2. *
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At the end of the module the learner will be able
to:
LO1. Follow organizational guidelines, understand
health policy and service delivery system
LO2. Plan, manage, monitor and evaluate health
system
LO3. Lead and build individual‟s and team‟s
capacity
3. *
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1. Health care – is the total societal effort, undertaken in the
private and public sectors, focused on pursuing/improving health
2. Health services – are specific activities undertaken to
maintain or improve health
or to prevent decrements of health Can be preventive,
promotive, curative or rehabilitative in nature
3. Health service organization: Organizational structures
within which health services are delivered directly to consumers.
4. Health systems Are formally linked HSOs, possibly
including financial arrangements, joined together to provide
more coordinated & comprehensive health services
5. Community packages were packages that were given for
every community members
4. *
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5. Community packages were packages that were
given for every community members
6. Vertical health program are centralized, non-
integrated and disease specific
health programs
7. Effectiveness, it is how well an organization, or a
person in an organization is meeting their goal
8. Efficiency, is a measure of how well the health sector
is using its resource to
achieve that goal
9. Equity; it is a matter of distributing resources as well
as service for all segment of the population equally
5. *
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10. Team spirit; it is creating an atmosphere of
mutual trust and understanding
between members of a team
11.Division of labor; it is an act of distributing
work, among all member of the team in equal
manner
12.Planning; it is forecasting and thinking about
things that you want to happen in
the future and then working to achieve that
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6
* LO1. Follow organizational guidelines understand
health policy and service delivery system
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.
Samuel M.
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*
*Why history of public health?
i. To learn from the past experiences
ii. To understand the present situation
iii. To forecast the future conditions
iv. To recognize the dynamic transition in social,
economic and political factors and their
implication on human health.
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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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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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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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*
Decentralization
expanding the PHC system, and
encouraging partnerships
the participation of the whole community in health
activities.
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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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*
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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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.
15. 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
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Primary health
care unit
PHCU
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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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*
Cluster Health Center
HP1 HP2 HP3 HP4 HP5
service
report
will
be
sent
for
the
woreda
through
the
cluster
health
center.
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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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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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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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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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Principles of primary health care
Accessibility (equal distribution).
Community participation
Health promotion
Appropriate technology
Inter-sectoral collaboration.
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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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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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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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LO2 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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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
harmoniously together and make effective
resources to achieve laid-down objectives.
work
use of
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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
management in every daily activity.
Concept of management is issue of:-
1.Effectiveness
is how well an organization, or
organization is meeting their goal.
you practice
a person in an
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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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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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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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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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*
Planning
Organizing
Leading
Coordination
Monitoring and
Evaluation
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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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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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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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*
• 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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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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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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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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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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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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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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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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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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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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Types of Planning
1.Strategic planning
2.Tactical/operational planning/activity planning
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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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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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*
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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*
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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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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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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Implementing your Health Plans
Implementation is a central
management.
part of healthcare
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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To do this you need basic skills and knowledge on
Getting organized
Setting up activities
Finding resources
Building a team, and leading
Motivating and training that team.
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Getting organised
is the first
combination
resources to
activities.
together
stage in bringing
of human, physical
undertake
the right
and financial
your planned
successfully
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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*
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?
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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Is all necessary information available?
Has the information been communicated?
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*LO3 Lead and build individual’s and
team’s capacity
*Building a team
A teamis twoor more people who work
togetherto 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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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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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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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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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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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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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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*
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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Leading is the management function that you will use
when influencing, motivating and directing people in
your team towards the achievement
organisational goals.
Different styles of leading a team.
Autocratic
Anarchic
Democratic
of your
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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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*
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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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
74. 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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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.
76. Purpose
to communicate information, others to exchange views
and ideas, and others to make decisions about plans or
activities.
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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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*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 feed back on your meeting management
73
79. Monitoring and Control
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*
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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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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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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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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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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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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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.
86. 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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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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Control is a basic managerial function involving setting
standards, evaluating against standards and taking
corrective action.
Steps of managerial control
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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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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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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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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Comparing performance with standards
third step in the control process.
summarise the outcomes as planned versus actual
results.
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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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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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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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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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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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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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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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Samuel M. 100
NUMBER OF GROUP 15 submission on March 30
All groups in section A-E work should never been similar.
Group 1. Perform business plan for owning
different business
Group 2. Write briefly the policy of health in
Ethiopia during different seasons
Group 3. Write the drug policy in Ethiopia
Group 4. Write different strategies to implement
different health policy
