Managing Human Resources for Health - 2010

Masters in Public Health

Managing Human Resources
for Health

Module Guide

Uta Lehmann

School of Public Health
University of the Western Cape


Managing Human Resources
for Health

Module Guide

Module Registration Number: 880102
Value of module: 20 credits
Study time required: 200 notional learning hours

Pre-requisites:
Introduction to Developing Human Resources for Health

Study Materials for this module:
Module Guide & Module Readings

Managing Human Resources for Health

Private Bag X17
Bellville 7535
South Africa
E-mail: ccarolissen@uwc.ac.za
Tel: +27 21 959-2166 or 959-2809
Fax: + 27 21 959-2872

Copyright 2010, by the SOPH, University of the Western Cape. This work is
licensed under a Creative Commons License : Attribution-ShareAlike 3.0.

First published in 2003
This version 2008/2010 (Module Intro)

Vision Statement of the School of Public Health

The Vision of the School of Public Health is to contribute to the optimal health of
populations living in a healthy and sustainable environment in developing countries,
particularly Africa, with access to an appropriate, high quality, comprehensive and
equitable health system, based on a human rights approach.

The Purpose of the School is to contribute to developing policy-makers and
implementers who are knowledgeable and skilled in the principles and practice of
Public Health, whose practice is based on research, influenced by informed and
active communities, and implemented with a commitment to equity, social justice
and human dignity.

MultiWorks Design & layout: Cheryl Ontong

CONTENTS

I MODULE INTRODUCTION PAGE
1 Letter of Welcome 1
2 INFORMATION ABOUT THIS MODULE 3
2.1 Module Aims and Rationale 3
2.2 Module Outline 3
2.3 Module Readings 3
2.4 Learning Outcomes 4
2.5 Module Evaluation 4
3 ASSESSMENT 5
3.1 Information About Assessment 5
3.2 Module Assignments for Human Resources Management for 5
Health
APPENDIX A: Reading for Assignment 2 9

II STUDY SESSIONS 25
UNIT 1 HUMAN RESOURCES MANAGEMENT IN 25
CONTEXT
Study Session 1 Key Components of Human Resource 27
Management
Study Session 2 Human Resources and Health Sector Reform 35
Study Session 3 Human Resource Development and the Policy 41
Context
Study Session 4 The Role of HR Development and Management 47
in your Organisation

UNIT 2 BEING AN HUMAN RESOURCES MANAGER 59
Study Session 1 What Managers Do 61
Study Session 2 Different Management Styles 65
Study Session 3 Managing Yourself 67
UNIT 3 MANAGING PEOPLE I 73
Study Session 1 The Role of Leadership 75
Study Session 2 Working in Groups and Teams 81
Study Session 3 Understanding Motivation 89
Study Session 4 Managing Conflict 95

UNIT 4 MANAGING PEOPLE II 101
Study Session 1 Staff Recruitment and Induction 103
Study Session 2 Skills Development in the Health Sector 111
Study Session 3 Staff Supervision and Support 117
Study Session 4 Performance Management 127
CONCLUDING KEY CHALLENGES IN HUMAN RESOURCES 131
SESSION MANAGEMENT TODAY

I MODULE INTRODUCTION

1 LETTER OF WELCOME

Private Bag X17
Bellville
7535
South Africa

Dear colleague

Welcome to the Managing Human Resources for Health Module.

Human resource management is one of the key functions within the broader
scope of human resource development. If you are or want to become a
manager in the health services, you will in all likelihood have some
responsibility for managing people. Some managers may fulfil human
resource functions as part of a much wider portfolio (for example, facility or
programme managers), while for others it may be a full-time responsibility (for
example the head of an HR department at provincial level). The unit should
therefore be of use to most managers in the health sector.
Human resource management is sometimes wrongfully equated with
personnel administration. While personnel administration is one aspect of
human resource management, the latter is actually much broader in scope. It
incorporates a range of issues such as leadership, capacity development,
support and supervision, etc.
All activities in human resource management aim to help people fulfil their
potential and to get the best out of them as individuals and in groups for the
benefit of health service delivery and quality of care.
Because the topic is so broad in scope, we had to be selective in what we
included in this module. We have tried to aim for a mix of understanding the
importance of human resource management in the context of developments in
the health sector and of gaining some knowledge and skills that will help you
in your day-to-day practice as a human resource manager.
The challenges facing HR managers in the health sector today are serious
and seemingly endless: HIV/AIDS, brain drain, low morale, transformation
fatigue, to name just a few examples. We will not discuss these topics per se,
although they will keep coming up in examples and illustrations, but the topics
are aimed to provide guidance to build human relations and organisations that
can address the challenges facing us today.

1

The module follows on from the module 'Developing human resources for
health', but it can also be chosen within the health management stream.
Finding your way around the Module Introduction
The introductory pages which follow provide you with an overview of the
Module, its outcomes, the assignments as well as the sources from which you
can expect support and assistance.
Assessment
This module is normally assessed through two assignments. You will find the
two assignment topics further on in the module introduction.
Evaluating the module
We hope that you will give us some feedback on your experience of this
module. Your feedback will be valuable to us in improving the module. An
evaluation form can be found on the site.
We hope you enjoy your studies.

Sincerely

Uta Lehmann
School of Public Health Module Convenor

SOPH, UWC: Managing Human Resources for Health - Module Introduction 2

2 INFORMATION ABOUT THIS MODULE

2.1 Module Aims and Rationale
As explained in the welcoming letter, the module aims to provide a contextual
understanding of as well as practical skills is human resource management.

2.2 Module Outline
The module consists of four units:
Unit 1 - Human Resource Management in Context
This unit places the topic in various contexts: within the broad scope of HRD;
in the context of health sector reform; in a policy and in an organisational
context.
Unit 2 - Being a Manager
Unit 2 examines various aspects of your role as a manager, emphasising
management styles and strategies for self-management.
Unit 3 - Managing People I
This unit focuses on managing relationships with and between people. This
includes the role of leadership, working in groups, motivating people and
managing conflict.
Unit 4 - Managing People II
This unit introduces a range of practical components of Human Resource
Management, including staff recruitment, skills development and supervision.
The Concluding Session brings the discussion back to the key challenges
which we face in Human Resource Management today.

2.3 Module Readings
The School of Public Health provides students with a Reader of just over 400
pages, which contains the required readings for the module, but not the
readings listed under Further Readings at the end of each session. SOPH
pays for copyright for these Readers per student and therefore cannot offer
the Reader as an OER.


2.4 Learning Outcomes

This module is intended to assist you in further developing the following skills
and knowledge in Human Resources Management.

By the end of this module you should be able to:

Understand the key components of Human Resource Management.
Understand the role of HRD in the health sector.
Understand the way in which policy impacts on Human Resource Management.
Conduct an assessment of the HR situation in your organisation.
Identify the different roles managers play in an organisation.
Demonstrate an understanding of the causes and effects of stress.
Diagnose leadership requirements in health sector transformation.
Appreciate the advantages and disadvantages of group work.
Assess and improve team performance.
Understand and apply two of the key theories on staff motivation.
Define and apply strategies to address conflict situations.
Understand the concept and purpose of staffing norms.
Prepare for and implement an interview process for new staff.
Develop an induction programme for new staff members.
Explain and apply the key concepts and mechanisms of the South African Skills
Development Strategy.
Design and implement training needs assessments and evaluations.
Facilitate the development of mentorships in your organisation.
Understand how a developmental approach to supervision differs from
traditional approaches.
Assess and revise performance management strategies.

Remember that these outcomes are taught through the sessions and
assessed in the assignments. At the same time, the module provides
opportunities to improve a number of your academic learning skills; these are
integrated into the sessions.

2.5 Module Evaluation

We would appreciate your help in evaluation and improvement of the module.
We have devised evaluation questionnaires which we would like you to fill in
honestly, when you reach the end of the module. A link to the evaluation form
is located on the webpage menu. This feedback will assist us in revising the
module, planning future modules and providing students with appropriate
support.


3 ASSESSMENT

3.1 Information about Assessment

There are TWO compulsory assignments in the module.
There are numerous self assessment tasks built into the module; through
these you can check your progress, and identify problem areas.
Formal assessment is in the form of TWO compulsory assignments.
The overall module result is calculated from the results of the two
assignments, with Assignment 1 weighted at 40% and Assignment 2 at 60%

3.2 Module Assignments for Human Resources Management for Health

There are two assignments for this module.

Assignment 1: Reflecting on the role of the manager (40 marks)
(2 000 words)

Write a reflective essay of about 2 000 words on your role as a manager.
In your essay, reflect on the role of a manager using the topics listed in (1)
below. Your essay should also reflect a wide range of reading, as described in
(2) below.
If you are a manager, use this assignment to reflect on your own role. If you
are not a manager, reflect on the role of another manager you know well in
her or his professional role.
1) The essay should cover the following topics:
a. Your strengths and weaknesses as a manager.
b. How you manage yourself.
c. How you manage people.
d. The role of being a leader – for your colleagues and within the
organization.
e. How the quality of management impacts on your organization’s
functioning.
Your essay should give a brief description of your work context, so that
the reader can understand the described managerial role.


2) In writing the essay, you should make use of the literature covering these
topics in the module. You should also find at least three additional
readings which talk to any of these topics. Please ensure that you
reference the literature consistently and correctly.
The Assessment Criteria for this assignment have been provided to guide
you.

Assessment Criteria for Assignment 1 Marks

The essay reflects on the role of the manager with insight and 14
understanding and draws on different aspects of the module.

Relevant literature has been consulted and used. 10

The literature is referenced consistently and correctly. 8

The essay is clearly structured and argued and shows no major 8
language errors

TOTAL 40

Assignment 2: Staff Supervision (60 marks)
(2 000 –– 3 000 words)

1. Read the text Family Planning Manager’s Toolkit (1998), Supervising and
supporting your staff (http://www.erc.msh.org) attached as Appendix A –
page 11a.
2. Describe your organisation’s supervision system.
3. Discuss to what extent the principles and practices of good supervision
described in the text, are followed in your own organisation.
4. Write a critique of your organisation’s supervisory system. Use these
considerations and any others to develop your argument – drawing on
appropriate literature in the Reader, and an additional three relevant
readings from different sources. Make sure that all literature is correctly
referenced.
5. End with a set of appropriate and realistic recommendations you would
like to make to your organisation to improve their supervisory system. If
appropriate, present these suggestions in your organisation.
NB! In this assignment you will not be given marks for referencing. However, an
assignment with serious and frequent referencing errors will not be passed.

The Assessment Criteria for this assignment have been provided to guide you.

Assessment Criteria for Assignment 2 60 Marks

Shows evidence that theory and information relevant to the topic have 15
been read and understood.

Organisation’s supervisory system is described and assessed with 15
understanding and insight.

Literature (including additional readings) has been drawn on 10
appropriately to develop the argument.

Recommendations are feasible with regard to actors, context and 10
budgets.

The assignment is clearly structured and argued and shows no major 10
language errors


APPENDIX A

READING: Management Sciences for Health. (1998). Supervising and
supporting your staff. Family Planning Manager’s Toolkit. [ Online], Available:
http://www.erc.msh.org//

Supervising and Supporting Your Staff
Excerpt from The Family Planning Manager’s Handbook (1998)

Introduction
Guiding, supporting, and assisting your staff. When you are trying to get
things done through other people, you soon find that instructions, training
sessions, lists of rules, and written procedures are not enough. These are all
good methods for communicating what you want done and how you want it
done. However, no matter how well these methods are applied, you will find
that it is essential to have direct personal contact with your staff on a regular
basis. Personal contact is essential for two reasons: first, to find out what is
actually happening (in all aspects of the work, particularly those aspects that
are never covered in service statistics), and; second, to renew the enthusiasm
of the staff for the work they are doing. This personal contact is important both
for the effective operation of the program and for staff morale and
commitment. The purpose of supervision is to guide, support, and assist staff
to perform well in carrying out their assigned tasks.
If you think of supervision as personal contact for these purposes, then you
will recognize that staff at every level, from service delivery to administration,
need supervision. Methods of supervision work for a whole range of
organizational levels and functions.
Your main function as a supervisor is to help your staff to perform their jobs
better by providing:
Guidance and tra ining
Assistance with resources and logistics
Support, encouragement, and advocacy for their rights
Monitoring and evaluation
Your role as a supervisor should be that of a problem-solver who supports the
employees, not a fault-finder who is always criticizing them. Your employees
should be pleased to see you and not find reasons to be absent when you are
coming.


Functions of a supervisor. Supervisors at every level and in all parts of an
organization have a number of basic functions. These include:

Setting individual performance objectives (the activities an employee
should accomplish by a certain date) with the employees themselves
so that they know what is expected of them.
Managing any performance problems and conflicts that arise and
motivating and encouraging employees to do their best work.
Having regular contact with staff members through supervisory
sessions to motivate and provide feedback, solve problems, and
provide guidance, assistance, and support.
Designing a supervisory system, including a supervisor's session
plan with selected items to supervise during each session.
Preparing a supervisory schedule of upcoming supervisory sessions
which shows the date and time of each session and lists any content
that can already be foreseen. This should be updated periodically.
Conducting periodic performance appraisals to review an employee's
past performance in order to make sure performance objectives are
being met.
Although the situations in which supervisors work may vary, effective
supervisors must perform all these basic functions.

The style of supervision should fit the employee. There are many different
styles of supervision, but all supervision is made up of two basic components:
giving direction and providing support. Giving direction involves one-way
communication in which the supervisor tells the employee what to do and
when, as well as where and how the tasks are accomplished. Supervisors
provide support through their relationships with their employees. This
implies more of a two-way communication in which supervisors encourage
and guide staff, discuss any questions or difficulties, and enable them to carry
out their jobs effectively.
A supervisor may instinctively be more inclined toward task-oriented or
relationship-oriented supervision. However, every supervisor must also
consider the type of supervision appropriate to each employee. Some
employees work best independently, needing direction but little support. Other
employees work better with a significant amount of support from their
supervisor. In any case, a supervisor should always consult with employees
before making judgements and decisions which affect the employee's work.

Elements of supervision. The foundation of supervision is the supervisory
session, when the supervisor meets with one or more employees to review
the work that has been done and to plan the work of the next few months.
There are different types of supervisory sessions, each of which covers a
different time frame and looks at the work to be accomplished in a different
way. On-site, day-to-day supervision keeps track of what is being done and
corrects any obvious problems as they occur. Supervisors also have

supervisory sessions with staff working in the same location; these involve a
longer-term review of the work and may look at the need for further training or
the possibility of staff development activities. Supervisory visits to staff
working in different locations look at work accomplished over a longer period.
In addition to trying to resolve problems arising from day-to-day work, the
visiting supervisor has a pre-determined list of activities to carry out.
An additional form of supervision is the performance appraisal, which occurs
at regular periods and looks at whether the employee is achieving her or his
performance objectives, how well she or he is carrying out the tasks, and what
support the supervisor should provide. This is a more formal version of the
review that takes place during the regular supervisory sessions and may the
basis for deciding whether the employee should receive a raise or promotion.
All supervisory sessions, whatever the circumstances, should:
Reaffirm the mission of the organization - reminding staff of the
organization's values, principles, and goals, and strengthening staff
commitment to them;
Make sure the staff have the interpersonal skills required to deliver
high-quality family planning services;
Check that the staff have the technical and intellectual skills necessary
for the jobs they do and that they are properly trained;
Deal with personal work-related issues of individual staff members.
A supervisory visit to staff working some distance away would also have to
cover the following items:
Checking and replenishing supplies;
Bringing messages and items from headquarters and taking others
back (the mailman function);
Collecting record forms that need to go to headquarters.

Provide effective supervision
Share the program's overall goals and objectives with the employees
as much as possible so they can participate intelligently in decisions.
Respect your staff and their contributions. They may have insights that
will lead to better decisions. Let them know that you rely on their self-
discipline and commitment.
Talk with your staff informally. This will help you learn their views and
opinions without asking them directly. Listen to them. Even if you don't
agree with their opinions, being familiar with them will help you to a
more effective supervisor.
Identify the types of decisions or issues which the staff feel are
important and in which they would like to be involved. Take their ideas,
suggestions, and wishes into account whenever possible. Employees


are more motivated to work hard on tasks they helped to decide on and
plan.
Do your best to make sure that all those employees that will be
affected by a decision have a chance to make their views on it known
to you.
Encourage staff to make suggestions for the agenda of regular formal
staff meetings. Put a sheet of paper on the notice board several days
before the meeting so that anyone (including yourself) can write on it
the subjects she or he would like to raise. When you conduct the
meeting, try not to dominate it; encourage participation by the staff
members.
Improving Staff Performance
Setting performance objectives
As a supervisor, you should aim to have the staff working towards a set of
performance objectives which they have helped to develop. Performance
objectives, which are individualized targets written for each staff member,
outline the tasks for which each staff member is responsible, as well as the
deadlines for the completion of these tasks, when relevant. When each
individual is working to meet performance objectives, the program itself is
more likely to reach its targets and objectives on time.
Performance objectives should be developed in consultation with the staff
member in question. Staff should be able to achieve their performance
objectives through their own efforts. Do not set objectives over which they
have little or no control. (For example, a nurse in a clinic has little control over
how many people she or he sees).
Performance objectives should be:
Specific, quantitative when possible, and qualitative when appropriate;
Time-limited, stating when the activity is to occur or the date by which it
must be completed;
Clearly worded, so that there is no doubt whether the objective has
been met.
Performance objectives will guide both the employee and the supervisor who
will be providing the employee with support and help. The supervisor is thus
making a commitment to the joint venture of getting the work done properly
and on time. Performance objectives for both the employee and the
supervisor are recorded during the supervisory meeting for review at the next
meeting, when the results will also be recorded. These records will be useful
for an objective review of the whole year's work at the time of the annual
evaluation.
In many countries or organizations, the concept of performance objectives is
unfamiliar, and it may take the staff time to be able to work comfortably with
this system. You can begin by introducing the idea of periodic reviews of the
employee's activities. Once the staff member is comfortable with this system,

you can introduce some performance objectives for each of the employee's
activities.

Identifying Performance Problems
Discovering the cause of performance problems .Problems and conflicts
are inevitable; no program will be completely trouble-free. One of the
supervisor's responsibilities is to help resolve the problems that employees
are encountering. However, it is not always obvious that problems exist, as
employees may be unwilling to mention them to a supervisor. As the
supervisor, you must make an extra effort to see whether problems exist.
Once it is evident that a program is not running as well as expected (for
example, it is not meeting its objectives or there is tension among the staff
members), the supervisor must determine the nature of the problem before
any corrective steps can be taken. As a supervisor, you should begin by
asking the following questions:
Who is involved in the problem?
What exactly is wrong?
When did the problem start?
Where exactly is the problem taking place?
What is the cause of the problem?
What resources will be needed to solve the problem?
Reasons for poor job performance
In general, there are two kinds of problems a manager has to handle with
staff: poor performance, which results when an employee does not or cannot
perform the job properly, and personal problems, which often interfere with
collaboration among employees or affect an employee's motivation. If you find
that an employee is not working as effectively or productively as you had
anticipated, find out why and correct the situation. Poor job performance may
occur because an employee:
Doesn't fully understand the duties of the position or how to carry out
the assigned tasks;
Is not properly trained for the position;
Has a personality conflict with a colleague which is interfering with the
work;
Is bored by the work or lacks motivation;
Feels she or he is not being properly or adequately supervised;
Is unable to adjust to the local environment.
If, after collecting information on the current situation, the solution is not
immediately obvious, begin trying different approaches to see if any of them
improves the employee's performance. For example, if an employee has been
working independently, try providing closer supervision and see whether the
employee's performance improves. If an employee's job involves repetitious
tasks, you might consider providing her or him with a new challenge.

Handling Job Performance Problems
Understanding the problem .To understand the job performance problems
of one or more employees, you must look at a variety of factors, including the
employee's employment history, training, transfers, performance, and
qualifications. You may also wish to consider the employee's work interest,
attitudes, and ambitions. Keep in mind that the employee's performance
problem may not be due to an inability to do the work, but rather to personal
problems, such as financial, family, or health problems.
Find out whether the employee has been adequately supervised.
Does the employee fully understand what is expected of her or him?
How do you know?
Has the employee received proper guidance when performing her or
his work?
Has good performance been recognized? When? How?
Has the employee received constructive help to correct a bad job?
When? What was the result?
Has the employee had the opportunity to advance in her or his work?
Has she or he had the opportunity to assume new responsibilities?
What was the result?
Has the employee been encouraged to improve? In what way? What
did she or he do?
Are the employee's work conditions satisfactory? What are they?
In answering these questions, the negative responses will indicate where
improvements in supervision may be able to solve the problem.

Determine the nature of the employee's problem.
Has the employee adequately carried out her or his duties?
Does the employee have a negative attitude?
Is the employee's work deficient?
What would the situation be like if everything were running smoothly?
What will prove that the problem has been solved?
If the poor work performance seems to be a result of the employee's not fully
understanding her or his duties, as the supervisor you should immediately
take the following steps:

Helping the employee to improve job performance

Compare the employee's performance objectives and job description
with her or his work performance. Review any previous disciplinary action

that may have been taken against this employee. Look at the nature of the
problem and what the organization's rules and procedures are.

Try to determine the reasons for this gap between objectives and results
before interviewing the employee by looking at:
The employee's personal circumstances;
The employee's relationship with other employees;
Whether there have been any recent changes in the nature of the
employee's work or in the staffing of the unit.

Talk privately with the employee. Go over the employee's performance
objectives and instructions and:
Find out how well the employee understands the work assignment;
Ask the employee for her or his assessment of the situation;
Determine the employee's attitude toward work;
Determine whether the employee is capable (properly trained,
physically and mentally able) to do the job;
Ask the employee how she or he thinks the situation can be corrected
and decide, together, what is needed to perform the job.

Take measures to correct the problem:
Go over the tasks and instructions, making sure the employee
understands what is expected of her or him.
If additional training is called for, arrange for the employee to have the
necessary training.
Give close supervision and help, making sure that the employee has all
she or he needs to carry out the tasks and that the employee knows
that she or he can call on the supervisor for help.
Let the employee try to improve her or his performance and then check
the work again.
Congratulate the employee on the improved performance.
Replace the employee if she or he isn't capable of doing the job; don't
keep an unsatisfied employee if you can help it.

Managing Conflict
It is inevitable that there will be a certain amount of conflict in an organization.
Often this conflict is a positive thing, as it can bring up new ideas or
techniques, or problems that need to be resolved. A manager should learn to


manage conflicts rather than suppress them and to address them as soon as
they arise. When conflicts arise from differences in personal values and
beliefs, they will probably never be resolved; they will have to be managed.
Conflicts between employees
Sometimes a problem that arises from a personality conflict between two or
more employees will lead to disputes or will keep the employees from working
together as they are supposed to. This ill feeling can infect other employees,
so such conflicts must be addressed right away. As a supervisor, you may
have to settle such a dispute between two workers. Proceed by taking the
following steps:
In order to find out what is the real cause of the quarrel, interview each
of the people involved separately.
Ask each person how she or he thinks the argument can be resolved
and if she or he is willing to be reconciled.
When there is a proposed solution, try to persuade all sides to accept
the solution, to stop arguing, and to work together.
If no agreement can be reached, tell the employees involved that they
will have to agree to differ, that they should not argue about it any
more, and that it must not impede their work in the future.
Managing employee's personality conflicts

Personality conflicts may be the most difficult kind of problem a supervisor
has to deal with. They can be emotionally charged and generally don't go
away of their own accord, as people's personalities are not likely to change.
When faced with this situation, a supervisor needs to establish reasonable
ground rules to minimize the conflict, such as the following:
If one employee criticizes another, she or he must also supply
suggestions for improving the situation.
No one may make attacks of a personal nature on another person.
Grievances must be brought up with the supervisor because
complaining among the staff will not improve the situation.
Personality clashed must not be allowed to hinder work.
Employees will be rewarded for helping and cooperating with others,
not for succeeding at the expense of others.
Conflicts between the employee and the supervisor

The problem may be a conflict between the employee and the supervisor. The
employee may feel animosity toward the supervisor and react to this by not
carrying out her or his assigned tasks or by doing them poorly. This is a
difficult situation, and there is no guaranteed solution for it. The supervisor
and the employee will need to sit down in a private meeting to air their
grievances and problems. As the supervisor, you should then go over the

grievances and outline which complaints you can do something about and
which you cannot, what can be done, and whether these changes will make
the situation satisfactory for the employee. If the complaints that have no
solution are very irksome to the employee, she or he might wish to consider
leaving the job.
In this meeting, you must be careful to remain non-judgmental, concentrating
on finding a solution and not letting yourself respond angrily or in an accusing
manner to the employee's grievances, as this will only make the employee
defensive and angry and will make it much more difficult to work out a
solution. Both of you should try to think rationally and not emotionally. As the
supervisor, it is your responsibility to make sure the meeting stays calm and
controlled.

Maintaining a positive atmosphere

Supervisors can maintain a helpful, cooperative, positive atmosphere by
examining their own behavior toward their employees. Use the suggestions in
Improving the Work Environment to identify ways to improve the work
environment of those you supervise. A supervisor must avoid falling into bad
habits which can negatively affect the work environment and the employees'
job performance; employees who feel their supervisors are unjust, vindictive,
or ineffectual will feel trapped in an unhappy position and may lose their
motivation to work.

Improving Staff Motivation
How a supervisor can motivate a staff
As a supervisor, you can be a powerful motivating force for your staff. You
can help them to carry out their tasks responsibly and efficiently and can
inspire them to strive for higher achievements, even if, as is generally the
case among supervisors, you don't have the power to motivate through
increased financial incentives. You can use a number of non-financial
incentives, such as:
Having senior staff voice their approval of good performance; Instilling
in employees a belief in the value their work;
Providing employees with opportunities to use their intelligence to solve
problems;
Offering employees opportunities to assume more responsibility and
leadership;
Providing opportunities for advancement and self-improvement.

Providing Effective Feedback
Principles of effective feedback


Feedback means communicating to the staff your reaction regarding their
work performance. Your feedback lets the employees know what they are
doing well, where they need improvement, and how they can improve.
In order to make sure your feedback is effective, your comments should be:
Task-related. Your comments should be related to the actual tasks
carried out by the staff and should be based on your own observations
of how these tasks are done.
Prompt. Give feedback after your observations of employees' work
and your conversations with them and in the presence of other staff
members who are involved. The longer the delay, the weaker the effect
of the feedback.
Action-oriented. Your comments should relate to improvements that
employees can make through their own efforts.
Motivating. Start with positive feedback, then progress to what needs
improvement.
Constructive. Discuss with the staff how they can improve their
performance, taking care to emphasize that their work has value.
In reality, feedback takes place almost continuously during on-site supervision
or during a supervisory visit.

Example
Ineffective feedback from a supervisor to a CBD agent:
"I've been meaning to tell you, I don't like the way you handled the visit to Mrs. R's
house last month. You spent too much time talking about unimportant things. This
program is not an excuse to sit and chat with your neighbors! She said she'd been
having headaches and you didn't ask her if she'd had them before. You obviously
haven't remembered our training sessions very well. Are you too lazy to re-read the
manual? Don't you remember what to do when a client complains of headaches? Go
back and read the manual, and don't let me catch you making that mistake again!"

Example
Effective feedback from a supervisor to a CBD agent:
"During the visit to Mrs. R's house today, you were very friendly and warm, and I see
that you have established a good relationship with her. Your reminders to her about
how to take the pill were clear and complete, and it is excellent that you remembered
to repeat them, since she is a first-time user who just started last month. You listened
well when she told you the problems she has been having with taking the pill.
"However, there are two things that you should do differently next time you see a
client with these complaints. She is a new pill user, and it is important to reassure
new pill users that their nausea will probably disappear by the second month. Her
headaches could be due to many causes. Next time a pill user complains of
headaches, ask her whether she had these headaches before she started taking the
pill. Take her blood pressure.* Also, keep track of who is complaining about
headaches. If a woman has this complaint two months in a row, refer her to the


health center. If her headache is severe and accompanied by nausea, refer her at
once. "Later this afternoon, I'll review our policies for treatment of side effects of the
pill with you, to refresh your memory."
* Not possible in some CBD programs.

Building a Supervisory System
Developing a system to help you supervise
As a supervisor, you are aware that much is demanded of you. You must
guide, support, and assist your staff to do the best job they can. You must
motivate them, manage any conflicts, resolve problems and emergencies, and
do your best to meet your performance objectives and help your employees to
meet theirs so that your program will meet its goals. How can you accomplish
all this?
Every program or department needs a supervisory system, that is, a set of
principles and rules to follow. A supervisory system guides supervisors
appropriately in planning, directing, and controlling the performance of their
employees. The system describes how the supervisors tasks will be carried
out, whether through supervisory sessions with one or more employees or
through written or telephone communication. It can include:
A supervisory schedule
A supervisory plan
A system for performance appraisal
By allowing you, the supervisor, to schedule future supervisory sessions and
plan the details of these sessions, such a system will help you to keep track of
all the activities and employees for which you are responsible. You should
hold supervisory sessions with all the employees that you supervise, whether
they are working in the same location as you are or in another site to which
you must travel to see them.

Supervising people you see frequently
If the staff you supervise are working in the same clinic or office as you, or if
they work near enough that you see them almost every day, you will get
regular feedback on the technical and interpersonal capabilities of your staff.
Issues or problems, particularly any personal issues, can be dealt with as
soon as they arise. You can vary the time you spend with individual members
of your staff as their needs require and the work situation allows.
When supervising people you see frequently, some supervisory functions are
performed easily, such as monitoring the volume and quality of the work
which has been done, reaffirming the mission of the organization (by personal
example), and being able to represent the organization and support the staff
members on personal issues. Because you see these staff members every
day, it may be more difficult to look at their training and staff development
needs from a long-range perspective. To overcome this problem, the
supervisor must set up regular meetings for longer-term reviews of the work

and for discussing the guidance, assistance, and support that staff members
should have.

Supervising people you see occasionally
If the staff you supervise are located at some distance from your office, then
you will not see them very often. Supervising staff who work a distance away
is different from supervising staff you see every day because these sessions
are usually less frequent, longer, cover a longer time frame, have a sense of
occasion, and are scheduled around constraints of geography, distance, and
the availability of transportation. With these staff you have only a short time,
perhaps a few hours each month or each quarter, to cover the basic areas of
supervision which have been mentioned earlier. To make sure your visit has
the greatest impact, you must think very carefully about what you are going to
do and plan how you are going to do it.
The main challenges for the supervisor in any supervisory session are:
To identify all the problems and issues to be addressed with staff
members;
To use the available time with staff members effectively.
Managing a supervisor's many roles

A supervisory system is especially necessary when the circumstances of a
supervisor's job are complex. As a supervisor, you may have a number of
employees to supervise in a variety of locations and in addition you may be
responsible yourself to more than one supervisor. A supervisory system will
help you to keep track of all the things you have to do so that no important
tasks are neglected and so that tasks are accomplished within this allotted
time.

Example from Lesotho
The Complexities of Supervision
The lines of supervision, like a chain of command, seem in theory to be very
straightforward; one person is supervised by another with more responsibility,
who is in turn supervised by someone else higher up in the organization. In
fact, it is rarely that simple.
The diagram below illustrated the lines of supervision for a District Public
Health Nurse who works for the Ministry of Health in Lesotho. She has not just
one supervisor, but five. Her most direct supervisor is the District Medical
Officer, but as shown in the right hand column, she is also responsible to the
Deputy Chief Nursing Officer, the Health Services Area Medical Officer, the
Director of the Department of Maternal and Child Health and Family Planning
(Family Health Division of the MOH), and the Coordinator of the Extended
Program on Immunization. Her real supervisor, the Senior Nursing Officer,
who is informally responsible for transfers and promotions, isn't even shown in
the official diagram.

The District Public Health Nurse's job is complex not only because of all the
people who are supervising her, but also because of her many roles and the
many people she supervises. The District Public Health Nurse acts as a
trainer, supervisor, administrator, technical advisor, and consultant. She
directly supervises eleven health clinics and her own office staff of three. She
supports the training of 60 health workers in the Health Service area or district
offices. She also consults and interacts with a number of other organizations
and entities in Lesotho, as shown in the column on the left.


Unit 1 - Introduction
Human Resources
Management in Context
Introduction

Welcome to the first unit of the module Managing Human Resources for Health.

Within the broad subject field of human resource development, human resource
management is the most substantial area, as it involves all aspects of personnel
management as well as issues of capacity, training, etc. In this unit we will
introduce you to the scope and context of human resource management in the
health sector.

This unit has four study sessions:

Study Session 1: Key Components of Human Resource Development.
Study Session 2: Human Resources and Health Sector Reform.
Study Session 3: Human Resource Management and the Policy Context.
Study Session 4: The Role of HR Development and Management in your
Organisation.

Session 1 will introduce you to the key components of HR Management in the
wider context of human resource development.

Session 2 will place HR Management in the context of health sector reform,
particularly in African countries.

Session 3 will continue to look at the context of HR Management, this time the
context of policy and the important role of policy analysis.

Session 4 will summarise previous sessions and lead into future modules by
discussing the role and function of HR Management within your organisation.
The first two sessions review the first two study sessions of the introductory
module Developing Human Resources for Health. Students who have completed
this module can skip over the sessions or, even better use them to do a bit of
revision.

SOPH, UWC: Managing Human Resources for Health - Unit 1 25

LEARNING OUTCOMES FOR THIS UNIT:

By the end of this unit you should be able to:

Demonstrate an understanding of the key components of human resource
management.
Demonstrate an understanding of the role of HR Development in the health
sector.
Discuss HR Development in the context of health sector reform.
Demonstrate an understanding of the way in which policy impacts on human
resource management.
Demonstrate an ability to analyse the policy context in your organisation.
Demonstrate an understanding of the role of HR Management within an
organisation.
Demonstrate an ability to assess the HR situation in your organisation.


Unit 1 - Session 1
Key Components of Human
Resources Development

Introduction

In this session we introduce you to the scope of human resource development
and how HR Management is situated within that scope. You will get an overview
of the different components making up Human Resource Development, and will
take first steps to reflect on the human resource situation within your
organisation, a reflection that will be ongoing throughout this module.

1 LEARNING OUTCOMES OF THIS SESSION

By the end of this session you should be able to:

Demonstrate an understanding of the key components of Human Resource
Management.

2 READINGS AND REFERENCES

You will be referred to the following readings in the course of this session:

Publication Details Page Nos In Reader
Mejia, A. (1978). Ch 2 - The health manpower process. In Hall, 4
T.J. & Mejia A. (Eds). Health Manpower Planning: Principles,
Methods, Issues. Geneva: WHO: 31-56.
Green, A. (1992). Ch. 13 - Planning human resources. In An 19
Introduction to Health Planning in Developing Countries. Oxford:
OUP: 291-315.


3 THE DIFFERENT COMPONENTS OF HUMAN RESOURCE
DEVELOPMENT

3.1 Introduction
'Human resources' is the term used today to Internet resources:
describe the key ingredient of any health Apart from a growing volume of printed
publications on health human resources, there are
system: the people running it - from the now some fascinating websites with information
cleaner and the gardener, to the heart on the topic. Visit one or all of the following three
surgeon, the volunteer and the top to whet your appetite:
administrator.
In the past other terms were used: 'health http://www.Hrhtoolkit.forumone.com/ This tool
kit, compiled by Prof. Thomas Hall for the
manpower', with its problematic gender WHO contains publications and tools for the
connotation, 'health workforce', etc. Today, entire spectrum of HRD for health.
the term 'human resources' seem to have http://www.moph.go.th/ops/hrdj/
become widely accepted and that is why we An international academic journal focussing
will be using it throughout this module. on HRD for health. Although this is an
academic journal, its articles are firmly rooted
The term flags the fact that the people in and based on HR practices with a
running the health system are indeed a commitment to improving health service
resource that has to be developed and delivery.
nurtured. In fact, they are the most crucial http://www.erc.msh.org/
and the most expensive resource in the The electronic resource centre of the US-
health system. Conventionally, between based organisation Management Sciences for
Health contains a wide range of tools in the
65% and 80% of the entire health budget is area of human resource management. It is
spent on human resources, leaving a extremely accessible and user-friendly.
relatively small proportion for everything
else: drugs, buildings, equipment, transport Many of the materials for this module have been
and other running costs. drawn from the above sources. Detailed
references are given in the text.
Furthermore, human resources require the
longest preparatory time of all health
resources and cannot be improvised. The training of health human resources is
subject to the rigidities of the health and education systems and yet, personnel,
unlike other health resources, cannot be stored or discarded. They have to be
available in the right numbers and type at the right time – no more and no less
than is needed. This is the most important challenge of human resource planning
and production, i.e. the education and training of health professionals.
Lastly, because their skills are subject to obsolescence, particularly in our times
of rapidly developing technology and knowledge, human resource abilities and
skills need to be updated and improved through continuous development,
training and supervision – a major challenge for human resource production and
management.
Strangely, what is often forgotten or neglected in health planning is the fact that
this most crucial and most expensive of health resources consists of human
beings, people with hopes, aspirations and feelings, and who live within families
and communities. We will see in this unit that the neglect of the human aspect of
human resource development has severe consequences for the system as a


whole, and has contributed to the negative track record of Human Resource
Development (HRD) within health sector transformation in the past decades.
Human Resource Development (or HRD for short) encompasses the planning
for, development and management of human resources. Within the health
system, these three components may each be controlled by a different authority,
which makes co-ordination between their functions difficult. As a consequence
formal mechanisms, such a Human Resource Planning or Development Unit may
be necessary.

3.2 Human Resources Planning

Human Resource Planning includes the estimation of staff numbers, categories,
knowledge, competencies and attitudes of personnel required both in the
immediate and long-term future; the allocation of resources to train and pay these
staff; the communication of this information to trainers and managers. It also
includes human resources policy, “where policy refers to statements made by
relevant authorities intended to guide the allocation of resources and effort".
(Moorman & Pick, undated: 10) HR Planning is essentially concerned with future
and long term needs for personnel, and ensuring that these match future health
service needs.
HR Planning is usually carried out at national and provincial levels. Some functions
such as resource allocation and the determination of the requirements for specialist
health services can probably most efficiently and equitably be done only at the
central level of an organisation or system (Green, 1992). However, the more a
service is decentralised, the more regional and district managers may be expected
to do HR Planning.
HR Planning has two essential steps:
estimations of supply (or what we have)
estimations of requirements (or what we need).

These two steps should include both quantitative and qualitative assessments, and
estimations of the skills required and the productivity of current and projected
personnel. There are different methods of estimating supply and requirements,
such as the needs-based and service-targets methods. Skills and productivity may
be measured by methods such as training needs assessment, task analysis and
job design, nursing workload study, performance evaluation, supervision.

3.3 Human Resources Training and Development

Human Resource Training and Development includes all aspects of the
education and training of health personnel (both basic and post-basic) to meet
the requirements of the system. In the literature it is often called human resource
production, which is a slightly dehumanising term, which is actually meant to set
it apart from the broad term of human resource development.
Institutions involved in the production of health personnel include nursing schools,
paramedical training schools, medical, pharmacy and dentistry schools, universities


and technikons. (Note that the levels of primary and secondary education in the
society are important for the future supply of trainees.)
These institutions are commonly controlled by the Ministry of Education, if they fall
within the public sector, or they are controlled by private organisations, both for-
profit and not-for-profit. Typically, the higher the level of education of a category of
health worker, the more it is regulated from outside the Ministry of Health - for
example, by professional bodies. In South Africa, there have been important
debates on the control and governance of education of health professionals, but so
far nothing fundamental has changed.

3.4 Human Resource Management

Human Resource Management (HRM) includes the employment, retention and
replacement, support and development of staff. It plays a crucial role in
determining the productivity, and therefore the coverage of the health services
system. Anybody responsible for the management of people in an organisation is
responsible in some way or another for HR Management. However, in larger, more
complex organisation, a great deal of HR Management will be carried out by a
specialised personnel department.
HRM functions may be divided into the following activities:

Employment
job analysis
job description
recruitment and selection
keeping personnel records and databases
staff induction
distribution of personnel

Retention & Replacement
career structure
promotion
grievance and dismissal procedures
working and living conditions
reward system incentives

Support
mentoring
forms of supervision
forms of communication and consultation
employer-employee relations and collective representation

Development
individual performance review
training


Most countries are now experiencing major changes in their health services due to
economic and political pressures which have implications for personnel. Such
changes therefore need to be considered carefully in the management of staff.
Management of change is an important thread that runs through all HRM functions
in the South African context typified by system-wide restructuring.
The policies and practice of HR Management consist, in part, of a series of
techniques and procedures concerning, for example, recruitment and selection, job
description and performance appraisal. The techniques are, however, not neutral
but take on the social and political characteristics of their immediate environment.
When the same technique is used in different social and political settings, then the
political consequences of the technique will differ.
Techniques are also contested and are certainly not universally standardised.
Different organisations are guided by quite different Human Resource Management
policies and practices. In some aspects, private sector HR Management is much
better developed than public sector health services, and in South Africa the health
sector has been considered the least developed in terms of HR Management and
labour relations.
Among the main problems in health services personnel management are the
following:
Personnel leaving the public service.
Inability to attract new staff into the public service.
Inappropriate use of personnel.
Unproductive or demoralised staff.
High levels of absenteeism and moonlighting (see also Green, 1992 and
Moorman/Pick, undated)

These problems may be linked to a number of causative factors, among them a
'task orientated' approach to human resource management, or the quantitative
rather than the human approach to planning and management. Personnel
managers need to broaden their understanding of their jobs to include human
communication and support skills. Another way of looking at this is that human
resources management is not only carried out by managers, but is a two-way
process of reaching agreement between employers and employees.

TASK 1: HRD COMPONENTS IN YOUR ORGANISATION

The text above has given you a preliminary overview of the scope and
components of Human Resource Development for Health. Based on this
overview, reflect on the personnel functions fulfilled by your organisation. If you
are not presently working in a health service, reflect on an organisation you
worked for in the past. Draw a mindmap or organogram to show the different
components and their relationship with one another.
What HRD roles are missing in the organisation? Are you aware of any problems
that arise from that?


TASK 2: HRD THREATS AND CHALLENGES IN YOUR ORGANISATION
The components discussed above make HR Development sound fairly technical.
This is, of course not the case, because HR Development deals with people, their
livelihoods, their emotions, etc.; and we find that health workers in most parts of the
world, and certainly in Africa, work under increasing strain and difficult conditions. If
you look at your organisation again, what are the greatest threats and challenges
facing the workforce in your organisation and therefore the planning, development
and management of human resources?
For example: Is HIV/AIDS decimating your workforce? Are people frustrated
because posts are cut and working conditions deteriorating? Do they feel
empowered, because the district health system has given decision-making powers
to facilities? Do they feel positive, because not only doctors are appointed to
management positions any more?

TASK 3: A SUMMARY OF MAIN TOPICS IN HR DEVELOPMENT
One of the few seminal texts on health human resource development is a book
published in 1978 by T. L. Hall & A. Mejia, Health Manpower Planning: Principles,
Methods, Issues. Geneva: WHO: 31-56. (Reader page 4).
Despite its age and dated terminology, its still presents an excellent summary and
discussion of the main topics in HR Development in the health sector, which is still
valid. Chapter 2 describes “The health manpower process”. Pre-read it to get an
overview of its contents and note that there is a summary at the end. Read this
first, as it will make your reading easier. Then read the chapter, reflecting on the
following questions:
a) How do the different components of HR Development influence each other?
b) Mejia states that HRD decisions are “as much or more influenced by political,
cultural and ideological considerations as they are by supposedly rational
factors such as cost-benefit or the availability of technology”. Do you agree
with this statement? If so, can you think of examples from your own experience
of political, cultural or ideological considerations influencing HR decision-
making?
c) Mejia talks about the multi-disciplinary nature of human resource issues. What
does he mean?
d) Mejia describes the functions and characteristics of the ideal HR unit. How
does this description resonate with your own experience or knowledge of HR
units at provincial or national level?
e) One of the key arguments of the chapter is for the integration of human
resource development. What are the advantages of an integrated approach to
HRD? You can also list possible disadvantages.


Feedback
(This feedback is quite detailed, talking you through the different sections of the chapter
and pointing out key arguments. This is to assist you in getting into the discourse and
language of HR Development in health. Not all readings will come with such detailed
feedback. In some cases the introduction to the reading will provide enough guidance,
so that feedback will be unnecessary):

Hall and Mejia published their book in 1978, soon after the Alma Ata Declaration,
which heralded the birth of the Primary Health Care Approach. They wanted to
emphasise the need for strong HR systems and organisation within a new policy
environment.

The chapter starts with a broad sketch of the environment within which what they
call the health manpower process takes place. They stress that it is multi-
facetted, and requires that those involved in HRD engage and come into contact
with a wide variety of problems and disciplines.

In the second part they talk about how the HR system fits into the health system
as a whole, and that both are influenced by a range of surrounding systems and
agencies (political and educational systems; professional bodies, etc.).
Mejia then describes in detail the component parts of the "manpower process":
Health manpower planning.
Health manpower production.
Health manpower management.

We would say today human resource planning, human resource production (or
development and training) and human resource management.
They emphasise the fact that HR Planning serves the purpose of providing
strong and implementable proposals for HR systems (i.e. the production and
management of human resources), which are in line with the needs and health
plans of the country (or unit of planning). As such HR Planning only serves a
purpose as a tool in the HR process. They say, "planning is neither self-
executing, nor self-fulfilling". (Mejia, 1978: 35)

"Manpower production", the training and development of human resources, relies
on good inputs from planning, to make sure that the right people are trained, in
the right numbers, with the right skills. The authors point out that most production
is not under the direct control of the health system, because usually the
education system is responsible for the implementation of training, a fact that is
not always without tension.

The authors go on to show that "health manpower management" relies on good
planning and production, but often the distinct existence of different units is a
barrier to good management.


After having discussed the key ingredients of the HR process and its component
parts, Mejia then turns to the organisational arrangements of HRD within
Ministries of health in the section on The Health Manpower Unit.

They discuss in detail the functions and responsibilities of each component part
of an HR unit. You do not have to go into the detail of all of this. The key
argument they are making here, and an argument which has been repeated by
HR experts ever since, is that all aspects of HR Development should be located
in one unit to ensure integrated functioning - not the separation of HR functions in
policy and planning, training and personnel administration departments.

You should have had a good look at the diagram at the end of the chapter (p.
54), which illustrates how the different HR Development components relate to
each other.

4 FURTHER READINGS

There are no further readings for this session. At present, there are very few
good overview texts for HR Development in the health sector.

5 SESSION SUMMARY

In this session we have introduced you to the scope of human resource
development and how HR Management is situated within that scope. You have
taken first steps to reflect on the human resource situation within your
organisation, a reflection that will be ongoing throughout this module. You have
also critically read one of the seminal texts in the field, the chapter by Hall &
Mejia.

In the following session, we will place Human Resource Development and
Management within a broader political and historical context, looking at the
impact that health sector reform has on human resources - and vice versa.


Unit 1 - Session 2
Human Resources and Health
Sector Reform
Introduction

Most countries throughout the world have been engaged in efforts to reform their
health systems for the past few decades, with waves of reform initiatives
following each other in quick succession. Whatever their specific objective, these
reforms often focussed on changes in financing, organisations and structures,
often to the neglect of the key resource – staff. Staff are fundamentally affected
by and, in turn, fundamentally affect the success of any kind of reform of the
health sector.
This study session will look at some of the main reform initiatives of the past 25
years, their effect on health human resources and vice versa. This will be a
reading session, aimed at locating HR Development in a broader political and
socio-economic context.
Each reading will come with a number of key questions, which will guide you
through the text.



Demonstrate an understanding of the role of HR Development in the health
sector.
Discuss HR Development in the context of health sector reform.


2 READINGS


Sanders, D., Dovlo, D., Meeus, W. & Lehmann, U. (2003). Ch 8 - 33
Public Health in Africa. In Beaglehole, R. Global Public Health - A
New Era. Oxford: OUP: 135 - 155.
Kohlemainen-Aitken, R-L. (1997). Decentralisation of human 44
resources: implications and impact. Human Resource
Development Journal, 1(3): 1-29.


3 HRD AND HEALTH SECTOR REFORM

In this session we start you of with a number of tasks straight away. The first is a
reading exercise, followed by two tasks that will draw on the text.

TASK 1: THE HISTORICAL CONTEXT OF HEALTH SECTOR REFORM
Read Sanders D. et al, (2002), Ch 8 - Public Health in Africa. In: Beaglehole, R.
(ed.). Global Public Health - A New Era. Oxford: OUP: 135 -155. (Reader page
33). The chapter places human resource development and health sector reform
in the context of socio-economic and political developments in public health on
the African continent over the past few decades. It thus provides a broad
historical and political context for the discussions that follow.
Consider the following questions and issues while reading the text:
What have been the main challenges facing health ministries in post-colonial
Africa?
What distinguished the PHC approach fundamentally from other approaches
to health care delivery?
What would you consider the main human resource implications of the PHC
approach?
How have human resources for health been affected by the health sector
reform initiatives of the past decade?
The authors talk about the inability to develop appropriate capacity. What
does this mean practically?
Which HR strategies should be put in place to counter the crisis? Do you
agree with the authors' suggestions?
You don't need to focus so much on the tables at the beginning of the text,
except to understand that health status in Sub-Saharan Africa has begun to
deteriorate again after a period of substantial gains. The article elaborates the
various historical, political and global developments that have contributed to this
situation, before it focuses on the key HR challenges in the present situation and
possible future solutions.
In answering the above questions, think back to the module on Health,
Development and Primary Health Care you did earlier in your studies. That
module introduced the concept and implications of the PHC approach and its
differences from other approaches.


TASK 2: MAJOR HEALTH REFORM INITIATIVES
Draw a timeline showing major health reform initiatives in Africa since 1950.
This should give you an overview of how policies have developed over the
past 50 years or so.

TASK 3: THE ROLE OF COLONIALISM AND POST-COLONIALISM
Spend about half an hour reflecting on how colonialism and post-colonialism
have affected human resource structures in ways that impact on health
systems to this day.
You can do this using a mindmap, writing a mini-essay, drawing a table or
using any form of writing you are most comfortable with. Share your
thoughts with at least one of your fellow students via e-mail or fax.
You don't only have to draw on the reading, but should base your reflection
on your own experience and knowledge as well. Examples of issues you
may reflect on may be: an unequal education system, the inequities between
urban and rural areas, the structures and hierarchies of the health sector,
professional cultures and hierarchies, and many others.

The above reading has placed health human resources in a broad historical and
political context.

The second text in this session looks specifically at the impact of decentralisation
on health human resources. As you learnt in previous modules (particularly PHC
II and Health Management II), decentralisation has been one of the key features
of health sector transformation initiatives over the past twenty years. Many
authors would contend, however, that despite the undisputed centrality of human
resources in the decentralisation process, there has been little consideration of
how human resources are affected, and how, indeed, they can manage the
results of decentralisation.

The article looks less at the external environment in which health sector reforms
have taken place, and more at the internal dynamics, impact and implications. In
this, it also provides a useful bridge to the following units, which will concentrate
on planning and management issues with respect to health human resources.

The author of the article, Riitta-Liisa Kolehmainen-Aitken, has many years of
experience with decentralisation processes, particularly in countries in the
Pacific. This article was published in the Human Resource Development Journal
in 1997.


TASK 4: DECENTRALISATION AND HUMAN RESOURCES

Please read Kohlemainen-Aitken, R-L. (1997). Decentralisation of human
resources: implications and impact. Human Resource Development Journal, 1(3):
1-29. (Reader page 44).
You will see that the paper consists of two parts: Part One consists of the main
article by Kolemainen-Aitken, and Part Two includes a number of responses from
international experts.
Read the article and the responses, making notes of the main points and your
comments and questions, and then write your own response to the article, based
on your professional experience.

4 FURTHER READINGS

Martinez J. and Martineau T. (1998). Rethinking human resources: an agenda
for the millenium. Health Policy and Planning, 13(4): 345-358.
WHO. (2000). The World Health Report 2000 – Health Systems: Improving
Performance. Geneva: WHO: 86 & 200.
Abel-Smith. B. (1987). The world economic crisis. Part 2: Health manpower
out of balance. Health Policy and Planning, 1: 309-16.
Cassels, A. (1995). Health sector reform: key issues in less developed
countries. Journal of International Development, 7(3): 329-347.

5 SESSION SUMMARY

This session looked at the international context of HRD within health sector
reform. We will continue to look at context issues in this unit. The next session
will focus on the policy environment of HR Management, helping us to
understand how policy shapes what can and cannot be done in HR
Management.


Unit 1 - Session 3
Human Resource
Management and the Policy
Context
Introduction

In the previous session we discussed the historical and broad political context of
HR Management. In this session we will spend a bit more time looking at the
policy context in some more detail. You will read two texts, which introduce an
approach to analysing and understanding policy. We have introduced this
session in a module on HR Management, because management is profoundly
influenced and shaped by policy developments, and we think that it is of great
benefit for a HR manager to have a good understanding of policy processes.



Demonstrate an understanding of the way in which policy impacts on human
resource management.
Demonstrate an ability to analyse the policy context in your organisation.


2 READINGS


Walt, G. & Gilson, L. (1994). Reforming the health sector in 59
developing countries: the central role of policy analysis. Health
Policy and Planning, 9(4): 353-370.
Walt, G. (1994). Ch 8 - Do those who implement decide? In 77
Health Policy: An Introduction to Process and Power.
Johannesburg and London: Wits University Press & ZED Books:
153-177.

3 POLICY AND HUMAN RESOURCE MANAGEMENT

TASK 1: THE CENTRAL ROLE OF POLICY ANALYSIS
Read Walt, G. & Gilson, L. (1994). Reforming the health sector in developing
countries: the central role of policy analysis. Health Policy and Planning, 9(4): 353 -
370. (Reader page 59). The text is quite dense, but the authors provide a very good
overview in their introduction.
Walt and Gilson argue that much health policy wrongly focuses attention only on the
content of reform, and neglects the actors involved, the process followed and the
context within which policy is developed.
To argue their point, they set the historical and political scene on pages 355 - 358.
Much of what they present should be familiar to you from the readings in the previous
session. You can use it to do a bit of revision and get a different perspective.
They then go on to define health policy analysis and how it is embedded in the
disciplines of political economy and economics (pp 358 - 361). All of this is very
interesting reading, but you do not have to understand every word of it. You can also
skim rather than read in detail the following sections on context, actors and process,
which evolve these concepts theoretically (up to page 364). The second-last section
on Health policy analysis takes us back to the context of health sector reform and the
multiple influences that shape such reform. It then goes on to show how different
authors have developed approaches to try and understand how these process work
and what their result are.
The last section of the text takes us back to the conceptual framework introduced at
the beginning of the article, arguing that this approach to policy analysis allows us to
better understand the implications of policies, and why they do or don't succeed.
Of particular interest in our context is the triangle the authors present on page 354,
which they use as a conceptual framework to understand policy. This triangle can
help us to better understand human resource policies and practices. It helps us to
understand why certain decisions get taken, who takes them, and why they do or do
not get implemented.


Let's look at the triangle in more detail. It consists of four components:
the actors in the policy process in the middle;
the context;
the content and
the process on each corner of the triangle.
Context

Actors
Content Process

According to Walt and Gilson, these four components make up and influence
policy.

To illustrate this approach, below is an example of how the triangle can be used
to better understand a policy, in this case the introduction of free health services
to children in 1994.

Context:
Soon after 1st democratic elections
Great enthusiasm for reform
Awareness of inequities in the health system
High infant mortality and malnutrition; high TB rates

Content: free health services
to children under 6 years of
age

Actors: Process:
President Presidential decree
New DoH Little consultation
Managers Immediate
Health care providers implementation
Consumers (patients)


This obviously is a very rough analysis. It tells us that:

in 1994 the context was such that such a policy had a very favourable
environment (soon after the election);
that the policy did not need a lot of technical preparation (eg. provision of drug
or special equipment) and could therefore be implemented quite easily;
that there was a strong key actor (the President) who simply decreed the
policy without extensive consultation, while it was left to health service staff to
implement;
that a large number of people benefited from the policy immediately, making it
very popular and difficult to resist.

This analysis can be refined greatly by:

looking in detail at different aspects of context (e.g. historical context, political
context, epidemiological context, situational context); or
by analysing the roles of each actor in detail, e.g. What was the position of
each group? Who benefited the most? Who had the power to implement - or
to resist implementation?

3.1 Why is policy analysis of use to a human resource manager?

Well, a frequent feature of managing human resources in our present context is
handling of new policies, whether big (e.g. PMTCT) or small (e.g. new leave
arrangements). These policies invariably affect staff, even, if they do not address
staff directly. Yet, many policies don't get fully implemented, or are implemented
but resented, or flounder between authorities. This has a profound effect on how
staff can or cannot fulfil their function, whether they feel empowered or frustrated,
whether morale is high or low. The above approach to policy analysis can help us
understand why things are the way they are. It may not solve our problems, but
it may tell us why we feel as if we are banging our head against a wall. Or why a
policy, although difficult, has to be implemented at this point. And sometimes this
understanding will assist us in making decisions for action.
As human resource managers, particularly, if we operate at facility, district or
provincial level, we mostly deal with the implementation part of policy. The
following text, which is a chapter from a book by Gill Walt on health policy, talks
about the role of implementers in the policy process.


TASK 2: IMPLEMENTING POLICY
Read Walt, G. (1994). Ch 8 - Implementation: do those who implement decide? In Health
Policy: An Introduction to Process and Power. Johannesburg and London: Wits University
Press and ZED Books: 153 - 177. (Reader page 77).
Start with the conclusion on page 177, which summarises the chapter and arguments.
This is a fairly easy to read book and is highly recommended, if you want to know more
about health policy. You should not encounter too many problems following Walt's
argument. Focus particularly on the following:
Part 1 on theoretical models repeats many of the points made in the previous article
(Walt/Gilson), using a number of illustrations. Use this section to revise what you
learnt earlier in this session about the different aspects of policy.
Part 2, “Implementation in practice”, focuses on the factors impacting on policy
implementation. From page 159, Walt talks at length about who controls what in policy
implementation, starting with the control of finances and budgets and then moving on
to control of the legislative process. Think about how the control of finances and
regulations impacts on policy implementation in your organisation. Can you be forced
to implement problematic policies, because your budgets are controlled elsewhere?
The last part, “A strategy for implementation”, talks about the resources required for
successful implementation, focusing also on HR requirements.

TASK 3: ANALYSING THE POLICY ENVIRONMENT IN YOUR ORGANISATION
Based on what you have learnt in this session, develop a policy analysis triangle for a policy
in your organisation. Choose either an HR policy (e.g. training policy, leave policy) or a policy
that affects staff in your organisation directly (e.g. integration of services; introduction of
abolition of user fees, etc.). Consider the four elements of the triangle:
Content
Context
Process
Actors


4 FURTHER READINGS

Walt, G. (1994). Health Policy: An Introduction to Process and Power.
Johannesburg and London: Wits University Press and ZED Books.
Collins, C., Green, A. & Hunter, D. (1999). Health sector reform and the
interpretation of policy context. Health Policy, 47: 69-83.

5 SESSION SUMMARY

In this session we introduced you to an approach to policy analysis, which will
help you to better understand policy developments around you. We believe this
understanding will greatly benefit you as a HR manager. We strongly agree with
Gill Walt, who says at the end of second text you read:

"It [policy] is a complex, interactive process, in which implementers
themselves may affect the way policy is executes, and are active in
formulating change and innovation. However, experience suggests that in
the real world there is all too often a major separation between policy
formulation and implementation, with little focus on the realities of putting
policy into practice.” (Walt, 1994: 177)


Unit 1 - Session 4
The Role of HR Development
and Management in Your
Organisation

Introduction

This is the last session of this unit. After having spent time placing HR
Management in a wider societal context, this session will bring the discussion
back to your own organisation. We will look at what role HR Management can
play in your organisation. In doing so, we will repeat aspects of previous
discussions (which is useful revision), and we will lead into some of the issues
and discussions which will follow in the units that follow.

This session is very largely based on an excerpt from one of the websites
introduced at the beginning of this module, the Electronic Resource Centre run
by the American organisation called Management Sciences for Health (MSH).
MSH has vast amounts of experience with health management support and
development in Africa, Asia and Latin America. It has developed numerous very
useful tools, manuals and publications, which are available from the website,
which can be found at http://www.erc.msh.org/

The following text and exercises have been taken from one of the publications of
this website, called The Manager. We have shortened the text and edited it
slightly to make it more readable. Please note that in this text the terms HRD and
HR Management are often used interchangeably, although the text talks about
HR Management. Please also note that this session is somewhat longer than
others. This is because you do not have to refer to any texts in the reader. The
reading is part of the session.




Demonstrate an understanding of the role of HR Management within an
organisation.
Demonstrate an ability to do a rough assessment of the HR situation in your
organisation.

2 READINGS

No readings in this session! However, you will engage with the HR Management
assessment tool, which is printed in the Reader.

3 THE ROLE OF HR DEVELOPMENT AND MANAGEMENT IN YOUR
ORGANISATION

At the organisational level HR Development (HRD) involves linking management
and the development of human resources to an organisation's strategic plan,
goals, and objectives. Establishing these links is an essential management
strategy. It involves assessing the capacity of an organisation's human resources
in six areas — HRD capacity, HRD planning, personnel policy and practice, HRD
data, performance management, and training. These HRD areas are relevant in
any organisation, regardless of its size, purpose, and degree of complexity, and
whether it is public or private.

This session will help you begin the process of assessing your organisation's
HRD system and determining how to improve it. We examine the expanding role
of HRD in helping an organisation deliver on its mission and discuss factors
related to performance management.

3.1 A quick look at your current HR Development system

HRD is perhaps the most misunderstood and poorly utilised management system
in the health sector today. As a result, determining your organisation's current
view of its human resources and how it should strengthen its systems can be a
challenging task. Whether you work at the national, regional, or local level, taking

the following Human Resources Quiz for Managers will help you begin to think
about some of the issues involved and begin the process of establishing an HRD
system that improves productivity and helps you provide quality services that
meet your clients' needs.

TASK 1: HUMAN RESOURCES QUIZ FOR MANAGERS

Some-
Question Yes No
times
1. Do employees understand how their work specifically contributes to
the mission and goals of the organisation?
2. Do employees view performance appraisals as an opportunity to
learn about their skills and competencies and discuss future plans?
3. Is the supervisor's role valued and supported by the organisation?
4. Are job descriptions up-to-date and readily available to all
employees?
5. Are employees routinely considered for job vacancies and other
opportunities for promotion?
6. Do employees understand the organisation's policies on salaries
and benefits and consider them fair and equitable?
7. Does your organisation have a clear system for managing
volunteers?
8. Can your organisation engage in long-range planning, knowing it
has or can develop the human resources required?
9. Does your organisation have strategies to provide meaningful jobs?
10. Does your organisation have a spirit of achievement and high
performance?
11. Do employees come to work on time and work productively for the
full work day?
12. Do managers spend less than 10% of their time dealing with
grievances?
13. Can your organisation take on new objectives or tasks with
cooperation from everyone?

If you answered "yes" or "sometimes" to the questions above, you are to be
congratulated! If you found yourself checking off "no" to many of the questions
above, it is time to re-think your approach to human resources and consider how
to improve it.

3.2 Looking at human resource issues at the national level

In many countries, the health-sector workforce is dissatisfied, underpaid, poorly
motivated, and sceptical of decision makers' ability to solve the problems facing
the health sector. Yet, it is people—the managers and staff working in health—
who are responsible for implementing the changes resulting from health-sector
reform. A comprehensive HRD system is essential for ensuring an efficient and


motivated workforce capable of contributing to the ultimate success of the
reforms.
In an era of health-sector reform and shrinking budgets, providing quality health
services requires leadership. Leaders and managers need to have:
The capacity to accurately forecast human resource needs in order to deliver
services to the public;
A workforce whose training and education are consistent with client needs
and with the management needs of their programs;
The ability to assign staff to the geographic areas where they are needed;
Positive relationships with union officials;
A workforce amenable to change in the workplace.

These human resource concerns will drive national policy development regarding
the training and education that your workforce needs in order to provide essential
services to your client populations.

3.3 Considering the implications of health-sector reform

Countries throughout the world are seeking better ways to structure and finance
their health services. If your country undertakes health-sector reform, you may be
expected to participate in the reform process, while at the same time ensure that
clients receive quality services. To accomplish this, you need to:
Have committed and skilled staff, in sufficient numbers, and with the skills
needed for their work;
Be able to distribute staff equitably among geographical areas and
organisations;
Provide training and staff development opportunities that are consistent with
your priorities and needs;
Have sound human resource management systems and policies.

Your staff must also understand and support the goals of health-sector reform,
appreciate the impending changes in health-service organisations and structures,
and be ready to adapt and respond appropriately to these changes.
Human resources are the essential engine of health-sector reform. Without the
support and participation of people, reforms are impossible to implement. But
changes in organisational structures, levels of responsibility, and financing
arrangements under reform can influence the motivation and productivity of staff.
You may face both opportunities and challenges in developing, maintaining, and
motivating a work force that will be effective both in implementing reforms and
delivering services.

Civil service reform. One opportunity you might have under civil service reform,
for example, is an increase in salaries for different types of jobs, which can
enhance your ability to attract and keep qualified staff. Civil service reform might
also involve efforts to improve the human resource information system, which
can provide you with better data on staff numbers, types, distribution, and costs.


This can greatly strengthen your capacity to undertake human resource planning.
Further, civil service reform sometimes involves transferring health workers from
the national civil service to local health boards, which can give local health
managers greater flexibility in deciding how many staff to hire and how much to
pay them.

Civil service reform also brings challenges. Radical civil service reform, for
example, can interrupt essential human resource management functions such as
hiring, firing, and paying salaries and benefits. If your country is considering
implementing radical civil service reform, you may need to clarify in advance how
you will implement these functions to avoid confusion and a swift drop in staff
morale. Further, if civil service reform includes an ambitious program to reduce
the size of the workforce, you may have to be creative in determining ways to
implement reforms and to deliver quality services with a limited number of staff.

Decentralisation: a tool of health-sector reform

Decentralising the authority for financial and programmatic management of
health services from central to local levels is intended to bring the planning and
management of health services closer to the clients. It is also intended to make
them more efficient. The magnitude of the human resource issues related to
decentralisation depends on the form and type of decentralisation that your
country has adopted. Transferring budgetary and staffing authority from a central
to a municipal level, for example, has far greater implications than delegating
limited powers to a provincial health office. A fully functional human resource
system and good HRD planning can facilitate the transfer of power to lower
levels by making it easier for you to restructure jobs, revise job descriptions, and
carry out ongoing supervision and training of the people at lower levels who will
assume new responsibilities.

3.4 Focusing on HRD at the organisational level

Even as policy makers adjust policy and regulatory frameworks at the national
level, there is much that managers of district health services, NGOs, public
hospitals, or health centres can do to strengthen the HRD system. Furthermore,
establishing a strong and comprehensive system has many benefits for
managers at all levels in both public- and private-sector organisations. Such a
system can help ensure that your staff deliver quality health services to their
client communities. The following box summarises some of the many benefits—
to both the organisation and the employee—of establishing a strong HRD
system.


Benefits of Establishing a Strong HRD System
To the Organisation To the Employee
Increases the organisation's Improves equity between employee compensation
capacity to achieve its goals and level of responsibility
Increases the level of employee Helps employees understand how their work
performance relates to the mission and values of the
Uses employee skills and organisation
knowledge efficiently Helps employees feel more highly motivated
Saves costs through the improved Increases employee job satisfaction
efficiency and productivity of
workers
Improves the organisation's ability to
manage change

When working to establish a strong HRD system in your organisation, there are
several key issues you should consider. These include:
Expanding the role of HRD in the organisation;
Encouraging human resources leadership at the organisational level;
Developing and maintaining a performance management system;
Establishing a responsive supervisory system;
Investing in training.

4 EXPANDING THE ROLE OF HRD

An essential part of your overall management strategy should be to consider how
HRD can help your organisation fulfil its mission. Looking at HRD from this
strategic perspective will help you focus on the relationship between human
resources and your organisation's mission, strategies, and objectives.
Often, people view HRD as having a limited, administrative role focused on
salaries, benefits, personnel policies and procedures, job descriptions, and
training. While this administrative role is very important and an essential part of
an HRD system, you should not limit the role of human resources to these
activities. HRD should:
Be a strategic partner in developing and attaining organisational goals and
strategies;
Act as an administrative expert in establishing and managing administrative
policies, procedures, and structures;
Represent and support employees;
Be a change agent for the organisation.

HRD as a strategic partner. Senior managers in both the public and private
sectors can use HRD strategically by working with human resource professionals
to establish systems and practices that align human resources with their


organisation's goals and strategies. Human resources practices that could
support strategic objectives might include:
Creating new jobs;
Revising job descriptions;
Recruiting new personnel with different skills;
Establishing clear transfer policies;
Conducting orientation sessions and training for staff at all levels;
Implementing leadership seminars for top managers;
Training supervisors.

HRD as an administrative expert. Human resource development also involves
managing the administrative infrastructure of an organisation so that it is more
efficient. Administrative infrastructure tasks may include designing and
establishing procedures for recruiting, hiring, work planning, and performance
review. They could also include developing clear policies for job classification,
compensation, disciplinary actions, and labour law compliance; and maintaining
the human resources database.

HRD representing and supporting employees. Human resource development
can also be an employee champion in the organisation by providing a
mechanism for employees to express their needs and concerns, acting as an
employee advocate, and developing and maximising staff skills and knowledge
and commitment to the organisation. Ways in which HRD can fulfil its champion
role include:
Holding face-to-face meetings between human resource staff and individuals
and groups of employees;
Supporting the work planning and performance review process;
Surveying employees;
Talking informally to employees in the workplace;
Bringing employees' concerns to senior management in a timely fashion;
Taking corrective action with supervisors and employees as needed;
Coaching or mentoring managers to help them to be more effective and
sensitive leaders.

HRD as a change agent. Human resource development can play a key role in
identifying and implementing processes for change and in preparing employees
for change. Human resource activities that support change can include analysing
competency, supporting reform processes, and redesigning systems to help an
organisation meet new objectives, such as increasing organisational
sustainability or reaching new target populations using existing staff.
Stress associated with change may be manifested at all levels in an organisation
by lack of cooperation and a decline in performance. Steps that human resource
professionals can take to minimise the negative impact of change on employees
and, ultimately, on their organisations, include:
Keeping all employees informed about the changes taking place and the
anticipated benefits;


Creating opportunities for staff to contribute ideas, help plan, ask questions,
and discuss the impact of the changes;
Being realistic about the expected benefits of the changes;
Soliciting ideas from employees about how to prepare for changes;
Encouraging team work and team spirit;
Following through on agreed-upon actions.

5 ENCOURAGING HUMAN RESOURCE LEADERSHIP AT THE
ORGANISATIONAL LEVEL

Many organisations treat HRD in a piecemeal fashion. Human resource leaders
link all components of human resources to create one, integrated HRD system.
When an organisation's leaders create this type of integrated system, the effect
on organisational performance can be profound. In supporting human resources
by giving it a prominent and strategic role, you, as a manager and a leader, are
also sending a message to all staff that the organisation will treat them fairly and
will respect their contribution to its success.
The following table provides suggestions for how to take a leadership role in
human resources in your organisation.

Taking a Leadership Role in Human Resources

Every organisation or program needs leadership at the highest level to support human
resources. To take a leadership role in HRD, you should:
Create a positive climate for human resources;
Create a management structure for human resources;
Define what needs to be done;
Forge new organisational arrangements that foster employee participation, team work, and
growth;
Ensure that human resource activities are integrated throughout the organisation;
Involve staff at all levels and from all departments in HRD;
Dedicate staff and budget to building human resource capacity within the organisation;
Make learning an organisational priority;
Provide a link between internal human resource management and external stakeholders;
Influence health policy makers;
Influence the curricula offered by pre-service training organisations;
Forge new directions for HRD in the organisation.

We will discuss leadership in more detail in Unit 3.


6 DEVELOPING AND MAINTAINING A PERFORMANCE
MANAGEMENT SYSTEM

One of the most important tasks for a human resource leader is to support the
establishment of an organisation-wide performance management system that
connects strategic and operational plans with performance measures for
organisational units and for individuals. This system will help employees
understand how their work contributes to the success of the organisation, which
may help them feel more motivated and be more productive. When implemented
in a systematic way, performance management has the potential to improve both
group and individual performance and make organisations more successful. We
will return to the issue of performance management later in the module.

7 ESTABLISHING A RESPONSIVE SUPERVISORY SYSTEM

The role of the supervisor in an effective human resource system is critical, as he
or she provides the bridge between the organisation and the employee. The
supervisor communicates the larger goals of the organisation to the employee,
and, through the work planning process, guides the work of the employee to
directly support these goals. The supervisor needs to be aware of gaps in job
readiness, and to support the development of employee skills and capacity as
needed. The supervisor must also be aware of problems in employee
performance that cannot be solved through training or development activities and
make decisions about how to address them in a positive and constructive
manner.

Managers must allow supervisors adequate time to meet with and develop their
supervisees in order for the supervisory process to be effective in meeting the
needs of the staff and of the organisation. Further, the organisation must fully
integrate the supervisory process with other HRD components, such as
performance management and personnel policy. Supervision will be discussed
in greater detail in unit 4.

8 INVESTING IN TRAINING

Throughout the world, health organisations devote a significant portion of their
funds and staff time to training, with the goal of improving the effectiveness and
efficiency of their staff and their programs. Often, however, they have designed
and implemented this training without adequately diagnosing or planning for the
needs of the organisation or the employee. As a result, it is not always clear

whether the training has either solved individual performance problems or
contributed to improving the organisation's performance overall. Further, many
health organisations are becoming reluctant to pay for expensive training until
they see more tangible benefits to employees, the organisation, and the
community.
When considering training, organisations and employees often have different
objectives. Organisations want their investment in training to result in improved
performance and to contribute directly to their ability to meet their objectives.
Employees hope that training will further their career development and
credentials.
With all training programs, you should first determine your training needs and
integrate training planning into your overall HRD system. This will enable you to
use training effectively to solve individual performance problems and contribute
to improving your organisation's performance.

8.1 HRD staff development responsibility

Making staff development a priority is an important component of a
comprehensive HRD system. Posting job opportunities within the organisation
and supporting internal candidates will send a signal that the current experience
of your staff is valued. A well-managed program of training and staff development
can broaden the skills and competencies of your staff and reap many pay-offs.
Formal, organized training is only one vehicle for staff development. Other staff
development strategies include:
On-the-job learning through mentoring relationships;
Cross-functional assignments;
Membership in task forces and committees;
Additional job assignments;
Technical presentations and discussions at staff meetings.
These can all provide the challenge and opportunity needed for personal and
professional growth as well as increase the knowledge that people have in
common and expose them to new ways of thinking and doing.

9 ASSESSING THE HRD CAPACITY OF YOUR ORGANISATION

One of the most important things you can do to establish a strong,
comprehensive HRD system is to gather the information that will help you plan
for and implement the system. To do this, you need to determine your
organisation's areas of strength and the areas that need strengthening. Once you
have identified the areas that require strengthening, you should prioritize them
and develop an HRD action plan to address them.

Your assessment should look at all the areas of your organisation's HRD system,
including human resource capacity, human resource planning, personnel policies

and practices, human resource data, the performance management system, and
training. Carrying out a comprehensive HRD assessment will help you address
your policy, planning, training, and management in an integrated way.
It is helpful to establish a team of staff from different departments and at different
levels in your organisation to work together to:
Do the assessment;
Discuss the findings;
Prioritise areas of need;
Develop an action plan;
Implement the plan;
Generate wider support for ongoing HRD efforts in your organisation.

Working in a team will also help increase the appreciation of staff in all
departments for the human resource concerns, priorities, and possible fears of
staff at all levels.

9.1 Using the Human Resource Development assessment tool

Organisations of any size or level of development can use the Human Resource
Development Assessment Tool (the supplement to this issue) to assess the
current status of their human resource system, identify areas they need to
strengthen, and take action to improve these areas.
The tool is organized by HRD component in a matrix with four stages of
development. Each stage describes the characteristics that are common to that
stage of human resource development. These characteristics are also useful for
developing a plan of action for your organisation to improve those HRD areas
that need strengthening.

TASK 2: THINK THROUGH THE HR MANAGEMENT ASSESSMENT TOOL
The HRM assessment tool mentioned above in printed in your reader. At this early stage of
the module, we want you to read through it, think through the categories, and possibly fill in
some of it in pencil. We will come back to the assessment tool at the end of the module.


10 MAKING A COMMITMENT TO HUMAN RESOURCES

Establishing HRD systems, policies, and procedures requires a long-term
commitment by an organisation's managers and leaders. In particular, it requires
a willingness to take the time to involve employees in developing and maintaining
these systems and applying them consistently and fairly. A responsive,
participatory system that is flexible enough to adapt to the changing needs of the
organisation over time will help you be more effective at meeting the needs of
both your client populations and your employees.

Managers and leaders should view themselves as human resource champions.
They should take responsibility for creating links between the public and private
sectors and with the different organisational actors who influence human
resource decisions, such as unions, registration bodies, and universities.
Developing and maintaining a fair, equitable, and effective HRD system that
provides opportunities for staff development, among other things, will motivate
staff and increase their level of job satisfaction. This can result in improving the
quality of services. It can also enhance your competitive advantage by increasing
the efficiency of your human resources. HRD should be an important part of your
long-term strategy to make your organisation more sustainable.

Ultimately, an HRD system is the responsibility of all staff—leaders, managers,
service delivery, and administrative personnel. Human resource leaders create
the organisational and management structure for HRD, and managers and staff
at all levels implement the HRD system. A human resource partnership between
senior managers, supervisors, human resource professionals, and staff is what
makes an HRD system work.

11 UNIT SUMMARY

This unit set the scene for the module. We discussed the role and function HR
Management within its broad historical and political context, as well as its role
within your organisation. In the following units we will first look at what it means
to be an HR manager, before examining various aspects of managing people.
The World Health Organisation asked us recently to develop an HRD Advocacy
Pack for them. It consists of a number of power point presentations, organised
along the same lines as this module. Its aim is to give senior health executives a
brief and concise overview of the role and functions of HRD. The slides of these
power point presentations have been included in your reader as a summary of
the material covered in the module and to allow you to easily revise material. The
four presentations have been inserted at the end of each unit. Please read
through Part One of the presentation to review Unit 1.


Unit 2 – Introduction
Being a Human Resources
Manager
In this unit we focus on the role of the manager - yourself - and what she or he
does, before we move to the manager in relation to other people. The reason is
simple: if you want to be a good HR manager, you have to be able to manage
yourself and to focus and reflect critically on your own practice.

We will focus on the role of the manager in general, not specifically the role of an
HR manager. There are two reasons for this. Firstly, what we discuss here,
applies to any manager, irrespective of whether he or she specifically deals with
HR issues. Secondly, as we have said before, virtually all managers also have an
HR management function. Whether you are a facility or programme manager, or
a manager at departmental level, you almost always have to manage people:
sometimes only one or two, sometimes many hundreds.

The unit consists of three study sessions:

Study Session 1: What Managers Do.
Study Session 2: Different Management Styles.
Study Session 3: Managing Yourself.

Session 1: is a short, introductory session, in which the different roles that a
manager can play in an organisation are introduced.

Session 2 introduces a number of different management styles that have
emerged over time. You are asked to reflect on which approach you favour.

Session 3 looks at some practical aspects of managing yourself, from taking
control and being disciplined to understanding the causes and effects of stress. It
also includes as an approach to managing your time more effectively.


Intended learning outcomes of Unit 2

At the end of this unit you should be able to:

Identify the different roles a manager plays in an organisation.
Reflect on your own job as a manager in terms of the identified roles.
Outline the main characteristics of the approaches to management .
Identify what each approach has contributed to management within your
workplace.
Identify which of these approaches you favour in your management practice.
Reflect on your own strengths and weaknesses as a manager.
Apply Covey's time management matrix to your own schedule.


Unit 2 - Session 1
What Managers Do
Introduction

In this session we introduce you to the scope of Human Resource Development
and how HR Management is situated within that scope. You will get an overview
of the different components making up Human Resource Development, and take
first steps to reflect on the human resource situation within your organisation, a
reflection that will be ongoing throughout this module.


By the end of this session, you should be able to:

Identify the different roles a managers plays in an organisation
Reflect on your own job as a manager in terms of the identified roles

2 READINGS

In this session you will be referred to the following reading:

Cook, C.W. & Hunsaker, P.L. (2001). Ch 1 - Managing people and 113
organisations. In Management and Organisational Behaviour.
Boston: McGraw-Hill Irwin: 15-20.


3 WHAT MANAGERS DO

The first reading in this session comes from a handbook on management and
organisations. As such, it does not talk to the health sector specifically. Its
examples are largely derived from big corporations in Europe, Japan and the
United States. But in this case, the insights and information contained in it are
useful and universally applicable.

TASK 1: THE ROLES OF THE MANAGER
Read Cook, C.W. & Hunsaker, P.L. (2001). Ch 1 - Managing people and organisations.
In Management and Organisational Behaviour. Boston: McGraw-Hill Irwin: 15-20.
(Reader page 113).
From page 15 - 17 of the original publication, the authors talk about two contradictory
views of what management is. We will return to these views in more detail in the next
session. Read these pages and complete the exercise on page 16 of the reading.
However, you do not need to engage with this section in detail.
Pages 18 - 20 talk in detail about ten different roles of the manager. Read these three
pages carefully. Can you see your own role reflected in them?
Fill in the table below: for each of the ten roles, think of an example of your own
management practice, where you fulfill this role. Do not worry if you cannot find an
example for each role. Not all managers play all roles at all times.


Management role Example from your own practice

1 Figurehead

2 Leader

3 Liason

4 Monitor

5 Disseminator

6 Spokesperson

7 Entrepreneur

8 Disturbance
handler

9 Resource Allocator

10 Negotiator


3 FURTHER READINGS

Mintzberg, H. (Nov/Dec 1998). Covert leadership: notes on managing
professionals. Harvard Business Review: 140-147.
Pugh, D.S. & Hickson, D.J. (1989). Writers on organisations. London:
Penguin Books.

4 SESSION SUMMARY

In this session you read about the different roles that managers play in
organisations, and reflected on your own practice in the light of these roles.
In the following session we will introduce a range of different management styles.
In the final session of this unit, we will look at your own personal management
style.


Unit 2 - Session 2
Different Management Styles
Introduction

The way in which managers manage people and organisations depends on a
number of factors. The personality of a manager and the culture of the
organisation play important roles. Equally, approaches to management have
changed over time. So, there are a number of different management styles.
While it is unnecessary for you to have detailed knowledge of the whole range of
styles, a basic understanding of different styles will help you to reflect on your
own style and maybe cause you to adapt it.
In this session we will introduce you to a number of different management
approaches and ask you to reflect on the approaches that you favour.



Outline the main characteristics of selected approaches to management.
Identify the influence of each approach on management within your
workplace.
Identify which of these approaches you favour in your management
practice.

2 READINGS


Management Education Scheme by Open Learning (MESOL). 120
(2000). Session 4: Alternative views of management. In Managing
in Health and Social Care. Module 1: The Manager. Book 1.
Milton Keynes: The Open University: 63-80.


3 DIFFERENT MANAGEMENT STYLES

This session on management styles has been taken from a session in a distance
learning course on Managing In Health And Social Care offered by the Open
University in the United Kingdom. We simply could not have done it better, and
we decided not to re-invent the wheel.

TASK 1: INTRODUCING DIFFERENT MANAGEMENT STYLES
Work through the following text: Management Education Scheme by Open Learning
(MESOL). Managing in Health and Social Care. Module 1: The Manager. Book 1.
Session 4: Alternative views of management. Milton Keynes: OU: 63-80. (Reader page
120).

Treat it as a session in your guide, although it is printed in the Reader and complete all
the exercises.

4 FURTHER READINGS

Mintzberg, H. (Nov/Dec1998). Covert leadership: notes on managing
professionals. Harvard Business Review: 140-147.
Pugh, D.S. & Hickson, D.J. (1989). Writers on Organisations. London:
Penguin Books.

5 SESSION SUMMARY

In this session we have introduced you to different management styles, using a
session from an Open University course on management. You will have seen
that management styles have differed substantially over time, and that they differ
depending on the history and culture of the organisation one works in and on
different managers' personal preferences.

You probably have your own preference and style. This session should have
helped you to reflect on whether your style is suited for you and the
circumstances you work in, and possibly, whether there is room for adaptation
and change.

In the next session, which is the last of Unit 2, we will focus on your own
circumstances as a manager, and on managing yourself.


Unit 2 - Session 3
Managing yourself
Introduction

Managing people starts "at home": if you want to manage other people well, you
will only be able to do so, if you can manage yourself. This may seem obvious,
but it is surprising, how often managers struggle to manage their own time,
manage their own tasks, manage their own stress, etc., yet think they can
manage other people's time, activities, conflict.

In this session we will consider a number of strategies to improve self-
management, focussing in particular on being in control, managing stress and
managing time. Clearly, self-management is much more multi-facetted and
complex that is suggested here. Nevertheless, we felt that a focus on these
crucial issues will be of benefit for a better understanding of HR management
more generally. Also, other important aspects of self-management, such as
interacting with and relating to others, will be an important component of units 2
and 3.



Reflect on your own strengths and weaknesses as a manager.
Apply Covey's time management matrix to your own schedule.


2 READINGS

In this session you will be referred to the following readings:

Iles, V. (1997). Ch 6 - Really managing yourself. In Really 138
Managing Health Care. Buckingham: OUP: 76-88.
Cook, C.W. & Hunsaker, P.L. (2001). Ch 16 - Self-Management at 146
Work: Managing Careers and Stress. In Management and
Organisational Behaviour. Boston: McGraw-Hill Irwin: 585-602.
Covey, S. (1989). Habit 3: Principles of Personal Management. In 165
The 7 Habits Of Highly Effective People. London: Pocket Books:
146-168.

3 MANAGING YOURSELF

To start this session, we would like you to spend a bit of time reflecting on your
strengths and weaknesses as a manager as you perceive them.

TASK 1: REFLECT ON YOUR STRENGTHS AND WEAKNESS AS A MANAGER
Draw a table with two columns titled strengths and weaknesses. Fill in the table noting
your strengths as a manager and your weaknesses. See whether this session will help
you gain new insights into any of your strengths or will address some of your
weaknesses.

There is a famous American author by the name of Steven Covey, whose book 7
Habits Of Highly Effective People has been a hit and bestseller ever since it was
published in 1989. The book takes a holistic look at how people relate to
themselves and to others - whether at home or at work, and it suggests the
development of "habits" that will make us happier human beings, and more
effective in our relationships with others. The value of the book lies in the fact
that instead of providing ready-made recipes that never really work, it makes us
look at what we do in new ways and it suggests a range of proactive and positive
approaches to problem-solving.

Iles, in her book, Really Managing Health Care, draws on Covey in her chapter
on "Really managing yourself".


TASK 2: EXERCISING CONTROL OVER OURSELVES
Read Iles, V. (1997). Ch 6 - Really managing yourself. In Really Managing Health Care.
Buckingham: OUP: 76- 88. (Reader page 138).
Iles suggests that in order to manage ourselves, we have to be able to exercise control
over ourselves (before we exercise control over others) through discipline, mastering
feelings and preparation.
Consider how Iles' arguments and suggestions resonate with your own practices and
experiences.

In the last section of the chapter on "Circumstances beyond our control", Iles
talks about the need to focus our energy where it can make a difference.
She quotes the following prayer, which, she says, is used by Alcoholics
Anonymous:

"Lord, grant me the courage to change the things I can change, the grace to
accept those I cannot, and the wisdom to know the difference".

Covey makes the same point in a different way, by drawing two circles, the circle
of concern and the circle of influence. The circle of concern contains issues,
events and people you care about, while the circle of influence encompasses the
issues, events and people you can have an impact on in some way.

Circle of concern

Circle of
Influence

Iles argues with Covey that "spending time and energy in our circle of concern
where we can achieve nothing, is counterproductive. It diminishes our ability to
work within our circle of influence, where we can and will have an impact". (Iles,
1997: 87)


TASK 3: YOUR CIRCLE OF INFLUENCE
Consider whether you agree or disagree with Iles.
Then try and draw your own circles, taking into account that the exercise is meant to
help you focus your attention on issues, events and people that you can influence and
that you should therefore spend your time and energy on.

4 MANAGING STRESS

Being a manager almost invariable means that you work under pressure. That is
not necessarily a bad thing. Many people feel that they are particularly productive
under pressure, that they grow and render their best work. But when pressure
gets too much, it becomes counter-productive. Then we talk of stress.
In the health services in South Africa (and in other African countries),
management, and particularly Human Resource Management is almost
synonymous with stress. Shrinking budgets, increasing workloads, brain drain
and ongoing transformation lead to burnout, low productivity and stress. In
addition, managers have to cope with the stress among staff members.
The following reading help us to understand what stress is and how it can be
managed, so that, even if we cannot avoid it, at least we can manage it for
ourselves and help our staff handle it better.

TASK 4: MANAGING STRESS
Read Cook, C.W. & Hunsaker, P.L. (2001). Ch 16 – Self-Management at Work:
Managing careers and stress. In Management and Organisational Behaviour. Boston:
McGraw-Hill Irwin: 585-602. (Reader page 146).
This is a fairly lengthy chapter, but it is broken into a number of sub-sections.
The first section explains what stress is, distinguishing between constructive and
destructive stress and episodic versus chronic stress. It is the chronic or constant stress
that makes people sick and has other negative effects.
The second section elaborates a long list of factors that cause stress, from personality
traits to working conditions and environmental factors such as politics. You may or may
not want to engage with this list in great detail. The important point the authors are
making here is that stress can have many and multiple causes, originating in all spheres
of our life. The list on pages 590-591 shows stressful events and how stressful (out of
100) they are considered. You may want to follow their invitation to put your own
personal score next to some of the headings.
The third section talks to the serious physiological, psychological and behavioural
consequences of stress, some of which may resonate with your own experiences. The
last section on pages 599 - 602 makes suggestions as to how stress can be managed
productively, elaborating a number of different strategies - some quite drastic, such as
changing jobs, some less dramatic, such as organising relaxation and taking more
exercise.


TASK 5: STRESS IN YOUR LIFE
Based on the above reading, think of two recent stressful events in your own life,
whether personal or working life.
Try to categorise them:
What kind of stress were you dealing with?
What were its causes?
What effects did it have on you?
What did you do to deal with it?
Then consider whether you could have adopted another, more productive strategy to
cope with these stressful events.

5 MANAGING TIME BETTER

In the last part of the session we will look at time management. Time
management is one of the hardest aspects of self-management: there are always
more demands than can be fulfilled, more commitments than hours in the day,
more crises than anybody can handle. The key is therefore to prioritise, to cut out
that which can be done by others or does not have to be done at all. Covey has
developed a time management matrix, which is useful as a tool to prioritise tasks
and activities.

TASK 6: PUTTING FIRST THINGS FIRST
Read Covey, S. (1989). Habit 3: Put first things first: principles of personal
management. The 7 Habits Of Highly Effective People. London: Pocket Books: 146 -
168. (Reader page 165).
On page 149ff, (i.e. and the following pages), Covey introduces a time management
matrix consisting of four quadrants or squares, by which, he suggests, you can divide
all your activities as a manager:
Quadrant I: urgent and important
Quadrant II: not urgent and important
Quadrant III: not important and urgent
Quadrant IV: not important and not urgent.
He furthermore gives examples of activities in all four quadrants.
Draw a quadrant like this for some of your own tasks and activities. Reflect carefully on
the importance and urgency of each of the tasks. You may find that some tasks appear
unimportant at first, but they are actually quite crucial (e.g. regular interaction with
staff). However, there may be other tasks that look very important at first, but they
actually fall in Quadrant III: urgent, but not important.


Covey's book does not only talk to managers, but talks to managers in particular.
In this session we have looked at one of Covey's chapters in some detail. If you
want to find out more, we recommend that you buy or borrow the book. It is easy
to read and nice to have in the bookshelf - and it is reasonably affordable.

6 FURTHER READINGS

Covey, S. (1989). The 7 Habits Of Highly Effective People. London: Pocket
Books.

7 SESSION SUMMARY

In this session we have looked at a selection of aspects of self-management.
Many of them have had to do with setting priorities and making choices, both
inevitable tasks for a manager under pressure. The session will not solve all your
problems of managing yourself. Hopefully, however, it will have given you a few
ideas, helping you to view your own management from a different perspective
and trying out a few new techniques.

8 UNIT SUMMARY

In this unit you have looked at your role as a manager from many different
perspectives. You will hopefully have gained some new insights into the
complexity of people management (in this case yourself), which will assist you
when dealing with your human resources.

The following two units have at their centre the management of people. The third
unit will primarily deal with managing relations between people, while the fourth
unit will consider issues of supporting people.


Unit 3 – Introduction
Managing People I
In the previous two units we discussed the context of HR Management as well as
your role as a manager. By now you are probably wondering whether we will
ever get to discussing the management of people.

Well by now you will hopefully have a good understanding of how HR
Management fits into and is shaped by the history, policies, politics and the
context of an organisation. The reflection on your own role as a manager and the
complexities of people management will furthermore hopefully help you to
manage others with compassion and insight.

As we said before, HR Management in South Africa, and probably most of Africa,
presently takes place in a very unstable environment. Health sector reform,
public service transformation, brain drain and HIV/AIDS all lead to tremendous
pressures on staff. Handling changes of structures and organisations, watching
colleagues leave or die, and seeing users of services become more demanding
and sicker creates tremendous challenges. While some may thrive on such
challenges, others may feel overburdened and frustrated. Under such
circumstances, burnout, stress and conflict become prominent features of the
human resource scenario in an organisation, and central to the work of an HR
manager.

In this unit, we will try to understand the causes, effects and possible solution to
some of these challenges. Don't expect ready-made answers! There aren't any!
The challenges at hand are enormously complex and not at all easy to solve.
What you can expect is to better understand where the challenges come from
and how we can begin to build organisations and relationships among people
which allow us to handle complex situations.

As you know, we discussed stress in the previous unit. Before we discuss issues
of teamwork, motivation and conflict, however, we will lead with a study session
on leadership. More and more experts and role players in health management
agree that particularly in times of change and uncertainty, leadership is a crucial
ingredient to successful transformation and good HR Management.


So, this unit consists of four study sessions:

Study Session 1: The Role of Leadership.
Study Session 2: Working in Groups and Teams.
Study Session 3: Understanding Motivation.
Study Session 4: Managing Conflict.

In Session 1 we will reflect on what leadership is, what role it plays in the running
of organisations and how leaders behave.

Session 2 will look at how groups and teams function, the differences between
them, and how groups can be formed into teams.

In Session 3, we will discuss what motivation is, how it works and what can be
done to improve it. Particularly in times of uncertainty at the workplace, when
many staff members may become frustrated and morale may be low, motivation
becomes a crucial part of the job of those who are responsible for others.

Session 4 will focus on conflict and conflict management: it includes the
symptoms and causes of conflict, and how it can be managed in ways that are
constructive for individuals and the organisation.


At the end of this unit you should be able to:

Identify leadership functions
Describe the stages of group development.
Identify group roles.
Debate the advantages and disadvantages of group work
Apply two of the key theories on staff motivation to your organisational
context.
Design strategies which address motivation of staff members.
Identify common symptoms of conflict in the workplace.
Assess underlying causes of conflict.


Unit 3 - Session 1
The Role of Leadership
Introduction

Leadership is a key concept in management, yet it is difficult to grasp what it
really means and how it is exercised. In this session we will reflect on what
leadership is, the role it plays in running organisations and how effective leaders
should behave.



Identify leadership functions.
Differentiate leadership and management.

2 READINGS


Cook, C.W. & Hunsaker, P.L. (2001). Ch 14 - Leadership 177
Practices. In Management and Organisational Behaviour. Boston:
McGraw-Hill Irwin: 490-512.


3 THE ROLE OF LEADERSHIP

"Leadership is doing the right things; management is doing things right."
This is a famous definition of leadership, which is used widely in teaching about
leadership. It implies that leaders are the ones who decide what to do, while
managers decide how to do things.

Leadership is a difficult concept to grasp, yet everybody agrees on its crucial
importance. Let's start with a brainstorm.

TASK 1: BRAINSTORM LEADERSHIP QUALITIES
One of the most outstanding leaders of recent decades is Nelson Mandela. Another,
very different leader has been the late Walter Sisulu.
In the table below, reflect on these two men's different leadership qualities. What made
them outstanding leaders?

Leadership qualities
Nelson Mandela Walter Sisulu

Now look at the following list of functions of effective leadership:
Conceptualising/understanding vision
Projecting and communicating vision to others
Initiating and guiding change
Mobilising commitment and support for change
Managing change - resolving conflicts and problems
Building trust
Building sustainability - developing others
Confidence in one's vision and oneself.

Did you come up with some of the same leadership characteristics for Mandela
and Sisulu? Looking at the verbs used in the above list (and maybe in yours), it is


striking that most revolve around charting the way ahead and inspiring (rather
than forcing) others to come with you.

Obviously, not all of us can be Mandelas and Sisulus, but, while they maybe
larger-than-life leaders, there are other, more normal-sized leaders among and
around us including youth leaders, church leaders, and leaders in our places of
work. The latter are, of course, those that we are particularly interested in here.

TASK 2: A LEADER YOU KNOW
A key characteristic of a leader is that he or she influences other people in different
ways.
Think of someone in your professional life who made a substantial difference in your
life. Was he or she a leader? What characteristics of a leader did he/she have? What
impact did the person have on your life?

Now that we have done a bit of brainstorming on what leadership is, let's have a
look at what some of the management literature says on the topic.


TASK 4: READ ABOUT LEADERSHIP THEORIES
Read excerpts from Cook, C.W. & Hunsaker, P.L. (2001). Ch 14 - Leadership
Practices. In Management and Organisational Behaviour. Boston: McGraw-Hill
Irwin: 490-512. (Reader page 177).
Cook and Hunsaker start by reflecting on the differences between managers and
leaders, repeating some of the same factors we listed above, but elaborating on
leadership traits and behaviours. Of particular importance is their distinction
between task-oriented behaviour and relationship-oriented behaviour on page
495 of the text.
On pages 589 to 507, they introduce a number of leadership theories and
models. We found the Situational Leadership Theory (pp 502 - 504) particularly
useful. It suggests that leadership behaviour does not only depend on the leader,
but also on the followers' ability and willingness to perform. It basically says that:
where staff are able and willing to perform a task, little leadership is needed;
where they are able, but unwilling, a lot of relationship-oriented leadership is
required,
whereas willingness and inability requires more task-oriented leadership.

Here are two possible examples from the health sector:
The introduction of anti-retroviral treatment for AIDS patients may be a
situation where task-oriented leadership is required: staff may be very keen to
have such treatment available for their patients, but they may not have the
technical knowledge to provide it. Leadership would focus on finding ways to
access training and support.
The withdrawal of certain drugs from the Essential Drugs List may be an
example where relationship-oriented behaviour is required. It is easy to do, but
staff may be unwilling to implement it. The leader’s role in this case would be
to argue, convince and cajole to win support.

Before we end this session, let's think about leadership and management in
practice.

TASK 5: LEADERSHIP IN AIDS TREATMENT IMPLEMENTATION
Let's assume that the national Department of Health decides on an HIV/AIDS treatment plan
tomorrow. The plan has at its core the treatment of AIDS patients in primary care facilities
throughout the country. Drug procurement and distribution has been ensured, so you don't
have to worry about that.
You are the district manager of your health district. As such you are responsible for the staff
at primary care facilities. What would be your leadership functions (as opposed to
management functions) to ensure that the plan can be implemented?
Make a list and share it with your fellow students and/or your course convenor.
Please note that the functions may look different, depending on the situation of your district
and your staff. For example, a rural district may have very different requirements from an
urban district.


So, why do we say that leadership is particularly important during times of
uncertainty and change?

We said that management is doing things right. It makes sure that the wheels
keep turning. No organisation can do without management, because things
would simply collapse.

Leadership takes people and organisations forward. It inspires people to try
harder, to do new things, to take risks. This is of crucial importance in times, such
as ours, when work overload, insecurity and never-ending cycles of
transformation may make people resistant to change, or when a great number of
new roles and new tasks may mean that people are unable to change. Under
such circumstances, leaders will need to convince, build trust, find solutions to
problems and develop sustainability. That is why leadership is important.

4 FURTHER READINGS

Covey, S. (1989). The 7 Habits Of Highly Effective People. Habit 3: Put first
things first: principles of personal management. London: Pocket Books.
Kotter, J. (1990). What leaders really do. Harvard Business Review, 68: 103 -
111.
Hersey, P. & Blanchard, K.H. (1993). Management Of Organisational
Behaviour: Utilising Human Resources. Upper Saddle River, NJ: Prentice
Hall.

5 SESSION SUMMARY

In this session, we discussed the importance and structure of leadership. We
identified leaders and their functions and engaged with leadership theory. In the
next session we will look at team work and the link between leadership and
building teams.


Unit 3 - Session 2
Working in Groups and
Teams
Introduction

Group work and team work are an indispensable part of health service delivery.
Health workers are part of groups and teams all the time: whether they work in a
hospital ward or a clinic, in an immunisation programme or a rehabilitation
department. Groups can either strengthen the quality of health service delivery or
weaken it, depending on how well the group functions. For health workers
themselves groups are of vital importance: how well a group works can make all
the difference between an unbearable work situation and a satisfying one.
In this session we will look at how groups and teams function, what the
differences are between them, and how groups can be formed into teams.



Describe the stages of group development.
Understand the difference between groups and teams.
Identify group roles.
Debate the advantages and disadvantages of group work.
Explain how to develop a group into a team.


2 READINGS


Bateman, A. (1990). Teambuilding: Developing a 201
ProductiveTeam: 1-9. [Online]. Available:
www.ianr.unl.edu/pubs/misc/cc352.htm#eytd
Blair, G. M. (n.d.). Groups that Work. : 1 - 9. [Online]. Available: 210
www.see.ed.ac.uk/~gerard/Management/art0.html

3 WORKING IN GROUPS AND TEAMS

What is a group? A group can be defined as a collection of people who, during
the existence of the group, have regular contact and interact with each other
because they share common interests or a common purpose. Would you agree
with this definition?

Groups come in different shapes, sizes and levels of formality. One can
distinguish between formal and informal groups. A formal group may be a
commission, a working group or a departmental group. They are usually set up to
perform a particular function within the organisation. The staff complement of a
clinic or a ward may also be defined as a group.

Informal groups form more organically, as people are drawn together by a
common interest or by the efforts of an individual. Examples of informal groups
are: groups of friends, support groups, the boys club, an interest group.
Group membership may not always be voluntary, particularly in formal groups.
You may be appointed to a commission, for example, because of your role in an
organisation; or you are placed in the clinic and become a member of that group
of staff, regardless of whether you want to be there or not.

TASK 1: IDENTIFY GROUPS YOU BELONG TO
Undoubtedly you, like all of us, belong to a number of different groups. Make a list of these
groups. Distinguish between formal and informal groups, work groups and groups outside
work.
Consider what role these groups play in your life. How do they help or hinder you in being a
complete and active human being and a good professional? Are your experiences with
groups positive or negative? We will come back to this question later on in this session.


There has been a large amount of research in the fields of management and
industrial psychology, which deals with how groups develop and function. We
won't go into the detail of this research and the theory it has generated. However,
it is useful for an HR manager to be able to identify key stages and roles in group
development in order to better understand what may be going on within a group
of people for whom he or she is responsible.

The most accepted theory of group development distinguishes five stages in
group development. The following is taken from Cook and Hunsaker. (2001: 343-
344)
FORMING In a newly formed group, a lot of uncertainties exist
about the group's purpose, structure and leadership.
They don't have a strategy for addressing the group's
Awareness:
task. As awareness increases, this stage of group
Commitment development is completed when members accept
Acceptance themselves as a group and commit to group goals.

The next stage involves intra-group conflict about the
STORMING clarification of roles and behavioural expectations.
Disagreement is inevitable as members attempt to
Conflict: decide on task procedures, role assignments, ways of
Clarification relating, and power allocations. Members have to work
through conflict and hostility to get to a sense of
Belonging
acceptance and belonging, which is necessary for the
next stage.

NORMING Cooperation is the theme of the norming stage, which
involved the objectives of promoting open
communication and increasing cohesion as members
Cooperation: establish a common set of behavioural expectations.
Involvement Members agree on structure that divides work tasks,
Support provides leadership, and allocates other roles.

At this stage of development, group members work
PERFORMING interdependently to solve problems and are committed to
the group's mission. Productivity is at its peak. For
Productivity: permanent work groups, such as the staff of a clinic, this
Achievement is hopefully the final and ongoing state of development.
Pride

The adjournment or separation phase occurs when
ADJOURNING temporary groups disband after they have accomplished
their goal. Feelings about disbanding can range from
sadness and depression at the loss of friendship to
Separation: happiness about what has been achieved. The leader
Recognition can facilitate positive closure by recognising and
Satisfaction rewarding group performance.


TASK 2: REFLECTING ON GROUP DEVELOPMENT
Do you recognise these stages from a group of which you are or were a member?
Spend ten or fifteen minutes reflecting on the process of group development in one
such group in terms of whether it fits this model.

Groups change over time and within groups, group members take on different
functions and play different roles. Some of you may be familiar with a group
exercise which is used in workshops. Group members have to associate
themselves or each other with different animals:
The lion who leads, the giraffe who observes from high above, the parrot who
chatters and interferes, etc.

Group theory differentiates between three sets of roles: task roles, maintenance
roles and personal roles which are detailed as follows:

Task roles Maintenance roles Personal roles
Initiating Encouraging Blocking
Giving information Harmonising Recognition seeking
Seeking information Setting group standards Dominating
Summarising Gate keeping Avoiding
Elaborating Compromising Seeking help
Consensus testing Providing feedback

Group members may play different roles at different times. But group members
may also identify certain roles for themselves. You may well find a group member
who is always the initiator, or another one who is always looking for compromise
and harmony. As a manager or a group leader it is important that your recognise
these roles, but also that you encourage people to leave their accustomed roles.

A good and easy-to-read overview article on groups is Blair, G. M. (n.d.).
Groups That Work : 1-9. [Online]. Available:
www.see.ed.ac.uk/~gerard/Management/art0.html. (Reader page 210). It
refers particularly to group development and group roles.

Groups are crucially important to completing tasks and to making organisations
work. But groups don't only offer advantages. There are certain disadvantages
to group problem solving.

The following is a comparative list of some of the advantages and disadvantages
of problem solving in groups:


Advantages groups have over individuals Disadvantages groups have compared to
individuals
More knowledge and information. A Competing goals. Group members
group of people meeting together to often have a prior commitment to other
solve a problem has more breadth and, reference groups or have personal
quite often, more depth of experience agendas that conflict. These
and knowledge than any one individual. differences can lead to disagreement
Diversity of view points. A number of about alternative solutions and
people with different experiences can destructive conflict.
generate more options and creative Time consuming. People have to plan
alternatives. They also bring a greater and coordinate group meetings and
number of approaches to solving then wait for everyone to arrive. The
problems. processes of being understood,
Increased understanding. By resolving interpersonal conflict, and
participating in the problem-solving irrelevant side conversations also
process, group members have a better detract from group problem-solving
understanding of the decision and why efficiency.
it was made. Domination by a few. A high status,
Increased acceptance. Group personality, or just an assertive
members are also more likely to accept personality can cause certain members
a decision they understand. Also, a to dominate group discussion. If the
participative decision is often perceived dominating people do not have the
as more legitimate than an autocratic best ideas and those who do keep
decision by a single manager. silent, the quality of the group decision
Better implementation. Participation in will suffer.
a decision creates a feeling of Ambiguous responsibility. Since no one
ownership of “our decision” versus one individual is held responsible for a
by some authority figure. People want group's decision, there is often
to show that they are right and uncertainty about who is accountable
consequently will work hard to for implementing decisions and who
implement it themselves as well as gets the credit or blame for outcomes.
encouraging others to do the same.

There are other phenomena that threaten groups. The literature talks, amongst
others of the groupthink phenomenon and of social loafing.
Groupthink is defined as the state of affairs in a group when the desire or
pressure to conform within the group is so strong that members either think alike
or cannot appraise alternative options to a problem anymore. With this, the
purpose of a group, to bring together diverse skills, experiences and approaches
is eliminated.

Social loafing is a phenomenon most of us will know. It refers to group members
who, protected by the group, will not make an effort to contribute. To have a
social loafer in the group initially is irritating, but may not be much more.
However, a dangerous dynamic can develop: if other group members reduce
their input because they feel that others are not doing their “fair share”, (based on
a subjective assessment), the productivity of the group may continuously

decrease, eventually rendering the group defunct. A manager has to guard
against such developments, e.g. by requesting frequent feedback and frequently
assessing outputs. Research seems to indicate that social loafing is less
common when group members expect their outputs to be measured.

3.1 Teams

We have looked at groups in some detail. Now how are teams different? Quite
often the terms are used interchangeably, and we would argue that the difference
is not a fundamental one.

But there is one key difference: groups are a number of people thrown together
to perform a task. Teams consist of a number of people who are carefully
selected and welded together to work together. Cook and Hunsaker use sports
teams as an illustration, which makes the difference very obvious. Bringing a
bunch of soccer players together to play makes them a group of soccer players,
but not a team. They will all know how to play soccer, but they may well not be
very good at playing together. To become a team, they have to train together,
they have to work out who is good at what, and who can best play in what
position, they have to trust each other and have confidence in each others’
ability. That is how a soccer team is built. The same principles apply for any other
team, including work teams. One can assume that when groups have reached
the fourth stage of their development (Performing), they will have welded into a
team.

Team work and building teams has become a bit of a fashion, and team-building
events are quite an industry. In preparing for this module, we did a very quick
internet search to see what is available electronically. Using the Altavista Search
Engine (www.altavista.com), we typed in teamwork as a keyword, and the
computer threw up thousands of internet references within a few seconds, most
of them concerned with the building of teams in companies.

One reading we found very useful is Alan Bateman's text on teambuilding. It is
very clearly written and practice-oriented, offering a number of useful
explanations and definitions. In particular, it highlights the inter-connectedness of
working in teams, leadership (discussed in the previous session) and motivation
(to be discussed in Session 3). What Bateman is saying is that teams can only
work with good leadership and when people are motivated to work together. In
addition, good motivation and leadership can have a very positive effect on
teams.


TASK 3: INGREDIENTS FOR GOOD TEAMBUILDING
Read Bateman, A. (1990). Teambuilding: Developing a Productive Team : 1-9.
[Online]. Available: http://www.ianr.unl.edu/pubs/misc/cc352.htm#eytd (Reader page
201).
This text summarises in simple and practical terms what it needs to build a good
team. Use the exercise on pages 6-7 to complete Task 4 below.

A note on team building techniques
There are dozens of techniques aimed at building and maintaining teams, but no
one easy-to-use recipe. Working with people is complex and defies recipes. We
believe two key factors will assist a human resource manager to successfully
work with groups:
a) To understand the needs, skills, aspirations and limitations of the people she
works with, whether individually or in groups;
b) To keep working at it. To know that individuals, groups and teams need to be
continually nurtured, assessed and developed.

This is not to say that techniques and models are not useful. Absolutely not. If
you want to know more about the area, by all means, explore it. But in a module
such as this, which provides an overview over a range of topics in HR
management, it is impossible to go into any particular techniques in any detail.

TASK 4: ANALYSE A GROUP OR TEAM YOU KNOW
You have learnt a fair amount about group functions, roles and developmental stages. Apply
these new insights to assess a group or team you are a member of or know well.
Go through all the above steps, including an assessment of the advantages and
disadvantages, as they apply to your group.

4 FURTHER READINGS

Handy, C. (1993). Understanding Oganisations. London: Penguin Books.
Casey, D. (1985). When a team is not a team. Personnel Management,
January: 3-7.
Hackman, J. (Ed.) (1990). Groups That Work and Those That Don't. San
Francisco: Jossey-Bass.
as well as almost endless internet sources, if you feel like searching.


5 SESSION SUMMARY

In this session we have looked at the ins and outs of group and team work, how
they function and at their advantages and disadvantages. In the next session, we
will look at the individual and the role of motivation in helping people work better
and more productively as well as being more satisfied.


Unit 3 - Session 3
Understanding Motivation

Introduction

Motivating other people is considered by many the most crucial and the most
difficult aspect of HR Management.
Particularly in times of uncertainty at the workplace, when morale may be low,
motivation becomes a crucial part of the job of those who are responsible for
others.

In this session we will do some work towards understanding what motivation is,
how it works and what can be done to improve it.
Again, there are no simple recipes, but insight and understanding, combined with
some ideas for what to do, will help you to get better at motivating people.
This session is largely based on a manual compiled by the World Health
Organisation, Training Manual on Management of Human Resources for Health,
1993.



Explain why staff motivation is important in an organisational context.
Apply two of the key theories on staff motivation to your organisational
context.
Design strategies which address the motivation of staff members.


2 READINGS


WHO. (1993). Annex 3: Motivation. In Manual on Management of 219
Human Resources for Health. Geneva: WHO: 1-27.

3 UNDERSTANDING MOTIVATION

It is not easy to motivate staff, nor can results be expected quickly. There are so
many things that negatively impact on staff motivation, for example low salaries,
high workloads, organisational uncertainty, difficult working conditions.
So, as a manager you might say, “Why talk about it at all? I cannot change any of
the things that really matter, like salaries or workloads”. You would be right and
wrong. You would be right, because you probably cannot change salaries or
reduce workloads. You would also be wrong, because as both experience and
research show, there are things you can do which make a difference to whether
staff feel positive about their work and are prepared to work hard or not.
This session is about these other things, and how you, as a manager, can
explore which factors are susceptible to change, and which not, within the
realities of their organisation context.

TASK 1: WHAT IS MOTIVATION?
Write down what you understand by motivation and then read the story which follows.

I am a housewife in Nokweni, a township in Cape Town. Three years ago the
local clinic asked me whether I could occasionally help out in the clinic, when
they were very busy. I jumped at the opportunity, because my children are grown
up and my husband is working during the day, so I had some time. Also, I had
had some training as a nurse 25 years ago, but I had to stop when I fell pregnant.
And I have been always active in the community.

Initially I helped with sorting folders and making sure that patients knew where
they had to go. I enjoyed the work, but what I enjoyed most was talking to the
patients, particularly the mothers with small babies, when they were waiting to be
seen. The mothers in the PMTCT programme (Prevention of mother to child
transmission of HIV) soon trusted me and began to come to me with all sorts of
questions that they sometimes did not want to ask the nurses. Pretty soon the
nurses and I had developed a system whereby I would pass questions on to
them that had been directed to me, and they would let me talk to the mothers

about some basics in hygiene and nutrition. Also, when a mother stopped coming
to the clinic, I was asked to go to her house and see whether everything was
alright. We soon had all mothers from the PMTCT programme regularly attending
the clinic. In addition, word got around that the clinic was client-friendly, and more
mothers, who had been referred, but never come to the clinic, started attending.
I was not paid for my work, but that did not matter. I loved my work. We were a
great team, and the mothers let me know every day how much they appreciated
having someone they could talk to. Also, the staff would make sure that there
was always something to eat for me at the clinic, and sometimes I could take
some tea or sugar home.

Then the old facility manager left the clinic and a new one was appointed. When
she saw me talking to the mothers for the first time, she called me to her office
and asked me why it was that I was talking to patients. I explained the
arrangement to her. She said that this would have to stop immediately. She could
not have an untrained non-professional interacting with patients. I was very
welcome to sort folders and make tea, but I could not continue with the work I
had done.

Well, I left the clinic soon afterwards. I was very disappointed that I could not
continue with what was obviously useful work. Also, mothers continued to
approach me and I had to send them away. It was simply too painful.
Now try Task 2.

TASK 2: ANALYSE MOTIVATION FACTORS
Jot down the factors, which you think affected this woman's decisions described in the story:
Motivating factors De-motivating factors


There are a number of factors which first motivated, then demotivated this
housewife from Nokweni. None of them had to do with material rewards or
incentives, but rather with her sense of fulfilment, of belonging to a team, of their
success and achievement; the disincentive was in the end a keen sense of
disempowerment.

Let's look at the theories which try to explain motivation. A lot of research has
gone into the question of what motivation is. Two of the very well-known theories,
Maslow's Hierarchy of Needs and Hertzberg's theory of Satisfiers and
Dissatifiers, are introduced in this introductory reading on motivation from the
WHO Manual (1993) which you should read now.

TASK 3: APPLY A THEORY
Can you relate any of the motivating and demotivating factors you listed in the story above to
Maslow's hierarchy of needs?

Herzberg coins the phrase “hygiene factors” (WHO, 1993: 10) to describe the
potential sources of dissatisfaction and demotivation for staff. Identifying them is
an important aspect of avoiding demotivation.

TASK 4: HYGIENE FACTORS IN YOUR ORGANISATION
In many organisations, it is likely that certain actions or procedures create a negative impact
on individual staff members.
Identify those actions or procedures at national or provincial and at local level which you feel
have a negative impact on most staff in the service.
Order (or sequence) the list to show those you believe to be the most damaging down to those
that are the least damaging.
How does your list compare to the demotivators suggested in the WHO (1993) text?

From page 11 to 13, the WHO (1993) text elaborates why staff motivation is a
particularly severe problem in the health services of developing countries, and it
shows that lack of attention to staff needs leads to vastly different perceptions of
what staff consider to be important (figure 5 on page 12). As you read these
pages, reflect on how this applies to your organisation.


From page 13, the text then addresses what organisations can do to improve
staff motivation and eventually even performance.

TASK 5: MOTIVATION-ENHANCING MEASURE IN YOUR ORGANISATION
a) Given the list of hygiene factors you listed in Task 5, which of the practical options to
enhance motivation (and performance) suggested in the text from page 13 onwards, would
you consider the most crucial and the most implementable in your organisation?
b) Identify one staff member in your organisation. Think about how the measures suggested
in the text could be used to improve his or her job satisfaction and subsequently
performance. Consider all the options presented on pages 14 to 18:
Pay
Security and structure
Providing companionship
Need for recognition and status
Self-fulfillment and personal growth.

4 FURTHER READINGS

Handy, C. (1993). Understanding Organisations. London: Penguin Books.
Maslow, A. H. (1970). Motivation and Personality. Harper and Row.
Cook, C.W. & Hunsaker, P.L. (2001). Management and Organisational
Behaviour. Boston: McGraw-Hill Irwin.

5 SESSION SUMMARY

After this session you should have a better sense of both the importance and the
complexity of motivation. You have read about two of the key theories and begun
to think about how strategies can be developed for staff in your organisation to
improve job satisfaction.

In the next session, we will consider another crucial element of management:
what to do when there is conflict, and what role a manager can play to resolve
conflict.


Unit 3 - Session 4
Managing Conflict

Introduction

Conflict is an inevitable component of working in an organisation, specifically in
times of uncertainty and change, but even in the routine life of an organisation.
As a manager, you are and will be confronted with conflict among individuals and
groups, and you will be called upon to resolve conflict situations. This is not
always easy to do, and some people may be inclined to ignore conflict or sweep
it under the carpet. However, if untreated, conflict may behave like an untreated
abscess: it may grow and eventually burst, poisoning the environment around it.
In this session we will analyse the symptoms and causes of conflict at the
workplace, and we will discuss strategies to address and resolve conflict
between individuals and groups.



Identify common symptoms of conflict in the workplace.
Assess underlying causes of conflict.

2 READINGS


PUBLICATION DETAILS PAGE NOS IN READER
Handy, C. (1993). Ch 10 - On politics and change. In 246
Understanding Organisations. London: Penguin Books: 299-312.
Encina, G. B. (n.d.). Conflict Management Skills. 1-18. [Online]. 255
Available://www.cnr.berkeley.edu/ucce50/ag.labor/7labor/13.htm.

Conflict Management Strategies and Styles. 1-3. [Online]. 273
Available: http://home.snu.edu/~hculbert.fs/conflict.htm.


3 MANAGING CONFLICT

What is conflict?

"Conflict is disagreement between two or more parties - for example,
individuals, groups, departments, organisations, countries - who perceive
that they have incompatible concerns. Conflicts exist, whenever an action
by one party is perceived as preventing or interfering with the goals,
needs, or actions of another party." (Cook & Hunsaker, 2001: 374)

This definition talks in the broadest sense about the causes of conflict
(disagreement), which we will have to explore further. But it does not say
anything about the symptoms of conflict: how do we know that conflict exists?
Sometimes it may be quite overt, such as open arguments between two
individuals. But sometimes conflict is much less obvious, yet may be very
serious.

TASK 1: READ ABOUT SYMPTOMS OF CONFLICT
Read pages 299-300 of Handy, C. (1993). Ch 10 - On politics and change. In
Understanding Organisations. London: Penguin Books. (Reader page 246).
Handy lists a number of obvious and not-so-obvious symptoms of conflict. Can you think
of others? List a few.

Recognising the symptoms of conflict is a first step. It may then be necessary to
decide whether, in fact, the identified conflict needs intervention because not all
conflict is unhealthy. Many authors emphasise the fact that some conflict can be
creative, spurring people on to try harder. Handy would argue that we then do not
talk about conflict, but about competition, but others talk about constructive
conflict.


TASK 2: EXAMPLES OF CONSTRUCTIVE CONFLICT
Can you think about disagreements/conflict/competition that are of benefit for an
individual or an organisation?

You may have thought of a new staff member joining the organisation, who has
lots of new ideas that are foreign to old staff. This may initially create conflict, as
old and new ways of doing things may clash. But eventually the new ideas may
be adapted and integrated into the organisation, helping everybody to improve
performance.

Another example might be two people with strong views clashing on a particular
issue, but the ensuing exchange actually benefits both of them in the long term.
Whether this is called conflict or competition, the situation may or may not need
some outside facilitation, but will in the end be of benefit. But other
disagreements will not be counter-productive to an organisation. So how do
people behave in conflictual situations?

TASK 3: THE TACTICS OF CONFLICT

Continue to read Handy, C. (1993). Ch 10 - On politics and change. In Understanding
Organisations. London: Penguin Books: 299-312. (Reader page 246). Focus on pages
306 - 308, where he talks about the tactics of conflict.

Do you recognise any of these tactics? Have you maybe ever used any of them - or
been the victim of them?

Jot down a memory or two of encounters with such conflict tactics.

4 THE CAUSES OF CONFLICT

Now that we have identified how conflicts can manifest, let's look at what some of
the causes of conflict may be.

TASK 4: BRAINSTORM THE CAUSES OF CONFLICT
To start with, brainstorm what causes conflict in your organisation - conflict between
individuals and conflict between groups of people.


Cook and Hunsaker (2001: 377) have a long list of they call sources of conflict:
Goal incompatibility
Mutually exclusive goals
Lack of resources
Different time orientations
Structural design
Interdependence
Lack of substitutability
Power differentials
Different role expectations
Role ambiguity
Role conflict
Uncertainty reduction
Degenerative climate
'Win-lose' attitudes
People with different values and expectations
Merged cultural differences
Personal differences
Different values
Different preferred ways of behaving
Different views of the world.

Do you recognise any items from your brainstorm in this rather abstract list?
Handy elaborates many the concepts listed above in Chapter 10. He uses the
term “role” instead of “territory”, suggesting that both terms can be used
interchangeably.

TASK 5: READ A TEXT ON THE CAUSES OF CONFLICT

Read pages 303 - 306 from Handy, Chapter 10 on the causes of conflict. Compare your
brainstorm and Cook & Hunsaker's list to Handy's suggestions?
You will find that most conflict has its source in roles, objectives and tasks either not
being clear or being in contradiction with each other. Alternatively you may have a
genuine clash of values or views of the world.

5 HANDLING CONFLICT

Clearly the cause of a conflict has an impact on how one tries to resolve that
conflict. Let us now turn from understanding conflict to handling conflict, finding
solutions that are beneficial to both individuals and organisations.


Handy believes that there are two managerial strategies to handling conflict:
either turn it into fruitful competition or control it. He elaborates both suggestion
on pages 309 - 312.

Other writers go into much greater detail. Again, an internet search reveals
hundreds and hundreds of readings, courses and videos in conflict management.

We extracted one very practical reading, which comes from the agricultural
sector, and elaborates conflict management strategies in great detail.

TASK 6a: ABOUT CONFLICT HANDLING STRATEGIES
Encina, G. B. (n.d.). Conflict Management Skills. 1-18. [Online]. Available:
www.cnr.berkeley.edu/ucce50/ag.labor/7labor/13.htm. (Reader page 255).
Encina bases his suggestions on two principles. The first one, “Seek first to
understand, then to be understood”, was introduced by Covey in 7 Habits of Highly
Effective People. The second one, getting people to focus on their needs, rather
than their positions, comes from a book by Roger Fisher and William Ury (1999),
Getting to Yes.
Based on these principles, Encina elaborates particularly the processes involved in
mediation and arbitration, i.e. getting a third person involved in a conflict. This may
well be your role as a manager, and we therefore thought the article would be
particularly useful in this context.
Task 6b: Apply your knowledge
You may not be able to immediately apply Encina's suggestions in practice (unless
you have a conflict situation on your hands at the moment). But you can revisit an
old conflict and replay how it was or could have been handled, based on Encina's
suggestions. Spend between 30 and 60 minutes on this task.

A last reading, also from the internet, summarises five conflict management
techniques in very quick, easy to understand way on just over three pages.

TASK 7: REVISION
Read Conflict Management Strategies and Styles. [Online]. Available:
http://home.snu.edu/~hculbert.fs/conflict.htm : 1 - 3. (Reader page 273).
Use the reading to revise what you learnt in this session.

6 FURTHER READINGS

Covey, S. (1989). 7 Habits Of Highly Effective People. London: Pocket Books.


Fisher, R., Ury, W. & Patton, B. (1981). Getting to Yes: Negotiating
Agreement Without Giving In. London: Penguin Books.

7 SESSION SUMMARY

In this last session of Unit 3, we worked towards understanding and handling
conflict situations, both of which are indispensable requirements for HR
managers. If, in the past, you were reluctant to tackle conflict and rather tried to
avoid it, you should feel more confident now to analyse what is going on in a
conflict situation and to confront it. If you believed that confrontation is always the
best strategy, you should have learnt that there are other strategies of convincing
conflicting parties to settle their dispute.

8 UNIT SUMMARY

You have come to the end of Unit 3. In this unit we have primarily discussed
themes which elaborated how people communicate with each other and relate to
each other. We started with the role and importance of leadership in an
organisation, how it can make the difference between stagnation and low morale
amongst staff and a dynamic organisation. We then discussed group processes
and the pros and cons of group and team work in Session 2. In Session 3, we
discussed the crucial role of motivation in getting people to perform well and do
their best, and your role as a manager in getting your staff motivated. The last
session focused on the times when things do not run smoothly and you as a
manager are called on to deal with conflict among staff: you explored how to
analyse it and what to do about it.

From this unit focusing on communication and interpersonal relations, we will
now move into a unit that discusses some of the more practical aspects of
managing people in an organisation: this includes recruiting and selecting
people, the importance of training, support and supervision and the role of
performance management. This unit follows, rather than precedes Unit 3,
because the elements of communication and interpersonal relations should
inform and underlie all activities discussed in Unit 4.


Unit 4 - Introduction
Managing People II
Welcome to the last unit of this module! In this unit we will cover the content of
what would make up many traditional courses on HR Management – namely
the key components of HR Management which we introduced at the
beginning of Unit 1: recruitment, utilisation and development of staff. Why, you
may well ask, only now and only in one unit?

You will have noticed by now that the entire course has a very particular
approach and perspective. We do not consider Public Health primarily a
technical exercise; instead we have a strong orientation to health systems
development. The same is true for our approach to Human Resource
Development and Human Resource Management. Very often courses on HR
Management are technical in orientation, concentrating primarily on personnel
administration. The inherent assumption is that by getting all the technical
details right, HR Management will work.

We have been quite open about the fact that we have a different perspective.
We have spent a great deal of time discussing the contextual issues of HR
Management because we firmly believe that if we do not understand and act
upon those issues, our technical knowledge will not help us. We also believe
that if we do not understand and act upon the fact that this field is about
people and that people, as individuals and in groups, are complex and defy
technical solutions, we will not improve HR Management. That is the reason
why only one unit deals with recruitment, utilisation and development of staff.
Clearly, given the time and space constraints, we had to be very selective. In
choosing the topics, we aimed to introduce you to new concepts or to give you
a different perspective on knowledge you may already possess.

The unit consists of four study sessions:

Study Session 1: Staff Recruitment and Induction.
Study Session 2: Skills Development in the Health Sector.
Study Session 3: Staff Supervision and Support.
Study Session 4: Performance Management.


By the end of this unit you should be able to:

Explain the concept and purpose of staffing norms.
Discuss the concept and purpose of job analysis.
Explain the key concepts and mechanisms of the South African Skills
Understand how the strategy affects your organisation.
Design and implement a training needs assessment.
Design and implement a training evaluation.
Explain the concept of a mentor.
Differentiate a developmental approach to supervision from traditional
approaches.
Consider the feasibility of a team-approach to supervision.
Understand the components of performance management.
Identify weaknesses in an appraisal system and suggest well-founded ideas
for overcoming them.
Conduct appraisal interviews.


Unit 4 - Session 1
Staff Recruitment and
Induction
Introduction

In the first session of this unit we will discuss the processes involved in
recruiting staff into your organisation and how to familiarise a new staff
member with the organisation, its members and the tasks required of her or
him.

The assumption which underpins this session is that there are aspects of staff
recruitment which are centrally-controlled, such as the setting of staffing
norms and job analysis, and which few of you are directly involved in. We will
therefore touch on these topics for purposes of better understanding, but will
not elaborate them. Instead, we will discuss interviewing and induction of staff
in some more detail, based on the assumption that these are areas you as an
HR manager are directly involved in.

This session is largely based on the WHO’s 1993 Training Manual on
Managing Human Resources for Health extracts of which are in your Reader.



Explain the concept and purpose of staffing norms.
Discuss the concept and purpose of job analysis.


2 READINGS


WHO (1998). Annex 5 - Staff establishment and recruitment. 276
Training Manual on Managing Human Resources for Health.
Geneva: WHO: 1-7.
HST. Sample Job Description For Clinic Supervisors. In HST 283
Technical Report: Investigating The Role and Functions of Clinic
Supervisors: Durban: HST: 1-4.

3 STAFF RECRUITMENT AND INDUCTION

Since the staff is the principal resource by which the health organisation
functions, the greatest care and efficiency must be used in the process of
recruiting people for employment.

Health systems are labour intensive and care must be taken not to employ
more staff than is needed or can be afforded. All too often, health services do
not have the necessary operational budgets, which results in a situation of a
fully-staffed service and no funds to run it. Equally however, a situation must
be avoided where new programmes or technologies are introduced, or
services expanded, without required staff being available and trained.

Responding to these realities, this session is concerned with the systems and
procedures by which necessary and affordable staff members are recruited,
selected, inducted and deployed for defined work in the organisation.

The session deals with the following activities:
Setting and controlling staff establishments, using norms and other
methods;
Job analysis and description;
Selecting and recruiting staff;
Induction and deployment of new staff.

TASK 1: REFLECT ON YOUR PERSONNEL FUNCTIONS
Before you start reading for this session, spend 20 to 30 minutes reflecting on the
recruitment functions fulfilled by you, or alternatively by the manager of your
organisation. Which functions do you perform in your organisation and which
functions are executed elsewhere, possibly more centrally?


4 SETTING AND CONTROLLING STAFF ESTABLISHMENTS

For our purposes, establishment control is the process which aims to regulate
either the numbers of staff employed, or the cost of such staff, or both, to
undertake the defined area of work.

A better understanding and control of the present labour force will permit
reasonable extrapolation into the future. The distinction between staff
establishment setting and human resource planning is blurred: the former is
done in relatively small organisations that can draw on a pool of potential
candidates already available on the market. Human Resource Planning, on
the other hand, takes place at the macro level, e.g. in a ministry of health,
especially when provision needs to be made for training new staff.
Establishment can be controlled in terms of either crude staff numbers or an
overall limit that can be spent on the staff resource (in other words, the budget
for staff costs which should not be exceeded).

The chosen method depends on current policies, some of which may be
nationally promulgated. For example, governments may say that they wish to
reduce the number of people employed in the “service” sector of the economy
so that more effort can be devoted to the ”productive” sector. Such a policy
would imply the application of establishment control policies based on crude
numbers.

Generally, where managers have been trained in the use of resources, a
policy based on budgets is preferable. Such a policy can then be used flexibly
by managers to employ the numbers and types of staff which they believe will
allow them to do the necessary work as effectively as possible.

4.1 Staffing norms

Staffing norms are a highly contentious issue, very much a case of “cannot
live with them, cannot live without them”. Organisations and managers
continuously call for staff norms to help them with their planning. But
invariably, when norms are set, the same organisations and managers will
complain that these norms are inappropriate, and do not reflect the complexity
and context of their situation. And they will mostly be right: norms cannot
reflect situational complexities. Norms have to generalise, that is their
purpose. And yet, they are needed to make planning possible. Keep this
inherent contradiction in mind when reading this section of staffing norms.
Most norms make explicit or implicit assumptions about the number of hours
staff will work, the amount of leave they will take (sickness, holidays and
special leave for training, etc), and the patterns of care which will be
delivered. Particular groups of staff will be deemed to have a particular role to
play in the delivery of health care.


There are different types of norms:
1. The “ideal service” norm: the staffing patterns envisaged in this type of
indicator cannot be achieved for many years and no realistic target date
can be set. When norms fall into this category, planners have to consider
what intermediate targets should be aimed for by a known date. This
allows the human resources structure to evolve smoothly and types of staff
appropriate to the eventual pattern are not recruited in advance of the
pace of service development. Establishing ideal service norms may well
be part of long-term HR Planning. For example, the HR planning section
may say that ideally all clinics should have at least two clinical nurse
practitioners (CNPs, sometimes call Primary Health Care Nurses). At
present this is impossible, because there are not enough nurses trained to
be CNPs. So, an intermediate target may be stated as: In five years, every
clinic should have at least one CNP.
2. The “policy” norms: staffing levels are set at a particular level - or at x%
above the present level - because agreed policy is to develop services
within the area. These norms will usually have a target date, and progress
towards them should be monitored. To stick with our CNP example: a
policy norm may be to say that because primary care services in clinics
are being expanded, in five years time an additional 30% of clinics should
have CNPs.
3. The “good practice” norm: it is important to relate norms based on good
practice to their date of origin. A norm may be good practice now, but will it
be equally relevant in the future? Managers using this norm will need to
build in an element for future improvement in the average staffing levels
(upwards or downwards). In other words, they need to make provision for
the fact that the basis for the norm may be changing.
4. The “if-then” norm: this type of norm is closely related to the good
practice norm, but is usually built up by a more objective assessment of
staffing requirements in relation to service provided and tends to be more
complex. Many such norms are derived from management service studies.
They are based on this type of calculation: if the workload is x and staff
can handle y processes per day, then there should be z staff. Simplified
example: if there are 50 immunisations and 50 DOTS treatments a day
and one nurse can handle 25 immunisations or 50 DOTS treatments
per day, then there should be 3 nurses.

4.2 Limits to the use of norms

In a service as complex as a health system it is unwise to take any specific
staffing norm and apply it throughout. The following factors may significantly
affect the relevance of any norm:
i. The type of population served by the health system. Is it, for example,
predominantly old, rural, well educated, etc?
ii. The type of buildings in which the service is provided. Are they new,
scattered, modified from some other purpose, etc?
iii. The number and type of support staff available.
iv. The source of the norm. Has it been adequately research, or
developed by a professional organisation aimed at its own growth?


Having cautioned against slavishly following norms, they can, when used
appropriately, raise relevant questions about staff establishment levels.
Norms do not provide complete answers; they should help the manager in
asking questions about health personnel levels. Major deviations from the
norm should be questioned to determine the validity of the explanations.
As we said in the beginning, this part of the session is aimed more at helping
you understand what norms are, and their pros and cons. It is not primarily
aimed at helping you to apply them.

TASK 2: REFLECT ON ORGANISATIONAL NORMS

Before we move on, spend a bit of time thinking about norms in relation to your
organisation:
Do you know what kinds of norms have been used to establish staffing in your
organisation?
Does your organisation have staffing norms?
Which of the norms discussed above do you think would help you rectify staffing
levels in your organisation?

5 STAFF SELECTION

Every time you select a person to join your organisation, you are not only
potentially investing a great deal of money, you are also introducing a new
member into the team. It is important, therefore, that the recruitment process
be done as thoroughly and as methodically as possible.

The following are the main stages in the selection process:
Analysing the need for the job;
Describing the job;
Drawing up the person specification;
Assessing the candidates;
Interviewing the candidates.

We will focus on the job description and the interview. The job analysis
basically entails assessing whether the job in question is still required or
whether it is still required in its present form.

5.1 Job description

The purpose of the job description is to set out the purpose of the job, and its
associated tasks described in terms of what outputs are required of the job
and to what standard. It will also describe relationships with other jobs in the
same department, as well as lines of accountability and reporting. A job
description is a crucial prerequisite for any kind of performance assessment.
An HR manager should not only make sure that each member of staff has a
job description, but also that they know and understand their job descriptions.


Typically, a job description should contain the following items:
Name of the organisation
Name of the department or section
Job title
Job grade
Necessary qualifications
Purpose of job
Accountable to whom?
Responsible for what?
Other relationships within organogram of the organisation
Main tasks of job and standard to be achieved
Limits of discretion (e.g. budgetary responsibilities)
Terms and conditions (e.g. salary, hours of work, leave, etc)

A sample job description for clinic supervisors is printed in your reader on
page 283.

TASK 3: YOUR OWN JOB DESCRIPTION

Spend about 40 minutes drawing up your own job description according to the
suggested format. Does it correspond with your existing job description?

5.2 The selection interview

Ideally, a selection interview should involve only the candidate and two or
three people from the organisation to do the selection.

Good management practice would suggest that the immediate superior of the
post to be filled should be involved, accompanied by a personnel specialist
who can guide the manager in ensuring that all areas that should be covered
in the interview are covered. He or she will also be the expert on the terms
and conditions of service that govern the post. Often it is also a requirement to
have a trade union representative present.

For some posts, it may be essential to have a much larger interviewing panel.
In some organisations the composition of the panel is regulated. Therefore,
the first decision to be taken is to select the interview panel. Your next step is
to prepare for the interview.

TASK 4: READ ABOUT THE INTERVIEW PROCESS

Read WHO (1998). Annex 5 - Staff establishment and recruitment. Training Manual on
Managing Human Resources for Health. Geneva: WHO: 1-7. (Reader page 276).
Focus on the selection interview - sections 3 and 4.

Think about the last interview you were involved in, either as an interviewer or as an
interviewee.
How was the interview structured and how appropriate was this structure?
How could the interview have been improved?


Interviewing is a complex process. You have a very limited time to find out as
much as you can about the candidate and to get a good impression of him or
her.

Getting the candidate to talk and listening carefully are therefore crucial
principles for interviewing.

6 INDUCTION AND DEPLOYMENT

Once a person has been selected and has accepted the job, a manager will
want to make sure that he/she is able to become “productive” as soon as
possible, and that she or he will want to stay with your organisation. The
newcomer needs to be oriented to the organisation, the team and the role.
Joining a new organisation is stressful, and a good induction will go a long
way to make the new staff member settle in fast. Unfortunately, induction is an
aspect that is all too often neglected.

A good induction programme should include the following:

a) Staff of the department or team should meet the new staff member.
b) A staff member should be briefed to
Meet the newcomer.
Explain rules and standards of conduct.
Show the person the premises.
Explain how the new job fits in with others.
Describe the organisation as a whole and what it is trying to achieve.
Confirm that he or she knows about pay arrangements and conditions
of service.
Be available to help and support her or him in the first few days and
weeks.
c) The new staff member should be familiarised with policies and other
documents that will be relevant to his or her work.

As the manager, you need to spend time establishing an understanding of
what you can expect from each other, how open you can be with each other,
and how much independence is needed and allowed. You will need to agree
on some initial objectives for the new person, review progress regularly and
develop and revise objectives, until you are confident that the new person has
settled into the job. If the appointment is subject to confirmation after a
probationary period, you will need to assess the person's performance at that
point. At this stage your role may well intersect with the role of the supervisor
(see Session 3 of this unit).


TASK 5: YOUR ORGANISATION'S INDUCTION PROGRAMME

Does your organisation have a functioning induction programme?

Based on what you have just read, rethink the induction programme in your organisation:
Are you providing guidance and support for new staff members?
Are new staff members systematically introduced to relevant documentation as well
as to colleagues?
What could be improved?

4 FURTHER READINGS

Shipp, Peter (1998). Workload Indicators of Staffing Needs (WISN): a
Manual for Implementation. Geneva: WHO.

5 SESSION SUMMARY

This session has been a bit a tough one, exploring fairly complex recruitment
procedures, highlighting the controversial issues of staffing norms and
providing some input on interviewing and induction processes.
In the next session we will discuss how to approach skills development in the
organisation in ways that are beneficial to both the individual and the
organisation.


Unit 4 - Session 2
Skills Development in the
Health Sector
Introduction

The new South African health system requires a whole range of new skills
and competencies for health workers. Few health workers have been trained
adequately to deal with the challenges confronting them. Skills development is
therefore a crucial aspect of HR Management. It covers training, but also
other forms of development, such as mentoring and coaching. As an HR
manager, you are likely to be responsible for the skills development of your
staff, although you are, in all likelihood, not yourself conducting training.
In this session, we will focus on the training aspect of skills development. We
will start by reminding ourselves about the dynamics of learning as adults. We
will then introduce the South African Skills Development Strategy and some of
its component parts.

In the second part of the session we will discuss how to conduct a training
needs assessment and how to evaluate training.



Explain the key concepts and mechanisms of the South African Skills
Understand how the strategy affects your organisation.
Design and implement a training needs assessment.
Design and implement a training evaluation.


2 READINGS


Powell, S. (1999). Ch 1 - Introduction & Ch 2 - Thinking and 287
learning. In Returning to Study. Buckingham: OUP: 1-31.
SA Department of Labour (2001). Skills for productive citizenship 304
for all. In National Skills Development Strategy. 1-4.
[Online]. Available: http://www.vhutsila.org.za.
SA Department of Labour (2001). The Skills Development Act, 308
1998, The Skills Development Levies Act. In Understanding the
Laws. 1-10.
SA Department of Labour (2001). Learnerships. 1-5. 318
HWSETA. Excerpts from the HWSETA website. 7 pages. 323
[Online]. Available: http://www.hwseta.org.za.
Management Sciences for Health. Training for effective 330
performance. In The Family Planning Manager’s Handbook: 1-15.
[Online]. Available: http://www.erc.msh.org.
WHO. ToolKit appendices: A*07 Illustrative training needs 345
assessment form. In Human Resources for Health: Toolkit for
Planning, Training and Management.
[Online]. Available: http://rhtoolkit.forumone.com.

3 SKILLS DEVELOPMENT IN THE HEALTH SECTOR

"Over the past five years the government has put in place a range of
policies to transform the health system with the aim to improve
efficiency as well as equity. With the policy framework largely in place,
the challenge is now one of implementation.

Successful implementation, however, depends crucially on a sufficient
supply of equitably distributed and competent personnel. Not only do
personnel costs account for by far the largest percentage of recurrent
expenditure in the health sector (around 65% in South Africa at the
present moment), but human resources are the backbone of the health
system. Furthermore, with the move towards decentralised health
systems, many health workers, particularly at district level, now require,
in addition to clinical skills, substantial public health skills in planning,
advocacy, programme design, programme implementation and
monitoring and evaluation which are fundamental to the successful
implementation of the Primary Health Care Approach (PHCA). These
are skills in which few of the newly emerging generation of health
personnel received training, resulting in a yawning gap between
existing and required job competencies. Consequently, health
personnel development assumes not only a priority place but is also a
primary step in health systems development." (Sanders et. al, 2001)

The above quote summarises the importance of skills development in a
context of health sector transformation. Additionally, management of the
HIV/AIDS pandemic particularly requires a wide range of new skills (see also
reading in Concluding Session).
So, while skills development is a crucial part of HR Management even under
“normal” circumstances, in the present environment of rapid change it has
become absolutely indispensable if health workers are to keep up with these
changes. Inability to “keep up” and a feeling of not being well enough
equipped to handle aspects of health services has been quoted by numerous
health workers as one reason for low morale and even decisions to leave the
service.

4 RETURNING TO STUDY

The training aspect of skills development for which you as a manager will be
responsible, falls within the ambit of adult education. Everybody for whom you
will be organising training will be a more or less experienced professional or
para-professional, just like you are in your studies with us at the moment.
When organising training, it is important to be aware of the specific dynamics
of working-adults becoming learners again.

TASK 1: REFLECT ON YOUR LEARNING EXPERIENCE
You are presently a learner, so you have valuable insights into what it means to become a
learner again, while having a full-time job, family responsibilities, etc.
Spend a bit of time reflecting on your situation, and what it may mean for your staff to be
in a learning situation.
Obviously, not everybody will embark on a full Masters programme, but many elements
remain the same, e.g.
People learn against the background of their own life and work experience;
People have to juggle work, family, community and study commitments;
Studying is a time to step back from the frenzy of day-to-day commitments and to
reflect and refresh.

TASK 2: HELPING YOU REMEMBER

Read Powell, S. (1999). Ch 1 - Introduction and Ch 2 - Thinking and learning. In Returning
to Study. Buckingham: OUP. (Reader page 287).

This is an easy-to-read text which talks about the same issues that you will have reflected
on in Task 1 - and maybe a few others. You do not have to engage in the text in great
detail, but it is a useful text for helping you think through some of the very real issues in
returning to study.


Keeping the constraints and the opportunities of adult learning in mind is very
important when conceptualising and organising training programmes for staff,
or when selecting staff to go for training.

5 THE SOUTH AFRICAN SKILLS DEVELOPMENT STRATEGY

This section may seem familiar to students of Developing Human Resources
for Health module. It repeats the first part of Session 2 in Unit 3. Students who
did this module can either skip the bit on the skills development strategy or go
over it again.

One of the most devastating legacies of South African history in general and
the Apartheid era in particular is the fact that it left behind an educational
desert. Education for "black" people at all levels was for decades poorly
resourced and often of very poor quality. This not only has disadvantaged the
vast majority of the population, it also means that as a country, South Africa
cannot keep up with skills- and knowledge- driven economies.

The new government made Human Resource Development a major priority.
This has implications for school and university education, which are beyond
our scope here, but it also has meant the development of a comprehensive
strategy for workplace learning. This strategy has become known as the Skills
Development Strategy. This strategy is a hugely complex framework of
legislation, structures, procedures and funding.

We are not concerned with the detail here, but with the basic principles and
mechanisms, because these inform any kind of training and development that
will happen in South Africa over the next decades.

In the Reader, we have included a number of short overview papers published
by the Department of Labour.

TASK 3: ANALYSE THE SKILLS DEVELOPMENT STRATEGY
Please read these documents from the SA Department of Labour: National
Skills Development Strategy; Learnerships; Understanding the Laws (pages
304, 308, 318 in the Reader) and consider their impact on training and
development in the health sector:
In which areas of skills development is the health sector facing its
greatest challenges?
Who in the health sector should be the main target audience for this
strategy?
Can you foresee problems in the implementation of the strategy? What
might these be?
What in your view are the opportunities and threats that this strategy
creates?
Share your thoughts with fellow students. The strategy is fairly new. Some of us
have some experience with implementation by now, while others are only just
starting. We all need to learn from each other as we translate this policy into
practice.

One of the new institutions that have been set up through the skills
development strategy are the so-called Sector Education and Training
Authorities, better known by their acronym, SETAs. There are SETAs for all
major fields of work, e.g. education, information technology, chemical
industry. And there is a SETA for the health and welfare sector, the HWSETA
(Health & Welfare Sector Education and Training Authority). The reading,
Understanding the Laws in Task 1, explains what SETAs are there for and
what they do. In particular they are responsible for disbursing money from the
Skills Development Levy (see same reading) based on a range of criteria, and
ensuring the quality of education in their sector. They are also expected to
help organisations and institutions to develop their workplace skills strategies
and plans. This is what makes SETAs very important to HR managers.

TASK 4: READ ABOUT THE HWSETA
Read excerpt from the website of the HWSETA (Reader page 323). It is rather sketchy,
but it gives you an overview of who they are and what they do. It also provides some
useful contact details.

6 MANAGING TRAINING

The HR manager's role in training is primarily three-fold: she has to assess
what training is needed by individuals and the organisation as a whole; she
has to ensure that staff receive training that is relevant for their and the
organisation's needs. And she has to assess the impact of training received.
None of these are easy tasks. Assessing training needs and impact of training
are not hard sciences with definite answers. But there are a number of things
that can be done to make choice of training more relevant.

Training is often a knee-jerk reaction to all kinds of human resource problems,
and inappropriate training will be expensive, wasteful and demotivating for
staff. This is not to say that training per se is unnecessary. On the contrary!
Unit 1 highlighted some of the problems arising from insufficient, but more
importantly, inappropriate initial training and continuing education.

In this second part of this session we will provide you with a number of tools
to conduct a training needs assessment (TNA) and to assess the impact of
training.


TASK 5: HOW TO ASSESS NEED AND IMPACT

Read and work through Management Sciences for Health. The Family Planning
Manager’s Handbook: Training For Effective Performance: 1-15. [Online]. Available:
http://erc.msh.org, which you will find on page 330 of your Reader.

The text takes you through the processes of deciding whether training is needed,
conducting a training needs assessment, and evaluating training. It introduces a number
of tools and examples.

You may well spend two hours or more on this exercise. Take your time. It is a very
useful, practice-oriented text. You may also decide to design and conduct a training
needs assessment for your assignment.

TASK 6: DESIGN A TRAINING NEEDS ASSESSMENT (TNA)

Design a training needs assessment questionnaire for either one particular job category or
one small unit in your organisation. This could be a self-assessment questionnaire or a
supervisor questionnaire.

The questionnaire may either ask questions about training needs in general, or focus on
one specific aspect that you may consider important, e.g. HIV/AIDS counselling, drug
management or specific programme implementation.

For feedback, look at the sample TNA questionnaire from the WHO Toolkit on page 345 in
your Reader.

7 FURTHER READINGS AND REFERENCES

Abbatt, F. (1990), Personnel development and training. In Streefland, P. &
Chabot, J. (Eds.). Implementing Primary Health Care: Experiences since
Alma Ata. Amsterdam: Royal Tropical Institute.
Sanders, D., Chopra, M. Lehmann, U. & Heywood, A. (2001). Meeting the
challenge of health for all through Public Health education; some
responses from the University of the Western Cape. South African Medical
Journal, 91(10): 823-829.
The ERC website (erc.msh.org) has a very bulky and very sophisticated
training impact evaluation tool, if you are particularly interested in this
area.

8 SESSION SUMMARY

In this session we began to discuss skills development of staff, concentrating
on training. In the next session we will focus on staff support and supervision,
which we consider to also belong within the ambit of skills development.

Unit 4 - Session 3
Staff Supervision and
Support
Introduction

Supervision and support of staff is one component along the continuum of
staff development. If done correctly, it should have considerable overlap with
skills development on the one side and performance management on the
other.

This session has two parts. Part 1 will introduce mentoring as a staff
development tool; Part 2 presents different approaches to supervision. In
particular, we will discuss the role of the supervisor and the feasibility of a
team approach to supervision.



Explain the concept of a mentor.
Understand how a developmental approach to supervision differs from
traditional approaches.
Identify the key roles of a supervisor.
Consider the feasibility of a team-approach to supervision.


2 READINGS


Ohio Women's Business Resource Network. (5/97). Mentoring - 349
What Goes Around, Comes Around. Chicago, Illinois: Columbus,
Ohio and Women's Business Development Center: 1-4. [Online].
Available: http://www.onlinewbc.gov/Docs/manage/mentoring.html
McNamara, C. (n.d.). Supervisors; Typical Experience of a First- 353
Time Supervisor; Responsibilities of a Supervisor; Typical Roles
of a Supervisor: 1-5. [Online]. Available: http:
http://www.managmenthelp.com
Management Sciences for Health (MSH). Improving Supervision: 359
A Team Approach. The Manager’s Electronic Resource Center,
ERC: 1-20. [Online]. Available: http://www.erc.msh.org/html//
MSH. (1998). Supervisor Competency Self-Assessment Inventory. 379
In The Health and Family Planning Manager's Toolkit: 1-6.
[Online]. Available: http://www.erc.msh.org/html

3 MENTORING

Mentoring is a very old concept, the value of which has been rediscovered
recently. A mentorship is a personal relationship between a more experienced
and a less experienced person, with the aim to nurture the latter.
Mentoring is used in many different contexts, e.g. in youth groups (big
brother-big sister) and in private companies, where young and promising staff
are systematically groomed for leadership positions.

In the context of the health services mentoring can play an important role as
part of staff induction (see Unit 4 - Session 1), but also to provide support in
times of stress. The mentorship concept might then be adapted to peer
mentoring.

Below are two excerpts from the internet which talk about what a mentor is
and what the mentoring process might consist of.


Mentor, Mentors and Mentoring
© Fred Nickols 2002

A few years ago my wife asked me to tell her what I know of mentors and mentoring.
Here is what I told her.

Mentor
Mentor is the name of the person to whom Odysseus (a.k.a. Ulysses) entrusted the
care of his son, Telemachus, when he set out on those famous wanderings of his
that we now call an "odyssey" and which took him, among other places, to the Trojan
Wars. Mentor was Odysseus' wise and trusted counselor as well as tutor to
Telemachus. Myth has it that the goddess Athena would assume Mentor's form for
the purpose of giving counsel to Odysseus but, for many centuries now, the goddess
has been unavailable for comment to confirm or disconfirm this rumor. At any rate,
Mentor's name -- with a lower-case "m" -- has passed into our language as a
shorthand term for wise and trusted counselor and teacher.

Mentors
Until recently, in ordinary usage, the term mentor typically was used by the recipient
of the counsel or teaching to refer to the person providing it. Thus, I might say that Ed
Trapp was my mentor. Observers of such counseling and tutoring relationships have
also been known to label certain people as mentors. Kierkegaard, for instance, has
been called mentor to an entire movement. But, mentors, it seems, have not and do
not characteristically refer to themselves as such.
This writer's own biases are such that he has always thought the term mentor was
exemplified in a situation wherein an older, influential male took a younger, promising
male "under his wing," so to speak, for the purpose of advancing the younger male's
career. The older male was then a mentor to the younger one. And the younger
male, of course, would be known to us as the protégé of the older man, just as
Telemachus was Mentor's protégé (although it seems only fair to point out that the
French language had not yet then evolved and so whatever term Mentor used to
refer to Telemachus might or might not be known to us but it seems certain he did
not use protégé).

Mentoring
In recent years, especially in the management and human resources literature,
mentor, which is a noun, has become a verb as well and -- with or without "ing" as an
appendage -- now refers to the patterned behaviors or process whereby one person
acts as mentor to another. And, in keeping with current mores and norms, gender
seems irrelevant. (This usage, however, has yet to make its way into any dictionary
to which this writer has access.) It will surprise some, but not others, to learn that
there are consultants whose practices center on advising the rest of us regarding the
mysteries of mentoring. (They are perhaps would-be or frustrated mentors
themselves.)
In sum, what has been historically an informal, unofficial, voluntary, mutually-
agreeable, and self-selected interaction between two people has become a program
-- an institutionalized stratagem for trying to force what probably can only come about
naturally -- and a staple, if not a commodity, in the bag of tricks toted from client to
client by many a consultant.


Frankly, I'm not against formal mentoring programs, but I'm not for them either. I'll
pick my own mentors, thank you, and I'll pick my own protégés too.
http://home.att.net/~nickols/mentor.htm

Mentoring
Mentoring is a tool that organizations can use to nurture and grow their people. It can
be an informal practice or a formal program. Protégés observe, question, and
explore. Mentors demonstrate, explain and model. The following assumptions form
the foundation for a solid mentoring program.

Deliberate learning is the cornerstone. The mentor's job is to promote intentional
learning, which includes capacity building through methods such as instructing,
coaching, profiding experiences, modeling and advising.

Both failure and success are powerful teachers. Mentors, as leaders of a learning
experience, certainly need to share their "how to do it so it comes out right" stories.
They also need to share their experiences of failure, ie., "how I did it wrong". Both
types of stories are powerful lessons that provide valuable opportunities for analyzing
individual and organizational realities.

Leader need to tell their stories. Personal scenarios, anedcotes and case examples,
because they offer valuable, often unforgettable insight, must be shared. Mentors
who can talk about themselves and their experiences establish a rapport that makes
them "learning leaders."

Development matures over time. Mentoring -- when it works -- taps into continuous
learning that is not an event, or even a string of discrete events. Rather, it is the
synthesis of ongoing event, experiences, observation, studies, and thoughtful
analyses.

Mentoring is a joint venture. Successful mentoring means sharing responsibility for
learning. Regardless of the facilities, the subject matter, the timing, and all other
variables. Successful mentoring begins with setting a contract for learning around
which the mentor, the protégé, and their respective line managers are aligned.

http://www.sonic.net/~mfreeman/mentor/mentsupp.htm


TASK 1: CONSIDER YOUR EXPERIENCE WITH MENTORING

After reading the two text excerpts, consider your own experience with mentoring:
Have you ever been mentored?
Have you ever been a mentor?
If so, what were the positive and negative experiences with the relationship?
Is there any form of formal or informal mentoring going on in your
organisation?
If yes, is it working? Could it be strengthened?
If not, is there space to develop and mentoring programme?

We said above that a mentoring relationship is usually between an older or
more experienced person and a younger or less experienced person.
If you followed events in South Africa in May 2003, you will have heard and
read about the passing away of one of the big old men of the South African
liberation struggle, Walter Sisulu. You will also have heard his closest
comrade and friend, Nelson Mandela, talk about their relationship. Mandela
has said many times in the past that Sisulu was his mentor, the man who took
him under his wing when he first arrived in Johannesburg, and who initiated
him into politics. Their relationship changed over the years, as Mandela grew
in stature. Yet, Mandela continued to refer to Sisulu as his mentor. This
mentorship clearly extended beyond the nurturing and grooming of a you
leader into a very close working relationship and friendship that saw both men
through exceptionally difficult times.

The following excerpt from May 2003 reflects this relationship.

Remembering Walter Sisulu, Father of South Africa's Liberation
Kate Tuttle

Nelson Mandela is now the only one left. Of the three-man partnership that
forged the African National Congress into a revolutionary tool for liberating
black South Africans - then transformed it into a ruling party of the continent's
most successful democracy - Mandela now stands alone. Oliver Tambo, the
professor and strategist, who held the ANC together during long years in
exile, died in 1993.

And now Walter Sisulu, who brought Mandela in to the party in the 1940s and
continued mentoring him during the next half century, has passed on to
history. While his name will never be as famous as Mandela's, Sisulu's role in
South Africa's liberation is hard to overstate. It was Sisulu who recruited
Tambo and Mandela, whom he met in Johannesburg in 1941 when the
younger man was a newcomer to the city, into the newly formed ANC Youth
League.

Walter Sisulu, whose work with South Africa's Communist Party and Indian
Congress had helped convince him of the power of multiracial coalitions, was
the man who helped Mandela and others cling to this ideal even as they
endured decades of imprisonment on Robben Island. Called by one of his
ANC colleagues "the organization's encyclopedia in prison", Sisulu was the

man, both wise and humane, whom Mandela relied on above all others. To
emerge from nearly 30 years in prison still committed to fairness and equality
- still believing in the concept of justice - was a genius shared by both men.

First published: May 6, 2003
About the author: Kate Tuttle is Senior Editor of Africana.com.
www.africana.com

Obviously, a relationship such as this cannot be created through management
intervention. However, what we can learn and take away for our purposes is
that close work-oriented relationships between older and younger members of
staff or between peers can nurture and support staff and help them grow,
particularly in difficult times. It can be the HR manager's role to encourage
and foster such relationships within the organisation.

TASK 2: A PRACTICAL GUIDE TO MENTORING
To end Part 1 of this session, work through Ohio Women's Business Resource
Network. (5/97). Mentoring - What Goes Around, Comes Around. Chicago, Illinois:
Columbus, Ohio and Women's Business Development Center: 1-4. [Online].
Available: http://www.onlinewbc.gov/Docs/manage/mentoring.html (Reader page
349), a very useful guide on mentoring. Consider its applicability for your
organisation.

4 SUPERVISION

The following is extracted from http://www.erc.msh.org. When you are trying
to get things done through other people, you soon find that instructions,
training sessions, lists of rules and written procedures are not enough. These
are all good methods for communicating what you want done and how you
want it done. However, no matter how well these methods are applied, you
will find that it is essential to have direct personal contact with your staff on a
regular basis. Personal contact is essential for two reasons: first, to find out
what is actually happening (in all aspects of the work, particularly those
aspects that are never covered in service statistics), and; second, to renew
the enthusiasm of the staff for the work they are doing. This personal contact
is important both for the effective operation of the programme and for staff
morale and commitment. The purpose of supervision is to guide, support and
assist staff to perform well in carrying out their assigned tasks.
If you think of supervision as personal contact for these purposes, then you
will recognize that staff at every level, from service delivery to administration,
need supervision. Methods of supervision work for a whole range of
organizational levels and functions.
Your main function as a supervisor is to help your staff to perform their jobs
better by providing:
Guidance and training
Assistance with resources and logistics
Support, encouragement, and advocacy for their rights

Monitoring and evaluation
Your role as a supervisor should be that of a problem-solver who supports the
employees, not a fault-finder who is always criticizing them. Your employees
should be pleased to see you and not find reasons to be absent when you are
coming. You will no doubt see the overlap here with mentoring, which we
discussed above and performance management, which will be the focus of
the coming session.

4.1 Functions of a supervisor

Supervisors at every level and in all parts of an organization have a number of
basic functions. These include:
Setting individual performance objectives (the activities an employee
should accomplish by a certain date) with the employees themselves so
that they know what is expected of them.
Managing any performance problems and conflicts that arise and
motivating and encouraging employees to do their best work.
Having regular contact with staff members through supervisory
sessions to motivate and provide feedback, solve problems and provide
guidance, assistance, and support.
Designing a supervisory system, including a supervisor's session plan
with selected items to supervise during each session.
Preparing a supervisory schedule of upcoming supervisory sessions
which shows the date and time of each session and lists any content that
can already be foreseen. This should be updated periodically.
Conducting periodic performance appraisals to review an employee's
past performance in order to make sure performance objectives are being
met.

Although the situations in which supervisors work may vary, effective
supervisors must perform all these basic functions.

4.2 The style of supervision should fit the employee

There are many different styles of supervision, but all supervision is made up
of two basic components: giving direction and providing support. Giving
direction involves one-way communication in which the supervisor tells the
employee what to do and when, as well as where and how the tasks are to be
accomplished.

Supervisors provide support through their relationships with their
employees. This implies more of a two-way communication in which
supervisors encourage and guide staff, discuss any questions or difficulties,
and enable them to carry out their jobs effectively.

A supervisor may instinctively be more inclined toward task-oriented or
relationship-oriented supervision. However, every supervisor must also
consider the type of supervision appropriate to each employee. Some
employees work best independently, needing direction but little support. Other
employees work better with a significant amount of support from their

supervisor. In any case, a supervisor should always consult with employees
before making judgements and decisions which affect the employee's work.

4.3 Elements of supervision

The foundation of supervision is the supervisory session, when the
supervisor meets with one or more employees to review the work that has
been done and to plan the work of the next few months. There are different
types of supervisory sessions, each of which covers a different time frame
and looks at the work to be accomplished in a different way. On-site, day-to-
day supervision keeps track of what is being done and corrects any obvious
problems as they occur. Supervisors also have supervisory sessions with
staff working in the same location; these involve a longer-term review of the
work and may look at the need for further training or the possibility of staff
development activities. Supervisory visits to staff working in different
locations look at work accomplished over a longer period. In addition to trying
to resolve problems arising from day-to-day work, the visiting supervisor has a
pre-determined list of activities to carry out.

An additional form of supervision is the performance appraisal, which occurs
at regular periods and looks at whether the employee is achieving her or his
performance objectives, how well she or he is carrying out the tasks, and what
support the supervisor should provide. This is a more formal version of the
review that takes place during the regular supervisory sessions and may be
the basis for deciding whether the employee should receive a raise or
promotion.

All supervisory sessions, whatever the circumstances, should:
Reaffirm the mission of the organization, reminding staff of the
organization's values, principles, and goals and strengthening staff
commitment to them;
Make sure the staff have the interpersonal skills required to deliver high-
quality services;
Check that the staff have the technical and intellectual skills necessary for
the jobs they do and that they are properly trained;
Deal with personal work-related issues of individual staff members.

A supervisory visit to staff working some distance away would also have to
cover the following items:
Checking and replenishing supplies;
Bringing messages and items from headquarters and taking others back
(the mailman function);
Collecting record forms that need to go to headquarters.


TASK 3: DIFFERENT VIEWS ON SUPERVISION

After having read the above introduction to supervision from the Electronic Resource
Centre, read the reading on supervision in the Reader (p. 353): Carter McNamara.
(n.d.) Supervisors; Typical Experience of a First-Time Supervisor; Responsibilities of
a Supervisor; Typical Roles of a Supervisor: 1-5. [Online].

4.4 text comes from a website called www.managementhelp.com, which offers lots
This Team supervision
of tips on management, directed mainly and private companies and non-profit
organisations.

You will find that although the emphasis in the texts may differ, they both stress the
role of supervisor as a person who provides guidance and support, not a person who
hovers behind your shoulder and finds fault.
In light of the readings, critique your organisation's supervisory system and make
recommendations to your organisation how to improve your system.

At all levels of the organization, supervisors in the health sector contribute to
the delivery of high-quality health services to clients. They do this in two ways:
through both individual and team supervision. For either supervisory
approach, the role of the supervisor is to facilitate the work of individual
employees or employee teams so they can effectively perform their job
responsibilities.

Individual supervision involves supervising the performance of an individual
employee on a one-to-one basis. It also involves periodic joint work planning
and performance review meetings between the supervisor and the staff
member. It can also involve day-to-day guidance, mentoring, and problem
solving.

In team supervision, supervisors build and support a clinic team whose
members work together to analyse and solve problems on an ongoing basis.
A team approach to supervision emphasizes individual performance only as it
relates to the ability of the team to achieve common goals. By using a team
approach to supervision and by placing an emphasis on team problem
solving, supervisors can overcome many of the shortcomings of traditional
supervision, which can focus more narrowly on vertical programmes or
individual performance and may not be as supportive or facilitative.

TASK 4: READ ABOUT A TEAM APPROACH TO SUPERVISION

Work through ERC: The Manager’s Electronic Resource Center. Improving Supervision:
A Team Approach: 1-20. [Online]. Available: http://www.erc.msh.org (Reader page 359).
It will take you step-by-step through the rationale and the process of team supervision.
You will find that there is some overlap with other readings above. That's fine. Either use
this text to reinforce and revise some of what you learnt above, or just skim the sections
that you do not need. You will see that the key difference between individual and team
supervision lies in the fact that in the latter, the team is the point of reference, that the
aim of the supervisory process is not to improve individual performance, but the
performance of the whole team and therefore the quality of service delivery.


Cont’d
The text speaks specifically about team supervision in a clinic context, but it could
equally be used for other teams, such as the staff of a hospital ward, a transport
department or the district headquarters.

Consider whether such an approach to supervision would be a viable option for your
organisation and what would have to be put in place to implement it.

And to end this session, yet another tool from the evidently very useful
Electronic Resource Centre. They have developed a "Supervisor Competency
Self-Assessment Inventory". It is meant to help you assess your skills as a
supervisor, but it is also very useful as a general summary of skills
requirements of a supervisor.

TASK 5: FILL IN THE SELF-ASSESSMENT INVENTORY
Read through and fill in the "Supervisor Competency Self-Assessment Inventory" from
MSH. (1998). Supervisor Competency Self-Assessment Inventory. In The Health and
Family Planning Manager's Toolkit: 1-6. [Online]. Available: http://erc.msh.org/html/ This
is a tool that you may also want to share with other supervisors in your organisation.

5 FURTHER READINGS

Fisher, Roger and Bruce Patton. (1981). Getting to Yes: Negotiating
Agreement Without Giving In. Boston, MA: Houghton Mifflin Company.

6 SESSION SUMMARY

This was quite a lengthy session, discussing mentoring and developmental
approaches to supervision. The key concern of the session focused around
the need to foster mentoring and supervisory relationships that nurture and
develop staff rather than inspect and find fault with them.
This theme will also be carried into the last session of the unit, which will
discuss performance management.


Unit 4 - Session 4
Performance Management
Introduction

Performance management is the last and very important aspect of staff
development in your organisation.

Some of you may be taken aback by this statement, because they have
understood and experienced performance management to be a largely
negative form of measuring and disciplining staff. Such a view is not without
reason. Performance management and performance appraisal which has
gone wrong can have exactly this effect, thus becoming an almost punitive
measure within the organisation.

In this session, we will discuss what performance management should be and
how it can be done so as to serve the developmental purposes of both the
individual staff member and the organisation.

We will, however, not introduce any specific performance management
system. Instead, we will discuss the principles underlying a good performance
management system as well as some of its component parts. The reason for
not introducing one specific system is that there simply are too many, and
often organisations are quite possessive about their particular system. This
session should enable you to interrogate and evaluate the system that is
being used in your organisation, and to possibly make suggestions for
alterations.



Discuss the components of performance management.
Identify key action objectives and targets for members of your team.
Provide constructive feedback.
Identify weaknesses in an appraisal system and suggest well-founded
ideas for overcoming them.
Conduct appraisal interviews.


2 READINGS



Management Education Scheme by Open Learning (MESOL). 386
(2000). Module 2: Managing people. Book 2. Session 2:
Performance management. In Managing in Health and Social
Care. Milton Keynes: OU: 25-50.

3 PERFORMANCE MANAGEMENT

This session on performance management has been taken once again from a
session in a distance learning course on Managing in Health and Social Care
offered by the Open University in Britain. We could not have done it better, so
decided not to re-invent the wheel.

TASK 1: INTRODUCING PERFORMANCE MANAGEMENT
Work through the following text: Management Education Scheme by Open Learning
(MESOL). Managing in Health and Social Care. Module 2: Managing people. Book 2.
Session 2: Performance management. Milton Keynes: Open University: 25-50. (Reader
page 386).
Treat it as a session in your guide, although it is printed in the Reader. Complete all
exercises.

4 FURTHER READINGS

Edis, M. (1995). Performance Management and Appraisal in the Health
Services. London: Kogan Page.
Handy, C. (1993). Understanding Organisations. London: Penguin Books.


5 SESSION SUMMARY

In this session, we have examined the idea of performance management and
paid particular attention to the place of appraisal within it. Performance
management is about ensuring that organisational and service objectives are
achieved, that the best use is made of staff resources, and that staff are
developed so that they can continually improve and respond to changing
expectations of health and social care services. The emphasis should be on
improving effectiveness and quality for the benefit of patients and service
users.

6 UNIT SUMMARY

You have come to the end of the last full unit in the module. In it we discussed
some of the practical aspects of managing people: how to make sure that the
right people are recruited into the organisation; how to make sure that they
can develop to their full potential and be productive for the organisation
through a wide array of skills development interventions; and how to use
performance management as a development opportunity.

We said in the beginning that we would have to be selective about what we
discuss in this unit, given the very wide range of possible topics under this
heading. We chose the topics we considered most important for your practice
as an HR manager. We hope you are satisfied with our choice. If not, we
would be delighted to get feedback on what you think should be included in
future.

You have one last session to go. In it we will try and tie together many of the
strands of thought we have developed in the course of this module from a
contextual as well as a practical point of view.


Concluding Session -
Key Challenges in Human
Resource Management
Today

Introduction
You have almost reached the end of the module On Human Resource
Management For Health. Clearly, we have not exhausted the topic. Many
topics were introduced, but could have been elaborated in much greater
depth. Many topics could have been added, were it not for the lack of space
and time. We had to make choices. We tried to aim for a mix of understanding
the importance of HR Management in the context of developments in the
health sector and of gaining some knowledge and skills that will help you in
your day-to-day practice as a human resource manager.
The challenges facing HR managers in the health sector today are serious
and seemingly endless: HIV/AIDS, brain drain, low morale, transformation
fatigue, to name just a few examples. We have not spent much time
discussing these challenges per se. This would probably warrant another full
module. However, many of the topics covered in this module are influenced
by or influence these challenges. For example, motivation plays a crucial role
in lifting low morale. So does a good supervisory system. Thorough staff
induction and development can go a long way to reducing role conflict.
Before we let you go, we want you to spend another two to three hours
working with the HRM assessment tool we introduced in Unit 1 Session 4
(Task 2) and reflecting on the key challenges we face in human resources in
South Africa specifically, but also in other African countries today. We recently
wrote an overview article for the South African Health Review, which talks to
these challenges. The article focuses on Human Resource Development in
general, but you will see that most topics relate directly to HR Management.




Conduct an HRD assessment of your organisation.
Reflect on the key HR challenges facing your organisation and how they can
be addressed.

2 READINGS

PUBLICATION DETAILS PAGE NOS IN READER

Management Sciences for Health (1998). HRD Assessment 91
Instrument for NGOs and Public Sector Health Organisations.
MSH: 1-15.
Lehmann, U. & Sanders, D. (2003). Human Resource 412
Development. In South African Health Review 2002. Durban:
Health Systems Trust: 119-427.

TASK 1: REVISIT THE HRM ASSESSMENT TOOL
We asked you to have a look at the HRM assessment tool on page 91 of the Reader
at the beginning of the module. This tool aims to help you to assess the state of
Human Resource Development in your organisation and to come up with possible
solutions to problems.
Now, at the end of the module, we want you to go back to the tool and to work
through it systematically, in the end making a summary assessment of HRD in your
organisation, which you may want to present to colleagues.


LAST TASK OF THE MODULE: REFLECTING ON KEY HR CHALLENGES

Read Lehmann, U. & Sanders D. (2003). Human Resource Development. In South
African Health Review 2002. Durban: Health Systems Trust: 119-427. (Reader page
412).

This chapter provides an overview of recent developments and key challenges in the
human resources in the health sector and develops an agenda for intervention. It
concentrates on issues of:
Legislation
Capacity and skills
Workloads
Management and support
HIV/AIDS
The chapter highlights problem areas, but also gives examples of good practice and
encouraging initiatives, such as the use of Action Research for building capacity.
Do the topics raised in the chapter resonate with your own experiences and
challenges? What are the commonalties? What are the differences?
What is your organisation doing to tackle these challenges?

This last reading and reflection concludes the module.

3 SESSION SUMMARY

While many issues remain outstanding, we hope you leave the module feeling
somewhat better equipped to Tackle Human Resource Management in your
organisation.
We also hope that you found the module both enjoyable and challenging,
providing some new ideas and maybe putting existing knowledge and skills in
context. Please don’t forget to give us your feedback on the module.
We thank you for choosing to do this module and wish you luck with the rest
of your studies!



Managing Human Resources for
Health

Readings


Managing Human Resources for Health

List of readings
The School of Public Health provides students with a Reader of just over 400
pages, which contains these required readings for the module, SOPH pays for
copyright for these Readings per student and therefore cannot offer the
Reader as an OER.

Publication Details
Bateman, A. (1990). Teambuilding: Developing a Productive Team: 1-9. [Online].
Available: www.ianr.unl.edu/pubs/misc/cc352.htm#eytd//

Blair, G. M. (n.d.). Groups That Work: 1-9. [Online]. Available:
www.see.ed.ac.uk/~gerard/Management/art0.html//
Chen, L. et al. (2004). Human Resources for Health: Overcoming the Crisis”, The Lancet
(364): 1984-90.

Conflict Management Strategies and Styles: 1-3. [Online]. Available:
http://home.snu.edu/~hculbert.fs/conflict.htm//

Cook, C.W. & Hunsaker, P.L. (2001). Ch 1 - Managing people and organisations.
Management And Organisational Behaviour. Boston: McGraw-Hill Irwin: 15-20.

Cook, C.W. & Hunsaker, P.L. (2001). Ch 16 - Self-Management at Work: Managing
Careers and Stress. In Management and Organisational Behaviour. Boston: McGraw-Hill
Irwin: 585-602.

Cook, C.W. & Hunsaker, P.L. (2001). Ch 14 - Leadership. Management and
Organisational Behaviour. Boston: McGraw-Hill Irwin: 490-513.

Covey, S. (1989). Habit 3: Put first things first: principles of personal management. The 7
Habits of Highly Effective People. London: Pocket Books: 146-168.

Encina, G. B. (n.d.). Conflict Management Skills: 1-18. [Online]. Available:
www.cnr.berkeley.edu/ucce50/ag.labor/7labor/13.htm//

Green, A. (1992). Ch 13 – Planning human resources. In An Introduction to Health
Planning in Developing Countries. Oxford: OUP: 291-315.

Handy, C. (1993). Ch 10 – On politics and change. Understanding Organizations.
London: Penguin Books: 299-312.

Iles, V. (1997). Ch 6 – Really managing yourself. Really Managing Health Care.
Buckingham: OUP: 76-88.

2

HST. Sample Job Description For Clinic Supervisors. In HST Technical Report:
Investigating The Role and Functions of Clinic Supervisors: Durban: HST: 1-4.

HWSETA. Excerpts from the HWSETA website. 7 pages. [Online]. Available:
www.hwseta.org.za//
Kohlemainen-Aitken, R-L. (1997). Decentralisation of human resources: implications and
impact. Human Resource Development Journal, 1(3): 1-29.

Lehmann, U. & Sanders, D. (2003). Human Resource Development. In South African
Health Review 2002. Durban: Health Systems Trust: 119-427.

Management Sciences for Health. (1998). HRD Assessment Instrument for Ngos and
Public Sector Health Organisations. MSH: 1-15.

Mejia, A. (1978). Ch 2 – The health manpower process. In Hall, T.J. & Mejia A. (Eds).
Health Manpower Planning: Principles, Methods, Issues. Geneva: WHO: 31-56.

McNamara, C. (n.d.) Supervisors; Typical Experience of a First-Time Supervisor;
Responsibilities of a Supervisor; Typical Roles of a Supervisor: 1-5. [Online]. Available:
http://www.managementhelp.com//
Management Education Scheme by Open Learning (MESOL). Module 1: The Manager.
Book 1. Session 4: Alternative views of management. Managing in Health and Social
Care. Milton Keynes: OU: 63-80.

Management Education Scheme by Open Learning (MESOL). (2000). Module 2:
Managing people. Book 2. Session 2: Performance management. In Managing in Health
and Social Care. Milton Keynes: OU: 25-50.
Management Sciences for Health (MSH). Training for Effective Performance. In The
Family Planning Manager’s Handbook. 1-15. [Online]. Available: http://erc.msh.org//
Management Sciences for Health (MSH). (1998). Supervisor Competency Self-
Assessment Inventory. The Health and Family Planning Manager's Toolkit: ERC: 1-6.
[Online]. Available: http://erc.msh.org//
Management Sciences for Health (MSH). (1998). Supervising and Supporting Your Staff.
The Family Planning Manager’s Handbook, ERC: 1-12. [Online]. Available:

Management Sciences for Health (MSH). Improving Supervision: A Team Approach. The
Manager’s Electronic Resource Center, ERC: 1-20. [Online]. Available:
Ohio Women's Business Resource Network. (5/97). Mentoring - What Goes Around,
Comes Around. Chicago, Illinois: Columbus, Ohio and Women's Business Development
Center: 1-4. [Online]. Available: http://www.onlinewbc.gov/Docs/manage/mentoring/html//
Powell, S. (1999). Ch 1 - Introduction and Ch 2 - Thinking and learning. Returning to
Study. Buckingham: OUP: 1-31.
SA Department of Labour. (2001). Skills for productive citizenship for all. In National Skills
Development Strategy. 1-4. [Online]. Available: www.vhutsila.org.za//

3

SA Department of Labour. (2001). The Skills Development Act, 1998, The Skills
Development Levies Act. In Understanding the Laws. 1-10. [Online]. Available:
www.vhutsila.org.za//
SA Department of Labour. (2001). Learnerships. 1-5. [Online]. Available:
www.vhutsila.org.za//
Sanders, D., Dovlo, D., Meeus, W. & Lehmann, U. (2003). Public health in Africa. In:
Beaglehole, R. Global Public Health - A New Era. Oxford: OUP: 135-155.

Walt, G. & Gilson, L. (1994). Reforming the health sector in developing countries: the
central role of policy analysis. Health Policy and Planning, 9(4): 353-370.

Walt, G. (1994). Ch 8 - Do those who implement decide? Health Policy: An Introduction
To Process And Power. Johannesburg and London: Wits University Press and ZED
Books: 153-177.

WHO (1993). Annex 3: Motivation. Manual on Management of Human Resources for
Health. Geneva: WHO: 1-27.

WHO. (1998). Annex 5 - Staff establishment and recruitment. In Training Manual on
Managing Human Resources for Health. WHO: Geneva: 1-7.

WHO/Afro. (2001). Part I. HRD Advocacy Pack. Compiled by SOPH, UWC: 1-6

WHO. A*07 Illustrative training needs assessment form. In Toolkit for Planning, Training
and Management. 1-4. [Online]. Available: http://hrhtoolkit.forumone.com//

4

MANAGING HUMAN RESOURCES FOR HEALTH – EVALUATION QUESTIONS
SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF THE WESTERN CAPE

Please give us some feedback on this module. Thank you.
1. In general, how do you feel about the module?
2. Did any aspects of the module challenge you to think more deeply about
human resource management?
3. Are there any sections of the module which could be better explained?
Be as specific as possible.
4. Were there any sections or sessions that you felt were unnecessary?
5. Were there any topics that you felt should have been included in the
module?
6. Are there any improvements you could suggest to the assignment?
7. Are there any interesting readings which you feel should be added to the
module?
8. Do you have any intention to use or adapt any part of the module?

Date:
Place:
Do you play a role in the field of Public Health? If so what?
Your name: [optional]:

Please paste your response into an email to: Ms L Alexander, SOPH, UWC
lalexander@uwc.ac.za

Evaluation from OER AFRICA Link

Managing Human Resources for Health - 2010

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