these are the general concepts of managerial science applied in public health

2. Contents
Definition of Public health
Administration
Management
Management process
Functions of manager
POSDCORB
Decision making
Training of health professional
Need of managerial skill in different field
References

3. Administration
• “Administration is the art and science of guidance,
leadership, and control of the efforts of a group of
individuals towards some common goal.”
• The term public administration refers to the
implementation of the public policy, which has been
laid down by the constitution and implemented by
the government.
• Public administration derives authority from the
authority of state and make use of laws, rules and
regulations, and laid down procedure.

4. Health Administration
Sound administration is essential for the success of
any public health program whether on the national,
intermediate or the local level.

5. Definition of Sound Administration
We can define sound administration as:
“ The process of achieving defined goals at a defined
time through the guidance, leadership, and control of
the efforts of a group of individuals and the efficient
utilization of non-human resources bearing in mind
adequacy, speed, and economy to the utmost possible
level.”

6. Bureaucratic Administration
The dictionary meaning is: A government
characterized by specialization of function, adherence
to fixed rules, and a hierarchy of authority.
The selection of individual for employment and for
promotion is made based on stated criteria and
technical competence.

7. Contd…
Administration is a business of government while
management is administration of business.
Attempt is made in bureaucratic administration to make
public administration predictable, rational and
appropriate and technically sound, getting rid of personal
whims and fancies.
The theoretical expectations do not usually persist in
reality so that as it actually exists, bureaucracy provides
examples of undesirable organizational characteristics.

8. Management
Management is the operational part of
administration.
It is defined as:
“ It is a set of interactive processes through which the
utilization of resources results in the accomplishment
of organization objectives.”
It is a “conversion mechanism”.

9. Process
Inputs Outputs
A systems view of management:
Human resources
Non-human resources
Conversion
mechanism Objectives
achievement

10. It is through “management” that the objectives of the
health care organization are achieved by gathering
and positioning of resources.
There are several elements for administration and
management. In practice all these elements are
interrelated to one another.
There are also 3 levels of administration.

11. Management Process
1. To define aims and objectives.
2. Strategic, tactical and operational planning.
3. Obtaining material, human and financial resources.
4. Organizational structure, behavior.
5. Definition of task of individuals, groups and
organization for making effective use.

12. Contd…
6. Managing work relationship by motivation,
delegation, supervision, team building etc.
7. Scanning the object being managed.
8. Identifying problems to assess their significance.
9. Developing and enlarging skills and capabilities.
10. Monitoring, control and evaluation.
11. Self management, time and stress management.

13. Functions of Manager
To define goals and specific objectives to be achieved.
To set priorities and to plan.
To organize formal structure.
To staff the organization.
To ensure necessary training.
To direct the working.

14. Contd…
To coordinate functions.
To establish effective communication.
To motivate individual.
To monitor, control and evaluate performance.
To develop staff and organization.
To budget the financial needs.
 To make decisions.
To supervise work.
To improve, develop and advance

15. POSDCORB(function/element of
management or administration )
It means:
Planning,
Organizing,
Staffing,
Directing,
Coordinating,
Reviewing and
Budgeting.

16. Planning
Planning has to be done to decide how to go about it,
breaking a job into several component activities,
deciding their sequence, which person will do what,
when, etc.

17. Organizing
The plan has to be carried out by organizing
resources, which comprises of personnel, materials,
vehicles etc.

18. Staffing
The staff is normally in place, and the responsibility
of filling up vacant position lies with senior
management.

19. Directing
The manager directs the working of the staff.
 Instructing what is to be done by each of them.
Keeping a watch on their performance
Giving them guidance as they are being supervised

20. Coordinating
The activities of different persons have to be
coordinated, so that these are mutually supportive.

21. Reviewing
The process of keeping an active watch on the way
things is going, to detect undesirable departure and
immediately take remedial actions.

22. Budgeting
Involves act of managing finance
Breaking down of each component activity into
valuable monetary form.

23. Levels of Management
Central
level
Intermediate
level
Local Level
Ministry of health
Directorates of health
e.g. health office,
Hospital, health
care unit

24. Contd…
Top management:
Its function are :
• the establishment of formal organizational structure
• recruitment of staff
• laying down general personnel policy
• the formal training programmes.

25. Middle and Lower
Management
Its functions are:
Direction of working
Coordination
Communication
Motivation
Conflict resolution
Monitoring and evaluation

26. Decision Making
Everyone does decision making where one of the
alternative courses of action is chosen, which is known as
Personal Decision.
The decision made by administrator or manager is
organizational decision and everyone recognizes this
decision making function because it is very obvious.
A situational thinking is to be done at the time of decision
making, drawing on past experience, knowledge, expert
advice.

27. Steps for Decision Making
• Problem recognition
• Problem identification
• Specification of decision objective
• Situational analysis
• Identification of alternative actions
• Selection of most appropriate actions
• Implementation
• Monitoring and feedback
• Evaluation

28. Management Training of Health
Professional
The necessity of education and training of medical
manpower for better administration of health services has
been accepted as necessary.
A public health manager needs training, which is tailored
to the job requirement.
This implies suitable amalgamation of the relevant aspects
of several academic disciplines, requirements of
management responsibilities and the needs of health
program and service.

29. Training Institutions
All India Institute of Hygiene and Public Health,
Calcutta.
Medical colleges primarily offering undergraduate
medical education, carry out training of public health
professional.

30. Contd…
Public Health Foundation of India is a recent
development.
It is an autonomous Public Private Partnership.
Beside a grant from Government of India, it has
received substantial donations from a number of
trusts, philanthropists, high network individual.

31. Assessment of training needs
N.I.H.F.W., Government, collaboration with
multilateral and bilateral organization had carried out
research and found list of management problems and
training needs at block, district, state and central
level.
The approaches adopted to identify needs are:

32. Contd…
1. Analysis of job functions of different personnel to study the
component of management in their job.
2. Interviewing of the personnel to determine how they manage
their various functions.
3. Observing the actual working of the personnel to know how
they manage their functions.
4. Discussion with state, district and PHC level staff in a
workshop to identify health management training needs for
primary health level staff.

33. Needs of health services
The activities of district and PHC level were adhoc
and lacked planning, supervision consisted fault
finding and record keeping.
Suitable training programs along with other actions,
could lead to improvement.

34. Needs of the hospital management
 The general climate of employees who are conscious
of their rights, deriving strengths from union, but not
knowing responsibilities has hampered smoothness of
private hospitals.

35. Contd…
The hospital service also includes hotel services and these
are not the professional service of doctors and nurses.
But, the medically qualified hospital administrators are
not willing to yield an inch to make it possible for the
people incharge of the hotel services to do their job.
There is an immediate need for including administrative
and management aspects in various training curricula.

36. Need for primary health care
Political skill and capacity for leadership
The understanding of health needs and programming of
health care
The provision of finances and the efficient use of resources
Teaching, supporting, supervision and collaborating with
the health workers and community.
The organization and coordination of activities.

37. Needs of project management
A project is temporary endeavour undertaken to
create unique product.
The planning and implementation of health projects
requires management practice.
Project management is the application of knowledge,
skills, tools and techniques to project activities in
order to meet stakeholders needs and expectation
from a project.

38. Contd…
The project management is concerned with various
aspects of requirement of resources like staff, fund,
equipment for timely successful completion.

39. Limitations of training
Only 33% of the trainees were able to organize new
activities or improve performance of already existing
activities.
This low effectiveness may be due to prevailing
administrative system.
Follow-up period may be short.
Difficulties in adaptation of micro to macro level
Socio-cultural factors

40. Problems of Adaptation In Health Field
Adaptation of managerial practices to
governmental and non- governmental
organizations in health field has given useful
results.
It has also indicated certain differences in the
methods of management as applied business in
private sector and to health care in public
administration

41. Reasons Posing Problems In Application
To Health Care Field
1. Acceptance by public administration.
2. Difference in developmental and routine activities.
3. Micro level to macro level adaptation.
4. Type of activities.
5. Socio - cultural factors.
6. Others problems.

42. Acceptance By Public Administration
Health care services in India, as in other
developing countries, are mostly governmental
concern.
In some ways governmental departments are
comparable to well-run big companies. Both have
worthy goals; well-designed rational processes,
and effective leaders.
The experience of management of complex
organizations, either manufacturing goods or
providing services, has limitation in duplication of
public administration.

43. The governmental policies, programmes and
services are subject to influence by a different and
far more complex set of factors with social,
political and economic dimensions.
The health sector activities are but part of the
total governmental activities and cannot be
considered in isolation.

44. Difference In Developmental and Routine
Activities
There are difference in managing organizations
for development and for carrying out routine
tasks.
The attitudes required for goals are radically and
entirely different.
Success with managing routine, predictable
activity does not guarantee success in
developmental activities, which require different
attitudes.

45. Micro Level to Macro Level Adaptation
Many problems crop up while transferring lessons
learnt in micro level projects to macro level for
general use.

46. Type of Activities
Difficulty crops up in the nature of the object being
managed in health care organization.
Health system is for service and not for production of
goods.
Conceptual problems come up in the definition and
measurement of health or morbidity.
There is a multiplicity of criteria for measuring them.
The interrelationship between determinants of health
is complex and cannot be known with certainty.
It is difficult to single out the influence of a specific
factor.

47. Further problems come up in the application of
economic analysis.
There are difficulties – emotional, conceptual,
methodological and practical – on placing
monetary value on health.
The cost benefit and cost effectiveness type of
analyses are difficult to apply, as the output of
health interventions is difficult to measure.
The lead time in many health projects is long, i.e.,
a long period will have to elapse between starting
of a facility, service, health educational drive or
programme and its measurable impact.

48. Socio – cultural Factors
In transferring western management without
modification to oriental situations, certain difficulties
are likely to be faced.
The materialistic outlook of the western societies
cannot be presumed to be a motivating factor in all
situations.
The value placed on work is different, the priorities
are different, and the influence of certain religious
and social factors is sometimes unpredictable.
Even the value placed on time is not found to be the
same in different societies.
The common Indian fatalistic attitude poses
problems in the operation of certain incentives and
disincentives for efficient working of organization.

49. Other Problems
Health institutions do not manufacture and
supply health to consumers.
They provide services, the impact of which on
health of individuals and communities may be
direct or indirect and immediate or delayed.
The demand for health services is mostly
generated by health service itself.
As distinct from business enterprises, there is a
lack of market forces operating.

50. The public participation is essential, both for
utilization of service and for regulation of
standards of care.
A strong and well informed public pressure is
essential as the society is both the provider of
resources and potential beneficiary.
Such public pressure is usually lacking, especially
in the rural area. Urban elite may be vocal, critical
and well attended.

51. Organizational Structure
Organization is defined as collection of
individuals seeking a common goal. It denotes a
group of individuals working purposefully at
different levels of authority and specialization for
achievements of common objectives in an orderly
coordinated fashion
It may be small, comprising of a few individuals
or large, made up of thousands of individuals.

52. Tall Organizations
Usually government departments, are “tall”, they
contains large number of levels and a long chain
of commands.
In tall organization, also sometimes called as
deep organizations, there is a place for individuals
of different capacities.

54. Disadvantages of Tall organization
It hamper speedy decisions as the decision
making is passed upward.
The organization tends to be inefficient.
Discourages individual initiative and requires
more supervision.

55. Flat Organization
In a flat organization the levels in the hierarchy
are limited.
These are more or less independent, but working
within the set common policies and goals of the
organization. Such an arrangement permits
getting over the drawbacks of tall organization
structure.

56. 1. Top at central / state levels.
2. Middle at regional /district / sub district levels.
3. Field at primary health centre / sub centre and
village level.
LEVELS OF
ORGANIZATION

57. The union of India is a federation consisting of a
number of states bound together by the
provisions of constitution, which has given
specific responsibilities and powers to individual
states and to the Federal Authority, viz, the
central government.
The GOI act 1935 introduced for the first time the
three lists viz, central list, provincial list and
concurrent list.
The 3 lists are enumerated under article 246 in
the 7th
schedule of constitution as List I (Union
list), List II (State list) and List III (Concurrent
TOP LEVEL

58. List I (Union list):- parliament alone has the
right to legislate in respect of subjects.
List II (State list):-the state legislatures have the
exclusive right, except under certain conditions,
to make laws in respect of subjects.
 List III (Concurrent list):- both the parliament
and the state legislature may make laws.

59. Top level is highest, i.e., apex of the health
services fully carrying out all the necessary
managerial function related to the services, e.g.,
policy, strategy, planning, coordination,
monitoring, evaluation, etc.
The top level comprises of two components:
policy making and programme formulation.

60. Middle management is rather non-specific and
denotes all intervening levels in the organization.
The function at his level is partly technical–
professional and partly managerial.
The term middle level of management should be used
in relation and with reference to the functions carried
out.
The middle level manager will have responsibility
involving supervision, control; and direction, decision
making, monitoring and evaluating the programmes.
Depending upon the organizational pattern the
middle level management may be divided into upper
middle level (district level officers) and lower
middle level (medical officers at sub district level
MIDDLE LEVEL

61. At regional / circle / zonal / divisional level,
which is in between the state head quarters and
district levels, separate officers exist in most
states.
Such an officer takes direction, guidance and
supervision to the civil surgeon and DHO.
REGIONAL LEVEL

62. AT DISTRICT LEVELAT DISTRICT LEVEL
DISTRICT HEALTH
OFFICER
DISTRICT HEALTH
OFFICER
DISTRICT CIVIL
SORGEON
DISTRICT CIVIL
SORGEON
DISTRICT FAMILY
WELFARE OFFICER
DISTRICT FAMILY
WELFARE OFFICER

63. In some states there is a sub divisional officer,
apart from the one looking after hospitals, who
looks after the public health activities and
supervises te rural health centers.
In some states at this level the MO of taluka
hospital has also been given certain public health
activities.
SUB DISTRICT LEVEL

64. The pattern of staffing is generally uniform
according to GOI pattern.
They may exercise the control of the PHC in
districts where zilla parishads and panchayat
samitis are functioning.
Subcentres.
PRIMARY HEALTH CENTRE LEVEL

65. The field level can be again divided into the first
supervisory level and the frontline, peripheral or
grass root level.
Supervisory level comprise Health Supervisor /
Assistance.
At the frontline, peripheral or grass root level –
ASHAs , Anganwadi Workers, trained dais, etc
FIELD LEVEL

66. References:
Sathe VP . Epidemiology and management for health
care for all. 3rd
edition; page 78-85.
Park K. Textbook of preventive and social medicine.
20th
Edition; page 773-775.
http://nurfac.mans.edu.eg/files/ /ppp_Management.
Retrived on 18-9-2014.