LECTURE NOTES: MED/BSN3302, PRIMARY HEALTH CARE, NUTRITION
AND HEALTH SYSTEMS.
CD OKOLIMONG
1st /FEB/2023
INTRODUCTION TO HEALTH SYSTEM MANAGEMENT
What is Health system Management?
HSM describes the leadership and general management of hospitals, their networks and other
health delivery establishments.
A health system, also sometimes referred to as health care system or as healthcare system, is the
organization of people, institutions, and resources that deliver health care services to meet the
health needs of target populations.
World Health Organization (WHO) defines a health system as “the sum of the organizations,
Institutions, and resources whose shared primary purpose is to improve health”. The broad
health system includes everyone responsible for good health, from the family in a rural village to
the surgeon in a hospital in the capital city. It encompasses sanitation and nutrition, involves all
branches of government. There is a wide variety of health systems around the world, with as
many histories and organizational structures as there are nations.
Basic concepts
System: A collection of components that work together to achieve a common objective
Information System: A system that provides information support to the decision-making
process at each level of an organization
Health Information System: A system that integrates data collection, processing, reporting, and
use of the information necessary for improving health service effectiveness and efficiency
through better management at all levels of health services
Health Management Information System: An information system specially designed to assist in
the management and planning of health programmes, as opposed to delivery of care.
HEALTH SYSTEMS BUILDING BLOCKS
Six building blocks constitute the overarching WHO health systems framework.
1. Service delivery
2. Health workforce
3. Information
4. Medical products, vaccines, and technologies
5. Financing
6. Leadership and governance (stewardship)
Providing quality health care
On one side
Nurses, doctors, community health workers, laboratory technicians, pharmacists, midwives, and
health facility administrators who lead and govern, manage human resources, financial resources,
supplies, and information; and deliver health services.
On the other side
People in the cities, towns, and rural areas who need information and community support to
engage in health seeking behaviors.
People at the center of health system
1. Health managers and administrators who have the knowledge, skills, responsibility, and
2. authority to build and maintain the management systems needed to deliver health services
3. Personnel at all levels, including health care providers and administrators, who use the
management systems to address challenges and achieve results;
4. Communities and families that are educated and empowered to promote their own health and
demand quality services;
5. Clients who have adequate information to use health services appropriately
FUNCTIONS OF THE HEALTH SYSTEM
1. Deliver healthcare services and other interventions aimed at maintaining or improving
health
2. Protecting households from the financial impacts of both illness and the costs of
healthcare.
3. Health systems also perform an economic function in society. For example, there is some
evidence that the health of a population can influence economic productivity, while for
many health workers and businesses, the health system is an economic sector that
provides employment, wages and business opportunities.
4. Health systems are also social and cultural institutions that play a function in helping
establish ‘a wider set of societal norms and values
5. Health systems can help define and shape the identity of countries. For many post-
colonial countries, health systems development is an important ingredient in nation-
building, with the construction of health facilities and the extension of healthcare to rural
populations viewed as indicators of progress and modernization that are sources of
national pride
CHALLENGES FACING THE HEALTH SECTOR
1. Insufficient skilled human resources. Moreover, there is mal-distribution of the available
health personnel, with some rural health centers being unmanned
2. Inadequate budgetary allocations, poor infrastructure, materials and high prevalence of
poverty prevents targeted populations from accessing services such as ITNs and inadequate
emergency facilities
3. The lack of national policy framework and identification of specific programmes to enable
accessibility of reproductive services by young People.
4. Slow reduction in maternal mortality rates, which have a direct relationship with the health of
the children.
5. 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 offered by other service
providers, especially the Faith Based Organizations.
6. Assessment of some of the performance targets and indicators such as infant and under-five
mortality through field surveys are conducted several years apart
7. Weak management systems including strengthening of decentralization of healthcare
systems.
8. Lack of sustained availability of required supplies and equipment.
9. Lack of a viable and sustainable national health insurance system to improve access to
healthcare services, particularly for the poor and vulnerable.
Concepts of Management
Management
According to Harold Koontz “Management is an art of getting things done through and with the
people in formally organized groups. It is an art of creating an environment in which people can
perform and individuals and can cooperate towards attainment of group goals”
There are three levels of management:
1. Top
2. Middle
3. Lower
Top management level
It consists of board of: directors, chief executive or managing director. The top management is
the ultimate source of authority and it manages goals and policies for an enterprise. It devotes
more time on planning and coordinating functions.
Roles of the top management
1. Lays down the objectives and broad policies of the enterprise
2. It issues necessary instructions for preparation of department budgets, Procedures, schedules
etc.
3. It prepares strategic plans & policies for the enterprise.
4. It appoints the executive for middle level i.e. departmental managers
5. It controls & coordinates the activities of all the departments.
6. It is also responsible for maintaining a contact with the external clients.
7. It provides guidance and direction.
8. Responsible towards the shareholders for the performance of the enterprise.
Mid-level management
The branch managers and departmental managers constitute middle level. They devote more
time to organizational and directional functions. In small organization, there is only one layer of
middle level of management but in big enterprises, there may be senior and junior middle level
management
Roles of mid-level management
1. They execute the plans of the organization in accordance with the policies and directives of
the top management.
2. They make plans for the sub-units of the organization.
3. They participate in employment & training of lower level management.
4. They interpret and explain policies from top level management to lower level- bridge
5. They are responsible for coordinating the activities within the division or department.
6. It also sends important reports and other important data to top level management.
7. They evaluate performance of junior managers.
8. Responsible for inspiring lower level managers towards better performance
Lower Level Management
Lower level manager is also known as supervisory / operative level of management. It consists of
supervisors, foreman, section officers, superintendent etc.
Roles of lower management
1. Assigning of jobs and tasks to various workers
2. Guide and instruct workers for day to day activities.
3. Responsible for the quality as well as quantity of production.
4. Entrusted with the responsibility of maintaining good relation in the organization.
5. Communicate workers problems, suggestions, and recommendatory appeals etc to the higher
level and higher level goals and objectives to the workers.
6. Help to solve the grievances of the workers
7. Supervise & guide the sub-ordinates Responsible for providing training to the workers.
8. Arrange necessary materials, machines, tools etc for getting the things done.
9. Prepare periodical reports about the performance of the workers.
10. Ensure discipline in the organization.
11. Motivate workers.
12. Are the image builders of the organization because they are in direct contact with the workers
Principles of Management
Henry Fayol's 14 Principles of Management
1. Division of work: Division of work or specialization alone can give maximum
productivity and efficiency. Both technical and managerial activities can be performed in
the best manner only through division of labour and specialization.
2. Authority and Responsibility: The right to give order is called authority. The obligation
to accomplish is called responsibility. Authority and Responsibility are the two sides of
the management coin. They exist together. They are complementary and mutually
interdependent.
3. Discipline: The objectives, rules and regulations, the policies and procedures must be
honored by each member of an organization. There must be clear and fair agreement on
the rules and objectives, on the policies and procedures. There must be penalties
(punishment) for non-obedience or indiscipline. No organization can work smoothly
without discipline – preferably voluntary discipline
4. Unity of Command: In order to avoid any possible confusion and conflict, each member
of an organization must receive orders and instructions only from one superior (boss).
5. Unity of Direction: All members of an organization must work together to accomplish
common objectives.
6. Emphasis on Subordination: This is also called principle of co-operation. Each shall
work for all and all for each. General or common interest must be supreme in any joint
enterprise.
7. Order: Fayol suggested that there is a place for everything. Order or system alone can
create a sound organization and efficient management.
8. Equity: An organization consists of a group of people involved in joint effort. Hence,
equity must be there. Without equity- no sustained and adequate joint collaboration.
9. Remuneration: Fair pay with non-financial rewards can act as the best incentive or
motivator for good performance. Exploitation of employees in any manner must be
eliminated. Sound scheme of remuneration includes adequate financial and nonfinancial
incentives.
10. Centralization: There must be a good balance between centralization and
decentralization of authority and power. Extreme centralization and decentralization must
be avoided.
11. Scalar Chain: The unity of command brings about a chain or hierarchy of command
linking all members of the organization from the top to the bottom. Scalar denotes steps
12. Stability of Tenure: A person needs time to adjust himself with the new work and
demonstrate efficiency in due course. Hence, employees and managers must have job
security. Security of income and employment is a pre-requisite of sound organization and
management
13. Esprit of Co-operation: Esprit de corps is the foundation of a sound organization. Union
is strength. But unity demands cooperation. Pride, loyalty and sense of belonging are
responsible for good performance
14. Initiative: Creative thinking and capacity to take initiative can give us sound managerial
planning and execution of predetermined plan
