District Health Management Tools Facilitator's Manual Dr. Barbara Kloss-Quiroga (Ed.

) Berlin 2004

Since 1992, InWEnt - Public Health Division (formerly DSE/Public Health Promotion Centre) has organised management trainings for health managers from Africa, Asia, Latin America and Europe. The positive feedback and great demand for this training programme led to the idea to develop a training manual to reach a wider audience. Assembling ten years of experience, this manual compiles the most successful training units and strategies. The manual is intended to be used as a training guide and source of information and reference by trainers, facilitators or presenters who will have some experience with District Health Management. It contains background readings as well as descriptions of procedures, teaching materials, instructions and proposals for possible further action. It answers practical questions on how to organise the training sessions, how to employ convenient methods, how to convey specific contents to name only a few. The following pages introduce the rationale and approach of the training course, the structure of the manual, and summarise training contents and objectives of each training module. Module 5 presents not only a summary but also provides detailed background information for facilitators/trainers, a description of the procedures, as well as selected exercises, handouts and transparencies taken from the manual.

Dis trict Health Manag ement Tools – Copy right: InWEn t, Hea lth Division , Bonn , Germ any – www.in went.o rg - P age 1

Rationale and Approach The approach to District Health Management presented in this manual is based on the concept and principles of Primary Health Care. Since the mid 1980s, the health district as an operational unit has become the essential element of health policy concepts in low income countries (Harare conference in 1987). Structural adjustment and health sector reform promote the decentralisation of decision making power and financial responsibility to the district level. The complex task of building up and managing a modern health system requires professional training that goes beyond the classical transfer of knowledge. Besides sound technical knowledge, District Health Managers need qualifications like good leadership ability, communications skills, process-oriented thinking and the capacity to co-operate in local and regional networks. The experiential, participatory, problem-oriented training approach outlined in this manual, promotes practical knowledge and skills, gender/diversity-sensitivity, and the exchange of ideas, personal experiences and perspectives.

Structure of the Manual The facilitator's manual is divided into four parts: Part I is an introduction to the training course giving an overview of the rationale, objectives and target groups for the course. It includes an overall explanation on how to use the manual and about its structure, giving recommendations on training methods and course schedules. Part II and Part III present the actual training contents, methods, didactic materials and additional literature recommended to cover two broad content areas: "The Basics of District Health Management" and "A System's Approach to District Health Management". Part IV, the annex, describes the authors of this manual, provides a glossary of terms and acronyms, gives materials for intermittent and final course evaluation, and presents a list of abbreviations and a pre/post-test questionnaire.

Dis trict Health Manag ement Tools – Copy right: InWEn t, Hea lth Division , Bonn , Germ any – www.in went.o rg - P age 2

Part I: Course Introduction: Module 1: How to Use the Manual Part II: The Basics of District Health Management Module 2: Training Course Introduction Module 3: The Essential Manager Module 4: Managing the District Part III: A System's Approach to District Health Management Module 5: Input . Bonn .Planning and Programming Module 7: Human Resources Development Module 8: Financial Management Module 9: Output . each composed of specific training units. Germ any – www. Hea lth Division .Training Modules The overall training programme guides you through nine training modules.Situation Analysis Module 6: Process .o rg .P age 3 .Evaluation and Quality Assessment Part IV: Annex Dis trict Health Manag ement Tools – Copy right: InWEn t.in went.

g.o rg . They have been introduced to the training approach and methods used. its content and programme as well as training approach and methodology.Module 2 Training Course Introduction by Barbara Kloss-Quiroga Every training course starts with the introduction for the participants and training team to get acquainted with one another. visualisation and participation and have agreed on the work procedure throughout the course. contents and the proposed programme schedule for the course. Dis trict Health Manag ement Tools – Copy right: InWEn t. Germ any – www.P age 4 . Objectives The training team and participants have introduced themselves and stated their expectations and fears. Bonn . Some time needs to be reserved for the expression of expectations and fears of participants.in went. e. This module presents different techniques to start the training course and build a strong learning community. The participants know the objectives. Hea lth Division . The course introduction includes the presentation of course objectives.

subordinates. superiors. resource-limited public service is a job for a very well trained. Bonn . gender and diversity. Dis trict Health Manag ement Tools – Copy right: InWEn t. colleagues. interacting with patients. skilled and competent manager. health professionals need to be multi-talented and skilled communicators. demand-driven. community representatives. communication and interpersonal skills are of utmost importance in dealing successfully with individuals. the interests of the community. Unit 1 Basic Skills in Communication Unit 2 Visualisation/Facilitation Unit 3 Leadership Unit 4 Gender and Diversity in Management Unit 5 Team Building and Team Work Unit 6 Staff Motivation Unit 7 Conflict Management Unit 1 Basic Skills in Communication Due to their role and function in the health system. Communication does not merely consist of one person speaking and another listening. This unit gives an introduction to the model of human communication.Module 3 The Essential Manager by Barbara Kloss-Quiroga and Gerlinde Reiprich Managing a very complex. relatives of patients. who intends to get a particular message content across to the receiver. such as: communication. facilitation. Besides having sound technical knowledge. officials.P age 5 .in went. who in turn needs to interpret the message correctly. and others.o rg . Objective At the end of the module participants have acquired basic knowledge and skills in issues relevant to management at various health system levels. Human communication is a very complex process involving a sender. leadership. Germ any – www. motivation and conflict management. providing good management practice. Hea lth Division . and political goals.

are aware of the important role of feedback in communication and know basic rules for giving and receiving feedback. etc. thoughts and feelings. statements and comments in order to value participation.Specific Objectives of the Unit At the end of the unit the participants: are able to distinguish the different steps of the communication model. etc. Specific Objectives of the Unit By the end of the module participants: are able to visualise theories. conferences. assuring the contribution of all participants. Hea lth Division . document results and structure communication processes. etc. messages. for presentation purposes or in group/team work. Group members need opportunities to contribute with their ideas. Unit 2: Visualisation/Facilitation Good modern management is based on the active involvement and creativity of all members of working groups. The manager's or leader's role is it to provide these opportunities and to guide the communication towards a defined or agreed upon goal/aim.P age 6 . have worked out a course contract/course rules. results. using questions and answers as instruments Dis trict Health Manag ement Tools – Copy right: InWEn t.o rg . departments or divisions. ideas. understand the different unsaid messages a sender can transmit to the receiver or the receiver can read from the sender. Bonn .in went. One important tool in facilitating group activities is to visualise ideas. have acquired basic knowledge on facilitating meetings. Germ any – www. teams. seminars... thoughts. group work sessions. The manager thereby becomes a facilitator/moderator.

Secondary dimensions of diversity are those that can be changed.Unit 3: Leadership Leadership is a way of directing and motivating people. rules. It is less of a technical skill and depends more on personal qualities like social and communicative competence. routine activities and division of resources in all forms of social organisation.o rg . marital status. and sexual orientation. geographic location. Such differences between men and women or between groups are often not taken into consideration. yet are present in other individuals and groups". distinguish between management and leadership. diagnose their own leadership styles. Bonn . In particular. Hea lth Division . Health managers need to consider the different characteristics of the people they are working with and the population covered by their catchment area. and include educational background. In this manual. religious beliefs. ethnicity. income. develop an idea or vision of their future leadership behaviour. gender relations form a social system which is supported by values.P age 7 . Specific Objectives of the Unit At the end of the unit participants are able to: identify functions and roles of a leader. and ability to cope with given socio-cultural settings. they are often unequal and hierarchical. Primary dimensions of diversity are age. Gender roles and relations are strongly related to power structures within societies. parental status. Dis trict Health Manag ement Tools – Copy right: InWEn t. physical abilities/attributes. or are taken for granted in a way that hinders work efficiency. Germ any – www.in went. and work experiences. intuition and emotional intelligence. Unit 4: Gender/Diversity Issues in Management Diversity is defined as "those human qualities that are different from our own and outside the group's to which we belong. gender. we refer to a set of leadership concepts we consider to be essential in health management. interpersonal relationships and unpredictable or irrational behaviour.

and to promote group ownership by relinquishing some control. distinguish between gender and diversity. Decisions are made by consensus. they are open. Unit 5: Team Building and Team Work Working as a team means working in a group with shared objectives. participants: have raised their awareness concerning gender issues in society. Bonn . people care for each other. Germ any – www. The manager's role within a team is to initiate group processes. understand the different stages of a team development process recognise their own roles as members of a team. apply management principles related to team work. to achieve commitment. consider gender aspects in analysing health problems applying systematic frameworks (Harward Analytical Framework/ Guidelines for the Analysis of Gender and Health).in went. Hea lth Division . Dis trict Health Manag ement Tools – Copy right: InWEn t. know the developmental concepts of "Women in Development (WID)" and "Gender and Development (GAD)". and TBC and their impact on men and women.P age 8 . equity and equality. analyse gender issues through the examples of HIV/AIDS. Specific Objectives of the Unit At the end of the unit participants will: describe the concepts and principles of team work.Specific Objectives of the Unit At the end of the unit. truthful and have a high level of trust. under specific rules/regulations and with equal members. malaria. there is strong commitment and conflicts are addressed and worked through.o rg . In successful teams that function properly. which have different but complementary competencies to fulfil a specific task. be aware of the differences between groups and teams. thereby enabling the group to attain its own process and success.

Specific Objectives of the Unit At the end of the unit participants: appreciate the complex factors surrounding the issue of motivation at work. Most importantly.P age 9 . reflect on the topic of motivation in the workplace. people must choose to change themselves.Unit 6: Staff Motivation by Marie Claude Foster Motivation is a complex issue which does not easily fit in with the cause and effect Newtonian model used by many scientific researchers in the field. Bonn . Dis trict Health Manag ement Tools – Copy right: InWEn t. it is also important for managers to reflect on the environment. and ability to exert choice differentiates humans from the machine-like state applied to the cause and effect model. While realising that change is an individual decision.o rg . The aim of this unit is to get participants to reflect on such complexities while using theoretical frameworks as guides. are familiar with a few of the classical theories on motivation.in went. behavioural change cannot be forced on other human beings. Hea lth Division . belief system. Having both conscious and unconscious drives. Germ any – www. motivation changes. attitude. structure and culture of organisations that inhibit people from working in balanced harmony within the workplace.

it is important to understand what happens in discussion. Therefore. understand and have an insight on how to be able to deal with interpersonal conflict in the workplace. B o n n . leading to unsolved conflict. managers have to learn to welcome conflicting views. i n w e n t . o r g . The clash which occurs when ideas are disagreed upon can be a potential source of creativity and solution. and at times chaotic. but invite debate on conflicting ideas. Conflict about ideas causes a disturbance of the status quo. challenges that arise. Working environments not only need to tolerate discussions. H e a l t h D i v i s i o n . Therefore.Unit 7: Conflict Management by Marie Claude Foster In order to contend with the complex. D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t .P a g e 10 . to know how to assess the interpersonal level and to be skilled in resolving conflict. Differing views become problematic when they are seen as a personal attack. managers have to invent new approach strategies and support staff needs to execute their work creatively. Specific Objectives of the Unit At the end of the unit participants: appreciate the importance of conflict in the workplace and how conflicting ideas lead to creativity. G e r m a n y – w w w . which when dealt with appropriately can lead to creative problem solving. which stimulate people to find creative solutions to their problems.

B o n n . it will be useful to look at our work systematically in order to be more effective and efficient. Finally. in particular at district level. We need to analyse the structures in which we are working and consider the wider context of our work. needs and demand of the people and the attributes of the community we care for. o r g . We need to know the influential structures. we need to have a close look at the environment that influences and shapes our work as managers. H e a l t h D i v i s i o n . G e r m a n y – w w w . i n w e n t .P a g e 11 .Module 4 Managing the District by Alois Dörlemann and Barbara Kloss-Quiroga This module describes the conceptual framework that will be applied to the following modules of the training course. Before we start to plan or implement any health programme or intervention. Unit 1 Introduction to Community Health Unit 2 The District Concept Unit 3 The Kissidougou Case Study D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . Objective The participants relate their tasks as district health managers to the broader conceptual background of the PHC approach in the organisation and management of health services at different levels.

i n w e n t . Intersectoral co-operation may be easier at this level. understand the motives and necessities for a further development of PHC in the global political environment of development co-operation. H e a l t h D i v i s i o n . The district is considered the most appropriate level to co-ordinate health activities. Specific Objectives of the Unit At the end of the unit participants: are able to describe the characteristics of a community. 'Community' ought to reflect not only a geographical location. know the WHO definition of health and can compare it to their own definition. cultural and individual patterns of a health concept and its different levels of definition. yet small enough to promote and guarantee community participation. It is big enough the ensure efficiency of the work. whose specific health needs are acknowledged and addressed. community involvement. emphasis of promotion and prevention. o r g . Unit 2: The District Concept The district health concept is one of the essential aspects of nearly every health care system in low-income countries. understand the relativity of health needs and their different aspects. accessibility. as personal contacts between the human resources are more likely to occur. intersectoral action. G e r m a n y – w w w . but community of interest. decentralisation of decision making power. relate the concept of health to its broader environment and have been introduced to a system's approach to health. The development of a district health system should be based on the same principles of PHC.Unit 1: Introduction to Community Health The definition of health goes beyond the absence of disease and the traditional medical concept of health.P a g e 12 . D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . B o n n . adequate nutrition. are familiar with the concept of primary health care and its further developments. social and educational services. environmental protection. and a host of other activities belong to the concept of community health. Besides health care. are aware of the historical. integration of health programmes (horizontal programmes) and co-ordination of all activities and actors in the system. incorporating: equity. Healthy communities actively work to improve the health and quality of life of all their residents.

sometimes incomplete. It provides a description of the district structure. The exercises in the following modules are based on this case study. Specific objectives of the unit At the end of the unit participants: are able to describe essential characteristics of the Kissidougou health district case. B o n n . identify missing information necessary for a complete analysis of the district. Then the training will become more realistic and relevant to them. describe the steps in the planning cycle and apply the systematic of the cycle to the system's approach.Specific Objectives of the Unit At the end of the unit participants: reflect on their own district health systems and compare structures in different countries.P a g e 13 . o r g . are able to describe in detail the characteristics of the district concept and the district health pyramid. Unit 3: The Kissidougou Case Study The case study presented in this manual is based on project data and experiences in a rural health district in Guinee. which will be the reference case for the following modules. the situation of the population and the situation of health services. The data provided are real data. i n w e n t . The document is a rather extensive collection of different information about the project viewed from different angles. G e r m a n y – w w w . sometimes changed according to the needs of the training course. relate the different aspects of District Health Management to their tasks as managers. D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . H e a l t h D i v i s i o n . If possible facilitators should try to obtain data from the working environment of their trainees. are able to use the information provided in the case study to systematically analyse the situation in the model district.

epidemiology is seen as being closely related to statistics. It is then planned how to best allocate resources and often also how to work best despite lacking resources. B o n n .P a g e 14 . They will be able to analyse the problems of the health services by the means of indicators as a basis to develop systematic managerial solutions for the identified problems. In earlier modules the planning cycle was introduced to structure the tasks of the district health management team.Module 5 Input . one goal of this unit is to remove such fears from participants by introducing the descriptive aspects of epidemiology and encouraging the participants to use this powerful tool in their routine public health practise. we look into structure (input). Objective At the end of the module. G e r m a n y – w w w . process and results (output) and finally impact aspects. the participants will be able to use basic tools for district health management like the nine epidemiological questions to assess the health situation in a district. o r g . Normally. analyse and prioritise health problems applying epidemiological tools and plan for an adequate intervention. In the following modules. Applying the system's approach to planning. we use the planning cycle as a systematic tool to organise the work in the district. D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . a science which is feared by many health professionals. i n w e n t . Module 5 deals with the first step in the planning process: doing the situation analysis. activities are generally planned when the annual plans are elaborated.Situation Analysis by Axel Kroeger and Barbara Kloss-Quiroga In the health sector. Therefore. H e a l t h D i v i s i o n . Unit 1 Introduction to Health Problems: The Nine Epidemiological Questions Unit 2 Priority Setting Unit 3 Introduction to Health Services Problems Unit 1: The Nine Epidemiological Questions This first unit of the module deals with an epidemiological approach to identifying health problems in populations by asking a series of pertinent questions.

P a g e 15 . Details Time Schedule Background Information Description of the Procedure Exercises: E5-1-1 Health Problems and Health Services Problems E5-1-2 Statistics as an Instrument for Epidemiological Analysis E5-1-3 Seasonal Variation E5-1-4 Endemic Curve E5-1-5 Mapping E5-1-6 Risk Factors and Health Problems E5-1-7 Measles Epidemic Handouts: H5-1-1 Health Indicators H5-1-2 Health Indicators: Comparison Transparencies D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . B o n n . proportion. are able to interpret rates. ratio as a means of quantifying health information. H e a l t h D i v i s i o n . G e r m a n y – w w w . can distinguish seasonal variations of different health problems and visualise them in an endemic curve. are able to describe the concepts of the risk approach and discuss its scope and applications. can draw simple geographical maps to identify relevant population patterns.Specific objectives of the unit At the end of the unit participants: identify relevant data sources for the analysis of health problems and health services problems. i n w e n t . o r g . use the "9 epidemiological questions" and are able to explain their relevance in health management planning.

are able to analyse advantages and disadvantages of the matrix method. i n w e n t .P a g e 16 . o r g .Unit 2: Priority Setting There are limited health care resources at district level. H e a l t h D i v i s i o n . B o n n . In the context of health sector reforms. Details Time Schedule Background Information Description of the Procedure Exercise: E5-2-1 Priority Setting Handouts: H5-2-1 Developing District Priorities H5-2-2 Definitions on Needs and Demands Transparencies D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . are able to critically analyse the relevance of different priority setting techniques for their work at district level. especially in developing countries. more and more tasks are decentralised to lower levels of the health system but very often there is a gap between these tasks and the available resources. are able to use a simple matrix to identify priority health problems and priority health services problems based on the case study and their own experiences. G e r m a n y – w w w . This gap will be the focus of the following unit: what kind of decision making tools do we have as health managers to rationally allocate the scarce resources and have the greatest impact on the health situation of the population? Specific objectives of the unit At the end of the unit participants: are able to describe different techniques of priority setting.

we need to know what results our activities have had. and to evaluate their impact on the health status of the population. we need to analyse what we are doing or have already accomplished with what we have. Specific objectives of the unit At the end of the unit participants: have been introduced to a conceptual framework for the evaluation of health services. a systematic approach is needed to provide a comprehensive picture. On the one hand. to make comparisons and measure change over time. G e r m a n y – w w w . this represents the conceptual framework of the analysis of health services. To monitor progress in implementing health programs.Unit 3: Introduction to Health Services Problems Concerning the analysis of health services. Details Time Schedule Background Information Description of the Procedure Exercise: E5-3-1 Analysis of Health Services Transparencies D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . In short. i n w e n t . have reflected on strategies to improve health service performance. o r g . indicators help to analyse the present situation. output). we need to consider what resources and information we have to work with. have systematically analysed health service performance by the means of indicators on the basis of data provided in the case study. Additionally. are familiar with health service performance indicators and are able to relate them to the systems approach (input. process. B o n n . on the other hand. H e a l t h D i v i s i o n .P a g e 17 .

as well named Project Cycle Management. there is a need to answer now the questions why does a specific problem occur (6). Objectives At the end of the module participants know the different steps of ZOPP (Target Oriented Project Planning). They are able to prepare and conduct a planning workshop in their working environment and develop and monitor a comprehensive plan of action.Module 6 Process . planning is therefore one of the essential functions of a manager.P a g e 18 . Alois Dörlemann. from establishing the overall goal of the organisation or a project to the day to day operating schedules. Quality Management (QM) D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . i n w e n t . They are familiar with quality management systems (QM) in health. Planning and programming start with an in-depth analysis of problems. and what else could be done (9). the World Bank and international agencies and NGOs. They are used by the EC. what have we done so far (7). the project planning matrix (PPM) as well as the logical framework. B o n n . Unit 1 Introduction to Project Planning Methods Unit 2 Objectives oriented planning: analytical steps Unit 3 Monitoring. This module introduces planning methods and tools and gives an introduction to monitoring and quality management. G e r m a n y – w w w . o r g . what were the results (8). Following the sequence of the nine epidemiological questions. Target Oriented Project Planning (ZOPP) and the Logical Framework approach are useful tools in intervention planning.Planning and Programming by Barbara Kloss-Quiroga. Module 5 introduced methods and tools to identify and prioritise health and health services problems. Michael Marx The process of planning involves a wide range of decisions. H e a l t h D i v i s i o n .

P a g e 19 . B o n n . SWOT analysis. programme interventions mobilising resources. G e r m a n y – w w w . flexible adaptation. priority setting. H e a l t h D i v i s i o n . transparency of decisions. control and evaluate. techniques and tools designed to facilitate the planning process emphasising the participation of all actors involved and the common formulation of decisions. Specific objectives of the unit The participants are able to explain the principles of the ZOPP. PRA and rights based approach) and their essential characteristics Unit 2: Objectives oriented planning: analytical steps Objectives oriented planning and the logical framework approach are very similar planning methods. and logframe approach to planning to conduct a planning workshop based on the ZOPP approach and develop a project planning matrix (PPM) to develop a realistic and achievable plan of action D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t .Unit 1: Introduction to Project Planning Methods The planning cycle displays the different steps in planning: situation analysis with the identification of needs and problems. plan: analyse problems and determine objectives . systematic decision making. programme: define activities to reach objectives. which are applicable at district level. i n w e n t . The ZOPP approach (objectives oriented planning) is a set of principles. objectives oriented planning. This unit gives a general introduction to different planning methods and tools. implement. consensus between all involved which includes negotiation and compromising. It is characterised by the following principles: participation of all important stakeholders and actors. o r g . Specific objectives of the unit The participants are able to describe different planning methods (strategic planning.

P a g e 20 . Specific objectives of the unit The participants are able to describe the basic principles of Quality Management and use one or more Quality Management tools/Monitoring D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . o r g . G e r m a n y – w w w . H e a l t h D i v i s i o n . i n w e n t . Quality Management (QM) To assure or improve the quality of health care in either a defined medical setting or a programme. The concept of quality management (QM) is a comprehensive and structured approach to organisational management and seeks to improve the quality of services through ongoing refinements in response to continuous feedback. planned interventions and activities need constantly to be monitored and followed up.Unit 3: Monitoring. B o n n .

H e a l t h D i v i s i o n . D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . i n w e n t . to increase the possibility of improving job performance and growth. budgeting. The development of a human resources inventory is a first step on the road to effective and efficient health manpower planning. implemented. conducted in a definite time period. Human Resources Development (HRD) has been defined as an organised learning experience. Very often part of the information exists in form of lists or records. career desires nor any information on actual personnel performance. Specific objectives of the unit At the end of the unit participants: know the importance of distributing the district health personnel according to their knowledge. distribution and productivity. personal competencies and interests according to the tasks compiled in the district health plan. Unit 1 Human Resources Management Unit 2 Target Setting and Job Planning Unit 3 Supervision and Coaching Unit 4 Training Unit 1: Human Resources Management The objective of human resource management is to ensure that the health district obtains and retains the quality and quantity of human resources needed and makes the best use of them. care for adequate health care delivery in health centres and hospitals. monitored and evaluated. G e r m a n y – w w w . The district health management team needs detailed information about the health workforce with regards to number.Module 7 Human Resources Development by Gerlinde Reiprich and Barbara Kloss-Quiroga The district health management team is responsible for a wide range of managerial and technical functions: organisation of health programmes. hindrances. HRD consists of three main categories: training. All these activities need human resources to be planned. education and development. o r g . qualification. other sectors and other levels of the health system. skills. scheduled. but neither includes specifications like special competencies. etc. understand the importance of compiling a human resources inventory. links to the community. B o n n . interests.P a g e 21 .

one which builds on trust. promote more effective job performance and employee development. Therefore. H e a l t h D i v i s i o n . participatory target-setting replaces the traditional role of job descriptions. the aim of supervision has become to provide professional back-stopping at close intervals to improve job understanding. because besides technical skills.To be developed D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . and encourage the flow of communication between different levels in the district.P a g e 22 . But regarding the various functions in the health system it is quite difficult to define the exact tasks of a health worker. Specific objective of the unit At the end of the unit participants: have developed their individual performance targets have elaborated a plan of action for their work place/work unit. Unit 3: Supervision and Coaching In the beginning. i n w e n t . Setting individual performance standards and targets integrates both health service as well as individual needs and objectives and tries to minimise demotivating factors for the individual health worker.Unit 2: Target Setting and Job Planning In the past the elaboration of job descriptions for health workers has been carried out in the context of quality control and performance monitoring and evaluation. more and more the approach of individual. are able to apply the instrument of supportive supervision Unit 4: Training . This approach demands a new relationship between the management and health workers. they include great flexibility. More recently. Specific objective of the unit: At the end of the unit participants are aware of the possible benefits from support supervision and individual coaching. intuition and empathic behaviour. and communication. the supervision system applied in the health district was a means of quality control and stressed aspects like controlling registers and bookkeeping. o r g . Job descriptions are now mainly used in job advertisements. maturity. are motivated to improve the supervision system in their district. B o n n . G e r m a n y – w w w .

including cost calculation. B o n n . This includes resource mobilisation and financial management. and transparency and accountability at district level. H e a l t h D i v i s i o n . i n w e n t . often delaying. accounting and budgeting know alternative concepts for health care financing applicable at district level.Module 8 Financial Management and Health Care Financing by Meinolf Kuper and Manfred Störmer The success of decentralisation initiatives depends upon better and more efficient use of scarce resources for improved service delivery to the people in a transparent and accountable manner. alternative concepts may be applicable solutions at local level. Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Unit 6 Unit 7 Unit 8 Financial Documentation Cost Calculation and Budgeting Revolving Funds Financial Control Sources of Health Care Financing User Fees Pre-Payment Schemes Health Insurance D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . denying them access to health services. User fees. financial control and auditing. In order to address these problems. Pre-payment schemes and health insurance systems are two examples receiving increasing attention. Objectives Participants get familiar with essential tools for financial management at district level.P a g e 23 . o r g . for example planning and budgeting. Most countries introduced user fees for services in order to supplement their tax financing of health care systems. or in the worst case. G e r m a n y – w w w . do create severe problems for poor populations. however. accounting and reporting.

-Assurance.P a g e 24 . will contain the following units: Unit 1: Quality Assessment. o r g . i n w e n t . -Control Unit 2: Health Management Information Systems Unit 3: Evaluation Methods Unit 4: Re-Planning D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t . B o n n .Module 9 Evaluation and Adjustment (E&A) To be developed. H e a l t h D i v i s i o n . G e r m a n y – w w w .

org Web: www. G e r m a n y – w w w . Germany Health Section Ralf Panse Tulpenfeld 4 53113 Bonn Germany Tel.for non-commercial use .from InWEnt . H e a l t h D i v i s i o n . containing all modules which are finished so far.How to Order the Manual If you are working for health care and you are interested in the complete manual.inwent.panse@inwent.: +49 (0) 228-2434-5 Fax: +49 (0) 228-2434-844 E-Mail: ralf. B o n n .Internationale Weiterbildung und Entwicklung gGmbH Capacity Building International.org D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t .P a g e 25 . i n w e n t . o r g . you may order a printed version or a CD-ROM .

doerlemann@health-focus. Barbara Kloss-Quiroga barbara. Dr. H e a l t h D i v i s i o n . i n w e n t .org Gerlinde Reiprich reiprich@health-focus.de Meinolf Kuper mkuper@aol.marx@urz. G e r m a n y – w w w .de Michael Marx michael.Feedback This manual is not a magic bullet for resolving district management problems: the editors and contributors are aware of its shortcommings to reach a broader. B o n n . o r g . 7 and 9 Modules 1 and 5 Modules 4.sax@urz. 6 and 9 Module 6 Module 8 Module 8 Module 9 D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t .uni-heidelberg.kloss-quiroga@inwent. InWEnt welcomes comments and suggestions to improve this original version from course instructors and users.de Sylvia Sax sylvia.int Alois Dörlemann a. or not so specialised audience.P a g e 26 .de Axel Kroeger kroegera@who.de Managing Editor Modules 3 (Unit 1-5).uni-heidelberg. including health workers who have used this manual for the management of district systems.com Manfred Störmer manfred_d@web.

images.de D i s t r i c t H e a l t h M a n a g e m e n t T o o l s – C o p y r i g h t : I n W E n t .Imprint InWEnt .kloss-quiroga@inwent.org Responsible for the Content of the Manual "District Health Management": Dr. Concept & Design: EYES-OPEN – Agency for Text & Design Web: www. Barbara Kloss-Quiroga. H e a l t h D i v i s i o n .org Copyright: Copyright © 2003 by InWEnt.org Web: www. These objects may not be copied for commercial use or distribution. Health Section. Germany Health Section Tulpenfeld 4 53113 Bonn Germany Tel. i n w e n t .: +49 (0) 228-2434-5 Fax: +49 (0) 228-2434-844 E-Mail: info@inwent. B o n n . Managing Editor barbara.eyes-open. Bonn The text. G e r m a n y – w w w . graphics.Internationale Weiterbildung und Entwicklung gGmbH Capacity Building International.inwent. o r g . nor may these objects be modified or reposted to other sites. and their arrangement on the website concerning "District Health Management" are all subject to copyright and other intellectual property protection.P a g e 27 .