The document provides an overview of Ethiopia's health system and policies. It discusses: 1) Ethiopia's historical focus on curative and urban-centered services until adopting a new policy in 1993 emphasizing primary health care, prevention, and rural access. 2) Ethiopia's three-tiered organizational structure for health service delivery comprising primary hospitals, health centers, and satellite health posts organized in primary health care units. 3) Key policies and programs introduced to expand primary health care coverage, including the Health Sector Development Program and Health Extension Program. 4) Primary principles of Ethiopia's approach including decentralization, community participation, and disease prevention.

1. MIZAN AMAN COLLEGE OF HEALTH
SCIENCE
DEPARTMENT OF CCN
Managing Community Health Service
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2. Chapter one
Understand health policy and service delivery system
Historical development of health service in Ethiopia
 The challenges through the process brought the
development and application of primary health care in
rural part.
 Ethiopia is a country with:-
 83% of its population living in rural areas and
 About nearly 80% of the disease that affect its population are
communicable disease that can easily prevented through the change of
behavioral practices.
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3.  Ethiopia previously had a health policy that focused
on curative and urban centered health services
until the government launched its new health policy
in 1993.
 During the past 15 years, the FMOH has built an
impressive frame work for improving the health for
all.
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4. There are also strategies on:-
 Free service for key maternal and child health services
 The training and deployment of HWs for promotion of
institutional delivery and Emergency surgery officers at
primary hospital to manage obstetric and other
surgical procedures.
 In recent time primary health service coverage
reached 92% of total population with 125 hospitals,
2999 health centers, 15668 health posts and >4000
private for profit and not for profit clinics
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5. Health policy in Ethiopia
 The first health policy in Ethiopia was developed in
1993 and it mainly focuses on prevention and control
of this communicable disease.
 Prevention and promotion components of health care
were given more attention by the new health policy.
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6. The main features of 1993 Health policy of Ethiopia include:
 Decentralization
 expanding the PHC system, and
 encouraging partnerships
 the participation of the whole community in health
activities.
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7.  The strategy of the policy has been to expand
healthcare delivery at the grass roots level through
implementation of the HSEP.
 The primary aim of the HSEP approach is to bring
health service delivery to the rural community at family
level where such a big percentage of the total
population lives.
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8. Organizational structure of health service delivery
In order to provide health services for the community in the
large the population and, Ethiopia used three
tier(organizational structure) system
1.Level one is a Woreda/District health system comprised of :-
 Primary hospital (to cover 60,000- 100,000 people),
 Health centers (15,000-25,000 population) and
Satellite Health Posts (3,000-5,000 population)
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9. The primary hospital, health center and health posts
form a Primary Health Care Unit (PHCU).
2.Level two is a General Hospital covering a
population of 1-1.5 million people.
3.Level three is a Specialized Hospital covering a
population of 3.5-5 million people.
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10. 12/26/2022
Specialized Hospital
3.5- 5 million
General Hospital
1-1.5 million
Primary hospital - 60,000-100,000
+
Health center – 15,000- 25,000
+
Five satellite health post – each 3,000- 5,000
Referral system
Primary health
care unit
PHCU
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11.  The bottom structure of health service delivery is networked
as 1 HC with 5 satellite health post.
 The five satellite health posts were mainly accountable for the
cluster health center.
 They identify problems together, map the problem together,
plan the cluster health problem together, implement and
evaluate together.
 This will strength the system and help the implementation of
preventive, promotive and curative health service in more
integrated and complete manner.
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12. Woreda Health Office
_____Cluster Health Center_________
HP1 HP2 HP3 HP4 HP5
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service
report
will
be
sent
for
the
woreda
through
the
cluster
health
center.
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13.  The referral system was also managed in such a way
that the satellite health post were refer their client for
further service for their cluster health center and if the
case is also above the ability of the health center then
the case will be referred to the primary hospital.
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14. 12/26/2022 Moges S 14

15. Primary health care (PHC)
 The essential health care that is universally accessible
to individuals and is acceptable to them with fulfilling
certain principles.
 It gained the world’s attention after the 1978
International conference on PHC held at ALMAATA.
 It focuses on disease prevention and health promotion.
 It is the type of health care delivery, can be described as
“by the people, of the people and for the people”.
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16.  Ethiopia is one of the countries in the world which has
adopted PHC as a national strategy since 1976.
 This strategy focuses on fair access to health services
by all people throughout the country, with special
attention on prevention and control of common
disease, self- reliance and community participation.
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17.  To achieve these principles of PHC the government of
Ethiopia started to decentralize the health service
delivery system from regional to woreda and kebeles
level since 1997 through vertical health program
approach.
 Vertical health program are centralized, non-
integrated and disease specific health programs.
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18. Principles of primary health care
 Accessibility (equal distribution).
 Community participation
 Health promotion
 Appropriate technology
 Inter-sectoral collaboration.
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19. Elements of Primary Health Care
 Education on health problems and how to prevent and control
them.
 Dev’t of effective food supply and proper nutrition.
 Maternal and child healthcare, including family planni
 Adequate and safe water supply and basic sanitation.
 Immunization against major infectious diseases.
 Local endemic diseases control.
 Appropriate treatment of common diseases and injuries.
 Provision of essential basic medication
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20. Health service extension program (HSEP)
 HSEP was a tool developed to effectively implement
primary health care unit in Ethiopia.
 It is an innovative, community- based programme that
was first introduced in Ethiopia in 2003.
 It is used to improve equitable access to mainly
preventive health service through community based
services by applying the five principles of primary
health care.
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21.  The principle behind this programme is to make the
community produce their health by themselves.
 is so an approach by which health services will bring to
the house hold level.
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22. CHAPTER TWO
PLAN,MANAGE,MONITOR AND EVALUATE HEALTH
SYSTEM
Management:-
 Is the process of directing,coordinating,and influencing the
operations of an organization so as to obtain desired results and
enhance total performance.
 is the process of forecasting and planning, leading, coordinating
and evaluating the resource of an organization in the efficient
and effective manner to achieve organizational goal.
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23. Who is the Manager?
 is the person who has the responsibility of achieving
certain outcomes having been given the authority to
utilize the resources of the organization.
 These resources consist of human, financial,
information and physical assets.
 a person who can organize people to work
harmoniously together and make effective use of
resources to achieve laid-down objectives.
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24. Concept and principles of management
Management is simply doing things through people.
 As a health workers you will involve in supporting
individuals to produce their own health, in doing these
job knowingly or unknowingly you practice
management in every daily activity.
 Concept of management is issue of:-
1.Effectiveness
 is how well an organization, or a person in an
organization is meeting their goal.
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25. 2.Efficiency
 is a measure of how well the health sector is using its
resource to achieve that goal
 Efficiency is the question of cost effectiveness.
3.Equity
 is a matter of distributing resources as well as service
for all segment of the population equally.
 Equity is a question of right, because every citizen has
a full right to get health service
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26. Principle of management
 Team spirit
 Division of labor
 Focusing on the result not activities
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27. Team spirit
 is creating an atmosphere of mutual trust and
understanding between members of a team so that you
can develop and ensure morale of your team member.
 In order to utilize resource among each individual of a
team member and get benefit of working as team, as
health extension worker you have to create a team
spirit.
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28. Division of labor;
 it is an act of distributing work, among all member of
the team in equal manner.
 So the role of you as a manager requires assigning a
balanced proportion of each type of worker to the work
to be done.
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29.  Focusing on the result not activities;
 is to make sure that everybody within the organization has
a clear understanding of the goals and objectives, and
 makes each person aware of their own roles and
responsibilities in achieving those objectives.
 Goals are the outcomes you intend to achieve.
 Objectives are the specific actions and measurable
steps that you need to take to achieve a goal .
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30. Management functions
 Planning
 Organizing
 Leading
 Coordination
 Monitoring and
 Evaluation
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31. Planning; it is forecasting and thinking about things
that you want to happen in the future and then working
to achieve that.
Organizing; is an act of assigning duties, grouping
tasks(put related tasks together) and allocating
resources for the planned activities.
Leading; is an act of directing, influencing and
motivating(alesasa alekaka) team members in that
community towards the plan to be implemented.
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32. Coordination; is an act of creating team spirit between
team members towards the set plan and activities to be
performed.
Monitoring is a regular observation and recording of
activities.
Evaluation is ensuring that the planned activities were
achieved.
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33. How can you build a team ?
 Team is two or more people who work together to
achieve a common goal.
 A heath team is a group of people who share common
health goal and common objectives determine by
community need to the achievement of which each
member of the team contribute in according to his or
her competent and skills and in coordination with the
function of others.
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34. Cont..
• Each member of the team contributes to the
achievement of the common goal.
Team comprises health promoters, model
households, community leaders respected
community members, representatives of varies
community associations.
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35. Team building is a process of selecting and creating a
team within a community.
Stages of Team building:-
Forming
Storming
Norming
Performing
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36. Management roles and levels
A health manager is someone who spends a substantial
proportion of their time managing areas of healthcare
provision such as:
 coverage of services (planning, implementation and
evaluation)
 resources (staff, budgets, drugs, equipment, buildings,
information)
 external relations with partners including service users.
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37.  A manager’s effectiveness is significantly influenced
by their insight into their own work.
 Health sector managers often become managers after
working in a technical role within healthcare.
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38. Management levels
In healthcare mgt there are 3 levels of managers:-
1) Top
2) middle, and
3) frontline.
 Together they are responsible for the work and
performance of the health sector.
 These managers have formal authority to use health
sector resources and to make decisions appropriate to
their level.
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39. Top-level managers
 called senior management or executives
 they hold titles such as Minister, Head of Regional
Health Bureau, and Director.
 make decisions affecting the entirety of the health
sector.
 do not direct the day-to-day activities of the sector;
rather, they set goals for the health sector and direct
others to achieve them.
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40. Middle-level managers
 are those in the levels below top managers.
 are responsible for carrying out the goals set by top
management.
 They also set goals at their level and perhaps for other
units they are responsible for.
 can motivate and assist frontline managers to achieve
the sector objectives.
 They may also communicate upwards, by offering
suggestions and feedback to top managers.
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41. Frontline managers
 are responsible for the daily management of health
activities in the community.
 are frontline managers of the primary health care
services
 they have a very strong influence on the sector and do
have to set goals for their own work.
 are the managers that interact most with the larger
community on a daily basis.
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42. What level of management is each of these ?
 Top level:-MOH,Head of Regional HB
 Midle level:-HC Director
 Frontline:-HEWs,HEPs
 Health Volunteer Has not managerial level.
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43. Planning health programme
Planning is the process of defining community health
problems, identifying needs and resources, establishing
priority goals, and setting out the administrative action
needed to reach those goals.
 It is also important to know why you need a health care
plan.
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44. Characteristics of planning
All plans in different situation share 3 different features:
 A good plan should give clear vision/mission, goal
and objective, a clear picture of the tasks to be
accomplished, the resource needed to accomplish the
tasks like human,material,money,time and information.
 Planning takes place at all levels.
 Planning must be collective undertaking; means
planning should involve different stake holders in your
work area.
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45. Types of Planning
1.Strategic planning
2.Tactical/operational planning/activity planning
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46. 1.Strategic planning;
 is the process of determining what an organization
intends to be in the future and how it will go there.
 It is finding the best future for your organization and
the best path to reach that destination.
 It is planned for long years like for example for five
years.
 It should be subdivided in to yearly plan.
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47. 2.Tactical/operational planning/activity planning
 is a short range planning that emphasize the current
operations of various parts .
 It is specific to mostly one year
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48. Stages of operational planning.
Once the Ethiopian FMOH sets a strategic plan, you
may be involved in the district (woreda) planning
process to develop operational plans for improving the
health of your community.
An operational plan outlines important answers to
such fundamental questions as:
 What needs to be done?
 How will it be done & Who will do it?
 By when must it be done &What resources are needed
to do it?
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49. Stages in planning process
 Situational analysis
 Problem identification and prioritisation
 Setting objectives
 Strategy formulation
 Identify and sequence activities
 Identify resources
 Prepare action plans and schedules
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50. SWOT analysis: is a strategic planning tool that matches
internal organizational strength and weakness with
external opportunities and threats a useful strategy for
achieving objectives will become evident.
S = strength of the organization
W= weakness of the organization
O = opportunities that an organization will have to
achieve that objective.
T= threats that an organization might face in the
implementation process.
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51. Manage resources at a Health facility
 An important aspect of your work at your health
service is getting the best use out of the supplies and
equipment that you are in charge of.
 The successful performance of your health service
activities will depend on using your resource in the
most efficien way.
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52. Implementing your Health Plans
Implementation is a central part of healthcare
management.
 It is the stage where you translate planned activities
into action.
 help you determine how best to use your group
activities and resources, and
 motivate members of your team to work in the best
interests of the health of the community.
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53. To do this you need basic skills and knowledge on
getting organised,
setting up activities,
finding resources,
building a team, and leading,
motivating and training that team.
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54. Getting organised
 is the first stage in bringing together the right
combination of human, physical and financial
resources to successfully undertake your planned
activities.
Organising is the means by which:-
 the right things are done (what)
 in the right place (where)
 at the right time (when) & in the right way (how)
 by the right people (by whom).
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55. Organising your team means
1.Organising activities:
 What is to be done and Where will the action take place?
 When will the action take place and What equipment is
needed?
 How will the activity be arranged?
2.Organising people:
 Which members of the health team will be involved?
 Who outside the health team will be involved?
 Who will do what and lead?
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56. 3.Communicating:
 Is all necessary information available?
 Has the information been communicated?
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57. Chapter -three
Lead and build individual’s and team’s capacity
Building a team
 A team is two or more people who work together to
achieve a common goal.
 A health team is a group of people who share common
objectives, determined by community need.
 Each member of the team contributes to the
achievement of the common goal.
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58. Types of health team
 Formal team :- are teams assembled to address a specific
problem or issue, or to achieve specific health goals. An
example of a formal team is a task force or committee.
 Informal team-emerge whenever people come together
and interact regularly; develop with the formal
organization.
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59. Four major functions of informal teams:
 Maintain and strengthen the norms (expected behaviour)
and values of members.
 Give members feelings of social satisfaction, status and
security.
 Help members communicate; create channels.
 Help to solve problems.
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60. Team building usually refers to the process of selecting
and creating a team within a community.
Stages of team building
 Forming
 Storming
 Norming
 Performing
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61. Forming
 The first stage in team development is the forming
stage.
 Team members get to know each other and find out
which behaviours will be acceptable to the rest of the
group members.
 Members establish initial rules and ways of working
with each other
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62. Storming
 Team members are encouraged to participate and
engage with the issues and decisions that are key to the
success of the community health team in achieving its
goals.
 It is the stage when health team members may
challenge, disagree with, and question one another.
 This stage can be uncomfortable for some members,
but it is an important stage in tackling problems
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63. Norming
 At this stage the team comes to an agreement on its
purpose and plans.
 Members are clear what their roles and responsibilities
are and how they fit into the team.
 The team has a sense of identity and tries to work
together
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64. Performing
 Group structure, norms and behaviour are understood
and accepted.
 Members know how to work with each other and can
effectively handle disagreements and
misunderstandings.
 Differences have minimised and members have dealt
with them.
 The group is now focused on accomplishing its
purpose.
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65. Leading a team
Leading is the management function that you will use
when influencing, motivating and directing people in
your team towards the achievement of your
organisational goals.
Different styles of leading a team.
 autocratic,
 anarchic and
 democratic
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66.  Autocratic leaders tend to be dictatorial, saying for
example ‘Do what you are told, and don’t ask
questions!’
 Anarchic leaders tend to say things like, ‘I don’t care
what you do, so long as you keep out of my way!’
 A consultative or democratic style is most suitable for
any team work that demands creativity and community
involvement
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67. Motivating a team
 Motivation of team members play an important role in the
success of any health plan for your community.
During motivation
 Involve teams in decisions
 Give members of the team the opportunity to grow and
develop new skills
 Provide team members with a sense of ownership
 Encourage new ideas, suggestions and initiatives.
 Celebrate individuals’ successes
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68. Training your team
Training as a means of solving health problems must
be closely related to work in the field, and to the
management of priority health problems.
Training a local health team is one of the health
profetinals responsibilities.
The quality of healthcare and its equitable distribution
in a population depends upon the staff employed by the
health services, and upon community members trained
with some knowledge and skills of health
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69. Conducting meetings
Meetings are a necessary part of the Health
Programme because meetings are the way in which
health teams communicate with people in their locality.
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70. When preparing for a meeting it is useful to plan the
following:
 Purpose of meeting
 Main subject matter
 Type of meeting
 Size of meeting
 Place, time and duration of meeting
 Who is convening and organising the meeting
 Announcement or information about the meeting.
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71. Purpose
to communicate information, others to exchange views
and ideas, and others to make decisions about plans or
activities.
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72. Have an agenda
Distribute the agenda to participants before the meeting
so participants can be prepared for the meeting.
Start on time and end on time
Every meeting should have established start and end
times.
Be sure to start your meetings at the appointed time and
run no longer than the end time
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73. Maintain focus
 Stay on topic and avoid the temptation to get diverted
by interesting but unproductive points of view.
 Stick to the topic and the timelines you set for each
item on the agenda.
Capture action points
 Have a system for capturing, summarising and
assigning action points to individual team members.
Get feedback
 Get feedback on your meeting management
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74. Monitoring and Control
Monitoring
 is about collecting information that will help you
answer questions about the health-related performance
of you and your team.
 is the regular observation and recording of activities
that will help you answer questions about your team’s
performance.
 It involves giving information to your supervisors and
managers about the health services that you are
providing.
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75. The purpose of monitoring
 Monitoring is very important in Primary Health Care
service planning and implementation.
 Determining whether the resources in the health
services are being well used.
 Ensuring that all activities are carried out properly by
the right people and at the right time.
 Ensuring that activities and tasks are performed in
accordance with set standards.
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76.  Identifying health problems facing the community and
starting to find solutions.
 Ensuring community groups and local individuals
participate appropriately in health activities.
 Understanding the health situation in your community
and how the health services are performing.
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77. Methods of gathering information for monitoring
You need to collect information from some of the sources
 Examining records: for example health service
records, financial and administrative records.
 Documentation: for e.g letters, reports, plans,
attendance lists, forms, invoices, receipts, minutes of
meetings and official reports.
 Continually observing work progress, staff
performance and service achievements.
 Discussing progress and any problems with staff and
with the community.
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78.  Information obtained from monitoring can be used to
identify day-to-day problems & for regular planning of
the health work in your community.
 It is essential to be aware of the significance of the
information you collect and to be confident of its
correctness.
 Records must be reviewed at regular intervals and
information must be verified
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79. Using a checklist
 is a set of criteria that you can prepare to assist you in
monitoring your own activities.
 A checklist can also be a record or a reminder of what
has been happening so that you can follow the
progress you are making.
 Is Used to observe performance and recognise
problems in work standards
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80. Supervision
 Monitoring information can also be gathered through
supervision.
 It is usually a meeting at which you are able to sit
down with a senior colleague and discuss issues that
are important in your work.
 It is way to make sure that your objectives
correspond(tesemama) to the health needs of your
community.
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81. A good supervision session is part of your monitoring work. It should help you understand
how your work is progressing and determine ways of helping if there are any problems.
(Photo: I-Tech/Julia Sherburne)
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82.  During supervision you can discuss, explain, justify,
and obtain the commitment of community workers to
the objectives of the programme.
 It makes sure that there are no divergences between the
objectives and the team’s standard of performance.
 It seeks solutions to any conflict that may have arisen
regarding the programme objectives.
 It is one way to discover how tasks entrusted(adera
sete) to different categories of worker are carried out,
and under what conditions
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83. Steps of managerial control
Control is a basic managerial function involving setting
standards, evaluating against standards and taking
corrective action.
 It is the process of regulating service activities
 It ensures that your health work is accomplished
according to agreed action plans.
 It is a process of ensuring that the work that you do
produces the desired results.
 Is a continuous activity
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84. Steps of managerial control
1) Establishing standards of performance
2) Measuring performance
3) Comparing performance with standards
4) Taking corrective action
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85. Establishing standards of performance
 first step in the control process
 must be established and expressed easily
understandable and the outcomes can be measured
without difficulty for people concerned
 standards of performance should be simple and
 capable of achievement with a reasonable commitment
of cost, effort and time.
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86. Measuring performance
 The second step in the control process.
 Measurement should b/n actual performance and
compare it with the standards.
 It can be done in quantitative or qualitative.
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87. Comparing performance with standards
 third step in the control process.
 summarise the outcomes as planned versus actual
results.
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88. Taking corrective action
 The fourth and final step in the control process.
 It involves those in management roles taking
appropriate decisions such as:-
re-planning or redrawing of goals or standards
perhaps changing the way that things are done
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89. Constructive and effective feedback
We all need feedback to help us improve.
If a member of your team does something well you
want to praise and reward them, but if they are
performing poorly you should let them know so they
can improve.
Try to be specific.
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90. Giving effective feedback
Feedback to individuals must be based on the evidence
gathered from the monitoring and controlling process.
Feedback must also be timely – it is no good giving the
feedback after the opportunity for improvement has
already passed.
If feedback is a routine part of management ,it should
become easier, with experience, to deliver feedback
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91. Effective feedback should be:-
 based on previously established performance goals/standards
 timely
 regularly given
 specific
 constructive
 motivating
 a routine part of your management function.
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92. Giving constructive criticism
Main steps Giving effective, constructive criticism:-
1.Provide feedback in a one-to-one meeting
 Give your feedback during a one-to-one, private session.
 Deliver the message in a single,focused conversation and
go directly to the point.
 E.g.‘I want to give you some feedback on your work,.….
 I want to help you to perform better in the coming
quarter,……
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93. 2.Be specific
Be specific about what’s wrong and how it can be
improved.
Constructive criticism should focus on specific actions
or behaviours that the person can change or do
something about
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94. 3.Reinforce the relationship
 Criticism needs to focus on an action or level of
performance, not on the person.
 Effective feedback requires direct, truthful
communication which will help build honest, open
relationships between you and your team.
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95. THANK YOU!!!!!
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