institute trans

GU Hospital board Direc public relation

V/P/ V/P V/P V/P Businus
Research&co Academic Administ
GUH
CEO

dev’t
m.servic Colleges,Fa Plan,budget
Com.serv culty,shool direct Director
.officer HRM of ICT
Registrar
Research PFPA Engineering
officer Library service dir
Service admin
Industry Teacing
linkage learning dir Student serv

Quality Assur Security

30/12/24 L/col Mebrate D. 156
 Organizing…
Why do we need an organizational
structure?

A clear organizational structure

• Clarifies the work environment,

• Creates a coordinated environment,

• Achieves a unity of direction, and

• Establishes a chain of command

30/12/24 L/col Mebrate D. 157

 Views(types) of organizational
design
1) Mechanistic System (Tall structure )
• Traditional or classical design
– common in medium & large sized
organizations.
• Organizational activities are broken down into
separate, specialized tasks
• Objectives for each individual & units are
precisely defined by top level managers.
• It is best suited to a stable environment
30/12/24 L/col Mebrate D. 158
 Views on organizational design
2. Organic system (flat structure)
• More flexible, adaptable to a participative
form of management
• Open to the environment
• Less emphasis on taking orders from a
manager or giving orders to employees
• Organizational members must be skilled at
solving a variety of problems
• Creative problem solving & decision making.
30/12/24 L/col Mebrate D. 159
 Organizing….
Functional Steps in Organizing
• The four building blocks of organizing
are:
Division of work
Departmentalization
Hierarchy
Coordination

30/12/24 L/col Mebrate D. 160

 Organizing….
1. Division of work / Division of labour/
work specialization
• Is the degree to which tasks in an
organization are divided into separate jobs.
• Is breaking of a complex task into
components
Individuals are responsible for a limited
set of activities instead of the entire task.
• Placing capable people in each job ties
directly with productivity
30/12/24 L/col Mebrate D.
improvement. 161
 Organizing….
2. Departmentalization
• Once work activities are divided in to jobs or
jobs have been classified through work
specialization,
they are grouped so those common tasks
can be coordinated and can be similarly
and logically connected.
• Departmentalization is the basis on which
work or individuals are grouped into
manageable units.
 Each single box in an organizational chart
represents departments
30/12/24 L/col Mebrate D. 162
 Organizing…
3. Hierarchy
 A concept that shows how many could be
effectively handled
 A pattern of multiple levels of an
organizational structure
 At the top the senior-ranking manager

 Bottom - low-ranking managers located at

various levels
30/12/24 L/col Mebrate D. 163
 Hierarchy
Span of management or span of control
• The number of people/departments directly
reporting to a given manager.
 After work is divided, departments
created and span of control chosen decide
on chain of command.
Chain of command
• The plan that specifies who reports to whom
• Fundamental feature of an organization
The result of the two decisions lead to a
pattern: hierarchy
30/12/24 L/col Mebrate D. 164
 Hierarchy…..
•Unity of Command: Each employee must
receive instructions from only one person.
– If an employee reported to more than one
manager, conflicts in instructions and confusion
of authority would result.

•Unity of Direction: should be directed by

only one manager using one plan.

30/12/24 L/col Mebrate D. 165

 Hierarchy….
Span of management / control
Does it have an effect
 on working relationships and
 on the speed of decision making? How?
The classical view of span of control :
• should have limited numbers of
subordinates
• Their conclusion was based on the ability of
managers to exercise close control
A. Too wide: Create flat hierarchies (fewer
management levels between the top and
the bottom)
30/12/24 L/col Mebrate D. 166
 Too wide span of control

30/12/24 L/col Mebrate D. 167

 Hierarchy…..
B. Too narrow: Create tall hierarchies (many
levels between the highest and lowest
managers)

30/12/24 L/col Mebrate D. 168

 Q

30/12/24 L/col Mebrate D. 169

Factors affecting span of control

1.Level of profession & training of

staff:
– Skilled staff require less close
supervision (Wider spans of control)
2. Level of uncertainty in the tasks to
be done :
– Complex & varied works require close
supervision (narrower spans of
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control ) L/col Mebrate D. 170
 Factors affecting span of
control…
3. Degree of standardization of
tasks :
– Standardized tasks require less frequent
supervision compared to less
standardized ones (wider spans of control )
4. Abilities & personal qualities of the
managers themselves

30/12/24 L/col Mebrate D. 171

 Organizing…
4. Coordination:
• The integration of activities of separate
parts of an organization for accomplishing
the organizational goals
Integration: the degree to which various
departments work in a unified manner
The degree of coordination depends on:
• Nature of task
• Degree of interdependence of people in
the various units
• Eg. Clinical services
30/12/24 L/col Mebrate D. 172
 High degree of coordination is
needed:
• When communication between units is important
• For non-routine & unpredictable works
• When organizations are challenged with
unstable environment
• When there is high interdependence between
units
• When the organization has set high performance
objectives
• For highly specialized task such as coordination
among different organizations
30/12/24 L/col Mebrate D. 173
Approaches to achieving effective
coordination
•Using basic management techniques
1. Specify relationships (managerial
hierarchy or chain of command)
2. Set rules and procedures
3. Management By Walking Around (MBWA)

30/12/24 L/col Mebrate D. 174

 Authority, Responsibility, and
Accountability

• Authority - formal and legitimate right of a

manager to make decisions, issue orders, and
allocate resources to achieve organizationally
desired outcomes.

• Responsibility - duty to perform, the task or activity

an employee has been assigned

• Accountability - the fact that the people with

authority and responsibility are subject to
reporting and justifying task outcomes to those
above them in the chain of command
30/12/24 L/col Mebrate D. 175
 Delegation

• The process managers use to transfer

authority and responsibility to positions
below them in the hierarchy

• Organizations today tend to encourage

delegation from highest to lowest possible
levels

• Can improve flexibility to meet customers

needs and adaptation to competitive
environments
30/12/24 L/col Mebrate D. 176
 Centralization, Decentralization,
and Formalization
• Centralization - The location of decision
making authority near top organizational
levels.

• Decentralization - The location of decision

making authority near lower
organizational levels.

• Formalization - The written documentation

used to direct and control employees.

30/12/24 L/col Mebrate D. 177

 Unit Four:

Leading health care

30/12/24 L/col Mebrate D. 178

Learning Objectives

At the end of this session you will be able to:

• Define leadership

• Describe the leadership practices.

 Discuss different leadership theories, types & styles.

• Explain the differences between leader and manager.

• Describe on different types of power

30/12/24 L/col Mebrate D. 179

30/12/24 L/col Mebrate D. 180
 What is Leadership?
• Multidimensional concept that can be
defined in different ways,
• The ability to influence a group toward the
achievement of goals.
• leadership is Enabling Groups to Make
Progress in Complex Conditions.
Management sciences for health (2006)
• Leadership is not domination, but the art of
persuading people to work toward a
common goal. Goleman and Daniel,1995.

30/12/24 L/col Mebrate D. 181

 Leadership…
• Leadership is always exercised in relationsh
ip with others.

• The true test of effective leadership is the

visible progress towards the realization of
vision,
inspire others to follow.

• Leadership involves unequal distribution of

power between the leader and group
members.
30/12/24 L/col Mebrate D. 182
 Leadership…
• The leader must win the willingness of the
workers to accept directions.

• Leaders are agents of change, persons

whose acts affect other people more than
other people’s acts affect them.

• Leadership is an activity that takes place at

all levels, not a position of authority

30/12/24 L/col Mebrate D. 183

 Leadership is
about:
» Influencing
» Motivating
» Inspiring
» Taking people to greater heights
» Working with participants on the how and
helping them figure out the what and why
» Encouraging them to push themselves to
achieve the highest possible performance
» Action
» Enabling, not telling

30/12/24 L/col Mebrate D. 184

 Who is a leader?
• A leader is an individual in a team influencing
group activities towards goal formulation and
achievement.

• In other words, a leader is someone who has a

vision, and the ability to make it a reality.

30/12/24 L/col Mebrate D. 185

 Who is a leader?
To achieve
objectives

Influence
followers
behavior

30/12/24 L/col Mebrate D. 186

 Dimensions of leadership
• Leadership involves not just “doing” but “being”
• Leadership is exercised with others.
• Leadership is responsibility, not rank, title, privilege, or
money.

• Leadership and management are both necessary.

• Leadership is about enabling people to face challen
ges.

30/12/24 L/col Mebrate D. 187

 Some of the Great leaders

30/12/24 L/col Mebrate D. 188

 Leading Practices

Four Leadership Practices

1. Scanning

2. Focusing

3. Aligning/Mobilizing

4. Inspiring

30/12/24 L/col Mebrate D. 189

 Leadership Practice: Scanning
 Leaders encourage their teams to scan their internal
& external environments, organizations, teams, and
themselves.
 Identify client & stakeholder need & priorities

 Recognize trends, opportunities, & risks that affect

organizations.

 Identify staff capacities & constraints.

 Know yourself, your staff, & your organization

values, strengths, & weakness.
30/12/24 L/col Mebrate D. 190
 Leadership Practice: Focusing
• Using information from scanning, focus on a
response.

• Leaders focus their limited time, energy, and

resources on the people and things that are most
important.
•Articulate the organization’s mission & strategy

• Identify critical challenges

• Link goals with the overall organizational

strategy
• Determine key priorities
30/12/24
for action
L/col Mebrate D. 191
 Leadership Practice:
Aligning/Mobilizing
• A leader aligns and mobilizes others to achieve
objectives.

• This means seeking out other groups or people whose

objectives are in line with yours and getting them to
work alongside you.

• You should align and mobilize stakeholders’ and staff

time and energies as well as the material and financial
resources to support organizational goals and priorities.

• Facilitate teamwork.
30/12/24 L/col Mebrate D. 192
 Leadership Practice: Inspiring

• Helps staff to face challenges creatively.

• They are the people whose example moves us to follow in their

footsteps.

Inspiring involves demonstrating:

 Values through actions as role model & supporting staff

 “Walking the talk” - matching deeds with words.

 Trust & confidence in staff, acknowledging their contribution

 Be a model of creativity, innovation ,learning& supporting staff.

30/12/24 L/col Mebrate D. 193

 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.

30/12/24 L/col Mebrate D. 194

 Managers  Leaders
 Cope with system  Seeks change
complexity  Set direction and shared values
 Plan and budget  Motivate people
 Control and solve problem
 Administers  Innovates
 A copy  An original
 Maintains  Develops
 Focuses on systems  Focuses on people
&structure  Inspires trust
 Relies on control  Long-range perspective
 Short- range view  Asks what and why
 Asks how and when  Eye on the horizon
 Eye on the bottom line  Originates
 Imitates  Does the right thing
 Does things right
30/12/24 L/col Mebrate D. 195
 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 are born but not made”

30/12/24 L/col Mebrate D. 196

 The trait approach…

• These leadership traits include

– personality characteristics (adaptability,

dominance, self-confidence),

– physical characteristics (above-average

height, medium weight, attractive appearance),
and

– ability (intelligence, task expertise, sensitivity in

dealing with others).

30/12/24 L/col Mebrate D. 197

 2. The behavioral approach(Theory):

Assumptions:

- Leaders can be made, rather than are born.

- Successful leadership is based in definable, learnable
behavior.
Description:
 Behavioral theories of leadership do not seek inborn traits or
capabilities. Rather, they look at what leaders actually do.

• Studied behavioral characteristics of leaders;

• What they do and how they interact with the

subordinates;
30/12/24 L/col Mebrate D. 198
 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.
30/12/24 L/col Mebrate D. 199
 Types of leaders
1. Transactional leaders

• Identify the expectations of their followers

• Act managerially by establishing a close link

between effort and reward.
• They evaluate, correct and train staff whenever
staff performance needs to be improved, and
they reward appropriately when the required
outcomes are achieved.

• Power is given to the leader to evaluate and reward

the followers.
30/12/24 L/col Mebrate D. 200
 2. Transformational leaders

• Transformational leaders, as defined by Bass (1985)

support their staff and encourage them to ‘do more
than they originally expected to do’.
• Transformational leaders motivate staff to do better.

• Transformational leaders provide encouragement

and support to followers.

• show trust and respect for them as individuals.

• They build self-confidence and heighten personal

development.

30/12/24 L/col Mebrate D. 201

 Types of Leaders…
3. Charismatic leaders
• Max Weber, a sociologist, defined charisma (from the Greek for “gift”)
more than a century ago as “a certain quality of an individual
personality, by virtue of which he or she is set apart from ordinary
people.”
• Charismatic leaders rely on their personality, their inspirational
qualities and their aura/ characteristic.
Key Characteristics of a Charismatic Leader
• Vision and articulation
• Willing to take on high personal risk
• Sensitive to follower needs

30/12/24 L/col Mebrate D. 202

 Types of Leaders

4. Situational leaders

• Is one who can adopt different leadership styles

depending on the situation.

• Effective leaders are versatile/Adapt in being able

to move between the styles according to the
situation, so there is no one right style.

30/12/24 L/col Mebrate D. 203

 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

• Believe that money is the only reward that will motivate staffs.

30/12/24 L/col Mebrate D. 204

 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

• What do you think? “Let’s do together”

30/12/24 L/col Mebrate D. 205

 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.

30/12/24 L/col Mebrate D. 206

 Styles Leadership….
3. Laissez – faire Leaders:
• Laissez-faire leadership is a style where the leader provides little
or no direction and gives staff as much freedom as possible.
• All authority or power 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.
Type I
• Leaders have little or no confidence in their ability
• “Do as you like”
• Have no concern for both staffs and the work output.
30/12/24 L/col Mebrate D. 207
 Laissez – faire Leaders
….
Type II:

• Leaders are extremely confident about their staffs.

• Subordinates may be high in their academic position.

• Every staff knows the objectives of his / her organiza

tion.
• Able to plan and implement independently.

30/12/24 L/col Mebrate D. 208

 Leadership use of power and
authority
• Leaders influence people to do things
through the use of power and authority.

30/12/24 L/col Mebrate D. 210

 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.
• Power is the ability to influence decisions and control
resources.

• Powerful people have the potential to exercise influence,

and they exercise it frequently.

• Only the organization can confer authority.

30/12/24 L/col Mebrate D. 211
 Five types of
power
1. Legitimate power
•It is a result of the position a person holds in the
organization hierarchy.

•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.

30/12/24 L/col Mebrate D. 213

 2. Reward power

 Emanates/issue from the leaders ability to

reward desirable behavior.
 It stems partly from the legitimate power.

 Reward includes pay increase, promotions,

work schedule, recognitions of
accomplishment, etc

30/12/24 L/col Mebrate D. 214

 3. Coercive power

• is the opposite of reward power

• based on the leader’s ability to punish or

prevent them from obtaining desired
rewards.

• Organizational punishments include

assignment to undesirable working hours,
demotion, and firing.

• Effective leaders generally avoid heavy

reliance on coercive power.

30/12/24 L/col Mebrate D. 215

 4. 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.

30/12/24 L/col Mebrate D. 216

 5. 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.

30/12/24 L/col Mebrate D. 217

 Unit Five:
Controlling and Decision
Making

30/12/24 L/col Mebrate D. 218

 Session Objectives
• Define controlling , monitoring & evaluation

• Determine the purpose of M&E

• Describe the relationship b/n M&E

• Identify the types of evaluations

• Evaluate the characteristics of indicators

30/12/24 L/col Mebrate D. 219

 Controlling
Management Control
 Is the process of ensuring that actual
activities conform to planned activities.
 Taking preventive / corrective action to keep
things on track is an essential part of control
process
 Primary aim of control is to improve
performance
30/12/24 L/col Mebrate D. 221
 Stages /steps of Controlling

1. Establish standards of Expected

performance

2. Measure actual performance

3. Compare performance against standard

4. Evaluate the comparison and take

appropriate corrective action.

30/12/24 L/col Mebrate D. 222

 Steps of Controlling

30/12/24 L/col Mebrate D. 223

 Controlling….
Types of Controls
1.Feed forward Control
• The active anticipation and prevention of
problems, rather than passive reaction.
• Monitor inputs
2.Concurrent Control
• Monitoring and adjusting ongoing activities
and processes.
3.Feedback Control outputs/products
• Checking a completed activity and learning
from mistakes.
30/12/24 L/col Mebrate D. 224
 Forms of Management
Control:
There are three basic forms of
management control:

1. Monitoring

2. Supervision

3. Evaluation.

30/12/24 L/col Mebrate D. 225

 1. MONITORING
- Monitoring = routine and continuous
tracking of planned activities
- It is the day-to-day watch on, or continuous
follow up of, the on going activities.
- It is regularly checking to see that program
activities are being done as planned.
- It is carried out through observation,
discussion and review of reports,
statistical data.

30/12/24 L/col Mebrate D. 226

 MONITORING…

• The goals of monitoring are:

 To identify any problem early, and
 To solve without delaying the progress of
the program.
• Hence it is a basic part of implementation
management.

30/12/24 L/col Mebrate D. 227

 2. Supervision:
• Intermittent processes to be conducted by the
management in line with controlling.
• A single person should not go for supervision
• The main styles of supervision are
autocratic, and democratic.
• Autocratic supervisions tend to humiliate/injury the
dignity/ people, make them irresponsible and mostly
one way.
• It may dry up the initiative of colleagues.
• Democratic supervision helps people to grow
• become responsible for their own work to show
initiative
228
30/12/24 L/col Mebrate D.
 3. Evaluation
• Evaluation = periodic (e.g., annual) assessment of
whether program objectives have been achieved
 Is systematical and periodical gathering, analyzing
and interpreting of information on the operation as
well as the effects and impacts of a development
programme/project.
• Assess the contribution and worth of an
intervention.
• It involves the comparison of the actual
performance of the system

30/12/24 L/col Mebrate D. 229

 Evaluation….
The results of evaluation are expected to show:
• What a program has been trying to do;
• What actually happened;
• Where there are differences/gaps between
plans and what happened
• The reasons for the difference/gaps, and
• What needs to be done about them?
The Purpose is: to note short comings,
deficiencies, duplicates, generate of
knowledge etc. in the system.

30/12/24 L/col Mebrate D. 230

Distinctive Characteristics of M & E
Characteristics Monitoring Evaluation
Purpose/objective Specific Broad
Scope Narrow Broad
Frequency Continuous Periodic
Data Gathered Primarily Primarily
Quantitative Qualitative
Focus Inputs/Outputs Impact and
Sustainability
Provides detailed
Alerts when to take
Uses action
information on what
type of actions to take
30/12/24 L/col Mebrate D. 231
Distinctive Characteristics of M &
E…
Character Monitoring Evaluation
What does - Activities performed - Why and how
it answers? - Problems encountered results were achieved or not
- Strategy and policy options

Actors Internal Internal/External

Analysis Simple Comparative Analytical tools

Primary Small group/project Large group /Project

Users Managers Managers, planners,
Financers, etc.)

30/12/24 L/col Mebrate D. 232

 TYPES OF EVALUATION

30/12/24 L/col Mebrate D. 233

 TYPES OF EVALUATION…
Some authors use the terms
• Input, Process, output ,Outcome &Impacts
to determine the value of a program
Others use the term
• Formative/diagnostic or progressive
Evaluation to Evaluate input and process. it
is performed during implementation.
• Summative or Terminal Evaluation
• to evaluate output, outcome, & impact it is
done at the conclusion of the program.
• focus on long term “ultimate” results
30/12/24 L/col Mebrate D. 234
 Types of Evaluation .
….
• Based on people primarily responsible to
lead evaluation activities, evaluation could
be classified as:
– Internal Evaluation

– External Evaluation

30/12/24 L/col Mebrate D. 235

Internal Evaluation
• Evaluation activities designed and
implemented primarily under a leadership
from program implementers

• Usually serve information for program

improvement by supplementing
monitoring activities

30/12/24 L/col Mebrate D. 236

 External Evaluation
• Evaluations designed and implemented
primarily by people who are relatively more
distant from the program (external
evaluators)

• Used when:
– objectivity is a concern because of issues
related to the purpose of the evaluation
– concerns of multiple stakeholders included
in evaluation questions
– evaluation expertise beyond the
organization’s capacity is required to
answer evaluation questions
30/12/24 L/col Mebrate D. 237
 Program Components

INPUTS Processes OUTPUTS OUTCOMES IMPACTS

30/12/24 L/col Mebrate D. 238

 Program Components
• Inputs
– Resources used in a program, such as money,
staff, curricula, and materials. Examples:
• Health workers
• Anti-TB drugs
• Laboratory reagents
• IEC materials
• Processes/ Activities
– Services that the program provides to
accomplish its objectives
– Examples:
• Training health workers for counseling and testing
• Screening patients for opportunistic infections
• Conducting supervision
• Educating women
30/12/24 L/col Mebrate D. 239
 Program Components…
• Outputs
– Are the immediate products or deliverables
of the inputs utilized and program activities
conducted
– Examples:
• Number of patients treated
• Number of clients counseled
• Number of condoms distributed
• Number of HIV tests carried out

30/12/24 L/col Mebrate D. 240

 Program Components…
• Outcomes
– Benefits that individuals, groups, communities
realize.
– The change that occur on the target beneficiaries
due to program output.
– such as changes in knowledge, attitudes, beliefs,
skills, behaviors, access, policies, and
environmental conditions
– Examples:
• Increase of condom use
• Improvement of quality of healthcare
• Reduction of risky sexual behaviors
30/12/24 L/col Mebrate D. 241
Program Components…
Impacts
– Long-term results of one or more programs over time,
such as changes in HIV infection, morbidity, and
mortality
– Examples:
• Reduction in incidence of HIV infection
• Reduction of HIV/AIDS mortality
• Improvement in quality of life of patients

30/12/24 L/col Mebrate D. 242

 INDICATORS
Development & selection for
M&E

“If you cannot measure results,

you can not tell success from
failure!”
indicators are:
A variable or summary of variables
that Measures key elements of a
program or project
Indicators provide critical M&E data at
every stage of program implementation
 Inputs, process, outputs,
outcomes and impact

30/12/24 L/col Mebrate D. 244

Indicators are signals which show;
 Whether we are on the right track & direction,

 How far we have progressed

 How far we still have to go to reach our

destination/objectives

30/12/24 L/col Mebrate D. 245

 Types of indicators
 Indicators could be classified based on different
aspects:
 Relationship with the subject of interest
 The nature of information they provide
 The component of a program they measure

30/12/24 L/col Mebrate D. 246

 Types of indicators con’t…
 Based on their relationship with the
subject of interest

• Direct indicators

• Indirect (proxy) indicators

30/12/24 L/col Mebrate D. 247

 Types of indicators con’t…
Direct indicators
 Are indicators directly related to the subject
intended to be measured

E.g. Proportion of children vaccinated in X district is

direct measure of EPI program output

30/12/24 L/col Mebrate D. 248

 Types of indicators con’t…
Indirect/proxy indicators
 They speak about a subject of interest only indirectly
 are used to measure change or results where direct
measures are not feasible
– Example:
• Monthly expenses of patients could be used to estimate
their monthly income.
• Client satisfaction may be used to measure the quality of
service

30/12/24 L/col Mebrate D. 249

 Types of indicators con’t…
 Based on the nature of information,
indicators could be classified as

– Quantitative indicators
– Qualitative indicators

30/12/24 L/col Mebrate D. 250

 Types of indicators con’t…
Quantitative indicators
 Are indicators which are measured numerically
 Include counts/frequencies, ratios, percentages,
rates, averages
Example
• Number of patients treated
• Prevalence of HIV

30/12/24 L/col Mebrate D. 251

Types of indicators con’t…
Qualitative indicators
 Are indicators which are measured non-
numerically
 Usually applied when quantitative indicators are
not applicable
 are more subjective than quantitative indicators
Example
• Cleanliness of a hospital

30/12/24 L/col Mebrate D. 252

 Types of indicators con’t…
• Based on the component of a program the indicator measures,
indicators could be classified as:

1. Input indicators: Measures the actual use of resources

2. Process indicators: Measures the activities performed

3. Output indicators: Measures what is accomplished with inputs

4. Outcome indicators: Measures the direct and immediate impact

5. Impact indicators: Measures the indirect and longer-term impact

30/12/24 L/col Mebrate D. 253

INPUT PROCESS OUTPUT OUTCOME IMPACT
• Human and • Conduct one • Providers •Increased use • Reduced
financial PMTCT trained in of PMTCT perinatal
resources training PMTCT services transmission
workshop in service of HIV
each district provision
for providers Indicator: percent of
infants HIV- born to
Indicator: # of providers who have HIV+ women
completed clinical training
Indicator: percent of HIV+
Indicator: % of pregnant women who are women receiving a complete
HIV tested course of ARV prophylaxis

30/12/24 L/col Mebrate D. 254

 Characteristics of Good Indicators
• Valid: accurate measure of a behavior, practice or task
• Reliable: consistently measurable in the same way
by different observers
• Precise: operationally defined in clear terms
• Measurable: quantifiable using available tools and
methods
• Timely: provides a measurement at time intervals in
terms of program goals and activities

30/12/24 L/col Mebrate D. 255

 Data sources to measure
Indicators
• Using Pre-Defined Indicators
 Surveillance
 Routine service reporting
 Special program reporting systems
 Administrative systems
 Vital registration systems
 Facility surveys
 Household surveys
 Censuses
 Evaluation and special studies

30/12/24 L/col Mebrate D. 256

 Self learning
Decision making

30/12/24 L/col Mebrate D. 257

 At the end of the session students be able:

• Define decision making

• Describe the relationship b/n decision making and other

functions of mgt
• Describe categories of decisions

• Decision making steps

• Identify factors influencing problem solving & decision making

30/12/24 L/col Mebrate D. 258

 Decision Making . . .
 Decision-making: the process of identifying and
selecting a course of action to solve a specific
problem.
 Decision making is a major part of management
because :
• When planning, organizing, staffing, leading, and
controlling, managers make decisions on a daily basis.
• It requires choosing among alternative courses of
action.
 Decisions must be made at many levels in an
organization from executive decisions on the goals
to the day to day repetitive operations performed by
lower level managers.L/col Mebrate D.
30/12/24 259
Interrelations of the mgt process
functions

Decision
making

30/12/24 L/col Mebrate D. 260

 Decision making….
The formal decision making process may be described
in 7 steps:

1. Identifying and defining the problem

2. Identifying limiting factors

3. Developing potential alternatives

4. Analyzing the alternatives

5. Selecting the best alternatives

6. Implementing the decision

7. Establishing monitoring and evaluation system

30/12/24 L/col Mebrate D. 261
 Decision making….
Types of decisions
1. Ends-means
• Ends: decision making based on our
objectives/outputs
• Means: decision making based on our Strategies
/operational programs/and activities
2. Administrative-operational
• Administrative decisions: made by senior managers
 “Policy decisions”
 Resource allocation and utilization
• Operational decisions: made by mid-level and first-
line managers
 Day-to-day activities, e.g. personnel deployment,
purchases, specific L/col
30/12/24 work assignments
Mebrate D. 262
 Decision making…
3. programmed – non-programmed

• Programmed decisions are elements of some decisions which are

similar and made so often repetitive and routine.

 Includes procedures, rules and manuals. E.g. patient admission,

scheduling, inventory and supply ordering

 Non-programmed decisions are unique and non-routine and may

have unclear implications for the organization, requiring creative
problem solving because they are unfamiliar.

E.g. Decision to expand, add or closes services

30/12/24 L/col Mebrate D. 263
 Ways of decisions making
1. Individual decision making:
Depends on :
 Style of the leader

 Ability to set priorities

 Timing of decision

 Creativity of the manager

2. Group decision making:
 Process of solving problems jointly

 It plays a key role in health care management

E.g. task force

 Especially very important in non-programmed decision making.
30/12/24 L/col Mebrate D. 264
 Techniques of group decision
making
1. Brain storming:- group effort art generating ideas and
alternatives that can help to solve a problem.

 Generates more information for decision.

 Dominant groups can be a problem.

2. Nominal group technique:- tries to solve the problem of brain

storming (dominant group) as the problems are identified
individually.

 Group members are presented with a problem; each member

independently writes down his or her ideas on the problem, and
then each member presents one idea to the group until all ideas
have been presented.

 No discussion takes place

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Mebrate
 Techniques of group
decision making
3. Delphi technique:- A group decision making
conducted by a group leader through the use
of written questionnaires.
 It provides equal opportunity to participants.

30/12/24 L/col Mebrate D. 266

 Outcomes of group decision making
• Indecision: failure to decide (disagreement)

• Authority rule: decision by the team leader

• Minority rule: decision dominated by few influential

individuals.
• Majority rule: the majority agree

• Consensus: immediate agreement without thorough

discussion
• Unanimity: agree after through discussion and argument

30/12/24 L/col Mebrate D. 267

 Think twice before you
decide!!

30/12/24 L/col Mebrate D. 268

30/12/24 L/col Mebrate D. 269
 Unit Six:
Managing Resources for
Health
 6.1. Human Resource
Management

30/12/24 L/col Mebrate D. 271

 Human Resource Management

Session objectives
Define human resource management

Identify components of HRM activities/functions

 Describe different stages of disciplinary actions

Discuss on performance appraisal types

30/12/24 L/col Mebrate D. 272

 Human Resource Management
• The process of attracting, developing and maintaining a
talented and energetic workforce to support
organisational mission, objectives and strategies.

• HRM is supplying organizations with the right people in

the right position, when they are needed.

• HRM is the integrated use of procedures, policies and

practices to recruit, maintain and develop employees to
meet the desired goals of the organization.

30/12/24 L/col Mebrate D. 273

 HRM…
HRM includes seven basic activities

1. Human resource planning

2. Recruitment

3. Selection

4. Socialization (Orientation)

5. Training and Development

6. Performance Appraisal

7. Promotions, Transfers, Demotions, and

30/12/24 Separations L/col Mebrate D. 274
 1. Human Resource Planning
• Planning for the future personnel needs of an
organization taking into account analysis of
both internal and external factors.

• Human Resource Planning includes the

estimation of numbers and categories of
personnel required both in the immediate and
long-term and the allocation of resources to
train and pay these staff.
30/12/24 L/col Mebrate D. 275
 Approaches used in calculating health
personnel requirements

• Health needs approach

• Human resource to population ratios

• Service targets

30/12/24 L/col Mebrate D. 276

 2. Recruitment
• Recruitment: Process of searching
/attracting potential candidates to fill the
vacant position in accordance with HRP
• Recruitment includes:
1.Job description: is a written
document that shows the nature and
characteristics of the task to be
performed.
2.Job specification: a written description of
the education, experience, and skills needed
to perform a job or fill a position effectively
– Note: Every employee should be provided
with a job description.
30/12/24 L/col Mebrate D. 277
 HRM…
Methods of recruitment
• Peer recruiter (advantage: well
informed person is identified)
• Within the organization (advantage:
familiar, inspiring, less expensive)
• Outside the organization (e.g.
colleges, graduate schools, other
organizations)
• Formal announcement (mass media)
30/12/24 L/col Mebrate D. 278
 Legal considerations
1. Prohibiting discrimination by: Race, Sex, Age,
Colour, National origin
2. Equal employment opportunity, which should
apply to both public and private sectors.
3. Affirmative action for like job for women, disable
persons
4. Comparable worth /equivalent/: Different jobs
that require comparable skills and knowledge
deserve comparable pay ( like pay for like job)
30/12/24 L/col Mebrate D. 279
 3. Selection
• It is the process of choosing individuals who can
successfully perform a job from available candidates

• It is a crucial process in management and requires

constant attention, interest and concern of
management.

• The three sources of information used in selection

are application forms, pre-employment
interviews and testing

30/12/24 L/col Mebrate D. 280

 4. Introduction (Socialization) and
Orientation
• When the candidate is selected and offered a job, it
is necessary to introduce the new employee to the
rules and polices, etc of the organization.

• Thus, before the employee begins his/her work,

he/she should be assimilated /full understand/ to
job and organizational environment.
 Introduce employee peers, superiors &
subordinates.

• Orienting him/her to the new working environment.

30/12/24 L/col Mebrate D. 281

5. Training and development
 Training begins at the first day, which is designed
to improve the person’s skills and knowledge to do
the current job at high level.
 Designed to provide learners with the knowledge
and skills needed for their present jobs – formal and
informal.
 Development refers to the organizations efforts to
help employee’s acquire knowledge, skills and
behavior that improve their ability to meet
changes in job requirements and customer needs.
Involves learning that goes beyond today's job –
more long-term focus.

30/12/24 L/col Mebrate D. 282

 Training and Development…
Approaches to training
On-the-job training
 Job rotation: Employees move from one job to another to
broaden experience.
 Helps new employees understand variety of jobs

 Internship: Combined classroom teaching, that offer students

the opportunity to gain real-life experience while allowing them

to find out how they will perform in work organizations.

 Apprenticeship: training under guidance of skilled co-worker

30/12/24 L/col Mebrate D. 283

 Training and Development…
Off- the-job training

• Vestibule training: training on realistic job setting

or equipment.

• Behaviorally experienced training: simulation

exercises, cases, games, role-playing (done outside

the organization).

30/12/24 L/col Mebrate D. 284

 Training and Development
Procedures to determine training needs of
individuals:

1. Performance appraisal

2. Analysis of job requirements

3. Organizational analysis

4. Employee survey

30/12/24 L/col Mebrate D. 285

 6. Performance Appraisal

30/12/24 L/col Mebrate D. 286

 Performance Appraisal
 The process by which an employee’s contribution to
the organization during a specified period of time is
assessed.

 It is the process through which a manager measures

employees’ activities and output against
organizations objectives.

 It involves measuring actual performance of an

employee and providing information about his/her
strengths and weakness.

 It is systematic, periodic review and analysis of

employees’ performance.
30/12/24 L/col Mebrate D. 287
 Performance Appraisal…

Purpose:
• To give feedback,

• To recognize outstanding performance,

• To locate the need for additional training

• To identify candidates for promotion

30/12/24 L/col Mebrate D. 288

Performance appraisal …
Types: informal appraisal and formal
systematic appraisal
• Formal appraisals
– An appraisal conducted at a set time during
the year and based on performance
dimensions that were specified in
advance(usually semi-annually or annually)
• Informal appraisals
– An unscheduled appraisal of ongoing progress
and areas for improvement
30/12/24 L/col Mebrate D. 289
 Who Appraises Performance?
• Self
– Self appraisals can supplement manager view.

• Peer appraisal
– Coworkers provide appraisal; common in team
settings.

• 360 Degree
– A performance appraisal by peers, subordinates,
superiors, and clients who are in a position to
evaluate a manager’s performance

30/12/24 L/col Mebrate D. 290

 Why Performance Appraisal Fails?
Ineffecti
ve
Applicati
on
Lack
Insufficient appraisal
of
Rewards Standar skills
ds

Mgr not Manager

honest not
or prepared
sincere

No on-
Fear of
going
Hurt
feedback
Feeling
Mgr s
Ineffecti
Lacks
ve
Inform
discussi
30/12/24 L/col Mebrateation
D. 291
on
 7. Promotion, Transfer, Demotion and
Separation
Promotion
• Moving to a higher position and responsibility
• Recognize outstanding performance
Transfer
Shift to other positions without change in status or
pay.
• For experience
• To fill gap
• To keep promotion ladders open
• To keep individuals interest in the job
sometimes, for those with inadequate
performance
30/12/24 L/col Mebrate D. 292
 Discipline, Demotion and
Separation
When the organization’s policy is violated.
Steps:
• Warning
• Admonishment-Counseling/Advising
• Probation Testing
• Suspension
• Disciplinary transfer
• Demotion
• Discharge/separation
“For poor performance, separation is better
than letting the employee stay on the
job”.
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6.2. MANAGEMENT OF FINANCE

30/12/24 L/col Mebrate D. 294

 Objectives
 Define Finance, Budget and Budgeting.
 Describe the different types of budgeting
 Mention the different models and codes of line
item budgeting

30/12/24 L/col Mebrate D. 295

30/12/24 L/col Mebrate D. 296
 Financial Management
 one of the useful resources for running
Health Sector Organizations is finance.
 It needs to be handled and managed
properly.

30/12/24 L/col Mebrate D. 297

 Why FM is Important?
• Could not implement our plans with out
finance.

• To be more accountable to donors

• Gain the respect and confidence of

funding agencies, partners, beneficiaries
• Give the HSO a competitive advantage for
increasingly scarce resources
• For financial sustainability
30/12/24 L/col Mebrate D. 298
 Financial Management…

Who Is Responsible For Financial

Management?
•Managers are more responsible to use it
more effectively and efficiently.

•Given in the form of budget.

30/12/24 L/col Mebrate D. 299

 Budget
 An estimate of income and expenditure for
a specified period of time.
• Budget is a plan for the allocation of
resources and a control for ensuring that
the results comply with the plans.
 The results are expressed in quantitative
terms.
 Budgeting – is the process of planning and
controlling future operations by comparing
actual results with planned expectations.

30/12/24 L/col Mebrate D. 300

 Types of Budget
1. Revenue Budget: It is the organization’s statements of
expected revenues for the coming year. e.g. taxes, surpluses,
etc.
2. Expenditure Budget
A. Recurrent expenditures: activities that are recurring
and continuous in nature (like salaries of civil servants)
B. Capital expenditures: Short-term activities that are
project in nature are included in capital budget (e.g.
construction of roads, buildings or other infrastructures)

30/12/24 L/col Mebrate D. 301

BUDGET Cont…
Other types
1. Line-Item Budgeting:
•Fixed amount of money is allocated to a given item
& expenditure.
Has a number of advantages: First, it promotes control since the budget
is detailed down to particulate expenditure items.
•The use of the budget of one line item for another may require the
verification of both the finance and health office.
2. Program Budgeting.
•Budget is allocated for the program/project rather
than for specific items.
•used by large organizations
•flexible decisions
• usually obtained from aids and funds
30/12/24 L/col Mebrate D. 302
Line-item budgeting in Ethiopia
The Ethiopian government prepares
its revenue and expenditure budgets
using Line item budgeting.
In line-item budgeting a fixed amount
of money is allocated to a given item.
Expenditures above the allocation or
transfer of allocation, whole or in
part, from item to another is
impossible without prior request and
authorization from government.
30/12/24 L/col Mebrate D. 303
 Budgeting Techniques
1. Incremental budgeting
• This approach bases any year’s budget on the
previous year’s actual, or budgeted, figures with
an allowance for inflation and known changes in
activity levels
• Most useful for organisations where activity and
resource levels change little from year to year

30/12/24 L/col Mebrate D. 304

 Budgeting Techniques

2. Zero-based budgeting
• Start with a clean sheet – a zero base.
• Zero-base budgeting (ZBB) ignores previous
experience and starts with next year’s targets
and activities
• May suit organizations going through a period
of rapid change
30/12/24 L/col Mebrate D. 305
 BUDGET…
• Budget Cycle
- Budget preparation
- Budget compiling and approval
- Budget execution
- Budget audit

Fiscal Year: A specified 12-month period during which

operational and financial performance is measured.
 Budget allocated has to be used within this time.

30/12/24 L/col Mebrate D. 306

 Budget Cycle:

30/12/24 L/col Mebrate D. 307

 AUDIT
WHAT IS AN AUDIT?
 An independent examination of records, procedures and
activities of an organization resulting in a report on the
findings.
Why do we need audit?
• Accountability
• Credibility
• Transparency
• Legal requirement.
30/12/24 L/col Mebrate D. 308
Coding the line item budget
There are three major line of item Coding
• 1000: Revenue items
• 6000: Items for recurrent budget:
e.g. 6101, 6102, 6201, 6202, 6301
• 8000: Item for capital budget

30/12/24 L/col Mebrate D. 309

 Line Item Budgeting
Once approved-money can not be transferred from one category
of item to another
61: Item for salaries
6101: Salary for civil servants
62: Line item for diff, services (Budget)
6201: Item for postage, water, telephone and electric bill
6202: Transport and per diem
6203: Information advertisement and publication
6204: Equipment, building and fence repair and maintenance
6205: Repair and maintenance of vehicles
6206: For rent
63 : Line item for expendable items
6301: For food

30/12/24 L/col Mebrate D. 310

 Line Item Budgeting...
6302: Drugs and equipment
6304: For clothing
6305: Fuel for cars
6306: For stationers
6307: Contingency fund for which item not set for
64 : Item for supportive fund
6401: For individual support
6402: For organization support
6403: For international organization support
65: Line item for non-expendable items
6501:For parches of cars

30/12/24 L/col Mebrate D. 311

 Line Item Budgeting...
There are six major items or recurrent
budget
6000: Recurrent Budget
6100: Expenditure for social service
6200: Non-social contract based service
6300: Expendable (consumable) goods
and
equipment
6400: Support and contribution
6500: Purchase of vehicles and machines
6600: Military construction works and
equipment
30/12/24 L/col Mebrate D. 312
 Line Item Budgeting...
8000: Capital Budget
8100: Surveying, surveillance, Design and Engineering works
8101: Preliminary studies and surveillance
8102: Engineering works and technical designs
8200: Building construction and related works:
8201: Residential Buildings
8205: Transport equipment (vehicles. etc)
8300: Labour and running expenses:
8301: Management and Control
8304: Financial expenses:
8400: Capital Transfer:

30/12/24 L/col Mebrate D. 313

Models dealing with property and
finance
• Model 20:Model for requesting items/drugs
• Model 21:Model for approving item delivery by
person in authority
• Model 22:Model for issuing items/drugs
• Model 19: Model for confirming delivery of items
• Model 33: (Pay roll) – payment of salary
• Model 85: to deposit money
• Model 86 : to release deposited money

30/12/24 L/col Mebrate D. 314

 6.3. Managing Time

30/12/24 L/col Mebrate D. 315

 Session objectives

• Understand the concept of time management

• Explain benefits of time management

• Describe strategies of effective Time management

• Understand time management matrix

• Obstacles to effective time management

30/12/24 L/col Mebrate D. 316

 Time management

30/12/24 L/col Mebrate D. 317

 Time
• It is a non-renewable resource
• No event can take place unless there is time for it.
• Using time efficiently requires managerial skills.
• Time can not be stored
• Time is equally shared to people
NB- Our ability to manage our time is the ONE to
make difference in life

30/12/24 L/col Mebrate D. 318

 What is time management?
 It is the ability to decide what is important in life, both at
work, in our home and personal life.

 Simply, it is devoting most of time and energy for the

bold goal.

• It is not a way to make you work harder and longer, but a

means to help you work smarter to accomplish your
work more easily and rapidly.

• Spending time on important, not just urgent matters

30/12/24 L/col Mebrate D. 319
 Time Management…

 Efficient time use  Inefficient time use

• Plan the time daily • Disorganized desk and
• cluttered files
Prioritize activities
• Wrong appointments,
• Time for important one
• Lack of delegation,
• Set recording system
• Stress/ tiredness ,
• Resources before start
• Counting saying no as
• Do one activity at a time
guilty,
• Decide time limit for
• Getting early or staying
every activity
late at work,
• Take rest whenever
necessary

30/12/24 L/col Mebrate D. 320

 The Benefits of Time Management

Yes!
 Increases productivity,
 Reduces stress,
 Improve self-esteem,
 Avoids meltdowns,
 Develops confidence,
 Reach goals.
Achieve Balance in your life.

30/12/24 L/col Mebrate D. 321

 Time Management…

Strategies to Effective Time Management

1. Set Goals
2. Set priorities
3. Plan your time
4. Avoid Procrastination
5. Delegation

30/12/24 L/col Mebrate D. 322

 Where to start? Go for
the goal!

1. Set Goals!
 Start with big, then set
smaller goals.
 Make your goals specific and
concrete.
 Set both long and short-term
goals support one other.
 Integrate your goals: school,
personal and career.
 Set a deadline for your goals.

30/12/24 L/col Mebrate D. 323

 Time Management…
2. Set priorities
• Select what’s important and what is not?
• What order do things need to be done?

• Based on your priorities, plan out a schedule

for the time period

• Planning may seem hard at first, but the more

you do it, the easier and more natural it gets.
30/12/24 L/col Mebrate D. 324
 Time Management… No! I have a
study group
3. Plan your time tonight. Are
Begin with blocking/portion/ all activities. you free on
Consider: office work, field work, social Thursday?
work, religious worships, meetings, so on.
Highlight all project due dates.
Identify routine work days.
Avoid temptation to socialize when you’ve
scheduled work.

30/12/24 L/col Mebrate D. 325

 Time Management…
3. Plan your time…
 common ways of time plan arrangement:
 Time table:- used for daily/weekly recurring and
regular events, e.g. staff meeting, classes, etc.
 Schedule:- for intermittent, irregular or variable
events, e.g. visit to peripheral health centers.
 Program: - Long term arrangements of events e.g.
TTP, apprentice, semester break, etc.

30/12/24 L/col Mebrate D. 326

 Time Management…
4. Avoid Procrastination
• “Procrastination is the theft of time” – it is a time
waster.
• It is the act of postponing tasks that could have been
done now.
 Note: Deadlines are really important, doing things at
the last minute is much more expensive than just
before the last minute

30/12/24 L/col Mebrate D. 327

 Time Management…
4. Avoid Procrastination…
Forms of procrastination:
 Ignoring the task, hoping it will go away.
 Underestimating how long it will take.
 Overestimating your abilities and resources.
 Telling yourself: poor performance is okay.
 Doing something else that isn’t very important
 Believing that repeated delays not hurt you

30/12/24 L/col Mebrate D. 328

 Time Management…
4. Avoid Procrastination…
How to Overcome Procrastination:
 Win mental battle to being on time.
 Organize, schedule & plan
 Set and keep deadlines.
 Divide a big job into smaller ones.
 Make game of your work or make it fun.
 Reward yourself when you have done it.
 Tell your friends to remind deadlines.
 Use memo
 Learn to say “no” to time wasters.
30/12/24 L/col Mebrate D. 329
 Time Management…
5. Delegation
“Delegation: is granting authority with responsibility”
 No one is an island
 Delegation is not dumping/discarding tasks.
 Treat your people well by delegating for tasks
 We can accomplish a lot more with help
 Graduate students, subordinates, secretaries, families,
colleagues etc. can be delegated.

30/12/24 L/col Mebrate D. 330

 Time management
Matrix
Urgent Not Urgent
I
M
I II
 Crisis Preparation
P
O
 Pressing problems . Prevention
R Deadline-driven projects, . Values clarification
T meetings, preparations . Planning
A  vital programs/schedules . Relationship
N building
T . True re-creation
Not III IV
I
• Interruptions, some phone Irrelevant talks
M Some Time wasters
P calls
O • Some mail, some reports Irrelevant e-mail, chat
R .Some meetings  Excessive TV
T . Many popular activities- Long fictions/novels
A breaking news
N
T 30/12/24 L/col Mebrate D. 331
 Focus here
Manage the
best you can

Avoid as much
Be careful here as possible

30/12/24 L/col Mebrate D. 332

 Obstacles to effective Time Management

Unclear objectives

Inability to say “no”

30/12/24 L/col Mebrate D. 333

Obstacles to Effective Time Management…

Too many things at once

Stress and fatigue- always

work, no play

30/12/24 L/col Mebrate D. 334

 Don’t let this be you!

30/12/24 L/col Mebrate D. 336

 manage your time Manage
your self!

30/12/24 L/col Mebrate D. 337

“Never do tomorrow what you can do today”

“Prioritize, and do the most

important things first”

30/12/24 L/col Mebrate D. 338

 8. 4: Logistics and Pharmaceutical Management

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 Pharmaceutical Logistics Mgt.
It is a system of:
 Selecting
 Quantifying
 Supply-planning
 Ordering/procuring
 Distributing products from one level to
another

30/12/24 L/col Mebrate D. 340

 Types of Logistics Systems
 Allocation or “Push” System: the higher-level
decides what, when and how much of each
pharmaceuticals move down through the system

 Requisition or “Pull” system: the lower level orders

what, when and how much of each pharmaceuticals,
thus pulling or receiving through the system

30/12/24 L/col Mebrate D. 341

Integrated Pharmaceutical Logistics System (IPLS)

 In the integrated pharmaceutical logistics system,

pharmaceuticals are handled and managed in an
integrated manner.

 There are three pipeline levels namely;

 Central PFSA(Pharmaceutical fund and supply
agency )
 PFSA Hubs/branches and
 Health Facilities (health centers and hospitals).

30/12/24 L/col Mebrate D. 342

 I. Central Level (Central PFSA)
 This level is the central medical store where pharmaceutical
products are procured, received and stored.

 Major activities done at this level are:

• Perform forecasting and quantification and procure

pharmaceutical products necessary for the country

• Perform supply planning, follow shipment status of procured

supplies

• Receive, store, manage and distribute them to PFSA Hubs

30/12/24
(branches) L/col Mebrate D. 343
 II. PFSA Branch or PFSA Hub Level

 Major responsibilities of branch PFSAs are:

 Plan, quantify and request pharmaceutical
requirement from central level for health facilities
under their area, periodically.
 Receive, store, and manage supplies coming from
central level
 Receive and check requests coming from facilities
 Distribute products to facilities appropriately

30/12/24 L/col Mebrate D. 344

 III. Facility Level
 Prepare and submit their reports and requests on time

 Receive, store and manage supplies at their facility

 Receive periodic reports from different units (for health

centers this includes from health posts) and issue
supplies to them

30/12/24 L/col Mebrate D. 345

Flow of pharmaceuticals and information in the IPLS

30/12/24 L/col Mebrate D. 346

 Inventory Management (Inventory Control) System

An inventory management is a system that informs the

store manager:
 How much stock is available
 When to order more stock
 When to issue
 How much to order or issue and
 How to maintain an appropriate stock

30/12/24 L/col Mebrate D. 347

8.5. Health Mgt Information
System(HMIS)

30/12/24 L/col Mebrate D. 348

 Learning objectives
 Understand the Organization of the health systems
of Ethiopia and healthcare reform
 Identify the flow of data in the health sector
 Define Health management information system
 Name the main information sources
 Describe the main strengths and weaknesses of
different data sources
 Discuss the main data quality issues that need to
be considered
 Discuss the different health indicators

30/12/24 L/col Mebrate D. 349

 MANAGEMENT OF INFORMATION
DATA
- collection of raw facts and figures
INFORMATION
- is the end processed product of
data/facts, by adding order, context &
purpose.

• Knowledge: the product of adding meaning to

information by making connections and comparisons
and by exploring causes and consequences
• System :- A collection of components that work
together to achieve a common objective

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 INFORMATION SYSTEM
 is a combination of people, equipment, &
procedures, organized to provide certain

information to make informed decisions.

 A system that provides information support
to

the decision making process at each level of an

organization
30/12/24 L/col Mebrate D. 351
 Flow of Information

Collection of
Reporting Processing
Data

Action Analysis

Feedback

30/12/24 L/col Mebrate D. 352

 Management Information
System (MIS)
Management Information System (MIS)
- An information system that utilizes
information for management purposes.
- Is a system to convert data from
internal & external sources into
information,
- To make timely & effectively decisions
for planning, directing & controlling
the activities.

30/12/24 L/col Mebrate D. 353

 Health Information System
• A system that provides specific information
support to the decision making process at
each level of an organization.

• A set of interrelated components working

together; to gather, retrieve, process, store
and disseminate information to support the
activities of health system planning, control,
coordination, and decision-making both in
management and service delivery.

30/12/24 L/col Mebrate D. 354

 Health Management Information
System
HMIS
- A combination of instruments,
norms (procedures) & activities
which together produce
information for health workers to
take decisions in the area of
health care services.

30/12/24 L/col Mebrate D. 355

 HMIS
• Instruments: e.g. formats, registration
books, etc.
• Norms/procedures:
- who should carry out the various activities?
- frequency?
- flow of information, etc.
• Activities: Registration (data collection),
Copying in the weekly forms, Processing into
information, Presenting (tables/graphs),
Interpreting, Utilization (decision to action),
Communication, Reception (within a specified
time), Feedback.
30/12/24 L/col Mebrate D. 356
 HMIS. . .

Sources of information
• Health institutions
• Vital registrations
• Laboratories and pharmaceuticals
• Community – census and survey
• Investigation of outbreaks –
surveillances
• Routine reports
• Information is collected, analyzed,
presented and communicated.
30/12/24 L/col Mebrate D. 357
 FMOH
Routine Data Collection & HMIS Data flow
RHB

WorHO/ Compile
d and
ZHD used
Compiled
and used
/
Compiled
reported
and used
Facility Based Data
/
reported
Community
Based Data
Compiled
Service delivery/disease
and used
/ report
 INTRODUCTION TO
HEALTH ECONOMICS
 INTRODUCTION TO ECONOMICS
At the end of this chapter, the student will be
able to:
Understand the meaning and purpose of
economics
Know the major branches and approaches of
economics
 Be able to identify and understand the
basic instruments of microeconomic analysis
Appreciate the importance of economics to
the resource allocation, planning and
management of the health sector.

30/12/24 L/col Mebrate D. 360

INTRODUCTION TO ECONOMICS…..
 Economics is the study of how people
allocate their limited resources in an
attempt to satisfy their unlimited wants.

 As such, economic is the study of how

people make choices.

 It is also the study of scarcity and choice,

finally helps how to use scarce or limited
resource.
30/12/24 L/col Mebrate D. 361
INTRODUCTION TO ECONOMICS…..
 The subject matter of economics lies on
the production, distribution and
consumption of economic goods.

 How much should be spent on education,

health, books, travel, food or clothing is
of course a matter of political, social or
simply personal judgment as well as a
question for the economist.

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 Branches of economics
Macroeconomics versus
microeconomics
A major distinction is made between
macroeconomics, which studies the
functioning of the economy as a whole,
and
 Microeconomics, which analyses the
behavior of individual components like
industries, firms and households
30/12/24 L/col Mebrate D. 363
 Macroeconomic policy
instruments
Policy instrument is an economic
variable under the direct or indirect
control of government; changes in
policy instruments affect one or more
of the macroeconomic objectives.
A nation has a wide variety of policy
instruments that can be used to
pursue its macroeconomic
objectives. The major ones are:
30/12/24 L/col Mebrate D. 364
 Macroeconomic policy
instruments..
1Fiscal policy: This consists of
government expenditures and taxation.
 Government expenditures influence the
relative size of collective as opposed to
private consumption
 Taxation subtracts from income and
reduces private spending; in addition, it
affects investment and potential output.
 Fiscal policy affects total spending and
thereby influences GNP and inflation
30/12/24 L/col Mebrate D. 365
 Macroeconomic policy
instruments..
2.Monetary policy: This is operated by
the central bank and sets the money
supply; changes in the money supply move
interest rates up or down and affect
spending on items like machinery or
buildings. Monetary policy has an important
effect on GNP
3. Foreign economic policies: Trade
policies and exchange rate management
attempt to keep imports in line with exports
and to stabilize foreign exchange rates
30/12/24 L/col Mebrate D. 366
 Macroeconomic policy
instruments..
4. Income policies: A final set of
macroeconomic policies are income
policies, more accurately denoted as wage
price policies.
 They are the most controversial of all
macroeconomic policies.
 Income policies are government actions
that attempt to moderate inflation by
direct steps, whether by verbal persuasion
or by legislated wage and price controls.
30/12/24 L/col Mebrate D. 367
 Normative versus positive
economics (Fact or opinion)
 When using economics we must be careful
to distinguish between normative
statements (or value judgments) and
positive (or factual) statements.
 In the world today, yet health care seems to
be in almost permanent crisis – there are
shortages of hospital beds and patients are
left to lie in corridors, while politicians argue
endlessly over whether more or less is being
spent on the National Health System (NHS ).

30/12/24 L/col Mebrate D. 368

 Positive economics
Positive economics describes the facts and behavior
in the economy.
 What percentages of teenagers are unemployed?
 How many people earn less that Birr 6,000 a year?
What will be the effect of higher cigarette taxes on
the number of smokers?
These are questions that can be resolved only by
reference to facts; positive economics.

30/12/24 L/col Mebrate D. 369

 Normative economics
• Normative economics: involves ethics
and value judgments.
 Should the government give money to
poor people?
 Should the public sectors (government)
or the private sector (business) provide
extra jobs for unemployed teenagers?
 Should higher taxes or lower spending
reduce the budget deficit?
 These are questions involving deeply
held values or moral judgments.
30/12/24 L/col Mebrate D. 370
 Basic concepts of supply and
demand analysis
Definition of Demand: Need + ability and
willingness to pay for a commodity

The schedule of amounts of any product

that buyers will purchase at different
prices during some stated time period

Desire refers to people’s willingness to

own a good. - Demand is the amount of a
good that consumers are willing and able
to buy at a given price.
30/12/24 L/col Mebrate D. 371
 Basic concepts of supply……
Definition Supply: the amounts of a
good producer are willing and able to
sell at a given price.
 It is used to describe any process of
exchange between buyers and sellers.
 Formally, a market can be defined as
any set of arrangements which allows
buyers and sellers to communicate
and thus arrange exchange of goods,
services or resources.
30/12/24 L/col Mebrate D. 372
 Basic concepts of supply……
 A free market is where such
exchange occurs without
interference from the government.
 Information is a vital ingredient for
any market.
 Both buyers and sellers need to
have access to sufficient information
to allow them to make rational
decisions.
30/12/24 L/col Mebrate D. 373
 The Demand curve….
 The relationship between price and
quantity demanded allows us to
define demand formally as the
quantity of a good or service that
buyers are willing and able to buy at
every conceivable price.

30/12/24 L/col Mebrate D. 374

 The Law of Demand

30/12/24 L/col Mebrate D. 375

 Introduction to Demand
• The demand curve slopes downward.

– This shows that people are normally willing

to buy less of a product at a high price and
more at a low price.
– According to the law of demand, quantity
demanded and price move in opposite
directions.

30/12/24 L/col Mebrate D. 376

 Changes in Demand
• Change in the quantity demanded
due to a price change occurs ALONG
the demand curve
•An increase in the Price of
Widgets from $3 to $4 will
lead to a decrease in the
Quantity Demanded of
Widgets from 6 to 4.

30/12/24 L/col Mebrate D. 377

 Demand
Price Quantity
$5 10
$4 20
$3 30
$2 40
$1 50

30/12/24 L/col Mebrate D. 378

 Determinants of Demand
• Income
• Price of related goods
– Complements
– Substitutes
• Tastes or preferences
• Expectations
• Number of buyers

30/12/24 L/col Mebrate D. 379

 Changes in Demand
• Demand Curves can also shift in response to the
following factors:
– Buyers (# of): changes in the number of consumers
– Income: changes in consumers’ income
– Tastes: changes in preference or popularity of
product/ service
– Expectations: changes in what consumers expect to
happen in the future
– Related goods: compliments and substitutes
• BITER: factors that shift the demand curve
30/12/24 L/col Mebrate D. 380
 Introduction to Supply
• As the price for a good rises, the quantity
supplied rises and the quantity demanded
falls. As the price falls, the quantity
supplied falls and the quantity demanded
rises.
• The law of supply holds that producers
will normally offer more for sale at higher
prices and less at lower prices.

30/12/24 L/col Mebrate D. 381

 Changes in Supply
•Change in the quantity supplied due to a price change
occurs ALONG the supply curve

•If the price of Widgets fell

to $2, then the Quantity
Supplied would fall to 4
Widgets.

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 The Law of Supply

30/12/24 L/col Mebrate D. 383

 Determinants of Supply
• Input prices
• Technology
• Expectations
• Number of sellers

30/12/24 L/col Mebrate D. 384

 Changes in Supply
• Supply Curves can also shift in response to
the following factors:
– Subsidies and taxes: government subsides
encourage production, while taxes discourage
production
– Technology: improvements in production increase
ability of firms to supply
– Other goods: businesses consider the price of
goods they could be producing
– Number of sellers: how many firms are in the
market
– Expectations: businesses consider future prices
and economic conditions
– Resource costs: cost to purchase factors of
production will influence business decisions
• STONER: factors that shift the supply curve
30/12/24 L/col Mebrate D. 385
 Market Equilibrium
Quantity Quantity
Price
Demanded Supplied
$5 10 50
$4 20 40
$3 30 30
$2 40 20
$1 50 10
30/12/24 L/col Mebrate D. 386
 Market Equilibrium

30/12/24 L/col Mebrate D. 387

 Market Equilibrium

30/12/24 L/col Mebrate D. 388

 Elasticity
 Elasticity provides a way of measuring how
sensitive demand or supply is to factors such as
a change in price.
 Take the relationship between price and
quantity demanded.
 We know that if price rises, then people will
buy less, but we do not know how much less.
 Price elasticity of demand allows us to calculate
this.
30/12/24 L/col Mebrate D. 389
 Health economics
 “Health economics” can be defined as the
application of Economic theories, tools and
concepts of economics as a discipline to the
topics of health and health care.

 Since health economics is concerned with

issues related to the allocation of scarce
resources to improve health, this includes both
resource allocation within the economy to the
health sector and within the health care
system to different activities and individuals
 Health economics….
 In Ethiopia, the need for health care is
increasing due to rapid population growth
and changes in disease pattern.
 Related with this, health care costs are
expected to be rapidly increasing.
 Apart from explosion of costs, inequity,
misallocation and inefficiency are believed
to be serious
 Terminologies
• Efficiency refers to obtaining the
greatest output for a given set of
resources.
• Equity refers to a fair distribution of
that output amongst the population.
• Equity is always an important criterion
for allocation of resources
• It is an important policy objective in
almost every health care system in the
world.
 Terminologies….
• Equity in the distribution of health is
almost always expressed in terms of
inequalities in health between different
socioeconomic and demographic groups
within populations
 Terminologies…
• A marginal change is defined as a
change in an economic variable that is
caused by the smallest possible change
in another variable, often expressed as
‘one unit’ of that variable.
• For example, the marginal cost of a
good or service is defined as the extra
cost that is incurred by producing one
more unit of it
cost of producing an extra unit
 Terminologies…
• Gross domestic product (GDP) is
the total market value of all final
goods and services produced within a
given period by factors of production
located within a country.
Intermediate goods are goods
produced by one firm for use in
further processing by another firm.
 Terminologies…
Nondurable goods: Goods that are
used up fairly quickly, such as food and
clothing.
Durable goods: Goods that last a
relatively long time, such as cars and
appliances.
Services: Things that do not involve the
production of physical things, such as
legal services, medical services, and
education
 Perspectives of Health
Health as a right
• Health is viewed by some as a right analogous to
justice or political freedom.
• Indeed, the WHO constitution states that ‘… the
enjoyment of the highest attainable standard of
health is one of the fundamental rights of every
human being without distinction of race, religion,
political belief, economic or social condition’
 Perspectives of Health…
 Although it is difficult to believe that equal health
status is attainable in the same way that equal
political freedom may be
 Health is seen as so fundamental that constraints
to its full attainment must be minimized.
 In part, this involves ensuring access to health
care.
 The government is seen as having a responsibility
to ensure this, comparable with its role in
ensuring equal justice. According to such a view,
a government will be particularly concerned with
issues of equity in health and health care.
 Perspectives of Health….
Health as consumption good
 For others, health is seen as an important
individual objective that is not comparable with
justice, but rather with material aspects of life.
• Such a view often refers to health as consumption
good. The government here has no special
responsibilities in the promotion of health, but
leaves decisions as to its comparative importance
to individual consumers.
• The role of the state under such a view might be
limited to ensuring that the health care provided
is of an adequate
 Perspectives of Health….
• quality (such as ensuring
professional standards in the same
way that it would monitor the quality
of any good or service, such as food).
 Perspectives of Health…
Health as an investment
 A third view of health is that it is
important, but largely it affects the
productive ability of the workforce.
 Illness may affect overall production,
either through absenteeism or by
lowering productivity through its
debilitating effects.
 How is the medical care market
different from other markets?
1. Presence of Uncertainty
 Demand is irregular and uncertain
 Accidents, can you deny someone
lifesaving care if they don’t have
the money?
market different from other
markets?
2. Supply–hard to understand the product
– Asymmetric information
 When we are sick we don’t understand the
treatment we need and must trust our doctor in
their diagnosis.
– Different doctors may suggest different
treatments due to uncertainty of outcome.
– Hard to judge quality
 Governments establish licensing requirements to
ensure minimum level of quality
 How is the medical care market
different from other markets?
3. Individual behaviors (smoking, over
eating)
– Direct impact on health of person and
others
– Impacts the cost of health
• premiums –i.e. lung cancer
– Impact on demand for health care
Positive externality (nutrition)
Health and Economic Development
 Development is the concern of all
developing countries.
 The health planner, manager, etc., is
equally charged with that concern and
must be knowledgeable about what
development implies and the role health
should play in the development of a given
country.
 The following questions are of paramount
importance for the health worker in a
developing country such as Ethiopia
 Health and Economic
Development…
 What is development?
 How does it differ from economic
growth?
 How can development be measured?
 What role does health play in
development?
 What role should the health worker
play in facilitating development?
 The meaning of Economic
Development
Development has been variously
defined.
The modern view of development
perceives it as both a physical reality
and state of mind in which society has,
through some combination of social,
economic and institutional processes,
secured the means for obtaining a
better life.
Health and Economic Development
• The definition of “a better life” may
vary from one society to another.
• Development in all societies,
however, must consist of at least the
following three objectives
Health and Economic Development
1. To increase the availability, distribution
and accessibility of life-sustaining goods
such as food, shelter, health, security and
protection to all members of society
2. To raise standards of living, including
higher incomes, the provision of more jobs,
better education and better health, and
more attention to cultural and humanistic
values so as to enhance not only material
well-being, but also to generate greater
individual community and national esteem.
 Health and Economic Development..
3. To expand the range of economic
and social opportunities and services
to individuals and communities by
freeing them from servitude and
dependence on other people and
communities and from ignorance and
human misery
 Growth and Development

• For a long time, Development and

Economic growth were used
interchangeably.
• Although the two are closely related
they are, however, different.
• Economic growth can be defined as an
increase in a country’s productive
capacity, identifiable by a sustained
rise in real national income over a
period of years
 Growth and Development

• The main differences between

growth and development can be
outlined as follows:
1. Development encompasses the total
well-being of the individual, a
community or a nation, while
economic growth is concerned with
the increase in per capita earnings of
the people making up the nation
 Growth and Development

2. Economic growth is one

characteristic of development, yet
development must not be measured
by the rate of economic growth.
• It is possible for a country to
experience economic growth without
becoming developed.
 Growth and Development

• A country, for example, may acquire

a great wealth from its mineral
deposits, but have a low level of
health services.
• This is due to the fact that the wealth
goes into the hands of a very small
minority who might squander it on
luxury goods instead of establishing
a viable infrastructure
 Measurement of Economic
Development
• The measurement of development
has presented social scientists with a
problem of finding the suitable tools
and techniques to do so and of
interpreting the results of such
measurements.
• Several suggestions have been
presented for measuring
development.
 Measurement of Economic
Development..
• One line of research has suggested the use
of so-called social indicators.
• The purpose of these is to measure the
well-being of the population by examining
factors such as health and nutritional
status, level of education, housing
conditions and so forth. However, it is
easier to calculate GNP, per capita incomes
and growth rates.
• As a result, in most reports these variables
are used as indicators of Development
 What measures can be used to
assess the development gap?
Gross Domestic Product (GDP)
•GDP is s how much money a country makes
from its products over the course of a year,
usually converted to US Dollars:
Gross National Product (GNP)
•GNP is the GDP of a nation together with any
money that has been earned by investment
abroad minus the income earned by non-
nationals within the nation.
 What measures can be used to
assess the development….
GNP per capita
•GNP per capita is calculated as GNP divided by
population; it is usually expressed in US Dollars.
 What measures can be used to
assess the development….
Birth and death rates
•Crude Birth and Death rates (per 1000) can be
used as an overall measure of the state of
healthcare and education in a country, though
these numbers do not give a full picture of a
nation’s situation.
• In 2020, crude birth rate for Ethiopia
was 31.44 births per thousand population.
Crude birth rate of Ethiopia fell gradually from
48.24 births per thousand population in 1971
to 31.44 births per thousand population in
2020.
• In 2020, crude birth rate for Ethiopia
was 31.44 births per thousand population.
Crude birth rate of Ethiopia fell gradually from
48.24 births per thousand population in 1971
to 31.44 births per thousand population in
2020.
• In 2020, crude death rate for Ethiopia
was 6.29 deaths per thousand population.
Crude death rate of Ethiopia fell gradually
from 21.11 deaths per thousand population in
1971 to 6.29 deaths per thousand population
in 2020. The description is composed by our
digital data assistant.
• The current fertility rate for Ethiopia in 2022 is
3.918 births per woman, a 2.39% decline from
2021. The fertility rate for Ethiopia in 2021
was 4.014 births per woman, a 2.31% decline
from 2020. The fertility rate for Ethiopia in
2020 was 4.109 births per woman, a 2.28%
decline from 2019.
 What measures can be used to
assess the development….
The Human Development Index (HDI)
The HDI is a composite statistic calculated from the:
•Life expectancy index
•Education index
•Mean years of schooling index
•Expected years of schooling index
•Income index
•Countries are ranked based on their score and split
into categories that suggest how well developed they
are.
• Ethiopia’s HDI value for 2019 is 0.485— which
put the country in the low human
development category— positioning it at 173
out of 189 countries and territories.
• Between 2000 and 2019, Ethiopia’s HDI value
increased from 0.292 to 0.485, an increase of
66.1 percent.
 What measures can be used to
assess the development….
Infant mortality rate
•Infant mortality rate is the number of infants
dying before reaching one year of age per 1,000
live births in a given year.
•The infant mortality rate for Ethiopia in 2021
was 32.514 deaths per 1000 live births, a 4.4%
decline from 2020. The infant mortality rate for
Ethiopia in 2020 was 34.010 deaths per 1000 live
births, a 4.21% decline from 2019.
 What measures can be used to
assess the development….
Literacy rate
•The rate, or percentage, of people who are able
to read is a useful indicator of the state of
education within a country.
•High female literacy rates generally correspond
with an increase in the knowledge of
contraception and a falling birth rate.
 What measures can be used to
assess the development….
Life expectancy
•This simple statistic can be used as an indicator
of the: healthcare quality in a country or provin
celevel of sanitation provision of care for the
elderly
•It should not, of course, be used on its own to
describe these things.
 Health Implications of Economic
Development
• The associations between health and
national development are complex.
• The interaction is a two-way
phenomenon with health being both
influenced by and influencing
economic development.
• Improved health has been considered
solely a result of economic growth, a
part of the product of growth rather
than one of its causes
 Health Implications of Economic
Development…
• Development planners and
economists are more optimistic
regarding the impact of health and
nutrition programs on economic
growth.
• There are three different ways by
which improved health programs can
accelerate development.
 Health Implications of Economic
Development
1. Improved health may increase productivity or
efficiency of the labour force leading to greater
output and reduced cost per unit of output
2. Better health conditions may serve to open
new regions of a country of settlement and
subsequent development.
3. Attitudinal changes towards achievement and
entrepreneurship may be lined to health and
nutrition
Major determinants of poor health
• The following are some of the main
determinants of poor health which have
direct or indirect interdependence with
Economic Development:
1.Population growth: rapid population growth
implies an increased need for medical and
other social services
2. Malnutrition
3. Sanitary conditions and inadequate shelter
4. Education
Major determinants of poor health
The following conclusions may be drawn from
the discussions of the relations between
health and development.
1.Development is not a simple process. It is a
complex intermingling of economic, social,
environmental, physiological, psychic, cultural
and political factors.
2. The measurement of development is not an
easy task. Economics provides certain tools
which can be brought to bear on crucial areas
of choice where decisions are required..
Major determinants of poor health
• Further research is required in this area so as
to develop tools and techniques for
evaluation in those areas that are not readily
quantifiable.
3. Development is linked not just to the
improvement of economic indicators or the
attainment of basic needs, but with wider
aspirations such as high health status, and
with social well-being and change. The
Development process embraces not only the
so-called “productive” sectors of the
economy, but also the social sectors
COST CONCEPTS AND ECONOMIC
EVALUATION
 Definition of Cost
• Economists define a cost as the
value of resources used to produce a
good or services. However, the way
these resources are measured can
differ.
• There are two main alternatives with
respect to measurement of these
resources: Financial and Economic
costing.
 Definition of Cost
• Financial cost represents actual
expenditure on goods and services
purchased.
• Costs are thus described in terms of how
much money has been paid for the
resources used in the project or services.
• In order to ascertain the financial costs of
a project, we need to know the price and
quantity of all the resources used or,
alternatively, the level of expenditure on
these goods and services.
 Definition of Cost
• Economic cost then include the
estimated value of goods or services
for which there were no financial
transaction or when the price of a
specific good did not reflect the cost
of using it productivity elsewhere.
 Types of costs
• Generally cost can be considered as
direct, indirect and intangible.
• Direct costs are those immediately
associated with an intervention such as
staff time, consumables etc
• Indirect costs might include a patient’s
work loss due to treatment.
• Intangible costs may be things like pain,
anxiety, quality etc..
 Economic evaluation
• Whatever kind of economic evaluation
may be applied, the costs must be
assessed.
• These are divided into costs borne by the
1. Ministry of health (like drug and
equipment),
2. By patients and their relatives (like
transport and food) and
3. By the rest of society (like health
education).
 Economic evaluation and
Health care
• Health economics uses various
economic evaluation tools to
evaluate medical interventions.
• Def : Economic evaluation (also
called assessment or analysis) refers
to methods to determine the value of
good, services, activities, policies,
program or project.

30/12/24 L/col Mebrate D. 441

 Types/Methods of Economic Evaluation:

• There are major 4 different types of

economic evaluation methods. They are:
Cost Benefit Analysis (CBA)
Cost Effective Analysis (CEA)
Cost Utility Analysis (CUA)
Cost Minimization Analysis (CMA)
• Each of this analysis involves systematic
identification and measurement of the
costs and consequences of the
interventions
30/12/24 L/col Mebrate D. 442
 Cost Benefit Analysis (CBA)

• In this method of evaluation, cost of the

intervention is compared with the benefit
incurred from the intervention
• Both costs and benefit is measured in
terms of monetary units
• The net benefit is measured as: Net
benefit= Benefit – Costs
• Therefore, if the benefit exceeds the cost
incurred during the intervention, the
intervention should be continued
30/12/24 L/col Mebrate D. 443
 Cost Minimization Analysis (CMA)

• In this method of analysis, costs of two or

more interventions achieving identical
outcome is measured.
• The intervention incurring the lowest cost is
then chosen
• It should be strictly noted that the
intervention can only be conducted when the
outcomes of the comparing interventions are
same
30/12/24 L/col Mebrate D. 444
 Cost Effective Analysis (CEA)
• In this method of analysis, cost is measured
against the effectiveness of the intervention
(effectiveness is the final consequence)
• The consequences of the comparing
interventions may vary here (different than cost
minimization analysis where the outcomes of
interventions were identical). However, these
consequences can be expressed in common
natural units like life years gained, saved years
of life etc or improvement in functional status
(units of cholesterol, blood pressure etc.)
30/12/24 L/col Mebrate D. 445
 Cost Effective Analysis (CEA)

• The limitation of this analysis is that it is

difficult to compare the interventions with
differing natural effects.
• Eg: interventions which are focused on
looking at life years saved cannot be
compared with other interventions which are
focusing on improving the physical functioning

30/12/24 L/col Mebrate D. 446

 Cost Utility Analysis (CUA)

• In this method of analysis, cost incurred in the

intervention is measured against the “utility” related
to health
• Utility refers to the Quality Adjusted Life Years
(QALY), Disability Adjusted Life Years (DALY)
• This method is specially used when there are
multiple objectives of the program and when both
quality of life and quantity of life are important to
know
• It is also used to make policy level decisions
30/12/24 L/col Mebrate D. 447
30/12/24 L/col Mebrate D. 448
•
END!!!

30/12/24 L/col Mebrate D. 449

• Health services coverage, utilization and
quality
The concept of coverage and patterns of health
care utilization (including organization and
use of the referral system)

30/12/24 L/col Mebrate D. 450

 Unit 8
Health service coverage and Quality
health care services
 Reflective Question

What is Health system ?

30/12/24 L/col Mebrate D. 452

 Health service coverage
 Objectives
At the end of this session students be able to
o Understand what health service coverage
mean
o Explain different stages of health service
coverage
o Describe factor affecting health service
coverage

30/12/24 L/col Mebrate D. 453

 Health service coverage

 Health service coverage is considered as the

extent of un limited interaction b/n the service

and the people for whom it is intended.

30/12/24 L/col Mebrate D. 454

 Coverage…

 For the measurement of coverage, several

key stages are first identified and defined for each stage,

namely the ratio between the number of people for

whom the condition is met and the target Population .

30/12/24 L/col Mebrate D. 455

 Coverage …
 In many developing countries high priority has
been given to basic health services or primary
health care.
One is the development of new resources
and technologies
 The other is the effective use of available
resources and technologies

30/12/24 L/col Mebrate D. 456

 Coverage…
 The fundamental issues in the management of
a basic health service are:
How should resources be allocated and
services be organized in order to serve as many
people as possible?
Is the service reaching the people it should
serve ?
Has the service been effective in meeting the
people's needs?

30/12/24 L/col Mebrate D. 457

 Comprehensive view of health service coverage

 Health service coverage depends on the ability of a

health service organization to interact with the

service users (the target population).

30/12/24 L/col Mebrate D. 458

 Coverage …

 This transformation process involves a variety of

factors, such
 as availability of resources and manpower,

 distribution of facilities,

 supply logistics, and

 people's attitudes to health and health care

30/12/24 L/col Mebrate D. 459

 Coverage…
 Coverage is normally expressed by the proportion

of the target population who can receive or have

received the service.

 The number of people for whom the service can be
provided expresses the service capacity or indicates the
potential of the service.

30/12/24 L/col Mebrate D. 460

 Coverage …
 On the other hand, the number of people who have
received the service indicates the service output and the
actual performance of the service.
 It defines the coverage related to service capacity as
potential coverage and that related to service output as
actual coverage.
 The relationship between service capacity and output is
called service utilization (ratio between output and
service capacity).
30/12/24 L/col Mebrate D. 461
 Coverage…
 Utilization refers only to the service, and its measurement
is only indirectly related to the size of the target
population; on the other hand, coverage expresses a
relationship between the service and the target population.

Eg. A high utilization of service facilities does not

necessarily imply satisfactory coverage and could in fact
imply the contrary.

30/12/24 L/col Mebrate D. 462

 Coverage…
 Looking at this process from the point of view of
service provision, it is possible to identify five
important stages that successively lead to a desired
health intervention and to define measurements of
coverage appropriate to these stages.

30/12/24 L/col Mebrate D. 463

 1. Availability coverage

 Some resources like manpower, facilities, drugs, etc.-are

always required, the availability of such resources limits
the maximum capacity of the services for target
population. The ratio between this capacity and the size
of the target population is called availability coverage.

30/12/24 L/col Mebrate D. 464

2. accessibility coverage.

 Even if all the necessary resources are available, the

service must be located within reasonable reach of
the people. Here, the capacity of the service is limited
by the number of people who can reach and use it.

The coverage based on this capacity called

accessibility coverage.

30/12/24 L/col Mebrate D. 465

 3. Acceptability coverage
 Once the service is accessible, it still needs to be
acceptable to the population.
 This " acceptability " may be influenced by such factors
as the cost of the service to the user, the form of religion
he/she follows, etc.
 Here, service capacity is limited by the number of people
who are willing to use the accessible service, and the
measurement of coverage called acceptability coverage.
30/12/24 L/col Mebrate D. 466
4.Contact coverage
 This is the process of service provision or actual
contact between the service provider and the user.

 The number of people who have contacted the

service is a measurement of service output; the
ratio between this and the size of the target
population gives is called contact coverage.

30/12/24 L/col Mebrate D. 467

5. Effective coverage

 The contact between the service provider and the user

doesn’t be always guarantee for successful
intervention related to the user's health problem.
 The measure, for number of people who have
received satisfactory service is called effectiveness
coverage.

30/12/24 L/col Mebrate D. 468

 Coverage diagram-illustrating relationships between the process of
service provision and coverage measurements.

30/12/24 L/col Mebrate D. 469

 Universal health coverage

 UHC is defined as ensuring that all people have

access to needed health services (preventive ,

promotive, curative, rehabilitative and palliative)

in a sufficient quality and ensuring that the use of

these services does not expose the users for

financial hardship.
30/12/24 L/col Mebrate D. 470
 Health care quality
 Objectives:
 At the end of this class, students will be able to:
– Define quality in the context of healthcare
– Identify perspectives in the definition and
measurement of HC quality
– Describe the components of quality in healthcare
– Differentiate between different components of
QM:QA,QC and QI
– Describe different models of quality management in
healthcare: Licensing, Certification, Accreditation,
30/12/24 CQI L/col Mebrate D. 471
 Concepts of Quality in healthcare

• Increasing attention to quality during the last few

decades

• However, the concept is among those lacking standard

definition and description.

• What constitutes quality in healthcare? What is quality

of Health Care for you?

– Definitions depend on what people value more.

30/12/24 L/col Mebrate D. 472
Definitions con’t…
IOM(1990), National Academy of Sciences
• Quality of health care is the degree to which health
services for individuals and populations increase the
likelihood of desired health outcomes and are consistent
with current professional knowledge.
• Important concepts:
 Quality can be assessed both at individuals and
population level
 Quality can be assessed from the current professional
practices
30/12/24 L/col Mebrate D. 473
 Important concepts in the definitions
• Quality of healthcare is about:

– Achieving positive health outcomes

– Economical/Efficient health care

– Limiting the negative consequences of health

care(balancing risk and benefits)

– Complying with scientific recommendations/Current

knowledge

– Addressing beneficiaries’ needs and expectations

30/12/24 L/col Mebrate D. 474
 Components of healthcare Quality
• Different dimensions of health care quality
by different scholars or organization

• But the most widely accepted being

Donabedian dimension/component of
quality

• According to Donabedian, quality of

healthcare has seven pillars/components
30/12/24 L/col Mebrate D. 475
30/12/24 L/col Mebrate D. 476
 Components con’t…

• Efficacy:
– Is the ability of the science and art of healthcare to
bring about improvement in health and well being
under best circumstances.
– What constitutes “best circumstances” is always
difficult to define and Controlling other factors is
always challenging
– Therefore, a more realistic definition could substitute
“specified circumstances” for “best circumstances”
30/12/24 L/col Mebrate D. 477
 Components con’t…

30/12/24 L/col Mebrate D. 478

 Components con’t…

30/12/24 L/col Mebrate D. 479

 Components con’t…
• Optimality
– the balancing of improvements in health against the
cost and other negative consequences of such
improvements
– becomes relevant when the effect of care are valued
not in absolute terms, but relative to the cost of care.
– The most advantageous balancing of cost and
benefits is optimizing benefits
30/12/24 L/col Mebrate D. 480
 Components con’t…
• Acceptability

– Is the level of conformity of care to the wishes, desires and

expectations of patients and their families
– Usually related to what beneficiaries of healthcare value more
including:
• Accessibility of care/services

• Patient-practitioner relationship

• Amenities of care(Time, expense, physical comfort to

receive services)
• Pt preferences regarding the effectiveness & cost of care
30/12/24 L/col Mebrate D. 481
 Components con’t…
• Legitimacy
– Is acceptability of care to the society or community at large.
– Is the conformity of healthcare to social preferences as
expressed in ethical principles, values, norms, laws and
regulations
– Is the equivalent of acceptability as applied to the society
– Sometimes what is best care for individuals couldn’t becomes
best care for the society.
– Society considers more issues: indirect and intangible costs;
effect at society level
30/12/24 L/col Mebrate D. 482
 Components con’t…
• Equity
– Conformity to a principle that determines what is just
and fair in the distribution of healthcare and its benefits
among members of the population
– Do interventions facilitate the fair distribution of health
services and benefits out of health care fairly among
different segments of the population?
– Equity is part of what makes care acceptable to
individuals and society legitimate
– So can able to stand as separate pillar of quality
30/12/24 L/col Mebrate D. 483
 Other dimensions of quality
IOM(2001):
 Safety-care intended to help patient that shouldn’t harm
them
• Effectiveness: Care should be based on scientific
knowledge and provided to patients who could benefit. In
other words, underuse and overuse should be avoided.
• Patient centeredness-Care should be respectful of and
responsive to individual patient preferences, needs, and
values, and patient values should guide all clinical
decisions
30/12/24 L/col Mebrate D. 484
 Other dimensions of quality
IOM(2001):
• Timeliness—Care should be provided promptly when
the patient needs it.
• Efficiency—Waste, including equipment, supplies,
ideas, and energy, should be avoided.
• Equity—The best possible care should be provided to
everyone, regardless of age,sex, race, financial status,
or any other demographic variable.

30/12/24 L/col Mebrate D. 485

 Other dimensions of quality

Dimensions of WHO:
• Safe
• Equitable
• Acceptable/Patient centered
• Accessible
• Efficient
• Effective
30/12/24 L/col Mebrate D. 486
Quality management
 Quality Management: Why?

• Three areas of gaps in

healthcare:
– Overuse of healthcare

– Underuse of healthcare

– Misuse of healthcare

30/12/24 L/col Mebrate D. 488

 Services Services
needed provided

A: Underuse

B: Overuse

C: Misuse

C: How?
30/12/24 L/col Mebrate D. 489
 Quality Management: Why?
Overuse of healthcare:
– Refers to providing health care for peoples who are not eligible for
it.
– Occur when drug or treatment given without medical justification.
• Consequences include
– Direct cost of services
– Opportunity costs of delivering useless services
– Side effects of services provided without indication
• Examples
– Prescribing antibiotics for common cold or other simple
infections.
30/12/24 L/col Mebrate D. 490
 Quality Management: Why?
Underuse of services
 Refers to Missed opportunities for provision of services(at facility
level)
 Occurs when doctors or hospitals neglect to give patients medically
necessary care or to follow proven health care practices
– Result in low coverage of services at population level
– Examples
• Patients with TB not tested for HIV
• ANC/FP clients not tested for HIV
• Low coverage of interventions for carcinogenic cases
• Mothers visiting OPD not screened for breast cancer
30/12/24 L/col Mebrate D. 491
 Quality Management: Why?
Misuse of services
– Inappropriate application of the science and
technology of healthcare resulting in:
• Low effectiveness
• High cost
• Discomfort and injury to patients
– Examples
• Diagnosis – Treatment mismatch,
procedural/medical errors
30/12/24 L/col Mebrate D. 492
 Quality Management: Why?
In general the need for quality management increased
due to:
 High cost of health care services
 Regulatory pressures
 Excessive variation in medical practices
 Growing power of the purchaser
 Malpractice incidents
 Declining morale among health care providers

30/12/24 L/col Mebrate D. 493

 Components of QM:Quality terms
• QM have four componments:quality plan, quality control, quality
assurance and quality improvement.
1. Quality plan: A document or set of documents that describe the
standards, quality practices, resources and processes pertinent to
a specific product, service or project.
2. Quality Control: is the ongoing effort to maintain the integrity of
a process to maintain the reliability of achieving an outcome.
3. Quality Assurance: is the planned or systematic actions necessary
to provide enough confidence that a product or service will satisfy
the given requirements.
4. Quality Improvement: can be distinguished from Quality Control
in that Quality Improvement is the purposeful change of a
process to improve the reliability of achieving outcome.

30/12/24 L/col Mebrate D. 494

 ….Quality terms

30/12/24 L/col Mebrate D. 495

 ….Quality terms
QA Vs. QC:
•Although QA and QC are closely related concepts, and are
both aspects of quality management, they are fundamentally
different in their focus:
QC is used to verify the quality of the output; QA is the
process of managing for quality.
Quality control is a product-oriented process;QA is a
process-oriented practice.
QC makes sure the end product meets the quality
requirements, QA makes sure that the process of
manufacturing the product does adhere to standards.
QC can be noted as a reactive process;QA can be identified
as a proactive process
QC involves detection and correction; QA involves
prevention.
30/12/24 L/col Mebrate D. 496
 Quality Management Models
• There are different models of QM in healthcare:
– Licensing
– Certification
– Accreditation
– Continuous quality improvement
• Most of the time, countries implement a
combination of these models.
• No single model can effectively improve
healthcare quality, a combination of models is
usually important.
30/12/24 L/col Mebrate D. 497
 Licensing
• Is a process by which a governmental authority grants
permission to an individual practitioner or health care
organization to operate or engage in an occupation or
profession.

• Licensure reflects fulfillment of minimum requirements

• No individual or organization can be engaged in

service provision without a license.

30/12/24 L/col Mebrate D. 498

 Certification
• Certification reflects the capability of an individual to
provide services additional to minimum requirements.

• Certification provides added credential to an entity’s

qualification.

• Examples.

– Certification of a GP to perform C/S in Ethiopia

– Certification of a general hospital to provide some

specialized services
30/12/24 L/col Mebrate D. 499
 Accreditation
• Is a formal process by which a recognized body
usually a non-governmental organization, assesses and
recognizes that a health care organization meets
applicable pre-determined and published standards.
• Participation is voluntary but advantageous

• Assessment involves self assessment and external

assessment by a team of peers

30/12/24 L/col Mebrate D. 500

 Continuous quality improvement …
• It is a continuous process with a goal of doing the right things
right the first time, every time.

– Doing the right things: investing resources on activities

proven to achieve desired benefits

– Doing things right: implementing designed interventions

in a way that is acceptable to beneficiaries, at the lowest
cost possible and inline with current professional
knowledge.

– Doing things right the first time, every time: achieving

these as an institutional culture.
30/12/24 L/col Mebrate D. 501
 CQI con’t…

• CQI includes two important

components and a supporting
infrastructure:
– Quality Measurement
– Quality Improvement

30/12/24 L/col Mebrate D. 502

502
 Unit Nine:

Health System and

Health Policy in Ethiopia

30/12/24 L/col Mebrate D. 503

 Health System

 is defined as the sum total of all organizations, people, resources

and all activities whose primary purpose is to promote health, to
restore or maintain health (WHO).

30/12/24 L/col Mebrate D. 504

 Health System…

The Broad health system:

• Includes everyone responsible for good
health, all branches of government and
operates within the public sector, civil
society and for-profit entities.

30/12/24 L/col Mebrate D. 505

 Health System…
Health systems have three objectives

1. Improving the health of the population they serve

2. Providing financial protection against the costs of ill-

health (Risk Protection)…sharing risk and providing
financial protection => Fairness in financial contribution

3. Responding to people’s expectations (Responsiveness)…

reflects the importance of respecting people’s dignity,
autonomy & the confidentiality of information

30/12/24 L/col Mebrate D. 506

 How is the Ethiopian healthcare delivery system
organized?

 The health service system in Ethiopia is

federally decentralized among the nine
regions and two city administrations.

 Offices at different levels of the health sector in

Ethiopia, from the Federal Ministry of Health
(FMOH) to Regional Health Bureaus and Woreda
health offices, share decision-making processes,
powers, and duties.
 Ethiopian healthcare system…
• The FMOH and the RHBs focus more on policy
matters and technical support

• also responsible for owning, financing

and supervising the service delivery of
regional hospitals.

• Woreda health offices focus on managing and

coordinating the operation of a district health
system that includes a primary hospital, health
centers, and health posts under the Woreda’s
jurisdiction.

30/12/24 L/col Mebrate D. 509

 Ethiopian healthcare system…

• Health service provision to the

community in Ethiopia is largely publicly
provided particularly in rural areas.

• However the private sector also plays a

significant role in healthcare service
provision in Ethiopia though mostly in
towns and mainly in providing curative
services.

30/12/24 L/col Mebrate D. 510

 How is the Ethiopian healthcare
system financed?
• In the Ethiopian health system, some public health
services have been provided to all citizens free of
charge, regardless of their level of income.
Almost all of the curative services are covered
by individuals from out-of pocket expenses.

• The state of healthcare financing in Ethiopia has

over the years been characterized by low
government spending and minimal participation
by the private sector.

30/12/24 L/col Mebrate D. 511

 Ethiopian healthcare system…

• As the government has the major

responsibility for funding the system,
changes in political regime has meant that
the politics of the day have greatly
influenced the financing policy environment.

• Spending was most depressed during the

Derg regime in the late 1970s through the
1980s, and is now growing.

30/12/24 L/col Mebrate D. 512

 Building Blocks of Health System

• What are the building blocks that make

up a health system?

30/12/24 L/col Mebrate D. 513

 Building Blocks of H/System…
Health systems are composed of the following
six building blocks:
1. Leadership and governance procedures and
practices, including planning, that engender
commitment and accountability.
2. Human resource policies and procedures
that produce a supported and motivated work
force.
3. Financial management, which is concerned
with accounting and budgeting, along with the
related reporting and analysis that make it
possible to ensure that the organization's
resources are used in the service of its mission
30/12/24 L/col Mebrate D. 514
 Building Blocks of H/System…
4. Management of medicines and medical supplies so that the
right products are delivered in the right quantities, at the right
time, and in the right place, and then used appropriately.
5. Health information and associated monitoring and
evaluation practices that facilitate effective problem solving,
informed decision-making, and the formulation of policy based
on evidence.

6. Health service delivery that is supported by quality

management processes and that addresses the basic health
needs of the populations to be served.
(Source: WHO, 2007)

30/12/24 L/col Mebrate D. 515

 Health System Building Blocks, The WHO framework

30/12/24 L/col Mebrate D. 517

 Health Tier System in Ethiopia

30/12/24 L/col Mebrate D. 518

 six tier system
Primary health care period (1974 – 1991)

Figure 1. the six tiered organization of health services delivery in

Ethiopia
30/12/24 L/col Mebrate D. 519
 Four tier system
Sector Wide Approach Period (1991-1998)

Figure 2. The four-tier system of health services delivery in Ethiopia.

30/12/24 L/col Mebrate D. 521
 The three tier healthcare delivery system of
Ethiopia (since 2010)

Figure
30/12/24 3. The current/ three-tier system of healthD.services delivery in Ethiopia.
L/col Mebrate 522
 Current Health Problems in Ethiopia
 High population growth rate and Malnutrition
 Highest rates of maternal & neonatal
mortality
 Health workforce shortage
 Low institutional delivery
 Increased Non Communicable Diseases
 prevalent Neglected Tropical Diseases
 Inadequate immunization coverage

30/12/24 L/col Mebrate D. 526

 Common healthcare Delivery gaps in
Ethiopia
 Poor management and governance of
service delivery systems
 Weak referral system
 Shortage of resources, and inefficient use
 Poor generation & utilization of health
information
 Poor Recording, Reporting, and
documentation
 Under-use of available services
30/12/24 L/col Mebrate D. 527
 BASIC CONCEPTS OF
POLICY

WHAT IS POLICY?

WHAT IS A HEALTH POLICY?

30/12/24 L/col Mebrate D. 528

 POLICY
 A policy is a set of clear statements and
decisions defining priorities and main
directions for attaining a goal.
 policy is concerned with what is to be done
(content); how to do it (strategy).
 A policy involves agreement or consensus
on the following main issues:
 Goals and objectives to be addressed,

 Priorities among those objectives and

 Main directions for achieving them.

30/12/24 L/col Mebrate D. 529
 Health Policy
HP can be defined as the “formal written
document, decisions, plans, and actions that
are undertaken to achieve specific health
goals within a society. ”
WHO

An explicit health policy can achieve several

things:
- It defines a vision for the future;
- It outlines priorities;
- The expected roles of different groups;
&
- It builds consensus and informs people.
30/12/24 L/col Mebrate D. 530
 Health Policy of Ethiopia
 It was issued in 1993 (without any revision since
then).

The policy formulation has been the result of

 Critical reviews and scrutiny of the nature,

 Magnitude and root causes of the prevailing

health problems of the country, and

 The broader awareness of newly emerging

health problems in the country.

30/12/24 L/col Mebrate D. 531

 Health Policy of Ethiopia…

 The policy emphasizes the importance of

achieving access to a basic package of
quality primary health care services
for all segments of the population
 In a decentralized way.

 It states that the health service should

include preventive, promotive and
rehabilitative components.
 Gives strong emphasis to the fulfillment of
the needs of the
30/12/24
less privileged rural532
L/col Mebrate D.
 Health Policy of Ethiopia…

The Ethiopian health policy Core

principles:
1. Democratization and decentralization of the health
system.

2. Comprehensive health care (prevention, promotive

and curative) components.

3. Equitable and acceptable health service system

that will reach all segments of the population within
the limits of resources.
30/12/24 L/col Mebrate D. 533
 Ethiopian Health Policy Core
Principles…
4. Promoting and strengthening of inter-
sectoral activities.

5. National self-reliance in health

development by mobilizing and maximally
utilizing internal and external resources.

6. Assurance of accessibility of health care for

all segments of the population.

30/12/24 L/col Mebrate D. 534

 Ethiopian Health Policy Core
Principles…
7. Working closely with neighboring countries,
regional and international organizations

8. Development of appropriate capacity

building based on assessed needs.

9. Payment according to ability with special

assistance mechanisms for those who can not
afford to pay.

10. Participation of private sector and NGO in

health care.

30/12/24 L/col Mebrate D. 535

 Health Policy:
Priorities
1. Information, Education and Communication
(IEC)

2. The control of communicable diseases,

epidemic and disaster related to malnutrition
and poor living conditions.

3. Support to the curative and rehabilitative cares.

4. Attention to traditional medicines: Research

and gradual integration to modern medicine.

5. Health research on major health problems.

30/12/24 L/col Mebrate D. 536

 HEALTH POLICY: Priorities cont…
6. Provision of medicines, medical supplies and
equipment.
7. Human resources Development
8. Special attention will be given to the health
needs of:
 Family particularly women and children,
Those in the forefront of productivity,
Most Neglected regions, Rural area, Urban
Poor, pastoralists, and national minorities.
 Victims of man-made and natural disasters

30/12/24 L/col Mebrate D. 537

 Health Policy: Strategies
1. Democratization within the health system
2. Decentralization
3. Inter-sectoral collaboration
4.Health education
5. Promotive and preventive activities
6. Human resource development
7. Availability of drug supplies and equipment
8. Traditional medicine
9. Health systems research

30/12/24 L/col Mebrate D. 538

 Health Policy: Strategies…
10.Family health services
11. Referral system
12. Diagnostic and supportive services
13. Health management information system
14. Health Legislations
15. Systematized and rationalized Health Service
Organization
16. Effective and efficient administration and
management of the health system
17. Public, private, and international sources for
financing Health Services
30/12/24 L/col Mebrate D. 539
Health Sector Development Program
(HSDP)

30/12/24 L/col Mebrate D. 540

The Health Sector Development Program
(HSDP)

• Following the national (1996-2015 GC)

health policy in 1993,
Ethiopia produced and was implemented a 20-
year Health Sector Development Program
(HSDP).
• launched in 1998
• The HSDP has been implemented in four phases
building on lessons learned from phase to phase.
 Has three main goals:
‐ Building basic infrastructure
‐ Provide standard facilities and supplies
‐ Develop and deploy appropriate health
personnel
30/12/24 L/col Mebrate D. 541
 HSDP…
The focus will be on preventive and
promotive aspects of care with:
• Health Education,
• Reproductive Health Care,
• Immunization
• Better Nutrition
• Environmental Health and Sanitation.

30/12/24 L/col Mebrate D. 542

 Phases of HSDP
• HSDP I -1997/8-2002

• HSDP II -2002/3-2006

• HSDPIII –July 2006-June 2010

• HSDP IV –June 2010-2015

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 HSDP I (1997/98–2001/02)
•Covered the first five years (1997/98–2001/02)

•Prioritized disease prevention

•Introduced a four-tier system for health service delivery

– Characterized by a primary health care unit (PHCU),

comprising one health center and five satellite health
posts; the district hospital, regional hospital and
specialized hospital.
•The three one’s principle and harmonization

30/12/24 L/col Mebrate D. 544

HSDP-II (2002/03–2005/06)
• Introduced the Health Service Extension
Program (HSEP).
• Innovative health service delivery system

• It is a community based health care delivery

system at kebele and household levels

30/12/24 L/col Mebrate D. 545

 HSDP III (2006/7-2009/10)
•Directly aligned with the health-related MDGs

•Focuses on high-impact health system

strengthening interventions needed to
accelerate scale-up and increase coverage of
key health services for HIV,TB, malaria, as well
as maternal and child health.

30/12/24 L/col Mebrate D. 546

 HSDP IV (2010 –2014)
• Developed as part of the National Growth and
Transformation Plan (GTP)
• The expression of the renewed commitment to the
achievement of MDGs as a top global Policy
• Gives priority to maternal and child health,
nutrition, as well as the prevention and control of
major communicable diseases, such as HIV/AIDS.
• Emphasizes the strengthening of HSEP to improve
the quality of PHC, human resource development
and health infrastructure.
• Developed the three tier health delivery system
• Community empowerment/ownership

30/12/24 L/col Mebrate D. 547

Health Sector Transformation plan
(HSTP)

30/12/24 L/col Mebrate D. 548

Health Sector Transformation plan (HSTP)
in Ethiopia

• The MOH embarked on an envisioning exercise to

develop its next 20-year plan after the HSDP IV mid-
term review.

• The envisioning exercise resulted in a long-term

health sector transformation roadmap titled,
“Envisioning Ethiopia’s Path towards Universal
Health Coverage through Strengthening Primary
Health Care”.

30/12/24 L/col Mebrate D. 549

 (HSTP) in Ethiopia…..
• The HSTP is therefore the first phase of the
“Envisioning Ethiopia’s Path towards Universal
Health Coverage through Primary Health Care”, and
as well part of the GTP II .

• The objective of the long-term visioning

programme is to enable Ethiopia to achieve the
health outcomes
– a middle-income country by 2035.
30/12/24 L/col Mebrate D. 550
 (HSTP) in Ethiopia…..
• The Health Sector Transformation Plan (HSTP)
is the five-year national health sector strategic
plan after successfully concluded the 20
years National HSDP.
• It has been prepared by conducting in-depth
situational assessment and performance
evaluation of HSDPs; considering the global
situation and the country’s global
commitment; and most importantly, the goals
of the national long-term vision and Growth
and Transformation Plan (GTP).
• It covers EFY 2008-2012 (July 2015 – June
2020).
30/12/24 L/col Mebrate D. 551
 Strategic Themes of
HSTP
• Strategic themes are the main focus areas of the sector‘s
strategy.
• Strategic themes are the Sector’s “Pillars of Excellence.”

• The HSTP Strategic Pillars are:

1. Excellence in health service delivery

2. Excellence in quality improvement and assurance

3. Excellence in leadership and governance

4. Excellence in health system capacity

30/12/24 L/col Mebrate D. 552

 (HSTP) in Ethiopia….
Strategic Theme 1: Excellence in health service delivery

•This theme refers to the promotion of good health practices at

individual, family and community levels and the provision of
preventive, curative, rehabilitative and emergency health services.

•The provision of service delivery should address existing gender,

geographic, economic and socio demographic inequities.

30/12/24 L/col Mebrate D. 553

 Strategic Theme 2: Excellence in quality
improvement and assurance

• This theme refers to managing and improving

quality and safety in health services at all levels
of the healthcare system.
• The focus on quality in health systems at this
time is due to the clear evidence that quality
remains a serious concern.
• Quality and safety have been recognized as key
issues in establishing and delivering accessible,
effective and responsive health systems.
30/12/24 L/col Mebrate D. 555
 Strategic Theme 3: Excellence in
leadership and governance

• This theme refers to evidence-based policy formulation

and planning; implementation; effective monitoring and
evaluation, motivation and partnerships to achieve
results.

• It incorporates:
Equitable and effective resource allocation;

Leadership development within the sector and the

community
Woreda transformation; and

Partnership and coordination

30/12/24 L/col Mebrate D. 557
 Strategic Theme 4: Excellence in health
system capacity
• This theme refers to the enhancement of
resources for health, which includes human and
financial resources, health infrastructure and
supplies that are accessible to communities.

• It also refers to professional development to

promote respectful and compassionate care.

• Health infrastructure includes construction of

new facilities, rehabilitation of older ones and
equipping these facilities as per national
standards.

30/12/24 L/col Mebrate D. 558

 Health sector
transformation agendas
• To achieve the targets set, the HSTP has
identified four interrelated transformation
agendas for this strategic period. These are:
1. Transformation in equity and quality of health
care

2. Information revolution

3. Woreda transformation

4. The Caring, Respectful and Compassionate

(CRC) health workforce

30/12/24 L/col Mebrate D. 560

Quality and Equity in Health Care
• Equity in health care is ensuring availability of the best care to
all whereby the quality of care provided does not differ by any
personal characteristics including age, gender, socioeconomic
status or place of residence unrelated to a patient’s reason for
seeking care.
• Quality health care refers to a care which is safe, reliable,
patient-centered, efficient and provided to all in need in an
equitable and timely manner.
• The substantial inequalities still existing in health outcomes based
on differences in economic status, education, place of residence
and gender need to be addressed.
• During implementation of the HSTP, efforts will be doubled up to
ensure equity in health care, which has the following important
elements;
• Equal access to essential health services,
• Equal utilization of equal need, and
• Equal quality of care for all
30/12/24 L/col Mebrate D. 561
Information Revolution
• Information revolution refers to the phenomenal
advancement on the methods and practice of collecting,
analyzing, presenting and disseminating information that
can influence decisions in the process of transforming
economic and social sectors.
• It entails a radical shift from traditional way of data
utilization to a systematic information management
approach powered by corresponding level of technology.
• Information revolution is not only about changing the
techniques of data and information management;
• it is also about bringing fundamental cultural and
attitudinal change regarding perceived value and practical
use of information.

30/12/24 L/col Mebrate D. 562

Woreda transformation

• The woreda transformation agenda has three

simple and interrelated goals.

• These goals are:

1. Developing high-performing primary health care
units (PHCU),

2. Graduation of model Kebeles and

3. Achievement of universal health coverage with

financial risk protection through CBHI.

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Developing Caring, Respectful and
Compassionate (CRC) health
professionals

•What is CRC?

30/12/24 L/col Mebrate D. 564

• CRC (Caring, Respectful and Compassionate) health
professionals have the following four essential
characteristics:

1. Consider patients as human beings with complex

psychological, social and economic needs and provide
person-centered care with empathy

2. Effective communication with health care teams,

interactions with patients and other health professionals
over time and across settings;

3. Respect for and facilitation of patients’ and families’

participation in decisions and care; and

4. Take pride in the health profession they are in and get

satisfaction by serving the people and the country.
30/12/24 L/col Mebrate D. 565
 Thank
you!!

30/12/24 L/col Mebrate D. 566

Primary Health Care (PHC)
 Objectives
To describe the historical development of
PHC

Definition of PHC

To discuss on Principles and components of

PHC

To identify possible problems in

implementing PHC
30/12/24 L/col Mebrate D. 568
 PHC Historical Development

 The World Health Organization (WHO), established in 1948.

 Major objective: The attainment by all people of the highest

possible level of health.

 Due to political and socio economic factors the various health care
approaches implemented in different countries between 1948 and
1978 did not enable WHO to meet the stated objectives.

30/12/24 L/col Mebrate D. 569

 PHC Historical
Development…
Strategies used by WHO
-In the 1950s the vertical health service strategy which included:

- mass campaigns and

- specialized disease control programs for selected communicable

diseases, such as control of malaria, tuberculosis and venereal
diseases.

-But it was found to be expensive and unsuccessful.

30/12/24 L/col Mebrate D. 570

 PHC Historical Development…

 Later In the mid 1950s the concept/strategy of

Basic Health Service came into practice.
 This approach gave more attention to rural areas
through construction of health centers and health
stations providing both preventive and curative
care.

 In the early 1970s integration of the specialized

disease control programs with the basic health
services was emphasized.

30/12/24 L/col Mebrate D. 571

 PHC Historical Development…
 All these approaches were disease oriented
based on high cost health institutions
requiring advanced technology to solve the
health needs of the people, and thus
ultimately failed to reach the desired goal.
 Specially in developing countries where their
health problems required emphasising on
health promotion and preventive care, the
strategies applied did not make much impact
on the health status of the population.

30/12/24 L/col Mebrate D. 572

 PHC Historical Development…
 The evaluation of these strategies during 1950s and 1970s
showed the following:
 The health status of millions of people in the world at that
time and even today is unacceptable.
 the health status of the majority of people in disadvantaged
areas of most countries of the world remained low.
 The organised limited health institutions failed to meet the
demands of those most in need of health services.
 The health services often created in isolation neglecting
other sectors such as education, agriculture, water,
communication etc.
 Health institutions stressed curative services with lacking
priority to preventive, promotive and rehabilitative care.
30/12/24 L/col Mebrate D. 573
 PHC Historical
Development…
 These situations called for WHO and UNICEF in the early
70s to seriously and critically re-evaluate and re-examine
existing policies, approaches and options in health.
 Thus, the magnitude of health problems and inadequate
distribution of health resources called for a new approach
and the Concept of PHC.
 In 1977 the WHO set a goal of providing “Health for All by
the year 2000” which aims at achieving a level of health
that enables every citizen of the world to lead a socially
and economically productive life.
 The strategy to meet this goal was later defined in the
1978 WHO/UNICEF joints meeting at Alma-Ata USSR.
 In this meeting it was declared that the PHC strategy
become a core policy to meet the goal of “Health for all
by the Year 2000”.

30/12/24 L/col Mebrate D. 574

 Primary health care
Definition :– PHC is essential health care based on
practical, scientifically sound, and socially
acceptable methods and technology made
universally accessible to individuals and families in
the community through their full participation and
at a cost that the community and country can
afford to maintain at every stage of their
development in the spirit of self reliance and self
determination.’ (WHO, 1978)

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 PHC Definition…
Terms in the definition:

• Essential health care: Health care provided through PHC is basic,

indispensable and vital.

• Scientifically sound: The strategy we use in implementing PHC should

be scientifically explainable and understood.

• Socially acceptable methods and technology: should be accepted by the

local community and to consider the local value, culture and belief.

• Universally accessible: The PHC approach is to bring health care as

close as possible to where people live and work in order to guarantee
universal accessibility to the individuals, family and community.

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 PHC Definition…
• Community involvement: Community can achieve better health
status through their own efforts and the health workers role is to
help them identify their problems and to point out methods for
dealing with the problems.

• Self-reliance and Self-determination: able to support yourself,

being independent understanding your own needs and trying to
minimize problems. Knowing when and for what purpose to turn
to others for support and cooperation.

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 Principles of primary
health care
• Equity
• Intersectoral collaboration
• Community involvement
• Appropriate technology
• Emphasis to promotion and prevention
• Decentralization

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 I. Equity

• Providing equal health care to all groups of people

according to their needs.
• giving highest priority to those with greatest
health needs
• Services should be physically, socially, and
financially accessible to everyone

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 II. Intersectoral
collaboration
• It means a joint concern and responsibility of
different sectors
• Which sector must be collaborated?
 Important to:-

 Save resources (effective use of resources)

 Identify community needs together

30/12/24 L/col Mebrate D. 580

 III. Community
involvement

The communities should be actively involved in:

 The assessment of the situation

 Definition/identification of the problems

 Setting of priorities

 Planning, implementation, monitoring and

evaluation and management of development
programs

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 IV. Appropriate
Technology
• Methods- procedures - techniques, equipments
used are;
 Scientifically valid

 Adapted to/based on local needs

 Acceptable by the professionals

 Acceptable by the community

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 Criteria of
Appropriateness
• Effective:-must work and fulfill its purpose

• Culturally acceptable and valuable:- must fit into the

hands, minds and lives of its users
• Affordable:-affordable cost by the major/ whole community

• Environmentally accountable:- should be environmentally

harmless
• Measurable:-needs proper and continuing evaluation if it is to
be widely recommended.

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 V. Emphasis on health promotion and
prevention
• Promotive: addresses basic causes of ill health at the level
of society.
• Preventive: reduces the incidence of disease by
addressing the immediate and underlying causes (risks) at
the individual level.
• Curative: reduces the prevalence of disease by stopping
the progression of disease among the sick.
• Rehabilitative: reduces the long-term effects or
complications of a health problem.

30/12/24 L/col Mebrate D. 584

 VI.
Decentralization
• Bringing decision making away from the
national or central level and closer to the
communities served & to field level
providers of services.
 It reflects Community participation

30/12/24 L/col Mebrate D. 585

 PHC
COMPONENTS

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 PHC COMPONENTS…
8 essential elements:
1. Health Education concerning prevailing health problems and
the methods of preventing and controlling them
2. Provision of Essential Drugs
3. Immunization against the major infectious diseases
4. MCH/FP
5. Appropriate Treatment of common diseases & injuries
6. Adequate supply of safe water & basic sanitations
7. Communicable diseases control
8. Promotion of Food supply and proper nutrition
Source: WHO, 1978.
30/12/24 L/col Mebrate D. 587
 PHC COMPONENTS…

 additional elements incorporated in the Ethiopian context;

1. Oral health
2. Mental health
3. The use of Traditional Medicine
4. Occupational health
5. HIV/AIDS
6. URTI
7. AYRH

30/12/24 L/col Mebrate D. 588

 Major problems in the implementation of PHC in Ethiopia

• Absence of infrastructure at the district level

• Difficulty in achieving inter-sectoral collaboration

• Inadequate health service coverage and mal-distribution

• Inadequate resource allocation

• Absence of clear guidelines or directives on how to implement PHC

• Presence of harmful traditional practices

• Absence of sound legal rules to support environmental health activities

• Weak community involvement in health

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 Thank you!

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 Unit Nine:

Health System and

Health Policy in Ethiopia

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 How is the Ethiopian healthcare delivery system
organized?

 The health service system in Ethiopia is

federally decentralized among the nine
regions and two city administrations.

 Offices at different levels of the health sector in

Ethiopia, from the Federal Ministry of Health
(FMOH) to Regional Health Bureaus and Woreda
health offices, share decision-making processes,
powers, and duties.