HEALTH SERVICE MANAGEMENT

Learning objectives

• Upon completion of the course the student will be able to:

• Describe the meaning and scope of management

• Identify contemporary organizational structures, functions and behaviors.

• Make appraisal of the health policy, strategy and structure of the Ethiopian

Health System.

• Acquire skill in planning, implementing and evaluating health programs.

• effectively manage health institutions

• understand the principles of human resource management

• make rational use of the available scarce resource

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 contents
• Unit 1-Introduction
• Unit 2- organization structure
– Structure and function
– Principles of organization and coordination
– Concepts of system design and analysis

• Unit 3-Organization of the Ethiopian Health

delivery system
– Historical development
– Health policy and strategy
– Health sector development program (HSDP)
– PHC
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 Contents…..
• Unit 4- The management cycle
– The planning process
– Techniques of implementing health program
– Techniques of monitoring and evaluating health
programs
• Unit 5- Principles of personal management
– Employment and recruitment
– Job description and job classification of the health center
staff
– Principles and techniques of supervision
– Skills in personnel motivation
– Understanding and managing conflicts
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 Contents…
• Unit 6- Managing resources
– Managing time, material , drugs, and space
– Use of models in finance
– Budgeting
• Teaching methods
– Lecture
– Discussions
Mode of Evaluation
• Continuous Assessment (Class Participation,
Assignments , Quizzes, Tests/mid-examination, )
• Final Written Examination
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 Unit 1. Introduction to Management

• Management is process of directing, coordinating, and

influencing organizational operations in order to
obtain desired results and enhance/maximize
performance.
• It is the process of planning, organizing, leading and
controlling the work of organization members and of
using all available organizational resources to reach
stated
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organizational goals. 5
 Importance of Management
• it is universally necessary function
• it is essential for all kinds of organizations
• because every organization requires the
following:
– making of decisions
– coordinating activities
– handling people
– evaluating performance

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 MANAGEMENT FUNCTION

1. Planning:

• Planning is the function that determines in advance

what should be done.

• It is looking ahead and preparing for the future.

• It is the process of deciding organizational

objectives and charting out the methods of attaining

those objectives.
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 Mgt. function….
2. Organizing:
• It is the process of defining and grouping the
activities of the organization and establishing the
authority relationship among them.
• The manager differentiates and integrates the
activities of his organization.

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 Mgt. function….
3. Staffing:
• Acquiring and placing of qualified people.

• It is the process of filling and keeping filled the positions

required by the organizational structure with right
people, at right places, and at the right time.
• It includes several sub-function like;

• Recruitment, Selection, Hiring, Transfer and promotions,

Training
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 Mgt. function….
4. Leading:
• According to Peter Drucker, “It is the lifting of
man’s visions to higher sights, the raising of mans
performance to a higher standard, the building of
man’s personality beyond its normal limitations”.

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 Mgt. function….
5. Controlling:

• According to EFL Brech, “controlling is checking current

performance against predetermined standards contained in the
plan, with a view to ensuring adequate progress and satisfactory
performance”.

• George R Terry, “controlling is determining what is being

accomplished, that is evaluating the performance and if necessary
applying corrective measures so that the performance takes place
according to plans”.
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 Mgt. function….
6. Communication
• Communication is necessary to share
data/information among:
– Managers
– Staff and
– Community

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 Mgt. function….
7. Decision making
• Decision is made during all of the
following:
– Planning
– Implementation
– Evaluation

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 Concepts of management

• Effectiveness
– Effectiveness is the degree to which a stated
objective is being achieved. It is something that
management tries to improve.
• Efficiency
– It is concerned with the balanced use of resources
(money, material, human resource, time, space
and information)

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 Concepts of management….
• Economy of Scarce Resources
– Some, and often many, resources are scarce and costly
thus we have to economize
• Work Relations -Work activities should be
designed and structured so as to support each other
towards the achievement of objective.
• Information-Management needs information to
make the right decision for action. At the same
time, information can easily handicap Management,
if it is not the right kind, at the right time and in the
right hands.
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 Principles of management

• Management by Objectives- The objective

should state:
– What is to be accomplished
– How much of it
– Where it is to be done
– When it is to be completed.
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 Principles of management

• Learning from Experience

– Analysis of the results between the objectives and

achievement made. For better performance there
should be feedback to learn from the experience
gained.
• Division of Labour-Management attempts to bring
about balance of work among the different people
concerned.
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 Principles of management….

• Substitution of Resources-Often when the

resources that are normally used to provide
service became scarce or too expensive,
different resources may be used to provide
the intended results.

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 Principles of management….

• Convergence of Work-Working relations should

contribute to the success of each activity and so to
general effectiveness. These working relations of
activities are:-
– the logical relations with each other
– time relations or sequence
– functional and structural-working relations between
people

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 Principles of management….

• Functions Determine Structure -When the work is

defined i.e. the function and duties of the
individual members of the team are clearly defined
and known to all. The working relations (the
structure) follow. The exact nature of authority will
be clearly delineated on the structure
• Delegation- takes place when some body's
authority is lent, so as to enable that person to
take responsibility when the occasion arises.

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 Principles of management….
• Management by Exception- Don't be overloaded
with the routine, unnecessary information, be
selective. Or Make big decision first
• In short management by exception means
selectivity in information and priority in decision.

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 Principles of management….
• Shortest Decision-Path
• This principle deals with issue
– Who should make which decision?
– When and where?
– Decision must be made as closely as possible in
time and place to the object of decision and to
those affected by it.
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 Level of management
• Top management is made up of individuals who
have the responsibility for making the decisions
and formulating the policies in an organization.
• Middle Management: includes all managers
above the supervisory level but below the level
where overall company policy is determined.
• Supervisory Management: Supervisors manage
workers who perform the most basic job duties
required in the organization.

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 Management Skills

1. Technical Skills: are the specialized knowledge and

abilities that can be applied to specific tasks. They
are most important at lower levels of management
and much less important at upper levels.
2. Human Relation Skills: are the abilities needed to
resolve conflict, motivate, lead, and communicate
effectively with other workers. They are equally
important at all levels of management.

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 Management Skills……

3. Conceptual skills: are the abilities needed to

view the organization from a broad
perspective and to see the interrelations
among its components. Conceptual skills are
most important in strategic (long-range)
planning; therefore, they are more important
to top-level executive; than to middle
managers and supervisors.

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 THE ROLE OF HEALTH MANAGER

1. Interpersonal roles
• Interpersonal roles provide managers with
opportunities to gather information.
1.1. Figurehead:
– Performs symbolic routine duties of legal or social
nature.
– As a figurehead, a manager routinely performs
certain ceremonial duties including attending a
subordinates wedding, entertaining visitors,
officiating a luncheon , signing documents etc
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 Role …..
1.2. Leader:
– Motivates subordinates ensures hiring and training of
staff.
– As a leader, manager creates the environment, works
to improve employees performance and reduce
conflicts, provides feedback and encourages individual
growth.
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 Role…..
1.3. Liaison:
– Allows managers in formal & informal contacts both
inside & outside their organization to establish
relationships that will help them achieve
organizational objectives.
– Maintains self developed network of contacts and
informers who provide favors and information.
– In addition to superiors and subordinates, managers
interact with others-peer level managers in other
departments, staff specialists, suppliers and clients.

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 Role….
2. Informational roles
2.1. Monitor:
– Managers gather information from their network of
contacts, including those established in their liaison roles
– Seeks and receives wide variety of special information to
develop through understanding of the organization and
environment.
– As a monitor, a manager should constantly monitor the
environment to determine what is going on.
– He should collect information both directly and indirectly.

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 Role….
2.2. Disseminator
– Transmits information received from outsiders or
subordinates to members of the organization that
would not ordinarily be accessible to them.

2.3. Spokesperson
– Transmits to outsider’s information about
organizations policies, plans, actions, results and
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 Role…
3. Decisional roles
3.1. Entrepreneur:
– Searches organization and its environment for
opportunities and initiates projects to bring about
change.
– Sharing and initiating new ideas or methods that may
improve the work units operations.
• He should implement strategy and review sessions
involving improvement.

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 Role…
3.2. Disturbance handler:
– Initiates corrective action when organization faces
important, unexpected disturbances.
– Implementing strategy to resolve disturbances and crisis
3.3. Resource allocator:
– Fulfills responsibility for the allocation of organizational
resources of all kinds-in effect, makes or approves all
significant decisions.

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 Role…

3.4. Negotiator:
– Represents the organization in major negotiations.
– Items to be negotiated include contracts with
suppliers, trade-off for resources inside
organization and agreements with labor
organizations.

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 Unit two- organizational structure

Organization
• A cooperative and coordinated social system of
two or more people with a common purpose.
• A pattern of relationship through which people
pursue to achieve common goals.
• Groups of people, with ideas and resources,
working toward common goals.
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 Characteristics of organizations
– Coordination of effort: multiplying individual
contributions to achieve results greater than those
possible by individuals working alone.
– Common goal or purpose: having a focus to strive for
something of mutual interest.
– Division of labor: dividing tasks into specialized jobs that
use human resources efficiently.
– Hierarchy of authority: using a chain of command to
control and direct the actions of others.
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 Classification of organizations by intended purpose

•Business Organizations: make profit in acceptable manner.

•Nonprofit Organizations: provide a specific public service to some

segment of society without attempting to earn a profit.

•Mutual-benefit Organizations: provide a vehicle for individuals to

pursue their own self-interests. Associations, parties, etc.

•Commonweal Organizations: provide standardized public services

to all members of a society without attempting to earn a profit.

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 Organizational Design

• The determination of the organizational structure

that is most appropriate for the strategy, people,
technology and tasks of the organization.
• Matching goals, strategic plan, capabilities with
environment.

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 Organizational Structure

• The way, in which an organization’s activities are divided, organized

and coordinated.

• Is the formal decision-making framework by which job, tasks are

divided, grouped, and coordinated.

• Formalization is an important aspect of structure.

• Formal structure is the official organizational structure conceived

and built by top management.

• It is the extent to which the units of the organization are explicitly

defined and its policies, procedures, and goals are clearly stated
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 A clear organizational structure

• clarifies the work environment,

• creates a coordinated environment,

• achieves a unity of direction, and
• establishes a chain of command

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Unclear or lack of an organizational structure results:

• frustration

• loss of productivity, and

• limited ability to pursue a strategy leading to

the attainment of the planned objectives

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 Organization charts

• The formal organization can be seen and

represented in a chart form.
• An organization chart displays the organizational
structure and shows job titles, lines of authority,
and relationships between departments.
• is helpful for managers as it is an organizational blue
print for deploying human resource.
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 Dimensions of Organization charts
• Representing the organization's structural skeleton,
charts have dimensions representing:
• Vertical hierarchy: the chain of command.
• Horizontal specialization: the division of labor

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 organizational systems
1. The mechanistic structure
• Is the traditional or classical design, common in
medium- and large-size organizations.
Mechanistic organizations:
• are rigid in that they consist of very clearly
delineated jobs,
• have a well-defined hierarchical structure, and
• Rely heavily on the formal chain of command for
control.
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 Mechanistic……
•Bureaucratic organizations, with their emphasis on

formalization, are the primary form of mechanistic

structures as they are driven by a top-down or command and

control approach in which managers;

–Provide considerable direction and have considerable control

over others

–Have tall structures consisting of hierarchies with many levels

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management. 46
 Mechanistic……

• Tall structure- people become relatively

confined to their own area of specialization
(functional division of labour)
• Mechanistic organizations are best suited to
– repetitive operations and
– stable environments,
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 2. Organic structure :
• Characterized by informality, working in groups
and open communication
• more flexible,

• more adaptable to a participative form of

management, and
• Less concerned with a clearly defined structure.
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 Organic…..
• The organic organization is open to the environment
in order to capitalize upon new opportunities.
• Have a flat structure with only one or two levels of
management.
• Flat structure- emphasizes a decentralized approach
to management that encourage high employee
involvement in decisions.
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 Organic…..
• The purpose of flat structure is
– To create independent small businesses or enterprises that can

rapidly respond to customers' needs or changes in the business

environment.

– The manager has a more personal relationship with employees.

– a non-bureaucratic organization

– referred participative-democratic

– Management and employees interact in a friendly environment

– Characterized by mutual confidence and trust.

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 Organic-----

• Organic organizations are best suited to an

– uncertain task and
– A changing environment

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 FUNCTIONAL STEPS IN ORGANIZING

• The four building blocks

– Division of work
– Departmentalization

– Hierarchy
– Coordination

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 1. Division of work
• Is the degree to which tasks in an organization are divided into

separate jobs.

• is breaking of a complex task into components

• Individuals are responsible for a limited set of activities instead of

the entire task.

• Work process requirements and employee skill level determine the

degree of specialization
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 Division of work…..

• Placing capable people in each job ties directly

with productivity improvement.

• In order to maximize productivity, supervisors

match employee skill level with task

requirements
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 Division of work…..
Division of work/ Job specialization creates
– simplified tasks
– Fosters specialization
– Opportunity for utilizing talents and interests
• Contrary it may create:
– Boredom and
– Alienation (unfriendliness ,isolation, distancing , division)

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 2. Departmentalization

• Once work activities are divided into jobs or jobs

have been classified through work specialization,
• They are grouped so those common tasks can be
coordinated and can be similarly and logically
connected

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 Departmentalization……
• The grouping of related jobs or processes into major
organizational units.

• Overcomes some of the effect of fragmentation caused by

differentiation (job specialization).

• Permits coordination (integration) to be handled in the least costly

manner.
– Sometimes refers to division, group, or unit in large organizations.

• Each single box in an organizational chart represents departments

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 Departmentalization……

• Types of departmentalization
– functional
– product-service,

– geographic location,
– customer classification, and
– work flow process departmentalization

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 Departmentalization……

• Functional departmentalization is
– Categorizing / organizing jobs according to the
activities/ functions to be performed.
– the most common approach
– helps to obtain efficiencies from consolidating similar
specialties and people with common skills, knowledge
and orientations together in common units
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 Departmentalization……

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 Departmentalization….
• Product-Service Departments
– Assembles all functions needed to make and market a
particular product are placed under one executive.
• Grouping jobs around a specific product or service.

– Eg. Major department stores are structured around

product groups such as women's clothing, men's
clothing, and children's clothing.

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 Departmentalization…..
• Geographic Location Departments
– Departmentalization by geographical regions
– Groups jobs on the basis of territory or geography.
• Adopting a structural format based on the physical dispersion
of assets, resources, and customers

– For example domestic sales departmentalized by regions

such as Northeast, Southeast, Midwest, Southwest, and
Northwest.
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 Various Departmentalization Format

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 3. Hierarchy
• A pattern of multiple levels of an organizational
structure locating senior-ranking manager at the top
and low-ranking managers located at various levels
below.
• Chain of command - The plan that specifies who
reports to whom
• Fundamental feature of an organization
• Span of management control has an effect on
working relationships and on the speed of decision
making
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 Hierarchy…
Span of management control:
• Determines the working relationships in a
department
– Too wide: Create flat hierarchies (fewer
management levels between the top and the
bottom) Implications:
• Overburdened manager,
• Little guidance or control of employee
• Overlooking or ignore serious errors

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 Hierarchy…
The span can affect the speed of decision making
• Too narrow: Create tall hierarchies with many
organizational/managerial layers.
• Implications:
– Managers are underutilized
– In-efficient
– Affects the speed of decisions (delay) in this changing
environment

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 4. Coordination
integration of activities of separate parts of an
organization for accomplishing the organizational
goals.
• Integration is
– The degree to which various departments
work in a unified manner.
– The degree of coordination depends on
• Nature of task
• Degree of interdependence of people in the
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various units 68
 Coordination….
High degree of coordination is needed:
• When communication between units is important
• For non-routine and unpredictable works
• When organizations are challenged with unstable
environment
• When there is high interdependence between units
• When the organization has set high performance
objectives
• For highly specialized task such as coordination
among different organizations
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 Coordination….
Approaches to achieving effective coordination
• Using basic management techniques
• Specify relationships (managerial hierarchy or
chain of command)
• Set rules and procedures
• Management By Walking Around (MBWA)

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