Health service management

By Furade Shukr
 Objective

At the end of thi chapter student should be able to:

Define what is managment
Understand managerial role and skill
Plan health programs
Manage vareous health system resource
Developing health service monitoring and
evaluation program
 What is managment?

 Some regard it as getting things done.

 Olso consider sa, it is the process of reaching organizational

goals by working with and through people and other
resources.

Others consider it as:

 The process of directing, co-ordinating, and influencing the
operations of an organization to obtain desired results and
enhance total performance."
 What is managment?

The definition of management is based on two principles:

 Commitment to achievement,

 The importance of people and other resources.

This means that people are the most important resource

for getting things done.
 Management is universal and it is essential for all
kinds of organisations.
 Importance of Management

 To make decisions

 For coordinating activities

 For the handling of people and

 Evaluating the performance directed toward its

objectives.

 Management is essentially an executive function, & the

active direction of human effort.
 Importance of Management

In addition to these three broad sequential functions

Planning, Implementation & Evaluation(PIE), their is

Two continuous functions of management wich are:-

 Communication

 Decision- Making
 Management Functions

 1.Planning Planning (p)

 2. Organising

 3. Staffing Implementation (I)

 4. Directing

 5. Controlling Monitoring and

Evaluation (M&E)
 Managerial role

 Interpersonal role: it shows the interpersonal

contact that
manager did which is vital in his/her daily activities.
Those are:
 Figurehead: this legal authority of the manager .
 Leader: as a leader a manager is accountable,
and responsible,

 Managerial Role

 Informational role: it is related to communication

and information channelling. those include:
 Monitor: serving as a focal person for all types of
communications
 Disseminator: communicating selected information
to subordinates.
 Spokesperson: communicating selected
information to outsiders
 Managerial Role

 Decision-making role: it is ablity to accomplish legal

authority to decide on matters that are assigned to him
based on his job description. it include:
 Entrepreneur: ablity to initiating changes within the
organization.
 Disturbance handler: taking corrective action and
handling conflicts.
 Resource allocator: Decides on resources and their
 Management Skill
 Technical Skill:
 The understanding of technical element of activities in
general and proficiency in specific kind of technical activity
 Conceptual Skill:
 The ability to visualize the organization as the whole and its
relationship with the community and other sectors
 Human Skill:
 This is the ability to work with others and win cooperation
from the health team with other sectors and the
community
 Planning Health programs

Planning is defined as:-

 Systematic method of trying to achieve clear
objectives for the future through the efficient and
appropriate use of resources, available now and in
the future.
 Planning is deciding in advance what is to be
done, it is projected course of action for the future
 Planning takes place at any level in health system
 Planning Health programs

Health Planning-
 It 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.
 To plan is to propose a forward programme for
guiding the future affairs of an organization.
 Planning Health programs

Health Planning-
 It is clear that individual activity and organizational
activity with out a plan will be ineffective.
 “if you do not know where you are going no
road will get you there”.
 In general, planning is a process that lay the base
for future action.
 Planning Health programs

Planning methods can be applied to

 A large program at national level
 A small one at village level.
Planning must be a collective undertaking of action: it require
the participation of,
 Professionals ( from health and other sectors)
 Community
 Government / party/NGO
 Planning Health programs

Importance of planning:- it helps:-

 To coping with future uncertainty and change
 To focus attention on objectives
 It obtains economical operation

• Provides performance standards and

facilitates control
• Helps foreseeing and identifying potential
 Planning Health programs
TYPES OF PLANNING
There are two types of planning:-
Strategic planning
 Often referred as allocative planning
 Normally five years or more.
Tactical/operational planning
 It is referred as activity planning.
 It covers a short period of time medium term-usually one
year.
 Planning Health programs
TYPES OF PLANNING
There are two types of planning:-
Strategic planning
 Often referred as allocative planning
 Normally five years or more.
Tactical/operational planning
 It is referred as activity planning.
 It covers a short period of time medium term-usually one
year.
 Planning Health programs
Strategic Planning Tactical Planning

Developed mainly by upper- Developed mainly by lower

level management level management
Facts are generally difficult Facts are generally easy to
to gather gather
Plans contain relatively little Plans contain substantial
detail amount of detail
Plans cover long periods of Plans cover short periods of
time time
 Planning Health programs
SIX STEPS OF PLANNING
1. Situational analysis
2. Selecting priority problems
3. Setting objectives and targets
4. Identifying potential obstacles and limitations
5. Designing the strategies
6. Writing the plan
 Planning Health programs
1. Situational analysis
 The first stage in the development of a plan, at whatever
level, national, district or community, is to improve the
understanding of the current situation.
 It provides a common reference point for the rest of the
planning process
 It allows the selection of priority areas of concern for
planning content of situational analysis
 Planning Health programs
2. Selecting priority problems, it is based on selection
criteria like:
 Magnitude: how big is this problem?
 Severity: how serious is it in terms of adverse outcomes?
 Feasibility :how easy or difficult would it be to tackle this
problem?
 Community concern is this problem is an important
concern for the community.
 Government concern: important concern for the
government.
 Planning Health programs
Table 1.1 Example of a priority setting analysis of four
identified problems Gover
Total
Commu nmen
Magnitu Severit Feasibili (out
Identified problem nity t
de y ty of
concern conce
25)
rn
Low PNC coverage 5 5 5 4 3 22

Low ANC coverage 5 5 5 4 5 24

low immunization
4 4 5 5 2 20
covrage

high malnutrion rate 5 5 3 2 3 18

 Planning Health programs
3. Setting objectives and targets
 Goals, aims, objectives and targets are all ways of describing
the desired direction of a service. They differ in terms of
breadth and detail.
 Goals:- Are broad statements.
 Aims:- number of aims for one the goal. specific to particular
problems.
 Objective:- For each programme aim, there may be a
 Planning Health programs
4,Identifying potential obstacles and limitations
 After setting objectives and targets the planner should
ask himself about the presence of any situation (obstacle
/limitation) that may prevent the achievement of each
objective and target.
5,Designing the strategies
 Once objectives and targets are set, the planner
assesses the different ways (strategies) for achieving
 Planning Health programs
6,Writing the plan
The purposes of writing the plan are:-
 To request funds or resources from the government or
funding agencies
 For monitoring and evaluating the implementation
process by all concerned
A plan can be written in several ways, Some
organizations may
require plans to be written on specific way.
 Introduction
It include :
 Human resourse managment

 Material managment

 Drug managment

 Financial managment

 Time managment

 Managing Space
 Developing team
Five stages of team development
1. Forming
 Development acceptable to the group.
 Period of orientation or acclimation.

2, Storming
 Members oppose the formation of the structure.
 Become hostile and fight to the ground rules.
 Developing team
Five stages of team development
3. Norming
 Conflicts are addressed and resolved.
 Group unity emerges.

4. Performing
 Structural issues resolved.
 Structure supports group dynamics and
performance.
 Structure used for task accomplishment.
 Developing team
Five stages of team development
5. Adjourning
 For temporary groups (task force): the group wraps
up activities.
 The attitude varies from excitement to depression.

Examples of team norms

 Showing up on time
 Dressing norm
 Leading Health Team

 A team is a special type of group having a small

number, preferably 2 - 8, of people who are
interacting and influencing each other to work for a
common goal.
 The members have attitudes of willingness to work
and active participation.
 The success of the team is more important than
individual achievement.
 Leading Health Team

The Health Team

 The health team has been defined as a group of
people who share a common health goal and common
objectives, determined by community needs, to the
achievement of which each member of the team
contributes, in accordance with his or her competence
and skill and in coordination with the functions of
others.
 Leading Health Team

Their are method of leading health team

 Setting and Sharing Objectives with the Team
Members
 Motivating team members
 Delegating authority and responsibility
 Using different styles of supervision
 Leading Health Team
Using different styles of supervision
 There are three main styles of supervision:
autocratic, anarchic and democratic.
 The type of supervision practiced should be varied
to suit the circumstances.
 An autocratic or strongly authoritarian style of
supervision can be used only when the staff can be
closely supervised and controlled.
 Leading Health Team

 Democratic supervision :helps people to grow, to

become responsible for their own work and to show
initiative. People like to be consulted.
 Most people prefer to work under a democratic
leadership

 Autocratic supervision : tends to humiliate

people and make them irresponsible
 It may dry up their initiative.
 Material Managment

Material management :
 It is the integrated functioning of purchasing and
allied activities to achieve the maximum
coordination and optimum expenditure in the area
of materials.
 One of the objectives of materials management is to
have the right materials at the right place at the
right time.
 Material Managment

Types of Material
1. Expendable: are those materials that should be
regularly kept in stock and used within a short time,
e.g. cotton, laboratory stains, paper, syringes, raw
materials, etc.
2. Non-expendable: are those materials that are
required only for specific purposes or jobs and Used
for several years, e.g. microscopes, vehicles, capital
 Material Managment

The four activities of materials management.

1. Ordering Equipment
 It is obtaining equipment from stores or shops.
 Only some people are authorized to order.
 Ordering requires the different skills:
 Material Managment

Ordering requires the different skills such as:

 Listing requirements, 
 Balancing requirements with available resources
and making cost estimates.
 Use of a catalogue
 Completing an order-form/ requisition form
 Material Managment

Table showing an example of ordering form

Item No Name of Type Unit Quantity Price per Total

article needed unit cost
 Material Managment

2. Purchasing
 It is the procuring of raw materials, components,
and services that the organization needs to achieve
its goals.
 The function of this to procure materials against
purchase requisitions received from stock control or
other departments.
 This section has also to ensure that materials do
 Material Managment
3. Storing Equipment
 Store keeping is the function of receiving, storing
and issuing materials.
 In the stores materials are properly stored until
drawn by the various using departments
 The stores also maintain a set of records called bin
cards.
 It is also the responsible to send a report when an
 Material Managment

store form........
Received Quantity Quantity Balance
Item Date from Invoice Received Issued in stock
 Material Managment

4. Issuing Equipment
Issue means supply of materials from stores to
the various workshops or departments of an
organization.
After equipment has been ordered, received, and
recorded in the stock book or ledger, it is issued
for use when it is needed.
Three paperwork procedures are required in issuing
 Material Managment

Controlling and maintaining equipment

 Expendable equipment must be controlled to avoid
wastage.
 Non-expendable equipment must be maintained,
i.e. kept in good working condition
Material Managment in the Ethiopian
Context
In most of the Government sectors receiving and issuing of
materials/equipment /items is carried out using different
―Model developed and distributed by Ministry of Finance.
Models that are being used now are:
Model 19: Model for confirming delivery of items/drugs
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
 Managing Drugs

The Drug Management Cycle/ The Logistic Cycle

 Drug management involves four basic functions:
selection, procurement, distribution, and use.
 Each major function builds on the previous function
and leads logically to the next
Managing Drugs

Procurement
 Financial resource

Definition: - Health Care Financing: - refers to mechanisms of

raising resources for health care services.
Sources of Health Care Finance are classified into three.
 Public and Quasi-Public
 Private
 International Organizations
1,Public and Quasi-Public Sources
 General taxation
 Earmarked taxes
 Social insurance
 Lotteries and betting
 Financial resource….

Private Sources
 Private health insurance
 Employer-finance schemes
 Charity and voluntary contribution
 Community-financing and self-help
 Direct household expenditure
 User fees/charges
 Co-payments
 Excess payments
 TIME MANAGEMENT
 Time is not often thought of as a resource. However, it is a
non-renewable resource; no event can take place unless
there is time for it.
 Using time effectively is one management skill.

Planning time arrangements:-

 Events are written in daily, weekly, monthly quarterly or
yearly time periods, depending on their frequency or
regularity.
 Time-plans are written in various common forms known
 TIME MANAGEMENT
Planning time arrangements......
 Timetable :for daily/weekly regular recurring events.
 Schedule :for intermittent, irregular or variable events,
including details of where the events take place.
 Roster :for duties planned for different staff members,
for different times in turn.
 Program :for long-term arrangements of several different
events or activities, of which the time-plan is only one
 Time manement in ethiopian context
 The daily attendance of staff is taken by using different
formats and each staff has to sign over the format.
 In most of the time, it is done twice per day during the
morning and afternoon sessions.
 The personnel office does the overall check up.
 TIME MANAGEMENT
Importance of Duty rosters in all types of health work.
 To distribute work fairly and evenly outside normal
working hours
 To distribute uninteresting or difficult work, equally
 To divide extra duties among the whole staff, e.g. Extra
duties.
 To disterbute program of any special health activity,
e.g. a vaccination campaign.
 Monitoring and Evaluation(M&E)
Introduction
 Both monitoring and evaluations are forms of management
control
 Management controlling is the process by which
management sees if what did happen was what was
supposed to happen.
 Essential part of the management control process is taking
corrective actions as needed.
 Monitoring and Evaluation(M&E)
Monitoring
 Program monitoring is used to improve a campaign by
influencing immediate decisions about how activities
can be improved.
 The key question in monitoring is: are things going all
right?
 Regular and accurate monitoring helps to ensure that
outputs are produced and distributed as planned.
 Monitoring and Evaluation(M&E)
Four steps monitoring program
 Establish data sources
 Collect data on program implementation and outcome.
 Compare program outcomes with prior or expected
outcomes.
 Assist in making policy and management decisions.
 Monitoring and Evaluation(M&E)
Evaluation
 It is about determining the value or worth of the objects of
interest (health programs) against standard of
acceptability.
Meaningful evaluation requires:
 Clear thinking
 Profound learning
 Correct action.
 Monitoring and Evaluation(M&E)
Steps of Evaluation
 Assess the evaluation situation.
 Decide on how to choose the evaluation design.
 Develop evaluation indicators and instruments.
 Plan on your approach for analyzing data.
 Plan for optimal use of results for learning and action.
 Monitoring and Evaluation(M&E)
Types of Evaluation
 Process Evaluation: Any combinations of measurements
obtained during the implementation of program activities to
improve the quality.It is also known as program monitoring.
 Impact Evaluation: Document and explain cause and effect.

Focuses on the immediate observable effects of a program

leading to the intended outcomes of a program
 Monitoring and Evaluation(M&E)
Types of Evaluation
 Formative Evaluation: Any combination of measurements
obtained and judgements made before or during the
implementation
 Summative Evaluation: Any combination of measurements
and judgements that permit conclusions to be drawn about
impact, outcome or benefits of the program or method.
 Monitoring and Evaluation(M&E)
Purposes of Evaluation:
 To determine achievements related to improved health
status
 To improve program implementation
 To provide accountability to funders, community and other
stakeholders
 To increase community support for initiatives
 To inform policy decisions
 Monitoring and Evaluation(M&E)
The Process of Evaluation:
 Planning
 Data Collection
 Data Analysis
 Reporting
 Application