BCM 426: HEALTH SYSTEMS MANAGEMENT (3 UNITS)

Management, Planning, Implementation and Evaluation of Health Services and Research

Important concepts
Manage- Is to focus and plan, organize and command to control.
Plan- To foresee and provide means of examining the future and drawing up the plan of action. Also
means, to decide in advance that is to be done, set goals and design ways of achieving them- effective
use of time, decision making.
Organize- Building up the structure of human and material, through organizational culture- to ease
productivity through believes and value i.e reporting on time etc
Command/Direct/lead- Building together unifying and harmonizing all activities and efforts. achieved
through; empowering to improve quality, motivation of employees, effective communication and staff
development to maintain competencies.
Control- Seeing everything occur in conforming with established rule and expressed demands-
evaluation

What is management?
Management is the art of getting things done through and with people in order to achieve stated
organizational objectives.
Management is also the systematic process involving planning, organizing, staffing leading and
controlling the efforts of organizational members and using all other resources to achieve stated
organizational objectives.

There are six main resources in an organization (6M)

1. Money
2. Manpower
3. Machines
4. Materials
5. Management (methods)
6. Minutes (time
Management is also defined as the process by which resources are mobilized, combined and
coordinated to effectively to achieve organizational objectives.

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It is a process that utilizes organizational resources in the most effective and efficient manner, in order
to attain stated organizational objectives.
• Efficiency in management refers to optimal utilization of organization resources with minimal
wastage. It is also the relationship between achieving objectives and consumption of resources.
• Effectiveness refers to attaining specific organizational goals that are timely and challenging. It
is also an outcome measure of the interventions that improve people’s health under ordinary
circumstances and in ordinary settings.

Management versus Administration:

Administration is part of management work but more concerned with execution. A manager is said to
be performing administrative work when he/she is involved in interpreting policies of the organization
and putting into plans and having those plans implemented. At every level of management, managers
perform some work which involves execution or “doing” which is one that completes the
administrative process. Therefore, administration is the total of planning, organizing, controlling,
coordinating and also operating work.

Who is a manager?
This is an individual employed by an organization who is responsible and accountable for efficiently
accomplishing the goals of the organization. Managers focus on coordinating and integrating resources
using the functions of planning, organizing, supervising, staffing, evaluating, negotiating and
representing
Characteristics of a manager
 Managers have assigned positions within a formal organization.
 They have legitimate source of power due to delegated authority that accompanies their
position.
 They direct willing and unwilling subordinates.
 Since managers work in a formal organization, they have a greater formal responsibility and
accountability for rationality and control than leaders.
 They are also expected to carry out specific functions, and responsibilities.
 Managers also manipulate people, the environment, money, time, and other resources to
achieve organizational goals

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Levels of management
Managers work at various levels in an organization. The number of levels will depend on the size of
the organization. Generally, three levels of management are used.
1. First level management
Also referred as first line managers and they are responsible for supervising the work of non-
managerial personnel and the day-to-day activities of a specific work units or ward. They are the
lowest level. In a hospital setting these would include, ward In-charge. They are responsible for
clinical practice, assigning staff to patients, interfacing with the public, patient care delivery, personnel
development, ensuring compliance with regulatory and professional standards, maintaining discipline
and motivating staff to achieve the organizational goals. First level managers are also responsible for
fostering inter-disciplinary, collaborative and strategic planning.
2. Middle level Management
The middle level managers supervise a number of first level managers usually with related specialties
or in a given geographical area. They have a 24hr responsibility for their defined area.
 Typically, middle level managers act as liaison between upper management and first level
managers. They are responsible for implementing the policies and plans developed by top
managers. They also supervising and coordinate the activities of first line managers.
 A middle level manager maybe referred as a supervisor, director or assistant director. This
group constitutes the largest group of managers.
3. Upper-level management (top managers)
This refers to top executives (such as Chief Nurse, Chief Clinical Officer) to whom the middle
managers report. They are responsible for establishing organizational goals and strategic plans for the
entire organization and operating policies for the entire division of nursing.

They also ensure integration of work units to achieve the organization mission and buffering the
effects of the external environment on workers within the organization. Top managers are relatively a
small group

Managerial Skills
Different types of skills are required to manage an organization effectively. These skills have been
classified into three categories namely:
a) Technical,

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 b) Human and
c) Conceptual skills.
Though the above skills are necessary at all levels of management, their importance vary according to
ranks. Technical skills are important at lower level whereas conceptual skills are important at top
levels.
a) Technical skills
Technical skills refer to the ability and knowledge in using the equipment, technique and procedures
involved in performing specific tasks in a specialized field. Technical skills are important in order to
accomplish or understand the specific kind of work being done in the organization.

b) Interpersonal/human skills
Human skills consist of the ability to work effectively with other people both as individuals and as
members of a group. These are required to win cooperation of others and to build effective teams.
Such skills require a sense of feeling for others and capacity to look at things from others point of
view. Managers interact with people within and outside the organization and therefore require these
skills to assist them communicate with, understand and motivate individuals and groups

c) Conceptual skills
This is the ability to see the organization as a whole, to recognize significant elements in a situation
and to understand the relationships among elements. It is a cognitive ability to coordinate and integrate
all of an organization’s activities. They allow managers to think in the abstract and strategically so as
to see the big picture and to make broad based decisions that serve the overall organization.
Conceptual skills also include the competence to understand a problem in all its aspects and to use
creative thinking in solving the problem
Functions of Management
 Planning: It is the first and foremost function of management, i.e. to decide beforehand what is
to be done in future. It encompasses formulating policies, establishing targets, scheduling
actions and so forth.
 Organizing: Once the plans are formulated, the next step is to organise the activities and
resources, as in identifying the tasks, classifying them, assigning duties to subordinates and
allocating the resources.

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  Staffing: It involves hiring personnel for carrying out various activities of the organization. It
is to ensure that the right person is appointed to the right job.
 Directing: It is the task of the manager to guide, supervise, lead and motivate the subordinates,
to ensure that they work in the right direction, so far as the objectives of the organization are
concerned.
 Controlling: The controlling function of management involves a number of steps to be taken to
make sure that the performance of the employees is as per the plans. It involves establishing
performance standards and comparing them with the actual performance. In case of any
variations, necessary steps are to be taken for its correction.

Management Roles
Henry Mintzberg (1973) identified ten management roles which he placed in three categories:
i. Interpersonal role,
ii. Informational roles and
iii. Decisional roles.
i) Interpersonal roles:
 Figure head role: symbolizes the organization or department and performs ceremonial duties
 Leader: determines the Mission and Objectives of the organization and sees that they are
accomplished effectively. He hires, trains and motivates employees and encourages them to do
better
 Liaison role: Involves networking with outside organizations, expanding information sources,
like conferences, professional meetings etc. Acts as a link between people, groups or
organizations within and without the organization
ii) Informational role:
 Monitor: As a monitor, the manager informally seeks information about the organization
through internal networks, gossips, and observations. (Get information useful to organization).
He/she tours of the organization and holds formal and informal meetings to provide
information about the needs of the organization
 Disseminator: A manager is a link in the organization chain of command. He shares
information from outside the organization and between work units (sharing information
improves job satisfaction)

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  Spokes person: The manager shares information with individuals outside the organization,
attends meetings, offering continuing education and participates in professional organizations

iii) Decisional Roles:

 Entrepreneur: The manager looks for profitable investments for the organization to improve its
performance (start a school of nursing)
 Resource allocator: Managers schedule their own time (work plan). They decide how resources
are distributed and with whom he will work most closely with.
 Negotiator; Enters into negotiation with other parties e.g. to enter into a long term relationship
with a supplier
 Disturbance handler: Responds to unforeseen circumstances eg. Replacement of a sick staff,
missing equipment, disease outbreaks (shift staffs)

PLANNING
Definition: Planning is the fundamental management function, which involves deciding beforehand,
what is to be done, when is it to be done, how it is to be done and who is going to do it. It is an
intellectual process which lays down an organization’s objectives and develops various courses of
action, by which the organization can achieve those objectives. It chalks out exactly, how to attain a
specific goal.
Planning is nothing but thinking before the action takes place. It helps us to take a peep into the future
and decide in advance the way to deal with the situations, which we are going to encounter in future. It
involves logical thinking and rational decision making.
Characteristics of Planning

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1. Managerial function: Planning is a first and foremost managerial function provides the base for
other functions of the management, i.e. organising, staffing, directing and controlling, as they
are performed within the periphery of the plans made.
2. Goal oriented: It focuses on defining the goals of the organisation, identifying alternative
courses of action and deciding the appropriate action plan, which is to be undertaken for
reaching the goals.
3. Pervasive: It is pervasive in the sense that it is present in all the segments and is required at all
the levels of the organisation. Although the scope of planning varies at different levels and
departments.
4. Continuous Process: Plans are made for a specific term, say for a month, quarter, year and so
on. Once that period is over, new plans are drawn, considering the organisation’s present and
future requirements and conditions. Therefore, it is an ongoing process, as the plans are
framed, executed and followed by another plan.
5. Intellectual Process: It is a mental exercise at it involves the application of mind, to think,
forecast, imagine intelligently and innovate etc.

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 6. Futuristic: In the process of planning we take a sneak peek of the future. It encompasses
looking into the future, to analyse and predict it so that the organisation can face future
challenges effectively.
7. Decision making: Decisions are made regarding the choice of alternative courses of action that
can be undertaken to reach the goal. The alternative chosen should be best among all, with the
least number of the negative and highest number of positive outcomes.

Planning is concerned with setting objectives, targets, and formulating plan to accomplish them. The
activity helps managers analyse the present condition to identify the ways of attaining the desired
position in future. It is both, the need of the organisation and the responsibility of managers.

Importance of Planning

 It helps managers to improve future performance, by establishing objectives and selecting a

course of action, for the benefit of the organisation.
 It minimises risk and uncertainty, by looking ahead into the future.
 It facilitates the coordination of activities. Thus, reduces overlapping among activities and
eliminates unproductive work.
 It states in advance, what should be done in future, so it provides direction for action.
 It uncovers and identifies future opportunities and threats.
 It sets out standards for controlling. It compares actual performance with the standard
performance and efforts are made to correct the same.

Planning is present in all types of organisations, households, sectors, economies, etc. We need to plan
because the future is highly uncertain and no one can predict the future with 100% accuracy, as the
conditions can change anytime. Hence, planning is the basic requirement of any organization for the
survival, growth and success.

Steps involved in Planning

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By planning process, an organisation not only gets the insights of the future, but it also helps the
organization to shape its future. Effective planning involves simplicity of the plan, i.e. the plan should
be clearly stated and easy to understand because if the plan is too much complicated it will create
chaos among the members of the organization. Further, the plan should fulfil all the requirements of
the organization.

IMPLEMENTATION

It involves work and activities aimed at achieving the goal. That is putting into action the planned
activity. Implementation efforts can be done by a person or a group who established the goals or
objectives or may be shared with or even delegated to others.

Roles during implementation

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 1. Change agent- to gather and analyze facts and implementing programs.
2. Change partner- takes the role of an enabler, catalyst
3. Teacher- of problem solving skills
4. Activist advocate

Implementation mechanism

They are the modes or vehicle’s by which innovations are transferred from the planner to the
consumer. Change on behave of the consumer/client requires multiple implementation mechanism e.g

• Use of small interactive groups

• Use of lay advisors- chiefs, church leaders, women groups e.t.c
• Can use mass media,
• Health policies e.t.c

EVALUATION

It is the appraisal of the effects of the organized activity or program. It may involve the design and the
conduct of evaluation research in which social science methods are used to determine program
effectiveness, efficiency, adequacy, appropriateness and intended consequences.

Evaluation may also involve a more elementary process of assessing progress by constructing
objectives and the results.

Evaluation begins in the planning phase, when goals and measurable objectives are made and goal
attaining activities are identified

CHALLENGES FACING THE HEALTH SECTOR

 Insufficient skilled human resources. Moreover, there is mal-distribution of the
available health personnel, with some rural dispensaries being unmanned.
 Inadequate budgetary allocations, poor infrastructure, materials and high prevalence
of poverty prevents targeted populations from accessing services such as ITNs and

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inadequate emergency facilities. Eg. The health sector received 8.4% of the total
Government budgetary allocation in 2008/09 financial year, which is lower than the
Abuja Declaration target of 15%.
 The lack of national policy framework and identification of specific programmes to
enable accessibility of reproductive services by young People.
Slow reduction in maternal mortality rates, which have a direct relationship with the
health of the children.
The low cost and apparent improved service provision has increased utilization of
services in public health facilities, which has had a negative impact on services ofered
by other service providers, especially the Faith Based Organizations. This is inspite of
the fact that a total of 70 doctors and 379 nurses have been seconded to the Faith Based
Organizations.
 Assessment of some of the performance targets and indicators such as
infant and under-five mortality through field surveys are conducted
several years apart
Weak management systems including strengthening of decentralization of
healthcare systems.
Sustained availability of required supplies and equipment.
Establishment of a viable and sustainable national health insurance
system to improve access to healthcare services, particularly for the poor
and vulnerable.

LEADERSHIP

Definition of Leadership
• Leadership as the art of motivating a group of people to act towards achieving a common goal,
It is also the process of persuading and influencing others towards a goal.

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Definition of a leader
• A leader is the person who influences and guides direction, opinion, and course of action. Also
a leader is anyone who uses interpersonal skills to influence others to accomplish a specific
goal (good or bad).
Characteristics of a leader
• Leaders often do not have delegated authority but obtain their power through other means, such
as influence.
• Leaders may or may not be part of the formal organization.
• Leaders focus on group process, information gathering, feedback, and empowering others.
• Leaders emphasize interpersonal relationships.
• Leaders direct willing followers.
• Leaders have goals that may or may not reflect those of the organization.
• Often do not have delegated authority
There are two types of leadership
• Formal leadership – Is practiced by a person with legitimate authority conferred by the
organization and described in a job description who is a manager.
• Informal leadership – Is exercised by a staff member who does not have a specified
management role. Informal leadership depends on one’s knowledge, status and personal skills
in persuading and guiding others
• This implies that, all managers are formal leaders while not all leaders are manager because we
have seen that there is informal type of leadership and managers work in a formal organization
• ASSIGNMENT
List five differences between the characteristics of a leader and a manager (10marks)
 A manager manages and takes responsibility of a situation. A leader takes charge, is
influential, and sets an example.
 The manager has responsibilities and is able to delegate and implement plans. A leader is
an example for others and is someone who doesn’t necessarily have a large responsibility.
 Managers have subordinates who follow their rules. Leaders have individuals who believe
in what they say, otherwise known as followers.
 Leaders focus on human emotion and charisma to lead. Managers focus on concise,
scientifically proven methods to lead

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  Managers are process focused but leaders are people focused. Leaders always think about
their teams and give importance to their growth because a good leader knows that once his/her
team grows, the business grows too.
 Managers supervise their team but leaders coach them. Leaders don’t micromanage their team but
instead guide them towards the vision when necessary.  A leader influences his subordinate to
achieve a specified goal, whereas a manager is a person who manages the entire organisation.
 A leader possesses the quality of foresightedness while a manager has the intelligence
 A leader sets directions, but a manager plans details.
 A manager takes decision while a leader facilitates it.
 A leader and the manager is that a leader has followers while the manager has the employees.
 A manager avoids conflicts. On the contrary, a leader uses conflicts as an asset.
 The manager uses transactional leadership style. As against this, transformational leadership
style is used by the leader.
 Leaders promote change, but Managers react to the change.
 A leader aligns people, while a manager organizes people.
 A leader strives for doing the right things. Conversely, the manager strives for doing the right
things.
 The leader focuses on people while a manager focuses on the Process and Procedure.
 A leader aims at the growth and development of his teammates while a manager aims at
accomplishing the end results.
HUMAN RESOURCE MANAGEMENT

Introduction
• The greatest asset of health care organizations is the collective and individual knowledge and
intelligence of their employees and nurses/clinical are among the health care providers called
“Knowledge workers” because the services they provide is based on specialized expertise and
complex decision making hence the importance of investing in human resource.

HUMAN RESOURCE MANAGEMENT CONCEPTS

Human Resource Management

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 • Human resource management (HRM) is the strategic and coherent approach to the
management of an organization's most valued assets - the people working there who
individually and collectively contribute to the achievement of the objectives

Human Resource: This is any individual employed by the organization

• Performance management: All that mediates the interactive process between work motivation
of the individual the performance rewards and development opportunities provided by the
organization (Frank 1998).
• Staff development It’s the process of orientation, in-service education, and continuing
education to promote the development of personnel within any employment setting consistent
with the goals and responsibility of the employer (Refers to both professional and non-
professional staff)
• Orientation: Introducing new staff members to the philosophy goals, policies, procedure’s role
expectations, physical facilities, and special services in a work setting
• In-service education: Learning of experiences provided in the work setting to assist staff in
performing their assigned functions
• Continuing education: Educational programmers’ that consists the concepts, principles,
research or theories related to profession that build on previously acquired knowledge, skills
and attitudes
• Strategic Human Resource Management: This is the linking of HRM strategic goals and
objectives in order to improve business strategy. That strategy then provides the framework
that guides the design of specific HR activities such as recruiting and training
HUMAN RESOURCE MANAGEMENT PROCESS
The following are the techniques required for Human Resource Management
1. Conducting a Job analysis determining the nature of each employees Job
2. Planning labor needs (HR Planning) and recruiting Job candidates
3. Selecting Job candidates
4. Orienting and training new employees
5. Managing wages and salaries (compensating employees)
6. Providing incentive sand benefits
7. Appraising performance
8. Communicating (interviewing, counseling, disciplining)

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9. Training and development
Human Resource planning
 Human resource planning is the process of identifying the member’s skills, occupational
categories, and performance and development needs of personnel in an organization.
 This identification has to be linked to the strategic plan of the organization. While the strategic
plan of the organization is to identify the future direction in the organization, the objective of
human resource planning is to ensure that the organization will always have the right people in
the right places to do the work required by the organization.
 It consists of forecasting human resource needs, forecasting the availability of human resources
and matching supply and demand for personnel
 In planning, consideration must be given to:
I. The type of patient care management used
II. The education and knowledge level of staff to be recruited
III. Budget constraints
1V. The historical background of staffing needs
V. The diversity of the client population to be served
Principles of effective human resource plan
i. The plan should be as detailed as possible
ii. Plans should not extend too far into the future, as accurate prediction of the distant future is not
always possible
iii. All alternative courses of action should be considered
iv. Implications of the actions envisaged should be assessed
v. Instructions to individuals and departments must be incorporated into the plans
vi. Plans should be concise and easy to understand

Recruitment process

1: Defining requirements:
Categories and number of people required should be specified in the recruitment programme derived
from human resource plan.
The department in which the recruit will work must draft or revise a comprehensive job specification
and job description (from job analysis) for the vacant position, outlining its major and minor

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responsibilities; the skills, experience and qualifications needed; grade and level of pay and particulars
of any special conditions attached to the job (temporary, permanent, contract, shift duty).

2. Attracting candidates:

After defining requirements then the job is advertised. This involves reviewing and evaluating
alternative sources of applicants inside and outside the company. First consideration should be given
to internal candidates, then advertising and outsourcing.

3. Selection of candidates:

This is the assessment of candidates and choice of the one who best meets the criteria for the available
position. It involves matching job requirements with the attributes of the candidates.

Normally involves the following steps

a) Short listing: List applications on a control sheet and comparing the applications with the key
criterion in the job specification and sort them into three categories.

 i) Possible

 ii) Marginal

 iii) Unsuitable

 Scrutinize the possible again to draw up a short –list for interview. Ideally should be 4-8
candidates per position

b) Interviewing: An interview may be defined as a verbal interaction between individuals for a

particular purpose. The goals of the selection interview are;

 The interviewer seeks to obtain enough information to determine the applicant’s suitability for
the available position

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  The applicant obtains adequate information to make an intelligent decision about accepting the
job should it be offered

 The interviewer seeks to conduct the interview in such a manner that, regardless of the
interview’s results, the applicant will continue to have respect for and good will towards the
organization.

Types of interviews
• There are many types of interviews and formats for conducting them.

a) The unstructured interview

• The interviewer asks whatever seems appropriate and adapts the discussion to the response.
This requires little planning because the goals for hiring may be unclear, questions are not
prepared in advance, and often the interviewer does more talking than the applicant.
b) Semi structured interview
• Only the major questions to be asked are prepared in advance and the interviewer may ask
other questions that open up areas of discussion during the interview session.
• They require some planning since the flow is focused and directed at major topic areas
although there is flexibility in the approach.
c). The structured interview
• The interviewer uses a prepared list of questions and does not deviate from them.
• This type of interview requires greater planning time yet because questions must be developed
in advance that address the specific job requirements.
• Information must be offered about the skills and qualities being sought, examples of the
applicant’s experience must be received, and the willingness or motivation of the applicant to
do the job must be determined. The interviewer who uses a structured format would ask the
same essential questions of all applicants
• Other formats of conducting interviews
i) Individual interviews
ii) Interviewing panels
iii) Selection boards

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 iv) References: This is to obtain in confidence factual information about a prospective employee
and opinions about his or her character and suitability for a job
v) Physical examination: The examination determines if the applicant can meet the requirements
for a specific job and provides a record of the physical condition of the applicants at the time of
hire. Also helps to identify applicants who will potentially have unfavorable attendance records
or may file excessive future claims against the organization’s health insurance
c) Confirming the offer
• Confirm offer of appointment after satisfactory references have been made and applicants have
passed medical exam. Contracts of employment should be written. Applicants offered a
position should confirm their acceptance in writing
• After the employee has been given the appointment and have reported to work they have to
understand the work environment and adjust effectively to the job. This is done through the
indoctrination process
d) Indoctrination Process
As a management function, this refers to the planned, guided adjustment of an employee to the
organization and the work environment.
The process includes;
 Induction
 Orientation
 Socialization
• Induction: This includes all activities that educate the new employee about the organization
and employment and personnel policies and procedures. This takes place before the employee
starts performing the job. A handbook can be given and a form signed to verify that it was
given. The form should be placed in the employee’s personal file.
• Orientation: Induction provides the employee with general information about the organization
whereas orientation activities are more specific to the position.
Orientation is the process of assisting new employees to adjust to new roles and responsibilities
within the organization. It is the process of introducing new employees to the organization and
to their superior, their juniors, colleagues and to their tasks. Recruiting and selecting high
potential employees does not guarantee they will perform effectively. People who do not know
what to do or how to do it can’t perform effectively even if they want to.

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 • Socialization: Socialization involves inducting new employees to the expectations and
behaviors of the organization. This is a sharing of the values and attitudes of the organization
by the use of role models, myths and legends. The leader introduces the employees to unit
values and culture and molds them to fit in the unit by introducing them to norms of the group.
Role models, preceptors and mentors can be used to clarify role expectations.
• Role models are examples of experienced, competent employees. The employee sees the role
models are skilled and tries to emulate them.
• A preceptor is experienced personnel who provides emotional support and is a strong clinical
role model to the new person. (Preceptors are usually assigned and have a short relationship
with the person assigned while a mentor has a long term relationship with the mentee)
• Mentoring is a supportive and nurturing relationship between an expert and a novice. The
mentor makes a conscious decision to assist the mentee in his or her career development.

ROLES OF HUMAN RESOURCES MANAGEMENT IN AN ORGANIZATION- 25/2/22

Performance management:
Performance management is taken seriously and it is a vital component in the systematic and strategic
processes of its HRM. When a new employee is added, the worker will be put to work together with the
group so as to know how the person works and if the new employee will fit in to the company system.
The information or feedback gotten from the group will determine the progress of the new worker.
There is also performance appraisal, the information gotten from this helps in recruiting, training, and
development of the existing staff and maintaining high level work force by properly rewarding their
performance. Management believes that without a reliable performance appraisal system, their human
resources system would result in a failure and would crash down.
• Performance management: All that mediates the interactive process between work
motivation of the individual the performance rewards and development opportunities provided
by the organization (Frank 1998).

PERFORMANCE APPRAISAL
Managing the performance of people is a fundamental organizational strategy to gain competitive
advantage through mobilization of human resources. An important part of a manager’s job is to define
performance in advance and to state desired results

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Definition of performance appraisal
• Performance appraisal means evaluating an employee’s current or past performance relative to
the person’s performance standards
• Also known as employee appraisal, it is a method by which the job performance of an
employee is evaluated (generally in terms of quality, quantity, cost and time).
• Performance appraisal is a part of career development. Performance appraisals are regular
reviews of employee performance within organizations and begin when an employee is hired
and stops when he/she leaves
Purpose of performance appraisal are:
• To identify an individual’s current job performance and give feedback on performance to
employees.
• Identify the strength and weaknesses of the employees
• Identify employee training and development needs
• To motivate the employee.
• Document criteria used to allocate organizational rewards.
• Form a basis for personnel decisions: salary increases, promotions, transfers, disciplinary
actions, etc.
• Provide the opportunity for organizational diagnosis and development.
• Facilitate communication between employee and administration
• Validate selection techniques and human resource policies
• Provide information for succession planning

The appraisal process

I. The management needs define the appraisal: This involves establishing the performance
standards/objectives/expectations and Communicating the expectations to the employee
II. Allow the employees some period to work
III. Appraisal: Assess and measure the actual performance of the work
IV. Compare actual with the expected performance
V. Complete the appraisal
VI. Conduct the appraisal interview and provide feedback
Appraisal problems

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 1. Unclear standards: This is where the performance standards have not been clearly defined
2: Halo and horns effect: The halo effect occurs when the appraiser lets one or two positive
aspects of the assessment or behavior of the employee unduly influence all other aspects of the
employee’s performance. The horns effect occurs when the appraiser allows some negative
aspects of the employee’s performance to influence the assessment to such an extent that other
levels of job performance are not accurately recorded.
3. Central tendency: This is where the appraisers stick to the middle when filling rating scales
by avoiding high or very low marks and hence cannot be used for promotions or salary
increase since everybody is average.
4.Leniency or strictness: This is where rating an appraiser rates employees consistently high
(leniency) or low (strictness)
5.Personal bias: The tendency to allow individual differences such as age, race and sex affect
performance appraisal ratings employees receive. How employees performed in the past can
affect current appraisal
6.Recency and primacy effects: This occurs when the a superior (appraiser) places to much
weight on factors that occurred recently (recency) or in the beginning (primacy
7.Matthew effect: The Matthew Effect is said to occur when employees receive the same
appraisal results, year after year. Those who performed well early in their employment are
likely to do well. Those who struggled will continue to struggle.
Appraisal methods /tools of appraisal
a) Immediate supervision
b) Use of professional appraisers
c) Rating by the customers/clients
d) Ranking methods- comparing workers doing the same work
e) Graphic rating- (sometimes called a Likert scale) is a performance appraisal method that lists
desired traits and behaviors for each role, then rates workers on each of those on a numbered
scale. The attributes might include punctuality, quality of work, job knowledge, teamwork,
accountability, responsibility, etc.
f) Behavioral anchored rating method- based on direct observation of behavior

Knowledge management:

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Personal relationship and shared visions are the main focus in the information system; we get to have
effective knowledge of our employees and their attitude to work by given them appropriate incentive
structure. have the right people Have the right place with the right attitude and behavior, employees are
exposed in the right ways to work, and should have the right mix of skills.
• Training: Training is the planned process of modifying employee behavior, attitude, and
skill through learning in order to increase the probability of goal achievement.
• Development

This usually suggests a broader view of knowledge and skills acquisition than training. It is less job
oriented than career oriented. It is concerned more with employee potential than with immediate skills.
It sees the employees as adaptable resources

Training and development cycle

• The primary objective of training is to reduce the gap between what employees know and
what they should know. Systematic training is initiated by the organization’s policy and
sustained by its training organization

Training Involves Five Steps

• Needs analysis/identifying training needs: The first priority is to establish what the training
and development needs of the organization are. A training need is any shortfall terms of
employee knowledge, understanding, skill, and attitudes against what is required by the job or
the demands of organizational change. This will involve use of job descriptions, employee’s
appraisal records and any other data that may indicate such needs.
• Plan training required; The next step is to plan the training required to the needs identified.
This involves such matters as setting budgets and timetables, and deciding on the objectives,
content and methods of training to be employed
• Implementation/carry out the training: This is training the targeted employee/ group. The
implementation of plan is a joint affair between the training specialist and their line and
functional colleagues.
• Evaluation and follow up: Management assesses the programme success. This is by
evaluating the results so that subsequent changes can be made if necessary. Then the cycle
starts again.

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Methods of training
1. On the job training
2. Apprenticeship training ( combination of classroom ,institutions and on the job training
3. Vestibule training: This is an internal off the job training method in which the environment of
the actual work place is simulated. Used by organizations where specific skills are needed
before actual job performance
4. Job Rotation; In this training method the employee is moved from one job to another. It gives
the employee a chance to use a variety of skills and abilities.
5. In coaching/mentoring: A senior experienced manager takes charge of training and
development of a new incumbent. The mentor/trainer helps the employee to adjust both to the
organizational culture and work setting
JOB ANALYSIS
Job analysis is the procedure through which you determine the duties of positions to be staffed in an
organization and the characteristics of the people to hire for them.
Job analysis produces information used for writing Job descriptions (a list of what the Job entails) and
Job specification ( what kind of people to hire for the Job).
The following types of information is gathered during Job analysis
• Work activities: identifying the tasks involved in the Job e.g giving medications, monitoring
vital sign etc.
• Human behavior: Included here is information regarding Job demands such as lifting weights
or walking long distances
• Machines, tool equipment's and work aids:
• Performance standards: This is the Jobs performance standards in terms of quality or
quantity level of each Job duty. (The standards will be used to appraise the employees)
• Job context: This includes physical working conditions, work schedule number of people with
whom the employee wound normally interact, information about incentives etc.
• Human requirements: This is the job related knowledge or skills (education, training, work
experience) and the required personal attribute (attitudes, physical characteristics personality
interest)
Job description

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 • This is a written statement of what the worker actually does, how he or she does it, and what
the jobs working conditions are.
• A job description set out the purpose of the job, where it fits in the organization structure, the
context within which the job holder functions and the principal accountabilities of job holder(s)
or the main tasks they have to carry out.
A job description mainly contains the following sections.
• Job identification; This contains the job title e.g. manager, etc. It also contains the date that
the job description was written, who prepared it, who approval the job description and the
location of the job e.g. hospital in charge
• Job summary: This describes the general nature of the job and includes only it major
functions or activities e.g. plan, directs, co-ordinates hospital activities.
• Relationships: This shows the job holders relationship with others inside and outside the
organization e.g. reports to, supervises who? Works with etc.
• Responsibilities and duties: This section presents the jobs main responsibilities and duties.
e.g. conducting performance appraisal, giving medication to patients etc.
• Standards of performance and working conditions: This lists the standards the employee is
expected to achieve under each of the job description duties and responsibilities.
• Job specifications: It shows what kind of a person to and for what qualities that person should
be tested e.g. the skills, knowledge, experience, attitudes etc.

HUMAN RESOURCE MANAGEMENT FUNCTIONS

Staff discipline
• Some of the very challenging problems for managers is what to do when an employee fail to
perform as per their expectations
• Discipline is the action taken when a regulation has been violated. Discipline can be defined as
the process by which an employee brings her or his behavior into agreement with the agency’s
official behavior codes. It can also be a managerial action to enforce employee compliance
with agency rules and regulations.
Purpose of discipline

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 • The purpose of discipline is to encourage employees to behave sensibly at work or adhere to
rules and regulations. Discipline is called for when rules and regulations are violated. The
purpose of rules is to inform employees ahead of time what is and is not acceptable behavior
The disciplinary process
• The purpose of a disciplinary action should be to correct rather than to punish a wayward
employee. Discipline should be administered promptly, privately thoughtfully and consistently.
Discipline should also be progressive and preceded by counseling

Steps in progressive discipline

a) Counsel employee regarding the problem (here informal talk with the employee and review the code
of conduct.
b) Reprimand employee. A verbal reprimand usually proceeds a written one. (others can issue both)
depending on organizational policies
(i) Verbal warning
(ii) Written warning

When written, the employee must sign to verify that the problem was discussed and a copy placed on
the employee personal file and a copy of written reprimand is also given to employee.

c) Suspend employee if the problem persists without pay (might change) for a period of time
depending on company’s policy

d) Allow the employee to return to work with written stipulation regarding problem behavior

e) Terminate employee if problem recurs/discharge

Staff Coaching

This is the day today process of helping employees improve performance. Coaching also should be
used when performance meets the standards but improvement can still be obtained. Before entering
into a coaching session the coach should prepare for the interaction. The goal of the meeting is to
eliminate or improve performance problems

Performance Deficiency Coaching

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 • Performance deficiency coaching is another strategy that the manager can use to create a
disciplined work environment. This type of coaching may be ongoing or problem-centered.
Problem-centered coaching is less spontaneous and requires more managerial planning than
ongoing coaching
• In performance deficiency coaching, the manager actively brings areas of unacceptable
behavior or performance to the attention of the employee and works with him or her to
establish a plan to correct deficiencies. Because the role of a coach is less threatening than that
of an enforcer, the manager becomes a supporter and helper. Performance deficiency coaching
helps employees, over time, to improve their performance to the highest level of which they are
capable. As such, the development, use, and mastery of performance deficiency coaching
should result in improved performance for all
Staff Motivation
• Motivation describes the factors that initiate and direct behavior.
• manager’s most important leadership task is to maximize subordinates work motivation
because employees bring to the organization different needs and goals, the type and intensity of
motivators vary among employees.
• Therefore the manager must know which needs the employee expects to satisfy through
employment and should be able to predict, which needs will be satisfied through the job duties
of each employee position.
What motivates you to add more to organizational effectiveness?
These are some of the things that motivate or encourage employee
• Seeing that I have a future with the company in question
• Ability to create and be innovative towards the organization productivity
• Salary, but it is not the main thing
• Constructive feedback and support from the management
• Feeling that I am part of the company and I have roles to play on daily basis • Motivational words
and incentives
• Good incentives
• Constructive feedback
• Involvement in the company success
• Team working, salary and bonuses

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• Health care
• Future assured
• Learning new things
• Feeling part of the success of the organization
• Mentoring and coaching others
• Analyzing complex data
• Doing well on individual task
• Working well in the team or on group task.

Supportive Supervision
• Supportive Supervision refers to an activity of more experienced or higher positioned
personnel whereby they support the work of their juniors so that it meets set standards. It
means assisting health, workers in achieving work outcomes, finding out work problems and
challenges and together finding solutions to the problems. Supportive supervision should aim
at encouraging team members to apply their ability and energy to work. It also means
understanding what makes people dissatisfied at work.

Conflict and Conflict Resolution

Introduction
• Conflicts are generally defined as the internal or external disorder that results from differences
in ideas, values, or feelings between or more people. Because managers have interpersonal
relationships with people having a variety of different values beliefs and backgrounds and
goals conflict is an expected outcome. The Managers role is to create a work environment
where conflict may be used as a consult for growth, innovation and productivity

Conflict resolution methods (strategies)

• Avoiding/Avoidance: This method/strategy attempts to keep the conflict from surfacing at all
e.g. ignore the conflict or impose a solution (especially where concern for people and
production is low.

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  Accommodating: This is also known as smoothing or co-operating. It is used when a person
ignores his or her own feelings about an issue in order to agree with (accommodate) the other
side.
N/B: Parties that consistently ignore feelings and give in can end up feeling frustrated or used and
may be less willing to co-operate in future.
• More conflict can ensue if parties disagree about importance of the issues being accommodated
 Competing: One side wins the conflict and the other side loses. It is also called forcing
because the winner forces the loser to accept his or her perspective on the conflict.
• This can cause anger and resentment to increase withdrawal/avoidance.
• The method is useful when an issue is critical or time to resolve it is limited. Can also help
move a critical but unpopular decision quickly through an origin
• Compromising: Each side gives up something as well as gets something. Used when both
sides have a reasonable, important goal and losing is not required.
• Negotiation: This is an extension of compromise with higher stakes and more deliberate
techniques to bargain for each side’s give and take. It is useful for high stake issues and
solutions are seen as formal and more permanent than compromise. Conflicts tend not to recur
once the negotiations are finished
• Collaborating: In this method both sides in a conflict work to develop the outcome that is best
for both sides.
• The emphasis is on creative problem solving so that each side meets its key goals.
• Confronting: This method attempts to block the conflict from the start. The method brings the
parties together, clarifies issues and achieves an outcome

TYPES OF CONFLICTS

Individual conflict
 common type is role conflict occurs due to incompatibility between one or more role
expectations
 When staffs do not understand the role of the other staff
 Misunderstanding can occur – for not doing some work

interpersonal conflict

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  Occurs between two people due to differences and personalities or competition

Intergroup conflicts – conflict occurs between groups e.g. unit service team ,health care professional
groups ,agencies
Causes of Conflicts
 differences in information, values, beliefs and interest
 Competition for resources, e.g money skilled manpower
 Inter group rivalry for rewards
 Take difficulties
 Skill differences
 Pressure to avoid failures
 Unworkable organization structure
Effects of Conflicts
 Advantages
 Prevents intellectual stagnation
 Decreases likelihood of group think
 stimulates employees curiosity
 Facilities employees change

 Disadvantages

 Disputes puts others in to conflict

 Unresolved causes violence
 Spread from peripheral to other issues

Grievances
Grievance Process = When a union member believes that management has failed to meet the terms of
the contract or labor agreement and communicates this to management. This process is called
grievance!

The grievance process steps

1. The employee informs the employer about the nature of the grievance

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2. The employer arranges for a formal meeting to be held without unreasonable delay after a grievance
is received.

3. The meeting is held and the employee should be accompanied at the meeting. Following the
meeting a decision is made on what action if any to take. Decision should be communicated to the
employee in writing without unreasonable delay.

4. The employee is allowed to take the grievance further (appeal) if not resolved)

5. The appeal should be dealt with impartially

6. The outcome of the appeal should be communicated to the employee in writing without
unreasonable delay

NB: Grievance procedures differ from union to union.

Change and Change Management

Change is fundamental in order to guarantee long term success in the organization. Some
organizations change in response to external circumstances (reactive change) and others change
because they have decided to change (proactive change)
Definition of change -To change something implies altering it, varying or modifying it in some way. It
is also the process of moving from one system to another. It is also the process of making something
different from what it was. Also change is any shift in status from an undesirable current status to a
desirable future status
Types of change
• Planned change: Results from deliberative, collaborative effort to improve system operations
and facilitate acceptance of the improvement by involved parties
• Unplanned /accidental change: Accidental or reactive change is an adaptive response to an
outside stimulus that is directed toward re-establishing balance between system and
environment.
The change process (planned change)
• Change is a continual unfolding process rather than an event. The process begins with the
present state, moves through a transition period then comes to a desired state once the desired

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 state has been reached the process begins again. The change process is very similar to the
problem solving process and involves :-
• Assessment At this stage problem or opportunity for change is identified. Data about change is
collected from both internal and external sources and then analyzed. Data analysis should
support both the need for change and the potential action selected
• Planning: During planning the change agent determines who will be affected by change and
when change will occur. Also all potential actions are examined which should include how
change will be implemented. An evaluation component to assess if the change met the
organizational goals for the change is also constructed
• Implement the change: The plans are put into motion. Interventions are designed to gain the
necessary compliance. The change agent creates a supportive climate, obtains and provides
feedback and overcomes resistance to change.
Change theories
• There are several theories that have been developed concerning the change process. These
theories are
I. Lewis force field theory
II. Lippitt’s phases of change
III. Rogers diffusions of innovations
IV. Bridges’ model of managing transitions
• In this session we are going to review the Lewins’ force field model while you can read about
the other theories
Lewin’s force-field model -Lewin provides a social psychological view of the change process. He
sees behavior as a dynamic balance of forces working in opposing directions within a field (e.g. an
organization) He suggested that there is need to do an analysis of change situations (which he referred
as force field analysis).
This includes identifying the following

(i) Driving forces (behaviors’ that facilitate change because they push participants in the desired
direction)

(ii) Restraining forces (behaviors that impede change by discouraging participants from making
specified changes

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 • Therefore for change to be effective driving forces must exceed restraining forces. To plan
change one must analyze these forces and shift the balance in the direction of change
through the following three step process:-

Steps of change according to Lewin

i) Unfreezing the existing equilibrium: Refers to the awareness of an opportunity, need or
problem for which some action is necessary. To unfreeze a status quo, a change agent must
increase driving forces or decreases restraining forces in the situation. According to Lewin it
involves motivating the participants by getting them ready for change, building trust and
recognition for the need to change To their attitudes, actively involve the participants in
identifying problems and generating solutions.
ii) Move the target system to a new level of equilibrium (moving): This is done by getting the
participants to agree that the status quo is not beneficial to them, encouraging them to view
the problem from a new perspective and helping them scan the environment to search for
relevant information
iii) Refreeze the system at the new level of equilibrium: This involves reinforcing the new
patterns of behavior (e.g. rewarding for desired behavior or research on new system).
Reinforcement can also be done through formal and informal mechanism (e.g. formulating
policies, establishing communication channels

Resistance to change
• Response to change varies from ready acceptance to full blown resistance. Forces that
oppose change are labelled resistance. Resistance is anything that leads to delay or
additional costs to a change Programme. This could be an extreme delay (non-starter) or
mild (a few months)

Reasons why people resist change

• There are several reasons why people resist change. Among them are the following

I. Fear of unknown: This is where the participants wants the status quo because they are not sure of
what will happen when change has occurred

II. When people do not know what is expected of them either during the change process or after
change has occurred

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III. Parochial self-interests: This is where people resist change because of personal interest is expense
of organizational interests. May be they fear that they might loose their position if change occurs.
IV. lack of information about what the change entails and the implication of change
V. Mistrust: This occurs especially when people don’t trust the leaders. They might assume that their
leaders could be having a hidden agenda e.g. layoff of employees.

Measures of dealing with resistance to change

I. Communication with employees; Speak in person and privately with those who oppose the change.
Get to the root of their reasons for the opposition
II. Educate the people; emphasize the goals of change and how the individual or groups will benefit.
Clarify information and provide accurate feedback
III. Facilitation: This can be done by providing the resources required. The change agent should also
maintain a climate of support and confidence
IV. Involve people affected by change: The change agent should be open to suggestions but clear
about the overall purpose and goals. Do not compromise on the intended outcome
V. Negotiation; It is also important to discuss the consequences of resistance e.g. compromised patient
care or closure of the organization so that the participants can see the importance of change
VI. Manipulation: This method can be used by rewarding those who have accepted change so that
those who are resisting can see there are some benefits and comply
VII. Coercion: This by threatening people who resist change and therefore they comply out of fear
Team Work
Teams: Teams are real groups in which individuals must work cooperatively with each other in order
to achieve some goals. They demonstrate healthy interdependence. A team is composed of a small
number of people with complementary skills who are committed to a common purpose, set of
performance goals and approach for which they hold themselves mutually accountable. Teams have
command or line of authority to perform tasks and membership is based on the specific skills required
to accomplish the task.
Team Processes
• Forming: This is the initial stage of group development in which individual members
assemble into a well-defined cluster ( members get to know each other, and very are
cautious..

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 • Storming: The second stage of group development where members wrestle with roles and
relationships. Conflict dissatisfaction and competition arise on important issues related to
procedures and behavior. Members often compete for power and status and informal
leadership emerges.
• Norming: This is the third phase of Group development. The Group defines its goals and
rules of behavior. They also define acceptable and unacceptable behaviors and attitudes.
The group structures, roles and relationships become clearer. Cohesiveness also develops.
• Performing: This is the fourth stage. The group members agree on basic purposes and
activities and came out the work. Cooperation improves and emotional issues subside.
Members communicate effectively and interact in a relaxed atmosphere of sharing.
• Adjourning(Mourning): This is the final stage of group development, in which a group
dissolves after achieving its objectives or reforming with some major changes takes place in
the environment
d. Characteristics of effective teams
• Clear objectives and agreed goals
• Openness and confrontation
• Support and trust
• Co-operation and conflict
• Sound procedures
• Appropriate leadership
• Regular review
• Individual development
• Sound intergroup relations

Problem Solving

Definition of problem solving

Problem solving is a systematic process that focuses on analyzing a difficult situation. Problem solving
is also an active process that starts with a problem and ends with a solution.
• Problem solving always includes a decision-making step.

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 • Managers are constantly faced with problems to solve in an organization.

Scientific Problem Solving

• Most problems are solved using step by step problem solving process. Problem solving
uses critical thinking to gather and analyze data/information, creative thinking to come up
with solutions and decision making at key steps on the process.

Steps of the scientific problem solving process

Problem solving process has the following seven steps
i. Define the problem, Issue or Situation: The most common cause of failure in problem
solving is improper identification of the problem. In work settings problems fall under certain
categories e.g. Manpower, methods, machines and material The definition of the problem
should be a descriptive statement of the state of affairs but not a judgmental or a conclusion.
ii. Gather information/Data: Collect the facts that can provide the clues to the scope and
solution of the problem. Obtain relevant, valid accurate and detailed descriptions from
appropriate people or sources and put the information in writing
iii. Analyze the information/data: Categorize information in order of reliability. List information
from most important to least important and set information into a time sequence Information
can also be categorized in terms of cause and effect e.g. is A causing B. The information can
also Classified into categories e.g. human factors, technical factors rules/procedures, legal and
ethical issues.
iv. Develop Solutions: As the information is being analyzed numerous solutions will come up and
should be written down and plans made to immediately start developing the best of them.
Develop alternative solutions, in case the first order solution proves impossible.
v. Make a Decision: Select one solution that is most feasible and satisfactory and has the fewest
consequences.
vi. Implement the decision: The manager implements the decision after selecting the best cause
of action.
vii. Evaluate the solution: Review the plan instituted and compare the actual results and benefits
to those of the idealized solutions. The Manager should ask herself or himself: Is the solution
being implemented?, are the results better or worse than expected and how can he/she ensure
that the solution continues to be used and to work?

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 Problem Solving Principles

To be able to solve problems effectively it is important to apply the following principles

I. Separate large problems from small ones, and rely on policy for small problems while conserving
managerial time for solving major problems.

II. Delegate smaller problems to subordinates trained to handle them.

III. Seek information for problem solving from internal and external experts so that the solution will be
based on current knowledge

V. Approach problems in relaxed fashion and avoid solving problems under stress.

V. After appropriate consideration, select and implement the best solutions without rumination. (do not
agonize over selecting a solution) it is impossible to expect 100% accuracy in diagnosing and
resolving problems

Decision Making

Definition:
• Decision making is a complex, cognitive process often defined as choosing a particular
course of action.
• “the process of making choices or reaching conclusions
• Choice made from at least two alternatives
Rational decision Making process
The primary steps of decision making process are similar to those of problem solving.
I. Define the problem/issue and diagnose the problem.
II. Collect relevant data
III. Develop alternative solutions
IV. Assess consequences
V. Select optimum solution
VI. Implement solution
VII. Measure and monitor
Delegation

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It is the process by which responsibility and authority for performing a task (function, activity,
decision is transferred to another individual who accepts that authority and responsibility. The
delegator remains accountable and responsible for the tasks

Principles for effective delegation:

I. Grant proper amount of authority: Responsibility should not be less than authority delegated.

II. Define the results expected: Delegation must define results expected (don’t give ambiguous
instructions).

III. Consider the capabilities of the subordinates: While delegating consider the background,
experience, intelligence, training and the limitations of the delegate

IV. Make sure authority is clearly stated: Authority relationships should be clearly defined not only
to the subordinate but also to others concerned as well. Everyone must know who is in charge and
where authority rests.

V. Modify authority whenever necessary: Authority is always revocable or subject to modification

and can be increased or decreased or even withdrawn altogether (depending on situations and also
environment).

VI. Follow unit of command/chain of command: Authority should flow from the highest manager to
all subordinates (each individual reports to one superior except in matrix organizations (according to
functional areas).

VII. Develop willingness to delegate: Managers lack confidence in their staff, fear to loose control.
Let go and let others make mistakes if delegation is to work.

VIII. Create a supportive climate. Give moral and material support. Provide advice and
encouragement continuously

IX. Develop effective communication system. There should be free flow of communication between
superior and subordinates for subordinates to seek clarification and guidance from superior.

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X. Establish an effective control system: Controls consent that authority delegated is used properly.
Superior should set performance standards and evaluate subordinate periodically and help them
improve.

XI. Appropriate incentives: Suitable financial and non-financial incentives should be provided to
reward subordinates for successful assumption of authority and completion of responsibility

Steps involved in Delegation Process

1. Decide what to delegate: Delegate only an aspect of your work for which you have responsibility
and authority. You need to define the nature of the task. In defining the nature of the work you need to
ask yourself the following questions

a) Does it involve technical skills or special knowledge

b) Are specific qualifications necessary?

c) Is the delegation of this task restricted by scope of practice, standards or job descriptions?

d) How complex is the task.

e) Is training or education required?

f) Is the task required to be done in a particular way or is there room for creativity.

g) Would a change in circumstance affect who could perform the task.

2. Decide on the delegate: Match tasks to the individual. Analyze the person’s abilities to perform
various tasks to be delegated and determine . Delegate to the person next in the hierarchy who has the
requisite capabilities and who is legally allowed to do the task and also by organizational policy.

3. Define the task/communicate : Clearly define your expectations to the delegate. Plan your meeting
with the delegate .Provide enough time to describe the task and your expectations and to entertain
questions. Communication should be clear and complete.

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4. Reach agreement: After outline your expectation you must be sure that the delegate agrees to
accept responsibility and authority for the task.

5. Monitor performance and provide feedback: monitoring performance provides mechanism for
feedback and control that ensures that delegated tasks are carried out as agreed
Benefits of delegation

To the delegator
 devote more time to these tasks that cannot be delegated. With more time,
 develop more skills and abilities facilitating the opportunity for career advancement.
 Improve interpersonal relationship with subordinates,
 Provides continuity of work in the delegator’s absence and offers ready replacement.
To the delegatee,
 gains new skills and abilities that can facilitate upward mobility.
 Delegation also brings trust and support thereby building self-esteem and confidence.
 Job satisfaction and motivation are also enhanced as individuals feel stimulated by new
challenges.
 Morale improves a sense of pride, develops greater awareness of responsibility and individuals
feel more appreciated and learn to appreciate the roles and responsibilities of others
To the Organization:
 Organization is able to achieve its goals more efficiently due to team work,
 Overtime and absences decrease and productivity increases and at the same time organization’s
financial position may improve.
 As delegation increases efficiency, the quality of care improves and hence patient’s satisfaction
Methods of training
vii. On the job training
viii. Apprenticeship training ( combination of classroom ,institutions and on the job training
ix. Vestibule training: This is an internal off the job training method in which the environment of
the actual work place is simulated. Used by organizations where specific skills are needed
before actual job performance
x. Job Rotation; In this training method the employee is moved from one job to another. It gives
the employee a chance to use a variety of skills and abilities.

39
 xi. In coaching/mentoring: A senior experienced manager takes charge of training and
development of a new incumbent. The mentor/trainer helps the employee to adjust both to the
organizational culture and work setting

Delegation DELEGATION

Time Management
Def. :- act or process of exercising conscious control over amount of time spent on specific activities
in order to increase efficiency and effectiveness

Time management skills

 Set goals – realistic and achievable
 Prioritize work – make a list of task
 Delegate task – to your subordinates as per their skills
 Avoid distractors - i.e. email face book politics
 Organize your time - identify when you waste time and reduce
 Break down tasks – so as to accomplish one step at a time
 Set deadlines – set realistic deadlines for task and stick to it. Challenge yourself and meet
the deadline, reward yourself for meeting difficult tasks
 Avoid stress – stress occurs when we accept more than our abilities resulting into tiredness
and loss of productivity, delegate tasks and leave time for relaxation

ASSIGNMENT

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 State possible time wasters in an organization and the principles of time management

Social media

Social media is one of the biggest time-wasters for professionals in any work environment. You can
log onto social media platforms via any device, including your phone and computer, meaning such
distractions are highly accessible regardless of where you are and what you're doing at a given
moment. Therefore, it's important to be able to overcome the urge to scroll through social media feeds
instead of focusing on other tasks. To avoid wasting time on social media, remove temptations by
using settings on your phone and computer that block certain applications during designated hours.

2. Interruptions

It's common for professionals to face a variety of interruptions throughout their workday, including
those from email notifications, calls, text messages and coworkers stopping by to ask a question.
While these interruptions may seem harmless, they can distract you from the tasks you were originally
working on and make it challenging to refocus. Consider setting a specific time period during your
workday that you can use to focus without interruptions. You can put up an away message on your
email, turn off your phone and hang a sign on your door to notify colleagues so they can come back
later.

3. Multitasking

Many professionals believe that multitasking—or the act of working on multiple tasks simultaneously
—can help them save time and accomplish their goals more efficiently. Unfortunately, though, this
isn't usually the case because multitasking often takes the form of task-switching, where professionals
shift between tasks rather than performing them at once. Therefore, to avoid wasting time, try to focus
on one task at a time and see it through to completion rather than attempting to multitask.

4. Working without a plan

As professionals often face many tasks throughout a single workday, it's important to plan
strategically. If you work without a plan, you may risk wasting time as you attempt to figure out what
duties to focus on and when. You can overcome this challenge by purposefully planning your

41
workflow for the next day at the end of your shifts. From here, you can come up with a schedule that
you can follow to achieve your objectives most efficiently.

5. Taking on coworkers' tasks

In a collaborative work environment, it's common for professionals to help coworkers by taking on
some of their responsibilities. While doing this can periodically help move workflow forward, it's
important to avoid taking on too much so you can save your time and energy for completing your own
tasks. You can overcome this challenge by being reasonable with your expectations of yourself and
setting clear boundaries with your coworkers regarding project workflow.

6. Disorganization

Working in a cluttered environment can lead to higher rates of inefficiency. If you need to spend time
searching for paperwork in your office or finding files on your computer, you may waste more time
trying to accomplish your goals than if you develop a more effective organizational system. You can
avoid wasting time due to disorganization by decluttering your workspace and strategically organizing
key items so you can easily access them when you need them.

7. Procrastination

When professionals procrastinate completing key to-do list items, they may waste more time than
otherwise. This is because procrastination often results in professionals spending time putting off their
tasks by worrying about them and rescheduling them continuously. To avoid wasting time
procrastinating, shift your workflow principles and implement a personal policy for taking care of your
tasks as they arise. This policy can help you become more efficient over time and strengthen your
reflexes so you can overcome the impulse to procrastinate in the future.

8. Unnecessary meetings

Meetings aren't always necessary. Sometimes, the information communicated in a meeting can be
relayed through alternative methods like email, instant messages or memos. Therefore, both in-person
and virtual meetings can often lead to wasted time in the workplace. You can avoid unnecessary
meetings by thinking logically about the objectives of a proposed meeting prior to its occurrence. Try

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 to identify the goals you intend to achieve through a meeting, and evaluate whether you may be able to
meet those goals more efficiently through other actions.

9. Equipment issues

Many professionals use equipment such as computers, tablets and phones to perform their tasks on a
regular basis. With this, when equipment malfunctions, it can create significant delays to workflow
and result in inefficiency. Therefore, it's important to avoid facing equipment issues whenever
possible. You can do this by ensuring all of your equipment is up to date, has functional software and
is serviced regularly.

The principles of time management

i) Be goal-oriented

To be successful in life you should be aware of the tasks and time you have. Plan tasks to achieve your
goal and utilize time to do goal-driven tasks. A well-defined goal will motivate you to work hard to
reach to aim.

ii) Have a plan

Failing to plan is planning to fail. – Alan Lakein

Planning is one of the most important principles of time management. If you don’t have any plan for
the day about where to go, what to do and how to do a task, chances are you’ll lose a lot of time
wondering what you should be working. And you’ll lose your efficiency as well.

With a plan you’ll be able to get started a task easily, finish it and move on to the next task quickly.

iii) Be organized

Being organized is one of the key factors to achieve maximum efficiency in time management. You’ll
need to do this in different aspects of your life. Your workplace – keep files, pen, pencil, note and
other available at hand, so that you can finish a task in less time and energy with fewer distractions.
iv) Form good habits

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 Having good habits is one of the key principles of time management. With good habits, you can
manage time easily and successfully.
v) Manage distractions

In this technology-reliant world, being focused is a big challenge for us. Therefore, an essential
principle of time management is to manage distractions. After the battle with procrastination to begin a
work, we need to fight against distractions to continue the work and finish it at the right time.

vi) Learn to delegate

One of the key time management skills is delegation. Therefore, learn to assign the right task to the
right person under the right circumstance maintaining the right communication and evaluation. The
right way of the delegation will help you accomplish more tasks during the shift.
Vii) Commitment—if you can’t commit to devoting time to a task, don’t put it in your schedule. Only
schedule tasks you WILL do. Be brutally realistic, not idealistic when making your schedule. Creating
a schedule you can’t actually keep is setting yourself up for frustration. If you don’t actually stick to
your schedule it will soon become useless.
viii) Routine—It takes 30 days to create a habit, but good habits make your life easier. With good
habits in place you don’t have to make as many hard decisions, thus you are less likely to make
unproductive ones such as talking yourself out of doing what you had planned

Challenges in facing human resource management

1. Rework the vision and mission of the company
HRM is becoming increasingly involved with strategic planning and the development of
means by which people can work proactively toward the achievement of organizational
objectives. This means a broader perspective focused on objectives and results. It implies
personal commitment by each worker to the organizational goals. The need for this personal
commitment means that employee education, communication, and involvement now become
fundamental. This being the case, companies develop and emphasize an HRM philosophy to
which top management is deeply committed, and which is clearly articulated and practiced by

44
all employees. HR planning is closely linked with strategic planning, so as to support the
company mission and give incentives to support its achievement.
2. Information & Knowledge age
Information and knowledge have replaced manufacturing as the source of most new jobs. And instead
of working with things, people increasingly work with ideas and concepts. The information age made
knowledge the most important organizational resource.
Now the important activities are the generation, structure, development, spreading, sharing and
application of knowledge; belongs to the people, the human capital.
Organization effectiveness will increasingly depend on attracting, utilizing and retaining people who
can use their knowledge to solve problems, create services, develop new work processes and satisfy
customer needs.
3. Attracting and Retaining Talent
One of the greatest challenges of human resource management today is to create HR
Capabilities that increase and sustain organizational performance. The ability to attract and
retain talent is a core HR capability that is critical to achieving sustainable business
performance. Retaining the employees has become more crucial.
4. Empowering Employees
Empowering is mutual influence; it is the creative distribution of power; it is shared
responsibility; it is vital and energetic, and it is inclusive, democratic, and long-lasting.
Empowering enables people to use their talents and capabilities, fosters accomplishment,
invests in learning, finds the spirit in an organization and builds effective relationships,
informs, leads, coaches, serves, creates, and liberates.
5. Managing Global Workforce
The biggest challenge the organization around the globe facing is to know the social classes
and categories from which the new global workers are recruited, and to understand the
systems of education and training that shape them so that they can be made socially and
culturally fit to serve consumers
6. Enhancing the supplementary Services
In today’s competitive world, the workforce are heavily loaded with work and stress
associated with it i.e. mental stress as well as physical stress. To have a sound body and
sound mind it is necessary to develop certain competencies to survive with the stressful

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situations.
7. Managing Workplace Diversity -
The future success of any organizations relies on the ability to manage a diverse body of
talent that can bring innovative ideas, perspectives and views to their work. The challenge
and problems faced of workplace diversity can be turned into a strategic organizational asset
if an organization is able to capitalize on this melting pot of diverse talents
Ways to overcome the challenges of human resources management in achieving organizational
effectiveness
When there is flexibility in the management, the employees listen to the management and the
management understands the employees in the time of urgency.
Introduction: It is essential to introduce the new hire to every group so as to know where it best fits.
The team must be satisfy with the new recruit as well as the new recruit must be free among the team.
Giving the employee enough trust put a management in the safer position and thereby adding to the
organizational effectiveness. When the workers have a clear view of what the future holds for them in
the company, the employee will give his/her best knowing there is a long-term prospect for him/her in
the company.
Change: It is good to prepare for change in the management, that is, when an important member of
the team leaves. For example, a team leader moved to another industry or company, the management
must be very sure of whom to select to be the next team leader. Good handling of change is an
excellent way to overcome challenges of human resource management towards organizational
effectiveness
Healthy competition: Having a healthy competition can boost the mood and attitude to work of the
employees. Every organization must put in place healthy competition to the employees because they
are in the front line of the business.
Open communication: When there is open communication flow in the organization, organizational
effectiveness will be achieved. The flow of information is a very essential element at the workplace.
Management and employees must be able to communicate well in order to achieve organizational
effectiveness. In an organization where effective communication is in place, everything is possible.
This means that all parties that have reached a foreseeable result and it also gives every worker equal
participation in achieving organizational effectiveness.

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 Involvement: Every company that wants or desire to achieve organizational effectiveness must
involve both the management and workers. The management controls the business but the employees
are the front line of the business and must work with the management to have good results.
Outsourcing of HRM should be kept minimal in order to have good quality and standards as well as
having full control of the business
Expectations: The management should keep their words to the employees and effective
communication will know all the expectations from both sides point of view. Hence, it will set clear
goals and promotes respect for the management.
Motivation: One major way to boost organizational effectiveness is through motivation. Presence,
noticing, complimenting and improvement not just results, are what every employee needs. Employees
become motivated above and beyond what is expected when they are valued in the organization.
There are various ways of promoting the balance of work and life which include:
• Asking the employees about their situation
• Keeping a close eye (monitoring) on their mood
• Embracing flexibility
• Encouraging efficient work for all
• Educating on health-related initiative

HEALTH FINANCING

In Kenya, the primary sources of funding for healthcare are: The public. These are government
allocations from the national budget comprising about 30% of the total yearly expenditure in
healthcare in the country. This also the main source of funding for about 80% of the population that
receives services from the public sector.

1. Private (consumers). This is the largest contributor of total healthcare funds spent in the
country at 35.9% of the total expenses. These funds serve about 20% of the population that is
able to access private healthcare services. These are mostly funded through company or
employee insurance schemes. These funds are thus not available for the newly decentralized
units.

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 2. Donors. These include funds to fight high burden diseases such as HIV, malaria and
Tuberculosis. These funds directly supplement public sector funds and contributes about 30%
of the total healthcare expenditure in the country.

SUMMARY

Currently, health care in Kenya is financed from three main sources: out of pocket
expenditure (households), government expenditure and donor

Vision

A Healthy, productive and globally competitive nation

Mission

To build a progressive, responsive and sustainable health care system for accelerated attainment of the
highest standard of health to all Kenyans

Goal

Attaining equitable, affordable, accessible and quality health care for all

Mandate

 Health policy
 Health regulation
 National referral Health facilities
 Capacity building and
 Technical assistance to Counties

Core Values

 Professionalism
 Ethics
 Integrity

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  Accountability
 Partnership and collaboration

Health centres

All government health centres have a clinical officer as the in-charge and provide comprehensive
primary care. Because of their heavy focus on preventive care such as childhood vaccination, rather
than curative services, local council (municipal) and most mission, as well as many private health
centres, do not have clinical officers but instead have a nurse as the in-charge.

Health centres are medium-sized units which cater for a population of about 80,000 people. A typical
health centre is staffed by:

 At least one Clinical officer

 Nurses
 Health administration officer
 Medical technologist
 Pharmaceutical technologist
 Health information officer
 Public health officer
 Nutritionist
 Driver
 Housekeeper
 Supporting staff

All the health centre staff report to the clinical officer in-charge except the public health officers and
technicians who are deployed to a geographical area rather than to a health unit and report to the
district public health officer even though they may have an office at the health centre.

The health centre has the following departments:

 Administration block where patients register and all correspondence and resources are
managed.

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  Out-patient consultation rooms where patients are seen and examined by clinical officers.
 In-patient (wards) where very sick patients can be admitted. The wards are divided into male,
female and paediatric with newborn units.
 Laboratory where diagnostic tests are done. These laboratories can do the following tests:
bloodslides for malaria parasites, sputum AFB, urinalysis, full haemogram, stool ova and cysts,
blood sugar, Elisa and CD4 counts in comprehensive care centres for HIV/AIDS patients.
 Pharmacy
 Minor theatre where minor surgical procedures are done, e.g., circumcision, stitching wounds
and manual vacuum aspiration
 Maternity
 Maternal and child health
 Kitchen and catering
Student hostels for rural health training centres where students go to get rural experience.
Challenges facing healthcare finances

Limited access to health care facilities

Lack of adequate personnel and expertise to address the medical needs

Poor Infrastructure where most facilities do not have the proper facilities to handle the medical
challenges

Ironically the facilities that are highly equipped with specialized equipment do not have effective
processes and personnel in place to execute the tasks, access to medical records and Healthcare
Financing.

The new constitution that brought forth the two arms of government, National and devolved
governments gave capital to projects aimed towards the BIG 4 agenda, healthcare being one of them,
through the Constituency Development Fund (CDF). Under financing of the health sector, our
government has reduced its funding and this has posed as a challenge in the health sector. Over 80% of
the country’s population is dependent on this funding for their healthcare needs. A very small
percentage of Kenyans have access to private insurance and can afford to pay for their own healthcare
expenses. This is less than 20% of the Kenyan population.

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Strategies on addressing the challenges in the health facilities
For a healthcare facility to deliver quality healthcare,
It should be well equipped with the right equipment and tools,
Quality medications,
Should be accredited,
Should have qualified and experienced staffs.

N/B The general challenge of leadership and governance has trickled down to the health care sector.
Allocation of resources has been hampered by poor governance and the lack of accountability in the
use of the resources allocated to the healthcare sector therefore, the Government should accelerate
discussions and implementation of public-private partnership initiatives for creation of sustainable
models for healthcare financing to achieve Universal Health Coverage.

Way forward

Healthcare Financing Committee believes in a three ideal strategy namely.

1. Tax funding system to strengthen the infrastructure that has been built over years.
2. Subsidize Pillars – Funding from both external sources like NGOs and FBOs and internal
sources like the government.
3. Choice in Competition – Suitable regulation for both public and private sectors must be put in
place.

4. To engage regularly with the government in providing input to finalise the Healthcare
Financing Strategy.
5. Engage on alternative models of Healthcare financing.
6. Review regulations appropriate with the healthcare financing environment including the
possibility of establishing Health Basics Regulatory Authority (HBRA)
7. Engage the counties in Healthcare Financing issues.

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HEALTH INFORMATION MANAGEMENT SYSTEM
concepts
Health: A state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity (WHO).
Data: (singular=Datum) abstract and unprocessed collection of numbers, characters, and Concepts
from which information and knowledge are derived
Information: processed data that is accurate, timely, specific, and contextual, that leads to increase in
understanding and decrease in uncertainty
OR
Information: specific data, organized in a way that leads to increase in understanding and decrease in
uncertainty
A System: A group of interacting/interdependent items, forming a network that serves a common
purpose
Information Science, is the study of processing, management and retrieval information. HIS-
Integration of healthcare sciences, computer science, information science, and cognitive science to
assist in the management of healthcare information

A health information system (HIS) refers to a system designed to manage healthcare data. This
includes systems that collect, store, manage and transmit a patient’s electronic medical record (EMR),
a hospital’s operational management or a system supporting healthcare policy decisions.

Health information systems also include those systems that handle data related to the activities of
providers and health organizations. As an integrated effort, these may be leveraged to improve patient
outcomes, inform research, and influence policy-making and decision-making. Because health
information systems commonly access, process, or maintain large volumes of sensitive data, security
is a primary concern.

WHO defined HIMS as an” integrated effort to collect, process, report and use health information and
knowledge to influence policy making, programme action and research. It is a science that combines a

52
domain science, computer science, information science, and cognitive science
Health Informatics and its sub discipline.
 Health Informatics have subdomains such as medical informatics, dental informatics,
pharmacy informatics, nursing informatics, etc.
 Each of this subdomains have integrated content and which are collaboratively working with
each other.

Health information systems can be used by everyone in healthcare from patients to clinicians to public
health officials. They collect data and compile it in a way that can be used to make healthcare
decisions.

Examples of health information systems include:

Electronic Medical Record (EMR) and Electronic Health Record (EHR)

These two terms are almost used interchangeably. The electronic medical record replaces the paper
version of a patient’s medical history. The electronic health record includes more health data, test
results, and treatments. It also is designed to share data with other electronic health records so other
healthcare providers can access a patient’s healthcare data.

Practice Management Software

Practice management software helps healthcare providers manage daily operations such as scheduling
and billing. Healthcare providers, from small practices to hospitals, use practice management systems
to automate many of the administrative tasks.

Master Patient Index (MPI)

A master patient index connects separate patient records across databases. The index has a record for
each patient that is registered at a healthcare organization and indexes all other records for that patient.
MPIs are used to reduce duplicate patient records and inaccurate patient information that can lead to
claim denials.

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Patient Portals

Patient portals allow patients to access their personal health data such as appointment information,
medications and lab results over an internet connection. Some patient portals allow active
communication with their physicians, prescription refill requests, and the ability to schedule
appointments.

Remote Patient Monitoring (RPM)

Also known as telehealth, remote patient monitoring allows medical sensors to send patient data to
healthcare professionals. It frequently monitors blood glucose levels and blood pressure for patients
with chronic conditions. The data is used to detect medical events that require intervention and can
possibly become part of a larger population health study.

Clinical Decision Support (CDS)

Clinical decision support systems analyze data from various clinical and administrative systems to
help healthcare providers make clinical decisions. The data can help prepare diagnoses or predict
medical events — such as drug interactions. These tools filter data and information to help clinicians
care for individual patients
The health information system collects data from the health sector and other relevant sectors, analyses
the data and ensures their overall quality, relevance and timeliness, and converts data into information
for health-related decision-making.
Health planners and decision-makers need different kinds of information including:
• health determinants (socio-economic, environmental behavioural, genetic factors) and the contextual
environments within which the health system operates;

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• inputs to the health system and related processes including policy and organization, health
infrastructure, facilities and equipment, costs, human and financial resources, health information
systems;
• the performance or outputs of the health system such as availability, accessibility, quality and use of
health information and services, responsiveness of the system to user needs, and financial risk
protection;
• health outcomes (mortality, morbidity, disease outbreaks, health status, disability, wellbeing); and
• health inequities, in terms of determinants, coverage of use of services, and health outcomes
A good health information system brings together all relevant partners to ensure that users of health
information have access to reliable, authoritative, useable, understandable, comparative data.

Benefits of Health Information Management Systems (HIMS) includes:

 Helping decision makers to detect and control emerging and endemic health problems,
 Monitor progress towards health goals and promote equity.
 It will empower individuals and communities with timely and understandable
health related information, and lead to an improvement in the quality of services.
 The use of HIMS will assist in strengthening the evidence base for effective health policies,
permitting evaluation of scale-up efforts,
 enable innovation through research,
 improve governance,
 mobilizing new resources and ensuring accountability.
 It has been seen as a tool that can be used to improve the quality of health care and patient
safety.
The critical role of information technology in health care systems is to meet the six aims of care;
 care that is safe,
 effective,
 efficient,
 timely,
 equitable
 patient-centered.

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Data from different sources are used for multiple purposes at different levels of the health care system.
• Individual level data about the patient's profile, health care needs, and treatment serve as the basis
for clinical decision-making. Health care records provide the basis for sound individual clinical care.
Problems can arise when health workers are overburdened by excessive data and reporting demands
from multiple and poorly coordinated subsystems.
• Health facility level data, both from aggregated facility-level records and from administrative
sources such as drug procurement records, enable health care managers to determine resource needs,
guide purchasing decisions for drugs, equipment and supplies, and develop community outreach. Data
from health facilities can provide immediate and ongoing information relevant to public health
decision-making but only if certain conditions are met. The data must be of high quality, relate to all
facilities (public and private), and be representative of the services available to the population as a
whole.
• Population level data are essential for public health decision-making and generate information not
only about those who use the services but also, crucially, about those who do not use them. Household
surveys have become a primary source of data in developing countries where facilitybased statistics
are of limited quality. But household surveys are needed everywhere because they are the only good
source of information on individual beliefs, behaviours and practices that are critical determinants of
health care use and of health status.
• Public health surveillance brings together information from both facilities and communities with a
focus mainly on defining problems and providing a timely basis for action. This is especially so when
responses need to be urgent, as in the case of epidemic diseases. The need for timeliness of reporting
and response, and the requirement for effective linkages to those in authority with the responsibility
for disease control, impose additional requirements on health information systems.
eHealth
eHealth is the application of informatics to healthcare, which began nearly 40 years ago. The growing
concern regarding medical error in Europe and the U.S. favors the massive recourse to eHealth tools.
eHealth improves quality of care through the health delivery system

Kenya is the only African country with a comprehensive eHealth strategy. The country has been
ranked the second highest country from the African continent (behind South Africa), on eHealth

56
innovation, and has made noteworthy progress in developing a sound policy foundation to manage the
rollout of Health IT in the country.

The Kenya e-Health Strategy is anchored on the achievement of Vision 2030, whose overall goal in
health is to have an “equitable and affordable healthcare at the highest achievable standard” to her
citizens. It is informed by the strategies and results emanating from the implementation of the Kenya
Health Policy Framework, 1994-2010, the health sector strategic plans and the e-Government and
shared services strategies implemented through the e-Government Directorate and the ICT Board
respectively.

The government of Kenya has a well-defined eHealth strategy with a specific e-Health policy tool, the
Kenyan e-Health strategy 2011-2017.

The document identifies five main areas of focus and implementation:

 Telemedicine;

 Health Information Systems;

 Information for Citizens;

 mHealth,

 eLearning.
HIS IN KENYA
Two main kinds of HIS exist
1. District Health Management Information System (DHMIS)
2. Community-based Health Management Information Systems (CHMIS)

DHMIS
 It’s a facility based health information system, hence generates information originating from
health facilities.

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  Information is limited in scope: it only captures information from healthcare-seeking clients
who are able to pay for health services i.e. those who don’t visit health facilities and those who
can’t afford to pay are not covered.
 Also, it can’t capture illnesses that are mild, culturally stigmatized, and those which are
culturally believed to be untreatable by western medicine
 The DHS, usually manned by the DHRIO is an example of a DHMIS

CHMIS
 Generates information through sources at the community level, hence captures all health
conditions including those omitted by DHMIS
 The CHMIS collects various information from the target communities including information
on environmental health (water, sanitation etc.), disease incidence, utilization of services (e.g.
FP, mosquito nets etc.) and traditional cultural practices that affect health e.g. FGM, TBAs
 Local communities use this information to plan and monitor and respond to their own health.

Definition of Health Indicator

An indicator is a unit of information measured over time that captures changes in a specific
condition.

A functioning HIS should be able to provide a series of indicators that relate

 To the determinants of health, including socioeconomic, environmental, behavioral, and
genetic determinants or risk factors;
 To the health system, including the inputs used in the production of health;
 To the health status of the population. The list of indicators should be defined by the
users of information at different level in a consensus-building process.

Users of health information

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At each level of the health care system, users of health information have differing needs and use
information in different ways.
At the most basic level of client–health worker interactions, patient
records are a vital source of information, whose utility is not confined to the individual level.
Record reviews can be used to ascertain the extent of conformity with agreed norms and standards
of care. Confidential enquiries and facility-based audits review provider practices in order to
determine to what extent care could be improved and the degree to which deaths were avoidable
and the potential policy implications of such avoidable factors.
At the facility level, managers need information on patient profiles, patterns of admissions and
discharges, length of hospital stay, use of medicines and equipment, deployment of different
categories of health care workers and ancillary staff, costs and income.
At district level, planners
and managers use this information and data on locally relevant population profiles and risk factors
in decision-making regarding allocation of resources to different facilities.
Within the public health sector, such information is transmitted upwards through district and
provincial levels to the national level where basic resource allocation decisions are made. More
problematic is the extent of such reporting by the private sector – unless there is a strong regulatory
framework within which the private sector operates, it is unlikely that such information will be
transmitted to the planning authorities.
When making strategic health sector decisions, national level authorities use health-related
information from sources such as routine service statistics, household surveys, vital registration,
census, national accounts, and education and employment data (particularly with regard to the
production and availability of human resources for health).
National authorities also report health-related information to international bodies such as the
United Nations
This rapid overview of the different users of health information at different levels demonstrates
three important principles:
Different types of health-related data are needed at different levels of the health care pyramid
– not all items of information need to be reported at every level.
Those working at the periphery, closest to patient management, need more detailed
information on clients seen and services provided than those working at the central level.

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In order to avoid overburdening health care workers at the peripheral level, managers and
planners should consider carefully what type of data should be generated at each level, bearing
in mind that to the extent possible, those collecting and transmitting data upwards through the
system need to understand and appreciate why the data are required

DATA REPORTING TOOLS ( SUMMARIES)

If the health information system forms are so complicated that those who are to complete them
cannot understand them or the forms are not available all the time, data will not be collected
properly. Therefore, every effort must be made to simplify forms and to ensure that there is a
constant supply of them. Such forms can have a space for some simple on the spot analysis e.g.
total numbers or percentage to be calculated. The summaries which draw information from the
above registers are listed below:
1. MOH 105 Service delivery
2. MOH 701 A Under five (<5) years Daily outpatient morbidity tally sheet.
3. MOH 701 B Over five (>5) years Daily outpatient morbidity tally sheet.
4. MOH 705 A Under five (<5) years Daily outpatient morbidity summary sheet.
5. MOH 705 B Over five (>5) years Daily outpatient morbidity summary sheet.
6. MOH 702 Immunisation and Vitamin “A” Tally sheet
7. MOH 710 Immunisation and Vitamin “A” summary sheet.
8. MOH 704 Child Health and Nutrition Information System tally sheet.
9. MOH 711 A Integrated tool for RH, HIV/AIDS, Malaria, TB, and CHANIS summary.
10. MOH 711 B Integrated tool - RH, HIV/AIDS, Malaria, TB, and CHANIS District summary.
11. MOH 717 Monthly Workload report for hospitals (Service workload for all areas)
12. MOH 268 Diagnostic Disease Index
13. MOH 718 In-patient morbidity and mortality summary sheet.
14. MOH 708 Environmental Health services

COMPONENTS OF A HIS
1. Health information system resources (inputs):
These include the legislative, regulatory and planning frameworks required for a fully functioning
health information system, and the resources that are required for such a system to be functional. Such

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resources involve personnel, financing, logistics support, information and communications technology
(ICT), and coordinating mechanisms within and between the six components
2. Indicators:
A core set of indicators and related targets is the basis for a health information system plan and
strategy. Indicators need to encompass determinants of health; health system inputs, outputs and
outcomes; and health status
3. Data sources:
These can be divided into two main categories; (1) population-based approaches (censuses, civil
registration and population surveys) and (2) institution-based data (individual records, service records
and resource records). A number of data-collection approaches and sources do not fit into either of the
above main categories but can provide important information that may not be available elsewhere.
These include occasional health surveys, research, and information produced by community based
organizations
4. Data management:
This covers all aspects of data handling from collection, storage, quality-assurance and flow, to
processing, compilation and analysis
5. Information products:
Data must be transformed into information that will become the basis for evidence and knowledge to
shape health action
6. Dissemination and use:
The value of health information is enhanced by making it readily accessible to decision-makers and by
providing incentives for, or otherwise facilitating, information use.
Standard Operating Procedures (SOPs)
Procedures for completing and forwarding health information reports:
In order to make the data comparable in time and space, data collection is standardized. Sets of
forms are designed on which the collected data can be recorded. Some are tally sheets, monthly
report forms and annual summary sheets. Each health facility, activities are instantly recorded by
tallying or register with or without existing tools and summed up at the end of the day. The sum
up of the daily totals makes weekly or monthly totals for each activity available easily. The
following sources of error are common and should be avoided:-
a) Forgetting to record in the service/activity register

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b) Forgetting to tally.
c) Misclassification
d) Miscalculations and
e) Figure “cooking”

GOOD PRACTICES IN DATA COLLECTION

 Keep data collection instruments as simple as possible
 Involve users in the design of tools
 Standardize definitions and procedures
 Train health care givers as data collectors and data users
 Keep communication between collection and action people
 disaggregate data (at least by age and sex)

Challenges in Health Information systems which can affect management decisions

 Problems in processing of data;
 Computer breakdown
 Delay in producing reports
 Volume of data too high for staff use
 lack of psychological ownership,
 Underestimation of complexity such as (missed deadlines, cost
overruns and lost credibility),
 failure to define and maintain success criteria,
 organizational factors such as (lack of a clear vision of change, ineffective reporting
structure,
 rapid staff turnover,
 low staff competency,
 lack of full support from higher management,
 confusion on roles and responsibilities
 inadequate resources, failure to benchmark existing practices, inability to measure success
etc.),

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  technological factors and training factors (such as inadequate or poor-quality training, poor
timing of training, i.e., too early or too late)
ORGANIZATION AND MANAGEMENT OF HEALTH FACILITIES, EQUIPMENT AND
MATERIALS

Over half of Kenya's healthcare services are provided by the public sector, through the Ministry of
Health (MOH), other government funded bodies, and donor partners, including the United States.
These services are supplemented by those offered in hospitals and clinics that are operated by private
companies, NGOs and various faith-based organizations such as the Kenyan Episcopal Conference,
Christian Health Association of Kenya, and the Kenyan Red Cross.

In June 2013, the devolved Government of Kenya passed a law that enabled devolved healthcare to all
the 47 counties, which meant the establishment of a level 5 and level 4 hospital in each of the counties.
For these developments to take place, the medical equipment facilities needed to be expanded and
modernized.

Most recently, the major problems related to heavy capital expenditure on medical equipment have
been addressed through the Managed Equipment Services (MES) project, a leasing model which was
launched by the government in February 2015. The multi-million-dollar project, was fully financed by
the MoH as the plan is part of the government’s vision to transform the health sector, and address
inequalities in access to quality healthcare. The MES project was been designed to cover six critical
areas of care: dialysis, emergency, maternal and child health, basic and advanced surgery, critical care
and imaging services.
To address the needs for these key areas, the equipment procurement was divided under seven clear
categories: Theatre; Sterilization; Laboratory; Dialysis; Intensive Care Unit (ICU); Radiology which
also covers Imaging (X-ray). A top U.S. medical device manufacturer was among the five companies
that were awarded the contract by the Ministry of Health (MoH) under the Managed Equipment
Service (MES) model. The firm has been applauded by the government of Kenya for the success of the
program.

Medical Device Procurement

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Public procurements for both medical equipment and pharmaceuticals are done by the Kenya Medical
Supplies Agency (KEMSA), a state corporation and a specialized medical logistics provider for the
Ministry of Health. Centralized purchasing and procurement are often used in both public and private
hospitals to obtain economies of scale. KEMSA, the largest source of healthcare public procurement in
Kenya uses either; open international tenders, open national tenders (limited to local Kenyan suppliers
only), restricted tenders or direct procurement (from government agencies only) to source for
products. Most tenders usually run for a two-year period.

All National and local level facilities are by law obliged to first purchase from KEMSA, and only if
the items are not available, are they allowed to source their supplies from other private sector
distributors. KEMSA procures medical supplies for county governments, referral hospitals, and for
programs funded by donors. KEMSA does not receive direct funding from the GOK, as it relies on a
revolving fund which is dependent on the payment from the public purchases and has program support
partnerships with various donors such as; UNICEF, Global Fund, DFID, USAID, KFW, UNFP, and
JHPIEGO. GOK funded programs prefer local suppliers and range from 6-12% of total procurements.
All public tenders are advertised on the treasury website and follow the Public Procurement Act.

Regulation

The Ministry of Health (MoH) is the lead healthcare policy-setting government institution in Kenya.
The Pharmacy and Poisons Board (PPB), an agency under the Department of Medical Services,
regulates the registration of medical devices.

The Kenya Bureau of Standards (KEBS) and the Pharmacy and Poisons Board (PPB) announced the
new import requirements to protect the public against products that do not comply with local quality
standards and technical regulations. These new regulations for imported medical devices will increase
compliance for importers and drive up standards in the Kenyan medical device market.
The government also announced the exemption of medical equipment and apparatus from VAT.

COMMODITY AND SUPPLY CHAIN MANAGEMENT

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 • Commodity management is a set of activities and procedures that ensure that health
commodities are available, accessible and of high quality.
• Importance of commodity management

This is to ensure consistent availability of and access to medicines, laboratory reagents and other
medical supplies.

Some of the supplies also have a short shelf-life and are costly and hence needs to management
effectively.

The other importance is to improve quality of life patients and to increase the consumer confidence in
the healthcare system

• Commodity management cycle

• Commodity management can be described as a cycle made up of various components. These

components are product selection, procurement, inventory management (with storage &
distribution) and use

• Product Selection: Selection is the process of identifying which commodity should be made
available as per the national guidelines. Appropriate selection ensures that the effective
medicines and related commodities for are selected. It also ensures that right dose, dosage
form, preparation are selected and the most affordable commodities are made available

• Procurement: This is the process of obtaining the required medicines and supplies through
purchase, donations or manufacturing. Key components of procurement includes quantification
which is the need to know how much to buy. It also includes supplier selection where who to
buy from and how to buy is identified. In procurement also quality assurance in order to ensure
quality of the products you buy

• Distribution: This is transferring commodities from a storage facility/supplier to a point of use

or from one point of use to another, including appropriate storage and inventory control. It
involves moving stocks from national stores, to district stores or central sites. It also includes

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 distribution from District stores or central sites to facilities and finally from the facility store to
user points.

• Use: Refers to practices that include dispensing the prescribed medicines to patients, patient
adherence and follow up and also issuing other commodities to points of use.

Types of Records used in commodity management

• Stock keeping cards: These keep information about commodities in storage at the facility

• Transaction records: Keep information about commodities being moved from one facility to
another or within a facility.

• Consumption records: Keep information about quantities of each commodity dispensed on

daily basis to patients

The Procurement

• Procurement means the purchasing, hiring or obtaining by any other contractual goods,
construction and services. Public Procurement means procuring by public funds. Procurement
also means acquiring affordable commodities of good quality, either by purchase or from
donations

Procurement cycle

Procurement follows a series of steps

• Select the commodity / Review the selection

• Forecast & quantify the quantities needed

• Reconcile the needs and the funds available

• Choose the procurement method

• Locate and select suppliers

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 • Specify terms of supply

• Monitor supply order progress

• Receive and check supplies

• Make payment to suppliers

• Distribute the commodities

• Collect consumption data

PROCUMENT METHODS

In Kenya, procurement in the public sector is governed by the Public Procurement Act. Let us briefly
look at the methods used in procuring health commodities:
• Open tender: This is a formal procurement process in which local or international suppliers
(or their representatives) are invited to submit bids for the supply of commodities under the
terms and conditions stipulated in the tender. This method allows for the widest selection of
potential suppliers. However it is a time-consuming and bureaucratic method

• Closed or Restricted tender: Similar to open tender but here the bidding is limited to
suppliers meeting certain conditions, e.g. suppliers of a certain financial capacity, suppliers
producing drugs of a certified quality. These suppliers are short-listed using a pre-qualification
procedure. It assists by reducing the potentially large number of suppliers who may bid, as
compared to the open tender.

• Competitive negotiation: Here, the buyer selects a small number of suppliers and negotiates
prices with them directly. It is useful for bulk procurements or for emergency supplies.

• Direct purchase: The product is purchased directly from one supplier. This is the simplest
method but usually very expensive since the buyer does not seek better value by checking out
other suppliers. It’s useful for small procurements or for emergency supplies

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Ethical and legal implications in commodity and supplies management

Public procurement in Kenya should be based on core principles and pillars. Some of these
principles include:

• Transparency and Accountability: Procuring entities should ensure there is openness and
clarity on procurement policy and its delivery.

• Efficiency: This encompasses the performance of the procurement process as cost effectively
as possible and in a timely manner.

• Consistency: The application of the procurement process should be the same across all
procuring entities.

• Open and Effective Competition: Provision of ample and equal opportunities for
participation by interested and qualified suppliers of goods, works or services.

• Ethics and Fair Dealing: Under the Public Officers and Ethics Act (2003), it is an offence for
those employed by contracting authorities in their official capacity to accept any gift or
consideration as an incentive or reward for acting in a manner showing favor or disfavor for
any person or entity

Legal Framework The legal framework for public procurement includes:

I. Public Procurement and Disposal Act, 2005
II. Public Procurement and Disposal Regulations 2006 and 2009
III. Public Procurement and Disposal Regulations (Public Private Partnerships) 2009
IV. Supplies Practitioners Management Act, 2007.

ALTERNATIVE PERSONNEL SYSTEMS MODELS AND PERSONNEL ISSUES

Efforts to reform public agencies have led to alternative strategies on these two personnel constraints.
Approaches to increasing managers’ ability to remove poorly performing employees include
empowering managers, removing constraints on their ability to manage, and instituting performance
management systems that connect employee efforts with results. Approaches to improving managers’

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ability to reward employees include increased reliance on the performance appraisal process and pay-
for-performance schemes. Evidence on the effectiveness of these reforms is not very impressive. This
evidence suggests that little progress has been made in developing strategies to remove poorly
performing managers, and that pay-for-performance has produced from little to negative results in the
public sector. Yet the evidentiary record is weak and consists mostly of case studies and empirical
studies that have rather major limitations: one such limitation is that few studies have examined the
impact of these reforms on robust measures of organizational performance. To this end, we undertake
what is – to the best of our knowledge –the first empirical test of the proposition that managers’
perceptions of personnel constraints suppress public service performance.

PERSONNEL ISSUES

People spend nearly one third of their adult lives at work, and workplace issues are a common source
of stress for many. It is impossible to have a workplace where everyone's roles, expectations, and
personalities work perfectly together, without conflict. As such, certain workplace issues may cause
negative psychological symptoms.

Research shows perceived stress in the workplace, for example, is associated with a higher prevalence
of mental health issues such as depression and anxiety. Workers may find discussing their workplace
stress or challenges with a trained mental health professional is helpful to them both professionally and
personally.

Common Workplace Issues

Common workplace issues that employees face include:

 Interpersonal conflict
 Communication problems
 Gossip
 Bullying
 Harassment
 Discrimination
 Low motivation and job satisfaction

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  Performance issues
 Poor job fit

Best Practices for Dealing with Personnel Issues

There are ways to deal with these problem employees.

When you first encounter an employee who has been labelled a problem, take a step back and evaluate
the situation. Observe the employee during the course of their working day to identify any problem
behaviors. It is tempting to rush in once someone reports an employee. However, taking time to
observe issues first hand allows you verify claims and determine the best course of action.

Once you assess the situation, create a plan of action. Never surreptitiously haul the employee into a
meeting and have a stern word. Determine whether the employee could benefit from some mentoring,
requires further training or whether formal disciplinary action is needed.

If you have an informal chat with a problem employee, make sure that you give clear feedback.
Informal chats are a way to discern the underlying reason for a problem behavior. To discover reasons
behind the behavior, it can be helpful to ask the employee questions to which they cannot give simple
yes or no answers. Be mindful not to interrupt. At the end of the answer, repeat it back to them (in a
natural and respectful way) to ensure you’ve taken in all the details. Set steps for improvement and
consequences for failing to change their behavior. In other words, if an employee still continues
causing issues, then make it very clear to them that the next step will be formal disciplinary
proceedings.

On occasion, an employee’s manager will have already tried coaching or training to correct the
problem. They may refer the employee to you as a last resort. In those cases, it’s important to take
management’s previous actions and their results into consideration, but do not allow their conclusions
to predetermine yours.

If possible, develop a solution in partnership with the employee. This helps invest them in the solution,
and improves their motivation and morale. This increased sense of ownership of the solution increases
responsibility and the chances of success in changing the behavior.

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Most importantly, remember to document everything. The moment someone brings you an issue, start
documenting. Record every observation of and interaction with your problem employee. Make sure
that any formal notice, reprimand, etc., is presented to the employee as a written statement and have
them acknowledge it with their signature. This way, if things become ugly or litigious, you have your
documentation in order.

Focus on the behavior and not the employee. Never attack the employee personally or assume that the
problems they are causing stem from malicious intent. The employee could be having personal or
professional issues beyond their control. When dealing with a problem employee, always remember
that an employee is never the problem, their behavior is. It is your job to differentiate the two.

PUBLIC HEALTH

Public health is the studied science of improving and protecting the health of the community with
several campaigns which promote a healthy lifestyle, contribute to disease prevention, and support
researches. It is mainly concerned with creating a healthy environment for people belonging to small
societies to the entire world.

Public health promotes and protects the health of people and the communities where they live, learn,
work and play.

Public health has always been an important segment of government programs. It is meant for the entire
society rather than focusing on a one-on-one health session. Public health promotes healthcare equity,
quality, and easy accessibility.

Public health provides the right health facilities while ensuring everyone is getting benefit from the
programs regardless of socio-economic backgrounds as it is everyone’s right.

Public health makes the individuals of society take the responsibility of taking care of each other’s
health. Those who take up public health as a subject become the voice for people who are suffering but
do not know any better for themselves

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Importance of Public Health

Public health researches target the biggest problems of the healthcare of society. The people who study
public healthcare are constantly researching remedies for diabetes, heart diseases, and cancer to
improve the health and well-being of society.

Public health creates programs to prevent diseases rather than curing them as prevention can be far
more effective and less expensive than the cure.

Public health helps prolong the lives of people with the help of preventive measures which keep the
body healthy and fit to live longer. With a good public health program, the people in the society can
live healthier for a longer time.

Public health researches are focused on detecting the issues and causes of a disease which can be
troublesome for the entire society. They mainly focus on viral diseases and research preventive
measures in order to control diseases. It helps detect the disease as early as possible in order to find
early solutions and preventions to avoid the development of the disease.

Public health creates awareness in society about the benefits of staying healthy. It aware the people
about the health hazards with educational programs, campaigns, and several government policies and
advertisements.

Public health also operates to provide equal health opportunities to everyone. The children, women,
and men of all ages are equally treated under public health programs which helps in improving the
condition of the entire society.
PUBLIC HEALTH LAW

Public health law is the study of the legal powers and duties of the state in collaboration with its
partners (e.g. health care, business, the community, the media and academia) to assure the conditions
for people to be healthy and the limitations on the power of the state to constrain the autonomy,

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privacy, liberty, proprietary or other legally protected interests of individuals for the common good.

Public health in the constitution

Public health law is principally about government’s assurance of the conditions for the population
health. The constitution stipulates the government:

• Duty (what government must do)

• Authority (what government can, but is not required to do)
• Limits (what government cannot do) and
• Responsibility (which government, whether county or national)
Core functions of public health

• Prevent epidemics
• Protect against environmental hazards
• Promote healthy behaviour
• Respond to disasters
• Assure quality of health services

Sources of public health laws

1. National level

• Constitution of Kenya
• Parliament
• Jurisprudence (court decisions)
• Ministries
• County / district
• National committee of ethics – documentations from these can serve as sources of law
• Professional bodies e.g. medical and dentist board, nursing board, Environmental

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 Health sciences board etc.
• Pressure groups – mass media (journalists)
• Political parties
• Religious organizations
• Industries -occupation hazards can prompt the government to enact law
• Others- Associations, NGOs, Kenya Bureau of standards, customs e.g. barring
equipment
• Moral and natural law – refers to naturalism
• Religion (Canon law, Roman Catholic Church)
2. International level
o WHO – health
o UNESCO – culture and health
o UNICEF – children health
o FAO – nutrition
o WORLD BANK – finance and health – money can be borrowed to finance health care
systems
o AFRICAN UNION –
o UN – United Nations
o EU – European Union
o International Court of Justice (ICC)
o Universal declaration of human rights
o International Jurisprudence
o European Parliament
o World Medical Association

Functions of public health law

1. Prohibitions of all injurious action to individual e.g.

• Sale of poisonous food
• Environmental health law (pollution of air, water and land)

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 • Solid and liquid waste management
• Occupation health hazards
• Noise (acceptable decibels)
2. Authorization of health programmes e.g. hospitals – The design of hospitals and health facilities are
well defined in the law.

3. Food production and processing – standards to be followed according to law e.g. levels of mercury
and other heavy metals in fish, labeling of products and definition of content.

4. Organization of health professionals

• Training programs
• Recognition of health professional bodies

5. Health facilities legislations

• Laydown how health facilities must be financed and organized.

6. Control of communicable diseases e.g. cholera, tuberculosis.

7. Mental illness – promotes protection of the mentally disabled persons

8. Reproductive health – burn of human cloning (replicate, making an identical copy of, propagating
an organism or cell), illegal abortion

9. Health promotion and education – example; campaign against AIDS, smoke, alcohol etc.

Examples of public health laws

• Public Health Act.

• Food Drugs and Chemical Substances Act
• Mental Health Act

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 • Meat control Act
• Building Code
• Malaria Prevention Act
• Water Act
• Factories Act
• Radiation Protection Act
• Environmental Management and Coordination Act
• Pharmacy and poisons Act
• Physical Planning Act
• Maritime pollution laws
ASSIGN:
1. Read on medical professional liability – negligence and mal-practice
1. Patients and medical professional’s rights and responsibilities

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PRIMARY HEALTH CARE SERVICES
Definition of PHC

PHC is essential health care that is a socially appropriate, universally accessible, scientifically sound
first level care provided by a suitably trained workforce supported by integrated referral systems
and in a way that gives priority to those most in need, maximizes community and individual self-
reliance and participation and involves collaboration with other sectors.

It includes the following:

 health promotion
 illness prevention
 care of the sick
 advocacy
 community development
PHC is:

Essential health care based on practical, scientifically sound and socially acceptable methods
and technology made universally accessible to individuals and families in the community
through their full participation and at a cost that community and the country can afford …
(Alma-Ata, 1978)

PHC is where people engage with the health system for the first time. It focuses on promoting
health, wellness, preventing disease and the underlying social determinants of ill-health.

A primary health care approach includes three components:

 meeting people's health needs throughout their lives;

 addressing the broader determinants of health through multisectoral policy and action; and.

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  empowering individuals, families and communities to take charge of their own health.

Public PHC facilities are governed by health facility committees, which include the facility in-
charge and community representatives. For private PHC facilities, government oversight is provided
through regulation, implemented through eight regulatory agencies
The principles of primary health care are accessibility, public participation, health promotion,
appropriate technology and intersectoral cooperation. Accessibility means that the five types of
health care are universally available to all clients regardless of geographical location

Functions of PHC
• To provide continuous and comprehensive care
• To refer to specialists and/or hospital services
• To co-ordinate health services for the patient
• To guide the patient within the network of social welfare and public health services
• To provide the best possible health and social services in the light of economic considerations.

Levels of Care

i) Primary health care

 The “first” level of contact between the individual and the health system.
 Essential health care (PHC) is provided.
 A majority of prevailing health problems can be satisfactorily managed.
 The closest to the people.
 Provided by the primary health centers.

ii) Secondary health care

 More complex problems are dealt with.
 Comprises curative services
 Provided by the district hospitals
 The 1st referral level

iii) Tertiary health care

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  Offers super-specialist care
 Provided by regional/central level institution.
 Provide training programs

Essential Elements of Primary Health Care (PHC):

There are 8 elements of primary health care (PHC). That listed below-

1. E-Education concerning prevailing health problems and the methods of identifying,

preventing, and controlling them.
2. L– Locally endemic disease prevention and control.
3. E– An expanded program of immunization against major infectious diseases.
4. M– Maternal and child health care including family planning.
5. E– Essential drugs arrangement.
6. N– Nutritional food supplement, an adequate supply of safe and basic nutrition.
7. T– Treatment of communicable and non-communicable diseases and the promotion of mental
health.
8. S– Safe water and sanitation.

WHO Strategies on PHC

1.Reducing excess mortality of poor marginalized populations:

PHC must ensure access to health services for the most disadvantaged populations, and focus on
interventions which will directly impact on the major causes of mortality, morbidity and disability for
those populations.

2. Reducing the leading risk factors to human health:

PHC, through its preventative and health promotion roles, must address those known risk factors,
which are the major determinants of health outcomes for local populations.

3. Developing Sustainable Health Systems:

PHC as a component of health systems must develop in ways, which are financially sustainable,
supported by political leaders, and supported by the populations served.

4.Developing an enabling policy and institutional environment:

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 PHC policy must be integrated with other policy domains, and play its part in the pursuit of wider
social, economic, environmental and development policy.

The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)
 Appropriateness- Whether the service is needed at all in relation to essential human needs,
priorities and policies. The service has to be properly selected and carried out by trained
personnel in the proper way.
 Availability – It means that care can be obtained whenever people need it
 Adequacy -The service proportionated to requirement. Sufficient volume of care to meet the
need and demand of a community
 Accessibility- Reachable, convenient services. Geographic, economic, cultural accessibility
 Acceptability- Depends on a variety of factors, including satisfactory communication between
health care providers and the patients, whether the patients trust this care, and whether the
patients believe in the confidentiality and privacy of information shared with the providers.
 Affordability- The cost should be within the means and resources of the individual and the
country
 Assessability- Meaning that, medical care can be readily evaluated
 Accountability- Implies the feasibility of regular review of financial records by certified public
accountants
 Completeness- Requires adequate attention to all aspects of a medical problem, including
prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.
 Comprehensiveness- It means that care is provided for all types of health problems.
 Continuity- Requires that the management of a patient’s care over time be coordinated among
providers.

Challenges in PHC

 Lack of political will. ...

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  Inadequate funding. ...

 Bad inter-sectoral collaboration. ...

 Poor Quality of Services in Primary Health care facilities. ...

 Low community participation. ...

 Human Resources in health care facilities.

WHAT IS A HEALTH STRATEGY

UHC-BIG FOUR AGENDA
The Kenyan government has made a commitment to achieve UHC by the year 2022. ... This means
that about half of Kenyans had coverage with both essential healthcare services and mechanisms to
protect them from financial hardship or poverty because of out of pocket healthcare payments.

The four pilot counties – Isiolo, Kisumu, Machakos, and Nyeri – were selected because they are
characterized by high incidence of both communicable and non-communicable diseases, maternal
mortality, and road traffic injuries

Benefits of UHC
Universal health coverage means that all people have access to the health services they need, when
and where they need them, without financial hardship. It includes the full range of essential health
services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

Challenges face by UHC implementation

Low levels of entitlements, large healthcare inequality, limited financial protection and poor
portability are deemed as major challenges in the progress of UHC.

MONITORING AND EVALUATION

Done on projects or programmes

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Monitoring is the routine tracking of the key elements of programme performance through
Continuous collection, analysis and reporting of information.

Evaluation is a process for determining, as systematically and objectively as possible, the

Relevance, effectiveness and impact of activities in the light of their objectives

Organisations use monitoring and evaluation for two key purposes:

 To learn about their own activities and results, and to support internal planning and
development
 To be accountable to their stakeholders – donors, sponsors, beneficiaries etc.

MONITORING EVALUATION

 Continuous process  Periodical

 Internally done  Done internally and externally
 Tracks programme implementation i.e.  Determines to what extent programme
tracks progress objectives have been met i.e. measures
change

KEY TERMS USED IN M&E

Indicator: Indicators are measurable variables which are used to measure certain aspects of a complex
variable
Input: Resources used for program implementation such as money, staff, curricula and materials.
Process: Activities/services that the program provides to accomplish its objectives.
Output: Direct products or deliverables of the program such as people trained, mosquito nets
distributed, etc.

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Outcome: (intermediate results) results that occur after some time after the program activities have
been implemented such as knowledge, attitudes, beliefs, skills behaviors, access, policies and
environmental conditions.
Impact: Long-term results of one or more programs over time, such as changes in morbidity and
mortality.

REASONS FOR EVALUATING PROGRAMS

1. To collect evidence on the effectiveness/impact of a program.

2. For accountability to stakeholders: funders/sponsors, clients, volunteers, staff, or community.
3. Institutional learning. To identify ways to improve a program: determining what works, what
doesn’t work and why, assessing needs of target population, improving the usefulness of program
materials
4. To compare a program with other programs.
5. To assess the efficiency of a program (cost-benefit analysis).
6. Provides a robust basis for raising funds and influencing policy-source of evidence.
7. To test a hypothesis i.e. for research purposes

THE WORTH OF A HEALTH PROGRAM CAN BE JUDGED BY ITS:

 Effectiveness – the extent to which aims and objectives are met
 Appropriateness – the relevance of the intervention to needs of
society/communities/beneficiaries
 Acceptability – whether it is carried out in a sensitive way
 Efficiency – whether time, money and resources are well spent, given the benefits
 Equity – equal provision for equal need

Log Frame

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The Logical Framework Approach (LFA) is a management tool mainly used for designing, monitoring
and evaluating international development projects. It is also widely known as a Goal Oriented Project
Planning (GOPP) or Objectives Oriented Project Planning (OOPP).

Monitoring and Evaluation Functions

M&E functions to achieve five main things - FALAM
F – Follow-up
A – Accountability
L – Learning
A – Action
M – Management

Benefits of Monitoring and Evaluation

• Evidence-based programming
• Management efficiency
• Documentation and determination of what works
• Early warning in programs for corrective action
• Information to manager for day to day decisions
• Participation, understanding and consensus
• Accountability
• Advocacy and transparency
• Demonstration of success and formulation of policies
• Wise allocation of funds

Expectations of Monitoring and Evaluation

 Innovation
 Reach or coverage
 Cost efficiency
 Replicability
 Public/stakeholder opinion
 Quality

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  Sustainability
 Impact

TYPES OF EVALUATION
Three main types of evaluation based on when the evaluation is done and the type of data collected:
1. Formative evaluation:
It’s part of the planning stages of a program, and ensures that programs are developed based on
stakeholder needs, and that the program adopts effective and appropriate materials and approaches. It
examines how well the program is developed/designed to achieve intended goals. It includes:
 Needs assessments,
 Evaluability assessment
 Program logic models
 Pre-testing program materials
 Audience analysis.

2. Process evaluation:
Examines procedures and tasks involved in program delivery. Focuses on extend to which the program
is delivered as designed.
Some of the questions addressed by process evaluation are:
 What services are being delivered? to whom? and how?
 How well was the programme implemented?
 Did the intervention reach the intended target recipients?
 What proportion of the target recipients actually received the intervention?
 Was the intervention acceptable to the recipients?
 What was the satisfaction level of the recipients?

3. Summative evaluation:
Focuses on programs that are already underway or completed and investigates intended and
unintended effects of the program.
Takes three main forms:
Impact evaluation: did the program make a difference?

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Outcome evaluation: did the program achieve intended objectives?
Economic evaluation: Is/was it worthy to spent X resources, given the program brought Y benefits?
Generally Summative evaluation can assess immediate (outputs), short term (outcome) and long term
(impact) achievements of a program e.g.
 Changes in attitudes, knowledge or behavior (output)
 Changes in morbidity or mortality rates (impact)
 Changes in policies (outcome)

METHODS OF EVALUATION
There are two methodologies for evaluation
1. Quantitative methods-wide/broad
2. Qualitative methods-deep
Each approach has certain advantages towards answering certain questions.
The type of evaluation therefore depends on what type of information the stakeholders want, and the
amount of resources available
Generally, formative evaluation employs qualitative methods while mixed methods (combination of
both qualitative and quantitative) is used for process and summative evaluations

CHALLENGES TO EVALUATION

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  Difficult to have a rigorous study design that includes a comparison or control group
 Finding a way to measure the effects of your project or program separate from other projects
and programs in the same target group or geographic area-programs can’t evade interference
 Insufficient staff (who can coordinate and guide evaluation design and implementation,
including when evaluation is conducted by an external body)
 Lack of skill in evaluation design, data collection methods, analysis, write-up, and
dissemination
 Insufficient financial resources.

STRATEGIC PLANNING
Strategic planning is a process that is designed to achieve goals in dynamic competitive environment
through the allocation of resources. Drucker (1973 defines strategic planning as a continuous
systematic process of making risk-taking decisions today with the greatest possible knowledge of their
effects on the future.

Steps in strategic planning process/planning cycle

1: Environmental scanning
• This involves assessment of the External an Internal-environment
• The economic, demographic, technological, social, educational and political factors are
assessed in terms of their impact on opportunities and threats within the environment
• Internal environment assessment (SW) includes review of the effectiveness of the structure
size, programmes, financial resources, human resources, information system, research and
development capabilities of the organization
2: Strategy formulation
• This includes the development of the mission, specifying objectives, developing strategies and
setting policy guidelines.
• Mission: The development of the mission statement provides a sense of direction and focus
and draws the organization together. The purpose of the mission statement is to communicate
what the organization stands for and where it is heading. Mission statement answers the
question, why do we exist. Everyone should participate in deciding of the mission statement.

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 • Goal Setting: This is the process of developing, negotiating and formalizing the targets or
objectives that an employee s responsible for accomplishing (performance standards). Goals
assist the managers to focus attention on what is relevant and to develop strategies and actions
to achieve the goal.
• Objectives: Objectives should be challenging, measurable, consistent, achievable, reasonable
and clear. Smart – outcome oriented
• 3: Identification of strategies: Strategy determines how the organization will go about
attaining their vision i.e. how it will exploit the external opportunities and internal strengths
and counter external threats and internal weaknesses. This involves preparing a detailed plan of
action, either short-term and long-term objectives. Formulation of annual departmental
objectives, resource allocation and preparation of budgets is also done at this stage. Strategies
may include; retrenchment, expansion, recruitment etc
4: Strategy Implementation
• This is the action stage. The specific plans for action are implemented in order of priority. It
entails open communication with staff in regard to priorities and formulation of area and
individual objectives related to the plan. Resource allocation (human/non human allows for
strategy execution. Resources are allocated in order of priority i.e. established by annual
objectives.
5: Strategy Evaluation
• At set periods, the strategic plan is reviewed at all levels to determine if the goals, objectives
and activities are on target. Monitors the results of formulation and implementation of
activities and includes measuring individual and organizational performance and taking
corrective actions when necessary
Operational planning
This is tactical planning and a short-term exercise designed to implement the strategies formulated
under strategic planning. It is based on strategic plans.

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