The purpose of this MPH course unit is to build the capacity (knowledge, skills, and attitudes) of the MPH trainees as future, policy makers, Health Services researchers , planners and health managers at International, National, regional, district and sub-district levels) who can implement and strengthen health systems in their respective countries

1. PUBLIC HEALTH MANAGEMENT
SYSTEMS (MPH 5202)
Dr Tumwebaze Mathias MPH
1 BSU-Feb 2022

2. Public Health Management systems
• Program: MPH YR1
• Course Unit: Public Health Management systems (PHMS)
• Course code: MPH 5202)
• Units: 4 CU course
• Term: Semester 1
Introduction
• Public Health Management systems course is designed, to
Impart management and leadership skills, that are critically
important in Public Health Systems & programs. MPH
officers are engaged in learning that is focuses on
Management, leadership and Governance all aimed at
building the trainees capacity to embrance the,
opportunities and handle the challenges inherent in tody's
modern Public Health practice.

3. Con’t Introduction
• Learners will have a deeper understanding of
the complex health systems, gaining a clear
understanding of how to manage and lead
healthcare delivery at all levels – from local
through to international level – for better
Health outcomes.
• Focusing on Health systems Management, MPH
officers will be prepared for senior positions in
health sector Health at MOH and local
government levels

4. Why PH Management systems course
• Public Health Training in management in this
modern era has shifted attention from the
traditional narrow focused Management
functions approach to a broader focused Health
systems management approach.
• The new management training approach looks at
imparting broad KSC to trainees in
,MANAGEMENT, GOVERNANCE and LEADERSHIP ,
that are required for health systems
strengthening and problem solving.

5. Background
• Health system weaknesses are a major impediment
to achievement of health targets.
• Globally, health systems strengthening has been
recognized as a critical approach for improvement of
health services.
• Specifically challenges in health system governance,
leadership and management;
• (Health financing; critical shortages and inadequate
performance of human resources for health;
inadequacies and inappropriate usage of health
information for decision making; limited access to
medicines and technology as well as poor service
delivery need to be adequately addressed as a

6. (Brainstorming Session )
• Most countries around the world and in Africa including
Uganda have weaknesses in their health systems:_
• It is critical that in order to have greater impact in health
system strengthening, future PH program managers,
leaders and governors receive special training that is
integrated, harmonized and linked to address all the key
components of the health system.
• The PHMS course unit in the MPH program at BSU is
developed aimed at effectively building competences of
the MPH officers:-In health leadership, management and
governance to enable them to apply the gained skills,
knowledge and attitudes to improve the functioning and
outcomes of health systems nationally and globally

7. Co’nt introduction
• Upon completion of this course unit, the
trained officers are expected to join the
critical mass of policy makers and practitioners
who understand the principles of Health
Systems
• In the long run will contribute to overall
Health Systems Strengthening (HSS) to
improvement of health outcomes globally

8. PHMS Course unit purpose
• The purpose of this MPH course unit is to build the
capacity (knowledge, skills, and attitudes) of the MPH
trainees as future, policy makers, Health Services
researchers , planners and health managers at
( International, National, regional, district and sub-
district levels) to implement and strengthen health
systems in their respective countries
Course Duration
This is a 4 credit unit course ( 4 lecture hours per week)
, 60 hours in 15 weeks of the semester. It is designed to
be taught in semester 1 of the first year of the MPH
program at BSU

9. Course Performance Assessment
• The MPH trainees will be assessed through
continuous assessments (assignments/tests and
course works that also include group activities
and class presentations and discussions)
• Attendance of all lectures is mandatory.
• Continuous assessment is 40% and end of
semester exam 60% pass mark is 60%

10. Course out line
• INTRODUCTION TO Health systems APPROACH
• Management for Health
• Leadership in Health
• Governance
• STRATEGIC PLANNING
• BUILDING TEAMS
• HUMAN RESOURCES FOR HEALTH
• HEALTH MANAGEMENT INFORMATION SYSTEMS
• Quality assurance
• Conflict management
• MONITORING AND EVALUATION

11. OVERVIEW AND CONTEXT OF THE HEALTH
SYSTEM
• Objectives
• By the end of this session , participants should
be able to:
• Explain the concept “ health system”
• Describe the components of a health system
• Explain the importance of systems thinking for health
systems strengthening.
• Discuss the characteristics of a functioning health
system
• Describe the challenges and emerging health systems
issues in Uganda.

12. DEFINING A HEALTH SYSTEM
WHAT IS A SYSTEM?
WHAT IS A HEALTH SYSTEM?
WHAT IS A HEALTHCARE SYSTEM?
Definition of a health system
• “A system is a group of interacting, interrelated, or
interdependent elements forming a complex
whole”(Heritage Dictionary, 4th ed., 2000)
• “A health system consists of all organizations,
institutions, people and actions whose primary intent
is to promote, restore or maintain health” (WHO,
2007)
• (Emphasize Prevention, management, care, financing,
…. Personal and people/public health)

13. Definition of a healthcare system
• A healthcare system is a means of organized
social response to the health conditions of the
population.
• It is narrower than a health system and is
often described in terms of the levels of
healthcare and organizational structure of the
Ministry of health.

14. Definition of systems thinking
Systems thinking is a paradigm shift that emphasizes a
deeper understanding of dynamism, linkages,
relationships, interactions and behaviors among the
elements that characterize the entire system
• It focuses on holistic approach to designing,
implementing and evaluating health interventions
• It is an approach to problem solving that views
‘problems’ as part of a wider dynamic super structure
Definitions: Health systems strengthening
Health Systems Strengthening (HSS) is defined as building
capacity in critical components of health systems to
achieve more equitable and sustained improvements
across health services and health outcomes (WHO, 2007)

15. Understanding systems thinking
• Systems thinking is the process of understanding
how those things which may be regarded as systems
influence one another within a complete entity, or
larger system.
• In organizations, systems consist of people,
structures, and processes that work together to
make an organization "healthy" or "unhealthy".
• Systems thinking is an approach to problem
solving that attempts to focus on holistic thinking .
By taking the overall system as well as its parts into
account .
• systems thinking is designed to avoid potentially
contributing to further development of unintended
consequences

16. Principles of a health system
• People-centered- Equity and fairness
• Results-oriented - Quality management system for
continual quality improvement
• Evidence-based - Technocrats, academicians, politicians,
community
• Community-driven- Leadership, governance
• accountability, transparency and sustainability
• interdependence of objects and their attributes -
independent elements can never constitute a system
• Ethically sound – Human rights and dignity, safety
for the client, community and environment
• Systems thinking- Holistic view of the health system
• Cost Effectiveness and Efficiency – Accountability and
value for money

17. Context of the health system in Uganda
• Organizational arrangements
• Economic context
• Socio-cultural and political context
• Legislative context
• Environmental Context
• Main actors in the health system
• Health systems: Organizational arrangements
• Centralised health systems
• Decentralised health systems
• Organisational levels of health systems

18. Context of the H/system in Uganda
Health systems: Centralized
• Top-down approach
• Authority concentrated at the top
• Bureaucratic
• Minimal community involvement
• Vertical programming
( learners share examples of centralized systems)
Health systems: Decentralized
• Bottom–up approach, Active participation of community
actors,Ownership
• Sustainability, Horizontal, primary health care programming
Decentralization include:
• Deconcentration
• Delegation
• Devolution and
• Privatization – outsourcing and contractual

19. Health systems: organizational levels
• The service delivery levels vary across countries. In Uganda
the health systems organization levels are as follows:
Tertiary
• National Referral Hospitals, Central semi-autonomous
institutions (CPL, UAC, UVRI, National Disease Control
Programs (MCP, ACP, )
Secondary
• Regional Referral Hospitals, General Hospitals
• Primary
• District Health Services, sub-district (HCIV) or sub-county
(HCIII)
• Community
• HCII, VHTs, Dispensaries, Clinics,
• Household
Individuals or families. Each level has standards and norms
that define the service delivery and health facilities.

20. Organization Levels of Health Services in Uganda

21. Health systems: Economic context
• High poverty levels
• Low investments in health at all levels
• Unsustainable and fluctuating donor support
• Uneven progress in health, growing gaps
– Focus on few programme areas, with others ignored / missed
– Gaps in health services increasing, as focus driven by priorities of
donors
– Burden of healthcare financing through
• Persisting inequalities in access, use and financing of services
– Poor, illiterate, and other disadvantaged groups still not accessing
services
• Inappropriate application of technology
• International Trade and Finance: Price of inputs, exchange
rates
• Low levels of employment

22. Health systems: socio-cultural and political
context
• Strong cultural norms and values that influence behavior – e.g.
circumcision
• Resilient yet ineffective traditional health system
• Poorly operationalized social dimensions of health
• Political and civil strife from protracted wars and/or conflicts
• Weak political will to implement policies and commitments
• Poor stewardship
• New challenges to health and health systems
– New / re-emerging conditions, and health threats
– Changing behavior, leading to new risks for various diseases (e.g.
Homosexuality)
• Rising expectations and growing dissatisfaction
– Globalization, better information flows many persons aware of
rights
– Mismatch between expectations and performance

23. Health systems: Legislative context,
• Laws, declarations and commitments on Health
– Global
– Regional
– National
Global: Declarations and commitments on health
– MDGs with emphasis on health related goals
– Paris – Aid effectiveness
• Regional health declarations and commitments
– Ouagadougou Declaration on primary health care(mentioning
Bamako and Alma Ata) and health systems strengthening
– Abuja Declaration- health sector financing
– Maputo Plan of Action – strengthening of reproductive health
– Libreville -social determinants of health
– Algiers - research for health
• Uganda vision 2040
• Sustainable development targets

24. Health systems: Environmental
Context
• Poor Water and Sanitation
• High levels of pollution
• Poor housing and access roads
• Effects of climate change

25. Health systems: main actors
• Core partners have the following primary roles:
funders, providers, purchasers, implementers,
watchdogs
• Government
• Private/NGOs
• Not for profit (e.g. faith-based)
• Private for profit
• Civil society organizations
• Development partners
• International
• Bilateral
• Foundations
• Media

26. COMPONENTS OF A HEALTH SYSTEM

27. Components of a health system
• 1. Service delivery includes delivery of effective, safe,
quality health interventions to those that need them,
when and where needed, with minimum waste of
resources. Demand for care, service delivery models and
integrated packages; leadership and management; and
infrastructure and logistics
• 2. Health workforce refers to a human resource that is
responsive, fair and efficient in order to achieve the best
health outcomes possible, given available resources and
circumstances. Need norms/standards that govern
production of sufficient staff and ensure fair distribution
(HRH must be competent, responsive and productive);
HRH observatories are essential for facilitating HRH
management.

28. Co’nt building blocks
• 3. Health information system ensures the production,
analysis, dissemination and use of reliable and timely
information on health determinants, health system
performance and health status by decision makers at all
levels of the health system; standardized and integrated
systems & tools; linkages– local, national, regional, global.
• 4. Medical products and technologies ensure equitable
access to essential medical products and technologies that
provide scientifically sound, quality, safe, efficacious,
efficient and cost-effective. The medical products include
medicine, reagents, etc. Technologies include health
infrastructure and equipment (e.g. X-ray, lab, vaccines,
etc.).Procurement processes and monitoring are essential
• There is need for standards and policy options to guide on
products and technologies.

29. 5. Health financing system includes:
• Raising adequate funds for health
• Ensure that people can use needed services
• Protection from financial catastrophe or
impoverishment associated with having to pay
for health services, (pooling)..
• Providing incentives for providers and users to
be efficient
• Use of information, sound financial
management
• Efficient allocation and use of resources

30. 6. Leadership, governance and stewardship
• This involves ensuring that strategic policy
frameworks exist and are combined with
effective oversight, coalition building, and
regulation, attention to system design,
transparency and accountability.

31. SYSTEM THINKING FOR
HEALTHSYSTEMS STRENGTHENING

32. Rationale for systems thinking
• Systems thinking works to reveal the underlying
characteristics and relationships of systems.
• Every intervention, from the simplest to the most
complex, has an effect on the overall system. The overall
system also has an effect on every intervention.
• It is a tool for diagnosing organisational issues and
understanding change dynamics.
• Work in fields as diverse as engineering, economics and
ecology shows systems to be constantly changing, with
components that are tightly connected and highly
sensitive to change elsewhere in the system.

33. Principles of systems thinking?
• Building shared vision
• Team learning
• Systems thinking

35. Nine characteristics of a functional
health system
• 1. Access to services
• 2. Quality of care and service delivery
• 3. Safety
• 4. Coverage
• 5. Equity
• 6. Efficiency
• 7. Effectiveness of health care delivery
• 8. Ethics, rights-based approach and gender
sensitivity in delivery of services
• 9. Sustainability of services

36. Characteristics of a responsive health
care system
Characteristics of a responsive health care system

37. END OF PRESENTATION: THANKS FOR LISTENING