HARAMBEE UNIVERSITY

TVET-PROGRAMME TITLE
PHARMACY LEVEL-IV

MODULE TITLE: Managing Community

Health Service
MODULE CODE: :HLTPHS4M090222
1 3/3/2024
Samuel M.
 *
At the end of the module the learner will be able
to:
LO1. Follow organizational guidelines, understand
health policy and service delivery system
LO2. Plan, manage, monitor and evaluate health
system
LO3. Lead and build individual‟s and team‟s
capacity

Samuel M. 2 3/3/2024
 *
1. Health care – is the total societal effort, undertaken in the
private and public sectors, focused on pursuing/improving health
2. Health services – are specific activities undertaken to
maintain or improve health
or to prevent decrements of health Can be preventive,
promotive, curative or rehabilitative in nature
3. Health service organization: Organizational structures
within which health services are delivered directly to consumers.
4. Health systems Are formally linked HSOs, possibly
including financial arrangements, joined together to provide
more coordinated & comprehensive health services
5. Community packages were packages that were given for
every community members
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 *
5. Community packages were packages that were
given for every community members
6. Vertical health program are centralized, non-
integrated and disease specific
health programs
7. Effectiveness, it is how well an organization, or a
person in an organization is meeting their goal
8. Efficiency, is a measure of how well the health sector
is using its resource to
achieve that goal
9. Equity; it is a matter of distributing resources as well
as service for all segment of the population equally
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 *
10. Team spirit; it is creating an atmosphere of
mutual trust and understanding
between members of a team
11.Division of labor; it is an act of distributing
work, among all member of the team in equal
manner
12.Planning; it is forecasting and thinking about
things that you want to happen in
the future and then working to achieve that

Samuel M. 5 3/3/2024
 * LO1. Follow organizational guidelines understand
health policy and service delivery system
Understand health policy and service delivery system
Historical development of health service in Ethiopia
 The challenges through the process brought the
development and application of primary health care in
rural part.

 Ethiopia is a country with:-

 83% of its population living in rural areas and
 About nearly 80% of the disease that affect its population are
communicable disease that can easily prevented through the change of
behavioral practices.

Samuel M. 6 3/3/2024
 *
*Why history of public health?
i. To learn from the past experiences
ii. To understand the present situation
iii. To forecast the future conditions
iv. To recognize the dynamic transition in social,
economic and political factors and their
implication on human health.

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  Ethiopia previously had a health policy that focused
on curative and urban centered health services
until the government launched its new health policy
in 1993.

 During the past 15 years, the FMOH has built an

impressive frame work for improving the health for
all.

Samuel M. 8 3/3/2024
 There are also strategies on:-
 Free service for key maternal and child health services
 The training and deployment of HWs for promotion of
institutional delivery and Emergency surgery officers at
primary hospital to manage obstetric and other
surgical procedures.
 In recent time primary health service coverage
reached 92% of total population with 125 hospitals,
2999 health centers, 15668 health posts and >4000
private for profit and not for profit clinics

Samuel M. 9 3/3/2024
 Health policy in Ethiopia
The first health policy in Ethiopia was
developed in 1993 and it mainly focuses on
prevention and control of this
communicable disease.
Prevention and promotion components of
health care were given more attention by the
new health policy.
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*

 Decentralization

 expanding the PHC system, and

 encouraging partnerships
 the participation of the whole community in health
activities.

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 The strategy of the policy has been to expand
healthcare delivery at the grass roots level through
implementation of the HSEP.

 The primary aim of the HSEP approach is to bring

health service delivery to the rural community at family
level where such a big percentage of the total
population lives.

Samuel M. 12 3/3/2024
 *
In order to provide health services for the community in the
large the population and, Ethiopia used three
tier(organizational structure) system

1. Level one is a Woreda/District health system comprised of :-

 Primary hospital (to cover 60,000- 100,000 people),

 Health centers (15,000-25,000 population) and

 Satellite Health Posts (3,000-5,000 population)

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 The primary hospital, health center and health posts
form a Primary Health Care Unit (PHCU).

2. Level two is a General Hospital covering a

population of 1-1.5 million people.

3. Level three is a Specialized Hospital covering a

population of 3.5-5 million people.

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 Specialized Hospital
3.5- 5 million

General Hospital Referral system

1-1.5 million

Primary hospital - 60,000-100,000

+ Primary health
Health center – 15,000- 25,000 care unit
+ PHCU
Five satellite health post – each 3,000- 5,000

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 The bottom structure of health service delivery is networked
as 1 HC with 5 satellite health post.

 The five satellite health posts were mainly accountable for the
cluster health center.
 They identify problems together, map the problem together,
plan the cluster health problem together, implement and
evaluate together.

 This will strength the system and help the implementation of

preventive, promotive and curative health service in more
integrated and complete manner.
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 service report will be sent for the woreda

Samuel M.
through the cluster health center.

HP1
HP2
*

HP3

17
HP4
Cluster Health Center

HP5

3/3/2024
  The referral system was also managed in such a way
that the satellite health post were refer their client for
further service for their cluster health center and if the
case is also above the ability of the health center then
the case will be referred to the primary hospital.

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Samuel M. 19 3/3/2024
 Primary health care (PHC)
 The essential health care that is universally accessible
to individuals and is acceptable to them with fulfilling
certain principles.

 It gained the world‟s attention after the 1978

International conference on PHC held at ALMA ATA.

 It focuses on disease prevention and health promotion.

 It is the type of health care delivery, can be described as
“by the people, of the people and for the people”.

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  Ethiopia is one of the countries in the world which has
adopted PHC as a national strategy since 1976.

 This strategy focuses on fair access to health services

by all people throughout the country, with special
attention on prevention and control of common
disease, self- reliance and community participation.

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  To achieve these principles of PHC the government of
Ethiopia started to decentralize the health service
delivery system from regional to woreda and kebeles
level since 1997 through vertical health program
approach.

 Vertical health program are centralized, non-

integrated and disease specific health programs.

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 Principles of primary health care

 Accessibility (equal distribution).

 Community participation

 Health promotion

 Appropriate technology

 Inter-sectoral collaboration.

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Elements of Primary Health Care

 Education on health problems and how to prevent and control

them.

 Dev‟t of effective food supply and proper nutrition.

 Maternal and child healthcare, including family planni

 Adequate and safe water supply and basic sanitation.

 Immunization against major infectious diseases.

 Local endemic diseases control.

 Appropriate treatment of common diseases and injuries.

 Provision of essential basic medication

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 Health service extension program (HSEP)

 HSEP was a tool developed to effectively implement

primary health care unit in Ethiopia.

 It is an innovative, community- based programme that

was first introduced in Ethiopia in 2003.

 It is used to improve equitable access to mainly

preventive health service through community based
services by applying the five principles of primary
health care.
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  The principle behind this programme is to make the
community produce their health by themselves.

 is so an approach by which health services will bring to

the house hold level.

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 LO2 PLAN,MANAGE,MONITOR AND EVALUATE
HEALTH SYSTEM.
Management:-
 Is the process of directing, coordinating and
influencing the operations of an organization so as
to obtain desired results and enhance total
performance.

 is the process of forecasting and planning, leading,

coordinating and evaluating the resource of an
organization in the efficient and effective manner to
achieve organizational goal27
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 Who is the Manager?
 is the person who has the responsibility of achieving
certain outcomes having been given the authority to
utilize the resources of the organization.

 These resources consist of human, financial,

information and physical assets.

 a person who can organize people to work

harmoniously together and make effective use of
resources to achieve laid-down objectives.
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Concept and principles of management

Management is simply doing things through people.

 As a health workers you will involve in supporting
individuals to produce their own health, in doing these
job knowingly or unknowingly you practice
management in every daily activity.

 Concept of management is issue of:-

1. Effectiveness
 is how well an organization, or a person in an
organization is meeting their 29goal.
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2. Efficiency
 is a measure of how well the health sector is using its
resource to achieve that goal

 Efficiency is the question of cost effectiveness.

3. Equity
 is a matter of distributing resources as well as service
for all segment of the population equally.
 Equity is a question of right, because every citizen has
a full right to get health service

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*
 Team spirit

 Division of labor

 Focusing on the result not activities

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  Team spirit
 is creating an atmosphere of mutual trust and
understanding between members of a team so that you
can develop and ensure morale of your team member.

 In order to utilize resource among each individual of a

team member and get benefit of working as team, as
health extension worker you have to create a team
spirit.

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  Division of labor;
 it is an act of distributing work, among all member of
the team in equal manner.

 So the role of you as a manager requires assigning a

balanced proportion of each type of worker to the work
to be done.

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  Focusing on the result not activities;
 is to make sure that everybody within the organization has
a clear understanding of the goals and objectives, and

 makes each person aware of their own roles and

responsibilities in achieving those objectives.

 Goals are the outcomes you intend to achieve.

 Objectives are the specific actions and measurable
steps that you need to take to achieve a goal .

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 *
 Planning

 Organizing

 Leading

 Coordination

 Monitoring and

 Evaluation

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  Planning; it is forecasting and thinking about things
that you want to happen in the future and then working
to achieve that.

 Organizing; is an act of assigning duties, grouping

tasks(put related tasks together) and allocating
resources for the planned activities.

 Leading; is an act of directing, influencing and

motivating(alesasa alekaka) team members in that
community towards the plan to be implemented.

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  Coordination; is an act of creating team spirit between
team members towards the set plan and activities to be
performed.

 Monitoring is a regular observation and recording of

activities.

 Evaluation is ensuring that the planned activities were

achieved.

Samuel M. 37 3/3/2024
 How can you build a team ?

 Team is two or more people who work together to

achieve a common goal.

 A heath team is a group of people who share common

health goal and common objectives determine by
community need to the achievement of which each
member of the team contribute in according to his or
her competent and skills and in coordination with the
function of others.

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 *
• Each member of the team contributes to the
achievement of the common goal.

Team comprises health promoters, model

households, community leaders respected
community members, representatives of varies
community associations.

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 Stages of Team building:-
 Forming

 Storming

 Norming

 Performing

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 Management roles and levels
A health manager is someone who spends a substantial
proportion of their time managing areas of healthcare
provision such as:

 coverage of services (planning, implementation and

evaluation)

 resources (staff, budgets, drugs, equipment, buildings,

information)

 external relations with partners including service users.

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  A manager‟s effectiveness is significantly influenced
by their insight into their own work.

 Health sector managers often become managers after

working in a technical role within healthcare.

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Management levels

In healthcare mgt there are 3 levels of managers:-

1) Top

2) middle, and

3) frontline.
 Together they are responsible for the work and
performance of the health sector.

 These managers have formal authority to use health

sector resources and to make decisions appropriate to
their level.
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 Top-level managers
 called senior management or executives
 they hold titles such as Minister, Head of Regional
Health Bureau, and Director.
 make decisions affecting the entirety of the health
sector.
 do not direct the day-to-day activities of the sector;
rather, they set goals for the health sector and direct
others to achieve them.

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Middle-level managers

 are those in the levels below top managers.

 are responsible for carrying out the goals set by top
management.

 They also set goals at their level and perhaps for other
units they are responsible for.

 can motivate and assist frontline managers to achieve

the sector objectives.

 They may also communicate upwards, by offering

suggestions and feedback to top
Samuel M. 45
managers. 3/3/2024
 Frontline managers
 are responsible for the daily management of health
activities in the community.

 are frontline managers of the primary health care

services

 they have a very strong influence on the sector and do

have to set goals for their own work.

 are the managers that interact most with the larger

community on a daily basis.
Samuel M. 46 3/3/2024
 What level of management is each of these ?
Top level:-MOH,Head of Regional HB
Midle level:-HC Director
Frontline:-HEWs,HEPs
Health Volunteer Has not managerial level.

Samuel M. 47 3/3/2024
 Planning health programme

Planning is the process of defining community health

problems, identifying needs and resources, establishing
priority goals, and setting out the administrative action
needed to reach those goals.

 It is also important to know why you need a health care

plan.

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 Characteristics of planning

All plans in different situation share 3 different features:

 A good plan should give clear vision/mission, goal
and objective, a clear picture of the tasks to be
accomplished, the resource needed to accomplish the
tasks like human,material,money,time and information.

 Planning takes place at all levels.

 Planning must be collective undertaking; means
planning should involve different stake holders in your
work area.
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 Types of Planning

1. Strategic planning

2. Tactical/operational planning/activity planning

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1. Strategic planning;
 is the process of determining what an organization
intends to be in the future and how it will go there.

 It is finding the best future for your organization and

the best path to reach that destination.

 It is planned for long years like for example for five

years.

 It should be subdivided in to yearly plan.

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2. Tactical/operational planning/activity planning
 is a short range planning that emphasize the current
operations of various parts .

 It is specific to mostly one year

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*
 Once the Ethiopian FMOH sets a strategic plan, you may be
involved in the district (woreda) planning process to develop
operational plans for improving the health of your community.
 An operational plan outlines important answers to such
fundamental questions as:

 What needs to be done?

 How will it be done & Who will do it?

 By when must it be done &What resources are needed to do

it?
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*
 Situational analysis

 Problem identification and prioritisation

 Setting objectives

 Strategy formulation

 Identify and sequence activities

 Identify resources

 Prepare action plans and schedules

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 S = strength of the organization

 W= weakness of the organization

 O = opportunities that an organization will have to achieve
that objective.

 T= threats that an organization might face in the

implementation process.
Samuel M. 55 3/3/2024
 Manage resources at a Health facility

 An important aspect of your work at your health

service is getting the best use out of the supplies and
equipment that you are in charge of.

 The successful performance of your health service

activities will depend on using your resource in the
most efficien way.

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 Implementing your Health Plans

Implementation is a central part of healthcare

management.

 It is the stage where you translate planned activities

into action.

 help you determine how best to use your group

activities and resources, and

 motivate members of your team to work in the best

interests of the health of the community.
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 To do this you need basic skills and knowledge on

 Getting organized

 Setting up activities

 Finding resources

 Building a team, and leading

 Motivating and training that team.

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Getting organised
 is the first stage in bringing together the right
combination of human, physical and financial
resources to successfully undertake your planned
activities.
Organising is the means by which:-

 The right things are done (what)

 In the right place (where)

 At the right time (when) & in the right way (how)

 By the right people (by whom).

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 *
 What is to be done and Where will the action take place?
 When will the action take place and What equipment is
needed?
 How will the activity be arranged?

 Which members of the health team will be involved?

 Who outside the health team will be involved?
 Who will do what and lead?

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  Is all necessary information available?

 Has the information been communicated?

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* LO3 Lead and build individual’s and
team’s capacity
*Building a team
A team is two or more people who work
together to achieve a common goal.

A health team is a group of people who share

common objectives, determined by community
need.

Each member of the team contributes to the

achievement of the common goal.
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 Types of health team
 Formal team :- are teams assembled to address a specific
problem or issue, or to achieve specific health goals.
An example of a formal team is a task force or
committee.

 Informal team-emerge whenever people come together

and interact regularly; develop with the formal
organization.

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 Four major functions of informal teams:
 Maintain and strengthen the norms (expected behaviour)
and values of members.

 Give members feelings of social satisfaction, status and

security.

 Help members communicate; create channels.

 Help to solve problems.

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 Team building usually refers to the process of selecting
and creating a team within a community.

Stages of team building

 Forming

 Storming

 Norming

 Performing

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 Forming
 The first stage in team development is the forming
stage.

 Team members get to know each other and find out

which behaviours will be acceptable to the rest of the
group members.

 Members establish initial rules and ways of working

with each other

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 Storming
 Team members are encouraged to participate and
engage with the issues and decisions that are key to the
success of the community health team in achieving its
goals.

 It is the stage when health team members may

challenge, disagree with, and question one another.

 This stage can be uncomfortable for some members,

but it is an important stage in tackling problems
Samuel M. 67 3/3/2024
 Norming
 At this stage the team comes to an agreement on its
purpose and plans.

 Members are clear what their roles and responsibilities

are and how they fit into the team.

 The team has a sense of identity and tries to work

together

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 *
 Group structure, norms and behaviour are understood and
accepted.

 Members know how to work with each other and can

effectively handle disagreements and misunderstandings.

 Differences have minimised and members have dealt with

them.

 The group is now focused on accomplishing its purpose.

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 Leading is the management function that you will use
when influencing, motivating and directing people in
your team towards the achievement of your
organisational goals.

Different styles of leading a team.

 Autocratic
 Anarchic
 Democratic

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  Autocratic leaders tend to be dictatorial, saying for
example „Do what you are told, and don‟t ask
questions!‟

 Anarchic leaders tend to say things like, „I don‟t care

what you do, so long as you keep out of my way!‟

 A consultative or democratic style is most suitable for

any team work that demands creativity and community
involvement

Samuel M. 71 3/3/2024
 *
 Motivation of team members play an important role in the
success of any health plan for your community.

During motivation

 Involve teams in decisions

 Give members of the team the opportunity to grow and
develop new skills

 Provide team members with a sense of ownership

 Encourage new ideas, suggestions and initiatives.

 Celebrate individuals‟ successes

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 Training your team

 Training as a means of solving health problems must

be closely related to work in the field, and to the
management of priority health problems.

 Training a local health team is one of the health

profetinals responsibilities.

 The quality of healthcare and its equitable distribution

in a population depends upon the staff employed by the
health services, and upon community members trained
with some knowledge and skills of health
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 Conducting meetings

 Meetings are a necessary part of the Health

Programme because meetings are the way in which
health teams communicate with people in their locality.

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 When preparing for a meeting it is useful to plan the
following:

 Purpose of meeting
 Main subject matter
 Type of meeting
 Size of meeting
 Place, time and duration of meeting
 Who is convening and organising the meeting
 Announcement or information about the meeting.
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 Purpose
 to communicate information, others to exchange views
and ideas, and others to make decisions about plans or
activities.

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 Have an agenda
 Distribute the agenda to participants before the meeting
so participants can be prepared for the meeting.

Start on time and end on time

 Every meeting should have established start and end
times.

 Be sure to start your meetings at the appointed time and

run no longer than the end time

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 *Maintain focus
 Stay on topic and avoid the temptation to get diverted by
interesting but unproductive points of view.
 Stick to the topic and the timelines you set for each item on
the agenda.
Capture action points
 Have a system for capturing, summarising and assigning
action points to individual team members.
Get feedback
 Get feed back on your meeting management

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73
 Monitoring and Control
*
 is about collecting information that will help you answer
questions about the health-related performance of you and
your team.

 is the regular observation and recording of activities that

will help you answer questions about your team‟s
performance.

 It involves giving information to your supervisors and

managers about the health services that you are providing
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 The purpose of monitoring
 Monitoring is very important in Primary Health Care
service planning and implementation.

 Determining whether the resources in the health

services are being well used.

 Ensuring that all activities are carried out properly by

the right people and at the right time.

 Ensuring that activities and tasks are performed in

accordance with set standards.

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  Identifying health problems facing the community and
starting to find solutions.

 Ensuring community groups and local individuals

participate appropriately in health activities.

 Understanding the health situation in your community

and how the health services are performing.

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Methods of gathering information for monitoring

You need to collect information from some of the sources

 Examining records: for example health service
records, financial and administrative records.

 Documentation: for e.g letters, reports, plans,

attendance lists, forms, invoices, receipts, minutes of
meetings and official reports.
 Continually observing work progress, staff
performance and service achievements.
 Discussing progress and any problems with staff and
with the community.
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  Information obtained from monitoring can be used to
identify day-to-day problems & for regular planning of
the health work in your community.

 It is essential to be aware of the significance of the

information you collect and to be confident of its
correctness.

 Records must be reviewed at regular intervals and

information must be verified

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 Using a checklist
 is a set of criteria that you can prepare to assist you in
monitoring your own activities.

 A checklist can also be a record or a reminder of what

has been happening so that you can follow the
progress you are making.

 Is Used to observe performance and recognise

problems in work standards

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 Supervision
 Monitoring information can also be gathered through
supervision.
 It is usually a meeting at which you are able to sit
down with a senior colleague and discuss issues that
are important in your work.
 It is way to make sure that your objectives
correspond(tesemama) to the health needs of your
community.

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 A good supervision session is part of your monitoring work. It should
help you understand how your work is progressing and determine ways
of helping
Samuel M. if there are any problems.86(Photo: I-Tech/Julia Sherburne)3/3/2024
 During supervision you can discuss, explain, justify,
and obtain the commitment of community workers to
the objectives of the programme.

 It makes sure that there are no divergences between the

objectives and the team‟s standard of performance.

 It seeks solutions to any conflict that may have arisen

regarding the programme objectives.

 It is one way to discover how tasks entrusted(adera

sete) to different categories of worker are carried out,
and under what conditions
Samuel M. 87 3/3/2024
 Control is a basic managerial function involving setting
standards, evaluating against standards and taking
corrective action.
Steps of managerial control
 It is the process of regulating service activities
 It ensures that your health work is accomplished
according to agreed action plans.
 It is a process of ensuring that the work that you do
produces the desired results.
M. Is a continuous activity 88
Samuel 3/3/2024
 Steps of managerial control

1) Establishing standards of performance

2) Measuring performance

3) Comparing performance with standards

4) Taking corrective action

Samuel M. 89 3/3/2024
 Establishing standards of performance

 first step in the control process

 must be established and expressed easily
understandable and the outcomes can be measured
without difficulty for people concerned

 standards of performance should be simple and

 capable of achievement with a reasonable commitment
of cost, effort and time.

Samuel M. 90 3/3/2024
 Measuring performance

 The second step in the control process.

 Measurement should b/n actual performance and
compare it with the standards.

 It can be done in quantitative or qualitative.

Samuel M. 91 3/3/2024
 Comparing performance with standards

 third step in the control process.

 summarise the outcomes as planned versus actual
results.

Samuel M. 92 3/3/2024
 Taking corrective action

 The fourth and final step in the control process.

 It involves those in management roles taking
appropriate decisions such as:-

 re-planning or redrawing of goals or standards

 perhaps changing the way that things are done

Samuel M. 93 3/3/2024
 Constructive and effective feedback

 We all need feedback to help us improve.

 If a member of your team does something well you
want to praise and reward them, but if they are
performing poorly you should let them know so they
can improve.

 Try to be specific.

Samuel M. 94 3/3/2024
 Giving effective feedback
 Feedback to individuals must be based on the evidence
gathered from the monitoring and controlling process.

 Feedback must also be timely – it is no good giving the

feedback after the opportunity for improvement has
already passed.

 If feedback is a routine part of management ,it should

become easier, with experience, to deliver feedback

Samuel M. 95 3/3/2024
 Effective feedback should be:-

 based on previously established performance goals/standards

 timely

 regularly given

 specific

 constructive

 motivating

 a routine part of your management function.

Samuel M. 96 3/3/2024
 Giving constructive criticism

Main steps Giving effective, constructive criticism:-

1.Provide feedback in a one-to-one meeting

 Give your feedback during a one-to-one, private session.

 Deliver the message in a single,focused conversation and
go directly to the point.

 E.g.„I want to give you some feedback on your work,.….

 I want to help you to perform better in the coming
quarter,……
Samuel M. 97 3/3/2024
2. Be specific
 Be specific about what‟s wrong and how it can be
improved.

 Constructive criticism should focus on specific actions

or behaviours that the person can change or do
something about

Samuel M. 98 3/3/2024
3. Reinforce the relationship
 Criticism needs to focus on an action or level of
performance, not on the person.

 Effective feedback requires direct, truthful

communication which will help build honest, open
relationships between you and your team.

Samuel M. 99 3/3/2024
 *
NUMBER OF GROUP 15 submission on March 30
All groups in section A-E work should never been similar.

Group 1. Perform business plan for owning

different business
Group 2. Write briefly the policy of health in
Ethiopia during different seasons
Group 3. Write the drug policy in Ethiopia
Group 4. Write different strategies to implement
different health policy
Samuel M. 100 3/3/2024
Samuel M. 101 3/3/2024