COMM 834: PRIMARY HEALTH CARE AND PRINCIPLES OF MANAGEMENT

Distance Learning Centre

Ahmadu Bello University
Zaria, Nigeria

COMM 834:
Primary Health Care and Principles of
Management

Course Material

Programme: Master of Public Health (MPH)

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COMM 834: PRIMARY HEALTH CARE AND PRINCIPLES OF MANAGEMENT

© 2021 Ahmadu Bello University (ABU) Zaria, Nigeria

All rights reserved. No part of this publication may be reproduced in any form or
by any means, electronic, mechanical, photocopying, recording or otherwise
without the prior permission of the Director, Distance Learning Centre,
Ahmadu Bello University, Zaria, Nigeria.

Published and Printed by

Ahmadu Bello University Press Limited
Zaria, Kaduna State, Nigeria.
Tel: 08065949711
E-mail: abupresslimited2005@yahoo.co.uk;
abupress2013@gmail.com; Website: www.abupress.org

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Course writers/
Development team
Editor
Prof. M.I Sule

Course Materials Development Overseer

Dr. Usman Abubakar Zaria

Subject Matter Expert

Usman Mohammed Aliyu

Subject Matter Reviewer

Rahamatu Shamsiyyah Iliya

Language Reviewer
Enegoloinu Ojokojo

Instructional Designers/Graphics
Usman Mohammed Aliyu

Course Coordinator
Rahamatu Shamsiyyah Iliya

ODL Expert
Prof. Adamu Z. Hassan

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Acknowledgement
We acknowledge the use of the Courseware of the National Open University of
Nigeria and University of Mekelle in collaboration with the Ethiopia Public Health
Training Initiative as the primary resources. Internal reviewers in the Ahmadu
Bello University who extensively reviewed and enhanced the material have been
duly listed as members of the Courseware development team.

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Contents
Copyright Page - - - - - - - - - ii
Course Writers/Development Team - - - - - - iii
Acknowledgement Page - - - - - - - - iv
Content - - - - - - - - - - v

COURSE STUDY GUIDE - - - - - - - - vi

i. Course Information - - - - - - - vi
ii. Course Introduction and Description - - - - - vi
iii. Course Prerequisites - - - - - - - vii
iv. Course Learning Resources - - - - - - vii
v. Course Objectives - - - - - - - viii
vi. Activities to Meet Course Objectives - - - - - viii
vii. Time (To complete Syllabus/Course) - - - - - ix
viii. Grading Criteria and Scale - - - - - - ix
ix. OER Resources - - - - - - - - x
x. ABU DLC Academic Calendar - - - - - - xii
xi. Course Structure and Outline - - - - - - xiii
xii. STUDY MODULES - - - - - - - 1

Module 1: Understanding Health and Health Care - - - 2

Study Session 1: Understanding Health - - - - - 2
Study Session 2: Understanding Levels of Health Care - - - 15
Study Session 3: Health Care Providers and Specialty Care - - 22

Module 2: Primary Health Care: Theoretical Concepts - - 32

Study Session 1: Basic Concepts of Primary Health Care - - 32
Study Session 2: Activities of Primary Health Care Stakeholders in
Health Care - - - - - - 44
Study Session 3: Challenges of Primary Health Care Centres and other Role
players in Primary Health Care Service Delivery - 51

Module 3: Principles of Health Management - - - - 56

Study Session 1: Understanding Health Management - - - 56
Study Session 2: Human Resources Management - - - 65
Study Session 3: Physical Resources Management - - - 75
Study Session 4: Financial Management - - - - - 82
Study Session 5: Health System Management: Community Involvement 91

Glossary - - - - - - - - - 99
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Course Study Guide

i. COURSE INFORMATION
Course Code: COMM 834
Course Title: Primary Health Care and Principles of Management
Credit Units: 3 Credit Units
Semester: Second

ii. COURSE INTRODUCTION AND DESCRIPTION

Introduction:
Primary health care is the backbone of a health system. It encompasses
primary care, disease prevention, health promotion, population health,
and community development within a holistic framework, with the aim
of providing essential community-focused health care. Primary health
care forms an integral part both of the country’s health system, of which
it is the central function and main focus, and of the overall social and
economic development of the community. It is the first level of contact
for individuals, the family and the community within the national health
system, bringing health care as close as possible to where people live and
work, and constitutes health care services.
Description:
This course is designed to give you extensive knowledge about primary
health care and principles of management. During this course, you will
learn about health, health care providers and specialty care. You will also
learn about basic concepts of primary health care, activities of primary
health care stakeholders in maintaining health care as well as challenges
of primary health care centres and other role-players in primary health
care service delivery. Furthermore, you will also learn about how to
manage human, physical and financial resources in health system.

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We will use a combination of lectures and video clips to accomplish the

goals of this course. Additionally, we shall tackle the complexity and
ambiguity of the course through class discussions. In class, I will act as a
facilitator, questioner, and lecturer to help you gain a better
understanding of the course. By actively participating in class
discussions, you will sharpen your own insights, and those of your
classmates. Thus you will not only become familiar with the content of
the course, but perhaps more importantly, you will also learn to master
the basic concepts of public health. I hope this course will amuse you and
make you want to learn more about other aspects of public health.

iii. COURSE PREREQUISITES

You should note that although this course has no subject pre-requisite,
you are expected to have:
1. Satisfactory level of English proficiency
2. Basic Computer Operations proficiency
3. Online interaction proficiency
4. Web 2.0 and Social media interactive skills

iv. COURSE LEARNING RESOURCES

Course Textbooks and Journals
These textbooks will be of immense benefits to this course:
 SB Buchbinder, NH Shanks, BJ Kite (2019.) Introduction to health
care management. Jones & Bartlett Learning
 Derek Wakeman, Max R. Langham (2018). Creating a safer
operating room: Groups, team dynamics and crew resource
management principles. Seminars in Pediatric Surgery, Volume 27,
Issue 2.
 Campbell, C. (2007). Essentials of Health Management Planning
and Policy. Lagos: University of Lagos press.
 Rose T, Dunn (2016). Haimann's Healthcare Management - 10th
edition. Health Administration Press
 Patrice Spath (2013). Introduction to Healthcare Quality
Management - 2nd edition (2013). Health Administration Press
 Alan M. Zuckerman. Health Care Strategic Planning 3rd Edition
Health Administration Press.
 The Well-Managed Healthcare Organisation - 8th edition (2016).
Assoc. of Univ. Programs in Health Administration
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 Joan Gratto Lieber and Charles R. MacConel (2021). Management

Principles for Health Professionals 8th Edition. Jones and Bartlett
Learning.
 Davies, C. and Bullman, A. (1999). Changing Practice in Health
and Social Care. SAGE.
 Encyclopedia of Public Health; Social Health. Answers.com
Retrieved from http://www.answers.com/topic/social-health.
 Karonne, B. J. (2002). Medical Office Procedure. NY: McGraw
Hill Pub. Merson, M. H. Black R. E. and Mills, A. J. (eds.).
International Public Health: Disease, Programmes, Systems and
Policies. Maryland: Aspen Publishers.
 Melia, K. M. (2004). Health Care Ethic. SAGE.
 Mitchell, J. & Haroun, L. (2001). Introduction to Health Care.
Canada: Delmar.
 Mills, A. J. & Ranson, M. K. (2001). The Design of the Health
System. In: M.H. Merson, R.E. Black & A.J. Mills (eds.).
International Public Health, Disease, Programmes, Systems and
Policies. Maryland: Aspen Publishers.
 Parker, R. (2006). Global Public Health. Routledge.
 Reike, W. A. (2001). Health Systems Management. In: M. H.
Merson, R. E. Black, and A.J. Mill, (eds.). International Public
Health: Disease, Programmes.

v. COURSE OBJECTIVES
This course is designed to ensure that you are able to:
1. Describe health and health care;
2. Explain the theoretical concepts of primary health care;
3. Outline the principles of health management.

vi. ACTIVITIES TO MEET COURSE OBJECTIVES

Specifically, this course shall comprise the following activities:
1. Studying courseware
2. Watching relevant course videos
3. Course assignments (individual and group)
4. Forum discussion participation
5. Tutorials (optional)
6. Semester examinations (CBT and essay based).

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vii. TIME (TO COMPLETE SYLABUS /COURSE)

To cope with this course, you would be expected to commit a minimum of 3 hours
weekly for the Course (study, assignments & Forum discussions).

viii. GRADING CRITERIA AND SCALE

Grading Criteria
A. Formative assessment
Grades will be based on the following:
Individual assignments/test (CA 1, 2 etc) 20
Group assignments (GCA 1, 2 etc) 10
Discussions/Quizzes/Out of class engagements etc 10

B. Summative assessment (Semester examination)

CBT based 30
Essay based 30
TOTAL 100%

C. Grading Scale:
A = 70-100
B = 60 – 69
C = 50 - 59
D = 45-49
F = 0-44

D. Feedback
Courseware based:
1. In-text questions and answers (answers preceding references)
2. Self-assessment questions and answers (answers preceding references)

Tutor based:
1. Discussion Forum tutor input
2. Graded Continuous assessments

Student based:
1. Online programme assessment (administration, learning resource,
deployment, and assessment).

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IX LINKS TO OPEN EDUCATION RESOURCES

OSS Watch provides tips for selecting open source, or for procuring free or open
software.
SchoolForge and SourceForge are good places to find, create, and publish open
software. SourceForge, for one, has millions of downloads each day.
Open Source Education Foundation and Open Source Initiative, and other
organisation like these, help disseminate knowledge.
Creative Commons has a number of open projects from Khan
Academy to Curriki where teachers and parents can find educational materials for
children or learn about Creative Commons licenses. Also, they recently launched
the School of Open that offers courses on the meaning, application, and impact of
"openness."
Numerous open or open educational resource databases and search engines
exist. Some examples include:
 OEDb: over 10,000 free courses from universities as well as reviews of colleges
and rankings of college degree programmes
 Open Tapestry: over 100,000 open licensed online learning resources for an
academic and general audience
 OER Commons: over 40,000 open educational resources from elementary
school through to higher education; many of the elementary, middle, and high
school resources are aligned to the Common Core State Standards
 Open Content: a blog, definition, and game of open source as well as a friendly
search engine for open educational resources from MIT, Stanford, and other
universities with subject and description listings
 Academic Earth: over 1,500 video lectures from MIT, Stanford, Berkeley,
Harvard, Princeton, and Yale
 JISC: Joint Information Systems Committee works on behalf of UK higher
education and is involved in many open resources and open projects including
digitising British newspapers from 1620-1900!
Other sources for open education resources
Universities
 The University of Cambridge's guide on Open Educational Resources for
Teacher Education (ORBIT)
 OpenLearn from Open University in the UK
Global
 Unesco's searchable open database is a portal to worldwide courses and
research initiatives

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 African Virtual University (http://oer.avu.org/) has numerous modules on

subjects in English, French, and Portuguese
 https://code.google.com/p/course-builder/ is Google's open source software that
is designed to let anyone create online education courses
 Global Voices (http://globalvoicesonline.org/) is an international community of
bloggers who report on blogs and citizen media from around the world,
including on open source and open educational resources
Individuals (which include OERs)
 Librarian Chick: everything from books to quizzes and videos here, includes
directories on open source and open educational resources
 K-12 Tech Tools: OERs, from art to special education
 Web 2.0: Cool Tools for Schools: audio and video tools
 Web 2.0 Guru: animation and various collections of free open source software
 Livebinders: search, create, or organise digital information binders by age,
grade, or subject (why re-invent the wheel?)

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X. ABU DLC ACADEMIC CALENDAR/PLANNER

PERIOD
Semester Semester 1 Semester 2 Semester 3
Activity JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC
Registration
Resumption
Late Registn.
Facilitation
Revision/
Consolidation
Semester
Examination

N.B: - Semester Examinations 1st/2nd Week January

- All Sessions commence Mid-February
- 1 Week break between Semesters and 4 Weeks vocation at end of session.
- Semester 3 is OPTIONAL (Fast-tracking, making up carry-overs & deferments)

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XI. COURSE STRUCTURE AND OUTLINE

Course Structure

WEEK MODULE STUDY ACTIVITY

SESSION
STUDY Study Session 1 1. Study the Course Material for Study Session 1.
MODULE 1 Title: 2. View the Videos on this Study Session:
(UNDERSTANDING Understanding https://www.youtube.com/watch?v=9UOljxJvil4
Week 1 HEALTH AND Health and
HEALTH CARE) Pg 2 https://www.youtube.com/watch?v=HgEWLUH2
ZoE.

Study Session 2 1. Study the Courseware for Study Session 2.

Title: 2. View the Videos on this Study Session:
Week 2 Understanding https://www.youtube.com/watch?v=mvljECmG00g
Levels of Health and
Care https://www.youtube.com/watch?v=PjG0KyeRORw.
Pg 15
Study Session 3 1. Study the Course Material for Study Session 3.
Title: Health Care 2. View the Videos on this Study Session:
Week 3 Providers and https://www.youtube.com/watch?v=3yeefQi89kY
Specialty Care and
Pg 22 https://www.youtube.com/watch?v=TqH5QAnIfOE
STUDY
MODULE 2 Study Session 1 1. Study the Course Material for Study Session 1.
(PRIMARY Title: Basic 2. View the Videos on this Study Session:
Week 4 HEALTH CARE: Concepts of https://www.youtube.com/watch?v=38Q-_DGrYtc
THEORETICAL Primary Health and
CONCEPTS) Care https://www.youtube.com/watch?v=EbHY1YHVd6
Pg 32 w.

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Study Session 1 1. Study the Courseware for Study Session 1.

Title: Basic 2. View the Videos on this Study Session:
Week 5 Concepts of https://www.youtube.com/watch?v=38Q-_DGrYtc
Primary Health and
Care https://www.youtube.com/watch?v=EbHY1YHVd6
Pg 32 w.

Study Session 2 1. Study the Course Material for Study Session 2.

Title: Activities of 2. View the Videos on this Study Session:
Week 6 Primary Health https://www.youtube.com/watch?v=69csBE4y1Uo
Care Stakeholders and
in Maintaining https://www.youtube.com/watch?v=V6cfT2jbOts.
Health Care
Pg 44
Study Session 3 1. Study the Courseware for Study Session 3.
Title: Challenges 2. View the Video on this Study Session:
of Primary Health https://www.youtube.com/watch?v=dQD3b43dMsE.
Week 7 Care Centres and
other Role-
players in Primary
Health Care
Service Delivery
Pg51

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Study Session 1 1. Study the Course Material for Study Session 1.

Title: 2. View the Videos on this Study Session:
Week 8 Understanding https://www.youtube.com/watch?v=Cl4GhjSALsI
Health and
Management https://www.youtube.com/watch?v=6e4s_AmOl_k.
Pg 56
STUDY
MODULE 3
Study Session 2 1. Study the Courseware for Study Session 2.
(PRINCIPLES OF
Title: Human 2. View the Videos on this Study Session:
HEALTH
Week 9 Resources https://www.youtube.com/watch?v=Gz0470G03qU
MANAGEMENT)
Management and
Pg 65 https://www.youtube.com/watch?v=1k3Vg4dZs3w.

Study Session 3 1. Study the Courseware for Study Session 3.

Title: Physical
Week 10 Resources
Management
Pg 75

Study Session 4 1. Study the Course Material for Study Session 4.

Title: Financial 2. View the Videos on this Study Session:
Week 11 Management https://www.youtube.com/watch?v=8k-v1EtAYXU
Pg 82 and https://www.youtube.com/watch?v=mX9nd0eQ-
6g.
Study Session 5 1. Study the Course Material for Study Session 5.
Title: Health 2. View the Video on this Study Session:
Week 12 System https://www.youtube.com/watch?v=sMzAmbttHsY.
Management:
Community
Involvement
Pg 91

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Week 13 REVISION/TUTORIALS (On Campus or Online)&

CONSOLIDATION WEEK

Week 14 SEMESTER EXAMINATION

& 15

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Course Outline
MODULE 1: Understanding Health and Health Care
Study Session 1: Understanding Health
Study Session 2: Understanding Levels of Health Care
Study Session 3: Health Care Providers and Specialty Care

MODULE 2: Primary Health Care: Theoretical Concepts

Study Session 1: Basic Concepts of Primary Health Care
Study Session 2: Activities of Primary Health Care Stakeholders in Maintaining
Health Care
Study Session 3: Challenges of Primary Health Care Centres and other Role-
players in Primary Health Care Service Delivery

MODULE 3: Principles of Health Management

Study Session 1: Understanding Health Management
Study Session 2: Human Resources Management
Study Session 3: Physical Resources Management
Study Session 4: Financial Management
Study Session 5: Health System Management: Community Involvement

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COMM 834: PRIMARY HEALTH CARE AND PRINCIPLES OF MANAGEMENT

Study Modules
MODULE 1: Understanding Health and Health Care
Contents:
Study Session 1: Understanding Health
Study Session 2: Understanding Levels of Health Care
Study Session 3: Health Care Providers and Specialty Care

Study Session 1
Understanding Health
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- What is Health?
2.2- The Health Triangle
2.3- Determinants of Health
2.4- Strategies for Maintaining Good Health
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
I believe by now you should have read through the course guidelines, which are in
your tablet or the hard copy sent to you. If you have not, I strongly recommend you
to do so right now before reading your study materials. I will like to welcome you
to study session 1. This study session is very vital as it will guide you through the
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definition of health, the health triangle, health determinants as well as strategies for
maintaining good health. So sit tight and enjoy your studies.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Describe health;
2. Explain how health can be achieved;
3. Discuss the determinants of health;
4. Describe strategies for maintaining good health.

2.0 Main Content

2.1 What is Health?
At the time of the creation of the World Health
Organisation (WHO) in 1948, Health was defined as
being "a state of complete physical, mental, and
social well-being and not merely the absence of
disease or ailment" (WHO, 1948; WHO, 2006).

This definition invited nations to expand the

conceptual framework of their health systems beyond www.optimizeottawa.com
issues related to the physical condition of individuals
and their diseases, and it motivated us to focus our attention on what we now call
the social determinants of health. Consequently, WHO challenged political,
academic, community, and professional organisations devoted to improving or
preserving health to make the scope of their work explicit, including their rationale
for allocating resources. This opened the door for public accountability (WHO,
2005).

Only a handful of publications have focused specifically on the definition of health

and its evolution in the first 6 decades. Some of them highlight its lack of
operational value and the problem created by use of the word “complete.” Others
declare the definition, which has not been modified since 1948, “simply a bad one”
(LaLonde, 1974). More recently, Smith suggested that it is “a ludicrous definition
that would leave most of us unhealthy most of the time” (The UN, Basic Needs).

In 1986, the WHO, in the Ottawa Charter for Health Promotion, said that health is
“a resource for everyday life, not the objective of living. Health is a positive
concept emphasising social and personal resources, as well as physical capacities.”
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Classification systems such as the WHO Family of International Classifications

(WHO-FIC) which is composed of the International Classification of Functioning,
Disability, and Health (ICF) and the International Classification of Diseases (ICD)
also define health. Overall health is achieved through a combination of physical,
mental, emotional, and social well-being, which, together is commonly referred to
as the Health Triangle.
(https://www.youtube.com/watch?v=myPMPyt4oYs)

In-text Question: What is health?

Answer: Health is a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity. It is a positive concept emphasising social and
personal resources, as well as physical capacities.

2.2 The Health Triangle

Health is achieved through a combination of physical, mental, and social health,
which, together is commonly referred to as the Health Triangle.

Physical Health

Mental Health Social Health

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Figure 1.1.1: The Health Triangle

A. Physical Health
Physical fitness is good bodily health, and is the result of regular exercise,
proper diet and nutrition, and proper rest for physical recovery.
Physical health is also the overall
condition of a living organism at a
given time, the soundness of the body,
freedom from disease or abnormality,
and the condition of optimal well-
being. People want to function as
designed, but environmental forces can
attack the body or the person may have
genetic malfunctions. The main concern
in health is preventing injury and healing
damage caused by injuries and
biological attacks (Kurtus, 2002).
www.colourbox.com
B. Mental Health
Mental health refers to an individual's emotional and psychological well-being.
Merriam-Webster (1828) defines mental health as “A state of emotional and
psychological well-being in which an individual is able to use his or her cognitive
and emotional capabilities, function in society, and meet the ordinary demands of
everyday life.”

According to the World Health Organisation, there is no single “official” definition

of mental health. Cultural differences, subjective assessments, and competing
professional theories all affect how “mental health” is defined. In general, most
experts agree that “mental health” and “mental illness” are not opposites. In other
words, the absence of a recognised mental disorder is not necessarily an indicator
of sound mental health.

One way to think about mental health is by looking at how effectively and
successfully a person functions. Feeling capable and competent; being able to
handle normal levels of stress, maintain satisfying relationships, and lead an
independent life. Also, being able to “bounce back,” or recover from difficult
situations are all signs of mental health.

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C. Social Health
The concept of social health is less intuitively familiar than that of physical or
mental health, and yet, along with physical and mental health, it forms one of the
three pillars of most definitions of health. This is partly because social health can
refer both to a characteristic of a society, and of individuals. “A society is healthy
when there is equal opportunity for all and access by all to the goods and services
essential to full functioning as a citizen” (Russell ,1973). Indicators of the health of
a society might include the existence of the rule of law, equality in the
distribution of wealth, public accessibility of the decision-making process, and
the level of social capital.

The social health of individuals refers to “that dimension of an individual’s well-

being that concerns how he gets along with other people, how other people
react to him and how he interacts with social institutions and societal mores”
(Russell, 1973). This definition is broad—it incorporates elements of personality
and social skills, reflects social norms, and bears a close relationship to concepts
such as "wellbeing,” “adjustment,” and “social functioning.”

Formal consideration of social health was stimulated in 1947 by its inclusion in the
World Health Organization’s definition of health, and by the resulting emphasis on
treating patients as social beings who live in a complex social context. Social
health has also become relevant with the increasing evidence that those who are
well integrated into their communities tend to live longer and recover faster from
disease. Conversely, social isolation has been shown to be a risk factor for illness.
Hence, social health may be defined in terms of social adjustment and social
support—or the ability to perform normal roles in society.

Definitions of social health in terms of adjustment derive from sociology and

psychiatry. Poor social adjustment forms a common indicator of neurotic illness,
and adjustment may be used to record the outcome of care, especially for
psychotherapy. Adjustment may be rated subjectively, or it may be judged in terms
of a person's fulfillment of social roles—how adequately a person is functioning
compared to normal social expectations. Role performance can also indicate the
impact of disability, bringing the concept of social health close to that of handicap,
which refers to the social disadvantage resulting from impairments or disabilities
(WHO, 1980). As norms vary greatly between cultures, however, a challenge lies
in selecting an appropriate standard against which to evaluate roles.

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Mutual social support is also commonly viewed as an aspect of social health.

Support attenuates the effects of stress and reduces the incidence of disease. Social
support also contributes to positive adjustment in children and adults, and
encourages personal growth. The concept of support underlines the theme of social
health as an attribute of a society: a sense of community—or the currently
fashionable concept of social capital, which refers to the extent to which there is a
feeling of mutual trust and reciprocity in a community—is an important indicator
of social health.

A combination of physical, mental and social health is necessary to achieve overall

health.

In-text Question 1: What is physical health?

Answer: Physical health is the overall condition of a living organism at a given time,
the soundness of the body, freedom from disease or abnormality, and the condition of
optimal well-being.
In-text Question 2: List the indicators of a healthy society.
Answer: 1. Existence of the rule of law.
2. Equality in the distribution of wealth.
3. Public accessibility of the decision-making process.
4. Level of social capital.

2.3 Determinants of Health

Health or ill health is the result of a combination of different factors. There are
different perspectives in expressing the determinants of health of an individual or a
community
According to the “Health field” concept, there are four major determinants of
health or ill health.
A. Human Biology
Every human being is made of genes. In addition, there are factors, which are
genetically transmitted from parents to offspring. As a result, there is a chance of
transferring defective trait.
1. Genetic Counselling: This is a service that provides information and advice
about genetic conditions. These are conditions caused by changes (known as
mutations) in certain genes and are usually passed down through a family. Genetic
counselling is conducted by healthcare professionals who have been specially
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trained in the science of human genetics (a genetic counsellor or a clinical

geneticist).
These specialists work as members of a healthcare team, providing information
and support to families who have members with birth defects or genetic disorders
and to families who may be at risk of a variety of inherited conditions. For instance
during marriage, parents could be made aware of their genetic component in order
to overcome some risks that could arise. Genetic counselling isn't a form of
psychological counselling or psychotherapy and shouldn't be confused with
counselling therapy used to treat mental health conditions, such as depression and
anxiety.

2. Genetic Engineering: This is the process of manually adding new DNA to an

organism. The goal is to add one or more new traits that are not already found in
that organism. Genetic engineering, also called transformation. It works by
physically removing a gene from one organism and inserting it into another, giving
it the ability to express the trait encoded by that gene. It is like taking a single
recipe out of a cookbook and placing it into another cookbook. It may have a role
in the treatment of cases like Breast cancer.

B. Environment
This involves all that which is external to the individual human host. Those are
factors outside the human body. Environmental factors that could influence health
include:
1. Life support, food, water, air etc
2. Physical factors, climate, rain fall
3. Biological factors: microorganisms, toxins, biological waste,
4. Psycho-social and economic e.g. Crowding, income level, access to health care
5. Chemical factors: industrial wastes, agricultural wastes, air pollution, etc.

C. Life style (Behaviour)

It is an action that has a specific frequency, duration, and purpose, whether
conscious or unconscious. It is associated with practice. It is what we do and how
we act. Recently life style by itself received an increased amount of attention as a
major determinant of health.

Life style of individuals affects their health directly or indirectly. For example:
cigarette smoking, unsafe sexual practice and eating contaminated food.

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D. Health care organization

Health care organisations in terms of their resource in human power, equipment,
and money determine the health of people. It is concerned with:
1. Availability of health service; People living in areas where there is no access to
health service are affected by health problems and have lower health status than
those with accessible health services.
2. Scarcity of Health Services leads to inefficient health service and resulting in
poor quality of health status of people.
3. Acceptability of the service by the community.
4. Accessibility in terms of physical distance, finance etc. and
5. Quality of care that mainly focuses on the comprehensiveness, continuity and
integration.
In-text Question: State 4 environmental factors that could influence health.

Answer: 1. Chemical factors like industrial wastes.

2. Psycho-social and economic factors such as income level.
3. Biological factors such as microorganisms.

4. Physical factors like rain fall.

2.4 Strategies for Maintaining Good Health

Achieving health and remaining healthy is an ongoing process. Effective strategies
for staying healthy and improving one's health include the following elements:

A. Social Activity
Personal health depends partially on the social structure of one's life. The
maintenance of strong social relationships is linked to good health conditions,
longevity, productivity, and a positive attitude. This is due to the fact that positive
social interaction as viewed by the participant increases many chemical levels in
the brain which are linked to personality and intelligence traits.

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B. Sports/Nutrition
Sports/nutrition focuses on the link between dietary supplements and athletic
performance. One goal of sports/nutrition is to maintain glycogen levels and
prevent glycogen depletion. Another is to optimise energy levels and muscle
tone. An athlete’s strategy for winning an event may include a schedule for the
entire season of what to eat, when to eat it, and in what precise quantities (before,
during, after, and between workouts and events).

C. Hygiene
Hygiene is the practice of keeping the body clean to prevent infection and illness,
and the avoidance of contact with infectious agents. Hygiene practices include
bathing, brushing and flossing teeth, washing www.activityday.co.uk
hands especially before eating, washing food
before it is eaten, cleaning food preparation
utensils and surfaces before and after preparing
meals, and many others. This may help prevent
infections and illnesses. By cleaning the body,
dead skin cells are washed away with the germs,
reducing their chance of entering the body.

D. Stress Management
Prolonged psychological stress may negatively www.airliquid.com
impact health, such as by weakening the immune system and mind. Stress
management is the application of methods to either reduce stress or increase
tolerance to stress. Relaxation techniques are physical methods used to relieve
stress.

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Psychological methods include cognitive therapy, meditation, and positive thinking

which work by reducing response to stress. Improving relevant skills and abilities
builds confidence, which also reduces the stress reaction to situations where those
skills are applicable.

Reducing uncertainty, by increasing knowledge and experience related to stress-

causing situations, has the same effect. Learning to cope with problems better, such
as improving problem solving and time management skills, may also reduce
stressful reaction to problems.
Repeatedly facing an object of one's fears may also desensitise the fight-or-flight
response with respect to that stimulus—e.g., facing bullies may reduce fear of
bullies.

A prolonged hour of surfing on the Internet is a major concern that can affect the
eyes significantly. A white background on computer screens with a viewing
distance of less than 14 inches is known to increase strain, mental fatigue and
temporary di-chromatic visions in a normal healthy human being. Trying to opt for
black or any non-white backgrounds can help in reducing eye strain in front of
personal computers.

E. Health Care
Health care is the prevention, treatment, and management of illness and the
preservation of mental and physical well-being through the services offered by the
medical, nursing, and allied health professions.

F. Workplace Wellness Programmes

Workplace wellness programs are recognised by an increasingly large number of
companies for their value in improving the health and wellbeing of their
employees, and for increasing morale, loyalty, and productivity. Workplace
wellness programmes can include things like on-site fitness centres, health
presentations, wellness newsletters, access to health coaching, tobacco cessation
programmes and training related to nutrition, weight and stress management. Other
programmes may include health risk assessments, health screenings and body mass
index monitoring.

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G. Public Health
Public health is "the science and art of preventing diseases, prolonging life and
promoting health through the organised efforts and informed choices of
society, organisations, public and private, communities and individuals. It is
concerned with threats to the overall health of a community based on population
health analysis. The population in question can be as small as a handful of people
or as large as all the inhabitants of several continents (for instance, in the case of a
pandemic). Public health has many sub-fields, but is typically divided into the
categories of epidemiology, biostatistics and health services. Environmental, social
and behavioural and occupational health, are also important fields in public health.

The focus of public health intervention is to prevent rather than treat a disease
through surveillance of cases and the promotion of healthy behaviours. In addition
to these activities and in many cases, treating a disease can be vital to preventing it
in others, such as during an outbreak of an infectious disease. Vaccination
programmes and distribution of condoms are examples of public health measures.
In-text Question 1: State the roles of sport activities in health maintenance.

Answer: 1. Maintenance of glycogen levels.

2. Optimisation of energy levels and muscle tone.

3.0 Conclusion
In this session, health was viewed as the state of complete physical, mental, and
social well-being and not merely the absence of disease or ailment. We also have
seen in this session that total health involves physical, mental and social well-
being; thus these variables formed the health triangle. We briefly identified some
determinants of health: biological, lifestyle choices, environmental and above all
health care services. We also identified basic strategies for maintaining and
sustaining good health, such as social activities, good hygiene, stress management,
health care and public health. I believe that you are now ready to study health care.

4.0 Session Summary

In this session, the following were described:
1. Health
2. Health triangle
3. Determinants of health
4. Strategies for maintaining good health.
Hope you enjoyed your studies. Now let us attempt the questions below.
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5.0 Self-Assessment Questions

1. Health is not just the absence of a disease or an ailment, but also the resource for
everyday life. Do you agree and how true is this statement in your country?
2. Describe four strategies for maintaining good health.

6.0 Additional Activities

a. Visit YouTube: https://www.youtube.com/watch?v=9UOljxJvil4 and

https://www.youtube.com/watch?v=HgEWLUH2ZoE. Watch the videos
and summarise in 1 paragraph.
b. Take a walk and engage any 3 people on how they are feeling both
physically, mentally and socially and summarise their opinions in 2
paragraphs.

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7.0 References/Further Readings

Björk, J., Albin, M., Grahn, P., Jacobsson, H., Ardo, J., Wadbro, J., Östergren, P.
and Skärbäck, E. (2008). Recreational Values of the Natural Environment in
Relation to Neighbourhood Satisfaction, Physical Activity, Obesity and Wellbeing.
Journal of Epidemiology and Community Health, 62:e2;
doi:10.1136/jech.2007.062414.
Campbell, C. (2007). Essentials of Health Management Planning and Policy.
Lagos: University of Lagos Press.
Encyclopedia of Public Health; Social Health. Answers.com Retrieved from
http://www.answers.com/topic/social-health. Site Accessed on 26th October 2008.
Russell, R. D. (1973). "Social Health: An Attempt to Clarify this Dimension of
Well-Being." International Journal of Health Education 16:74–82.
United Nations. (1995). Basic Facts. Geneva: United Nations.
World Health Organisation (1948). Preamble to the Constitution of the World
Health Organisation (Official Records of the World Health
Organisation, no. 2, p. 100); and entered into force on 7 April 1948.
World Health Organisation (1994a). Basic Documents. Geneva: WHO.
World Health Organisation (1980). International Classification of Impairments,
Disabilities, and Handicaps. Geneva: Author.
World Health Organisation (2005). Constitution of the World Health Organisation:
Promoting Mental Health: Concepts, Emerging evidence, Practice: A
Report of the World Health Organisation, Department of Mental Health
and Substance Abuse in Collaboration with the Victorian Health Promotion
Foundation and the University of Melbourne. World Health
Organization. Geneva.
World Health Organisation (2006). Constitution of the World Health Organisation.
Basic Documents, (44th ed.). Supplement, October 2006.
Wikipedia (2009). Primary Health Care. Wikipedia Foundation Inc. Page Last
Modified 16th July 2009.
Wikipedia, (2009). Health. Wikipedia Foundation Inc. Page last Modified on 14 th
July 2009. Page accessed on 14th July 2009.

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Study Session 2
Understanding Levels of Health Care
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- What is Health Care?
2.2- Levels of Health Care
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
I welcome you to study session 2. In the preceding session, we described health,
health triangle, health determinants and strategies for maintaining health. In this
session, we will look at health care and its levels. It is the view of the World Health
Organisation that health care should embrace all the goods and services designed
to promote health, including “preventive, curative and palliative interventions. So
sit tight and enjoy your studies.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Describe health care; and
2. Explain the levels of health care.

2.0 Main Content

2.1 What is Health Care?
Health care is the prevention, treatment, and management of illness and the
preservation of mental and physical well-being through the services offered by
the medical, nursing, and allied health professions.

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www.nvidia.com

According to the World Health Organisation, health care embraces all the goods
and services designed to promote health, including “preventive, curative and
palliative interventions, whether directed to individuals or to populations”
(Wikipedia, 2009). The organised provision of such services may constitute a
health care system.

Since health is influenced by a number of factors such as adequate food, housing,

basic sanitation, healthy lifestyles, protection against environmental hazards
and communicable diseases, the frontiers of health extend beyond the narrow
limits of medical care. It is thus clear that “health care” implies more than “medical
care.” It embraces a multitude of “services provided to individuals or communities
by agents of the health services or professions, for the purpose of promoting,
maintaining, monitoring, or restoring health.

The term “medical care” is not synonymous with “health care.” It refers chiefly to
those personal services that are provided directly by physicians or rendered as the
result of physicians’ instructions. It ranges from domiciliary care to resident
hospital care. Medical care is a subset of health care system (Wikipedia, 2007).

In-text Question: What is health care?

Answer: Health care is the prevention, treatment, and management of illness and the
preservation of mental and physical well-being through the services offered by the
medical, nursing, and allied health professions.

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2.2 Levels of Health Care

The delivery of health care differs from region to region, but the basic approaches
are somewhat similar. Levels of health care include:

2.2.1 Primary Health care

This is the medical care a patient receives upon first contact with the health care
system, before referral elsewhere within the system. It is defined as "essential
health care based on practical, scientifically sound and socially acceptable
methods and technology made universally accessible to individuals and
families in the community through their full participation and at a cost that
the community and the country can afford to maintain at every stage of their
development in the spirit of self-determination” (McGilvary, 1981); (Alma Ata
international conference definition).

The concept of primary health care was defined by the World Health Organization
in 1978 as both a level of health service delivery and an approach to health care
practice. Primary care, as the provision of essential health care, is the basis of a
health care system. It provides both the initial and the majority of health care
services of a person or population. This is in contrast to secondary health care,
which is consultative, short term, and disease-oriented for the purpose of assisting
the primary care practitioner. Tertiary care is for patients with unusual illness
requiring highly specialised services. Primary care clinicians may be physicians,
nurses, or various other health workers trained for the purpose. Countries with
better provision of primary health care have greater patient satisfaction at lower
costs and better health indicators.

www.internationalmedicalcorps.org.uk

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While there are many definitions of primary care, the principles of accessible,
comprehensive, continuous, and coordinated personal care in the context of family
and community are consistent. Primary health care should be available to all
people without the barriers of geography, cost, language, or culture. In primary
care, all types of problems, at all ages and for both genders, are considered,
including care for acute self-limited problems or injuries, the care of chronic
diseases such as diabetes or AIDS (acquired immunodeficiency syndrome), the
provision of preventive care services such as immunisations and family planning,
and health education.

Because primary health care is broad, it is information-rich. Primary care clinicians

coordinate care for patients among different service providers and for different
patient concerns, responding to the fact that most patients have multiple problems.
Continuity of care refers to the ongoing relationship between individual patients
and primary care clinicians who are committed to the person, not a specific
disease, body of knowledge, or specialised technique, and who recognise that
physical, mental, emotional, and social concerns are related. Primary care
clinicians, interested in the meaning of illness to the particular person, must
negotiate care with that individual. A person's health is greatly influenced by the
individual's family, culture, and community. Thus, the delivery of primary health
care may be different for each individual and in different areas of the world
(Encyclopedia of Public Health).

2.2.2 Secondary Health care

The term secondary care is a service provided by medical specialists who
generally do not have first contact with patients, for example, cardiologists,
urologists and dermatologists. A physician might voluntarily limit his or her
practice to secondary care by refusing patients who have not seen a primary care
provider first, or a physician may be required, usually by various payment
agreements, to limit the practice this way. Some areas of secondary care are also
managed by allied health professions who work to co-manage that aspect of health
care with physicians, such as occupational therapists and orthopedists.

Secondary health care is also the intermediate level of health care, which is the
responsibility of the state government. It provides mutually supportive referral sub-
system to the primary health care. It is involved in curative as well as promoting
services. Health institutions under the secondary level include: general hospitals,
cottage hospitals and comprehensive health centres. Providers of services here
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are doctors, nurses, midwives, pharmacists, laboratory staff, x-ray

technologists/technicians, etc.
2.2.3 Tertiary Health care
In medicine, tertiary health care is specialised consultative care, usually on
referral from primary or secondary medical care personnel, by specialists working
in a centre that has personnel and facilities for special investigation and treatment.
Specialist cancer care, neurosurgery (brain surgery), burns care and plastic
surgery are examples of tertiary care services. In comparison, secondary medical
care is the medical care provided by a physician who acts as a consultant at the
request of the primary physician.
Also as the name implies, tertiary health care is the top most level of health care,
which provides referral base for all cases sent from primary and secondary levels.
Health institutions involved here are: specialist and teaching hospitals. This level
also provides the mutually supportive referral sub-systems to the secondary care
level and specialists with rehabilitation care as well as training for capacity
building.
The tertiary level care is the responsibility of the federal government in Nigeria.
This is because of the high financial commitment of the activities involved, such as
specialist services, huge technology, advanced diagnostic procedures and
counseling. The federal government therefore controls the tertiary level of health
care in Nigeria through:
1. Legislation
2. Policy making
3. Standard setting
4. Health manpower training
5. Provision of teaching committee
6. Providing assistance to state and local government
In-text Question: What is primary health care?

Answer: Primary health care is an essential health care based on practical,

scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community through their full
participation and at a cost that the community and the country can afford to maintain
at every stage of their development in the spirit of self-determination.

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3.0 Conclusion
In this session, we noted that health care is the prevention, treatment, and
management of illness and the preservation of mental, social and physical well-
being through the services offered by the medical, nursing, and allied health
professions. World Health Organisation also affirms that health care embraces all
the goods and services designed to promote health, including “preventive, curative
and palliative interventions, whether directed to individuals or to populations”.
This session also looked at levels of health care which include: primary, secondary
and tertiary health care. Thus, primary health care is the medical care a patient
receives upon first contact with the health care system, before referral elsewhere
within the system. Secondary care is a service provided by medical specialists who
generally do not have first contact with patients while tertiary health care is
specialised consultative care, usually on referral from primary or secondary
medical care personnel. I believe that you are now ready to look at different health
care providers.

4.0 Session Summary

In this session, we have learnt:
1. Health care
2. Levels of health care.
We hope you enjoyed your studies. Now let us attempt the questions below.

5.0 Self-Assessment Questions

1. Distinguish between primary, secondary and tertiary health care.
2. Explain how tertiary level of health care can be controlled in your country.

6.0 Additional Activities

a. Visit YouTube: https://www.youtube.com/watch?v=mvljECmG00g and

https://www.youtube.com/watch?v=PjG0KyeRORw. Watch the videos and
summarise in 1 page.
b. Visit all the health care centres in your community and distinguish them
in relation to the type of services they offer.

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7.0 References/Further Readings

Campbell, C. (2007). Essentials of Health Management Planning and Policy.
Lagos: University of Lagos Press.
Encyclopedia of Public Health; Social Health. Answers.com Retrieved from
http://www.answers.com/topic/social-health. Site Accessed on 20th July
2009.
McGilvray, J. C. (1981). The Quest for Health and Wholeness. Tübingen: German
Institute for Medical Missions.
Merson, M. H.; Black, R. E and Mill, A. J. (2001). International Public Health:
Disease, Programmes, Systems and Policies. Maryland: Aspen
Publishers.
Mitchell, J. and Haroun, L. (2001). Introduction to Health Care. Canada: Delmar.
World Health Organisation (1978). "Alma Ata 1978: Primary Health Care". HFA
Sr. (1).
Wikipedia (2009) Primary Health care. Retrieved from
http://en.wikipedia.org/wiki/Primary_health_care. Site visited on 20th July
2009.

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Study Session 3
Health Care Providers and Specialty Care
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- Primary Care Provider
2.2- Nursing Care
2.3- Drug Therapy
2.4- Specialty Care
2.5- Complementary and Alternative Care
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
Welcome to session 3 of this course. Remember this course is about primary health
care and principles of management, but we need to have a firm knowledge of basic
health concepts and determinants. In previous sessions, we presented definitions of
health as well as levels of health care. In this session, we will look at different
health care providers, specifically, health care professionals as well as specialty
care available in health care. Enjoy your studies.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Identify primary health care providers/professionals;
2. Explain the features of nursing care;
3. Describe the features of drug therapy;
4. State the various specialty cares obtainable in health care; and
5. Explain complementary and alternative medicine.

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2.0 Main Content

2.1 Primary Care Provider
A primary care provider (PCP) is the person a patient sees first for checkups
and health problems. The following is a review of practitioners that can serve as
PCP.
1. The term "generalist" often refers to medical doctors (MDs) and doctors of
osteopathic medicine (DOs) who specialised in internal medicine, family practice,
or pediatrics.
2. Obstetricians/gynecologists (OB/GYNs) are doctors who specialised in
obstetrics and gynecology, including women's health care, wellness, and prenatal
care. Many women use an OB/GYN as their primary care provider.
3. Nurse practitioners (NPs) are nurses with graduate training. They can serve as a
primary care provider in family medicine (FNP), pediatrics (PNP), adult care
(ANP), or geriatrics (GNP). Others are trained to address women's health care
(common concerns and routine screenings) and family planning. In some countries,
NPs can prescribe medications.
4. A physician assistant (PA) can provide a wide range of services in collaboration
with a Doctor of Medicine (MD) or Osteopathy (DO) (Medical Encyclopedia,
2006).

www.aginginplace.org

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In-text Question: Who is a primary care provider?

Answer: A primary care provider is the person a patient sees first for checkups
and health problems.

2.2. Nursing Care

Nurse care is provided by
registered nurses (RNs) that
have graduated from a nursing
programme, have passed a state
board examination, and are
licensed by the state.

Advanced practice nurse

training with education and
experience beyond the basic
training and licensing is
required of all RNs. This
includes nurse practitioners (NPs) and the following:
1. Clinical nurse specialists (CNSs) with training in a field such as cardiac,
psychiatric, or community health.
2. Certified nurse midwives (CNMs) with training in women's health care needs,
including prenatal care, labour and delivery, and care of a woman who has given
birth.
3. Certified registered nurse anaesthetists (CRNAs) with training in the field of
anaesthesia. Anaesthesia is the process of putting a patient into a painless sleep,
and keeping the patient's body working, so surgeries or special tests can be done
(Medical Encyclopedia, 2006).

In-text Question: List four categories of registered nurses that required

advanced practice nurse training.

Answer: Nurse practitioners, clinical nurse specialists, certified nurse midwives

and certified registered nurse anaesthetists.

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2.3 Drug Therapy

This is provided by licensed pharmacists with graduate training from a college of
pharmacy. Your pharmacist prepares
and processes drug prescriptions that
were written by your primary or
specialty care provider. Pharmacists
provide information to patients about
medications, while also consulting
with health care providers about
dosages, interactions, and side effects
of medicines. Your pharmacist may
also follow your progress to check
the safe and effective use of your
medication (Medical Encyclopedia, 2006).
In-text Question: State the roles of a pharmacist in health system.

Answer: Preparation and processing of drug prescription written by a primary or

specialty care provider, provision of information to patients about medication,
involvement in consultation with health care providers about dosages,
interactions, and side effects of medicines and monitoring of patients to check the
safe and effective use of medication.

2.4 Specialty Care

Your primary care provider may refer you to professionals in various specialties
when necessary, such as:
1. Allergy and asthma.
2. Anesthesiology -- general anesthesia or spinal block for surgeries and some
forms of pain control.
3. Cardiology -- heart disorders.
4. Dermatology -- skin disorders.
5. Endocrinology -- hormonal and metabolic disorders, including diabetes.
6. Gastroenterology -- digestive system disorders.
7. General surgery -- common surgeries involving any part of the body.
8. Haematology -- blood disorders.
9. Immunology -- disorders of the immune system.
10. Infectious disease -- infections affecting the tissues of any part of the body.
11. Nephrology -- kidney disorders.
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12. Neurology -- nervous system disorders.

13. Obstetrics/gynaecology -- pregnancy and women's reproductive disorders.
14. Oncology – cancer treatment.
15. Ophthalmology -- eye disorders and surgery.
16. Orthopaedics -- bone and connective tissue disorders.
17. Otorhinolaryngology -- ear, nose, and throat (ENT) disorders.
18. Physical therapy and rehabilitative medicine -- for disorders such as low back
injury, spinal cord injuries, and stroke.
19. Psychiatry -- emotional or mental disorders.
20. Pulmonary (lung) -- respiratory tract disorders.
21. Radiology -- X-rays and related procedures (such as ultrasound, CT, and MRI).
22. Rheumatology -- pain and other symptoms related to joints and other parts of
the musculoskeletal system.
23. Urology -- disorders of the male reproductive and urinary tracts and the female
urinary tract (Medical Encyclopedia).

www.sschc.org

In-text Question: List 10 specialisation available in the modern health care.

Answer: Haematology, Radiology, Oncology, Urology, Psychiatric,
Rheumatology, Neurology, Nephrology, Dermatology and General surgery.

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2.5 Complementary and Alternative Medicine

Complementary and Alternative Medicine (CAM) is the use of treatments that are
not commonly practiced by the medical profession.

CAM includes visits to:

A. Faith Healing
This is the use of suggestions, power and faith in God to achieve healing.
According to Denton (1978), two basic beliefs are prevalent in religious healing.
They are:
1. The idea that healing occurs through psychological processes and is effective
only with psychophysiological disorders.
2. The other idea is that healing is
accomplished only through the
intervention of God. This, thus,
constitutes the present day miracle.
Denton (1978) also offers 5 general
categories of faith healing. They are:
1. Self-treatment through prayer.
2. Treatment by a lay person thought
to be able to communicate with
God.
3. Treatment by an official church leader for whom healing is only one of many
www.bbc.co.uk
tasks.
4. Healing obtained from a person or group of persons who practice healing
fulltime without affiliation with a major religious organisation.
5. Healing obtained from religious leaders who practice full time and are affiliated
with a major religious group.
A common theme running through each of these categories is an appeal to God to
change a person’s physical and mental conditions for the better (Denton, 1978).

B. Folk Healing
Folk medicine is often regarded as a residue of health measures leftover from pre-
scientific historical periods (Bakx, 1991). Yet, folk healing has persisted in modern
scientific society, and major reasons appear to be dissatisfaction with professional
medicine and a cultural gap between biomedical practitioners and particular
patients (Bear, 2001; Bakx, 1991; Madsen, 1973). These patients, typically low
income persons, may view folk medicine as a resource because it represents a body
of knowledge about how to treat illness that has grown out of historical
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experiences of the family and ethnic group (Thorogood, 1990). Common

ingredients in folk remedies are such substances as ginger tea, honey, whisky,
lemon juice, garlic, pepper, salt, etc.

www.americanmigrainefoundation.org

C. Acupuncture
Acupuncture is an ancient Chinese technique of inserting fine needles into specific
points in the body to ease pain and stimulate bodily functions.

D. Homeopathy
Homeopathy is the use of micro doses of natural substances to booster immunity.

E. Aromatherapy

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Aromatherapy is the use of aromatic oils for relaxation.

F. Naturopathy
Naturopathy is based on the idea that diseases arise from blockages in a person’s
life forced in the body and treatments like acupuncture and homeopathy are needed
to restore the energy flow.
G. Ayurveda
This is an Indian technique of
using oil and massage to treat
sleeplessness, hypertension and
indigestion.
H. Shiatsu
Japanese therapeutic massage.

I. Crystal Healing
This is based on the idea that healing energy can be obtained from quartz and other
minerals.
J. Biofeedback Therapy
This is the use of machines to train
people to control involuntary bodily
functions.

K. Use of Dietary Supplements www.today.ucf.edu

Use of supplements like garlic to prevent
blood clot, ginger, fish oil capsules to
reduce the threat of heart attack.
In-text Question: Write briefly on the following:
1. Acupuncture
2. Naturopathy

Answer:
1. Acupuncture is an ancient Chinese technique of inserting fine needles into
specific points in the body to ease pain and stimulate bodily functions.
2. Naturopathy is based on the idea that diseases arise from blockages in a
person’s life force in the body and treatments like acupuncture and homeopathy
are needed to restore the energy flow.

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3.0 Conclusion
As you can see, there are quite a number of options available for medical care/self-
care. The usage of one or more available options depends on one’s orientation,
experience and socialisation. The list of healing options provided in this session is
of course not exhaustive. In the next session, we shall look at the theoretical
concepts of primary health care.

4.0 Session Summary

In this session, we have looked at:
1. Several healing options available in modern health care; and
2. Complementary or alternative health care.
Now let us attempt the exercise below.

5.0 Self-Assessment Questions

1. Explain the roles of health practitioners available in the modern health care. Add
a note on Complementary and Alternative Medicine (CAM).

6.0 Additional Activities

a. Visit You-tube: https://www.youtube.com/watch?v=3yeefQi89kY and

https://www.youtube.com/watch?v=TqH5QAnIfOE Watch the videos and
summarise in a page.

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7.0 References/Further Readings

Ajala, J. A (2005). Health Education in Wellness and Sickness: This day, This Age;
an Inaugural Lecture Delivered at the University of Ibadan, on
th
Thursday, 24 November, 2005.
Bakx, K. (1991). The ‘Eclipse’ of Folk Medicine in Western Society. Sociology of
Health and Illness, 13: 20-38.
Bear, H. A. (2001). Biomedicine and Alternative Healing System in America:
Issues of Class, Race, Ethnicity and Gender. Madison, WI: Univ. of
Wisconsin.
Cockerham, W. C. (2003). Medical Sociology, 9th edition. NY: Prentice Hall.
Cole, R. M. (1970). Sociology of Medicine. New York: McGraw-Hill Book Co.
Denton, J. A. (1978). Medical Sociology. Boston: Houghton Mifflin.
Health Care in Britain, pp 140-152. In: P. Abbott and G. Payne (eds.). New
Directions in the Sociology of Health. London: Taylor and Francis.
The British Journal of Psychiatry (2001) 178: 490-49 © 2001 Royal College of
Psychiatrists.
United Nations (1995). Basic Facts. Geneva: United Nations.
World Health Organisation (1994a). Basic Documents. Geneva: WHO.
World Health Organisation (1980). International Classification of Impairments,
Disabilities, and Handicaps. Geneva: Author.
Wikipedia (2008). Health. Wikipedia Foundation Inc. Page last modified 27th
October 2008. Page accessed on 27th October 2008.
Wikipedia (2008). Primary Health Care. Wikipedia Foundation Inc. Page Last
Modified 16th September 2008. Page accessed 27th October 2008.
Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and
Illness, (5th ed.). Safari book online. Retrived from
http//www.safarix.com/0131928406/ch07iev1sec3. Accessed on 10th July,
2007.

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Study Modules
Primary Health Care: Theoretical Concepts
Contents:
Study Session 1: Basic Concepts of Primary Health Care
Study Session 2: Activities of Primary Health Care Stakeholders in Maintaining
Health Care
Study Session 3: Challenges of Primary Health Care Centres and other Role-
players in Primary Health Care Service Delivery

Study Session 1
Basic Concepts of Primary Health Care
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- Historical Development of Primary Health Care
2.2- Features of Primary Health Care
2.3- Principles of Primary Health Care
2.4- Strategies of Primary Health Care
2.5- Skills of Workers of Primary Health Care
2.6- Supportive Programmes of Primary Health Care
2.7- Misconceptions about Primary Health Care
2.8- Strategy for the Delivery of Primary Health Care Services
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
In Session 2, we dealt with the levels of health care. The session introduced us to
what primary health care is all about. In this session, we will look at the basic
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concepts of primary health care. We will also look at the supportive programmes
of primary health care as well as the misconceptions about primary health care. So
sit tight and enjoy your studies.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Explain how primary health care was developed;
2. Describe the features of primary health care;
3. Outline the principles of primary health care;
4. Explain the strategies of primary health care;
5. Describe the qualities of primary health care workers;
6. List and substantiate with examples the supportive programmes of primary
health care
7. Explain the misconceptions about primary health care; and
8. State the strategy for the Delivery of Primary Health Care Services.

2.0 Main Content

2.1 Historical Development of Primary Health Care
The definition of health, in the Charter of World Health Organisation as a complete
state of physical, mental, and social well-being had the ring of utopianism and
irrelevance to states struggling to provide even minimal care in adverse economic,
social and environmental conditions. The World Health Organisation was
concentrating on vertical programs, such as eradication of smallpox and malaria
during the 1960s.
Hence, the historical development can be presented as follows:
A. Early Approaches
In the 1950’s, there were vertical health service strategies that included mass
campaigns, specialised control programmes for communicable diseases such as
Tuberculosis, Malaria, Sexually transmitted diseases (STDs), etc.; but the strategy
was very expensive and so unsuccessful. The concept of basic health service came
into being in the mid-1960s. This gives more attention to rural areas through the
construction of health centres and health stations providing both curative and
preventive services.
Early 1970s witnessed the Integration of specialised disease control programs with
the availability of basic health services. However, even this approach was disease
oriented, based on high cost health institutions and requires advanced technology.

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B. Summary on the net effect of health services and programs during 1950-
1970s.
1. Despite health being a fundamental human right, the health status of hundreds of
millions people in the world was unacceptable.
2. In spite of the tremendous efforts in medicine and technology, the health status
of people in disadvantaged areas of most countries remained low.
3. The organised limited health institutions failed to meet the demands of those
most in need who are usually too poor or geographically or socially remote to
benefit from such facilities (Accessibility).
4. The health services often created were in isolations, neglecting other sector
(Agriculture, Education, Water Supply etc.), which are relevant to the
improvement and development of health.
5. Health institutions stressed curative services with insufficient priority to
preventive, promotive and rehabilitative care.
6. The community has already been given the opportunity to play an active role in
deciding the types of activities they want and have not participated in the actual
services they receive.
All the above facts summed up and led World Health Organisation and United
Nations International Children's Emergency Fund to evaluate and reexamine the
existing policies in 1978, Alma-Ata, and the concept of primary health care.

2.2 Features of Primary Health Care

A. Essentiality
Care is essential to permit socially and economically productive life. The minimum
package (contents) should include:
1. Maternal and child health care services (reproductive health care).
This includes premarital counseling and examination, prenatal, natal, postnatal and
child care
2. Adequate nutrition.
3. Environmental health.
4. School health.
5. Control of communicable diseases.
6. Curative care for common illnesses and injuries.
7. Health education.
8. Compilation of vital and health statistics.

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B. Accessibility
Care can be used when and where people needs arise. Distance, cost and
administrative arrangements should not act as barriers to the use of health care
services.

C. Acceptability
Care can accommodate provider and consumer characteristics, both from social
and economic point of view. A female doctor is certainly more acceptable to
provide prenatal care from the sociocultural point of view.

D. Participation of people
Care can involve people at the levels of planning, financing and evaluation.

E. Integration
Care can be integrated within other sectors of development.

F. Effective two-way referral system

Primary health care facilitates the transfer of patients to secondary or tertiary levels
of health care. A feedback of the measures done to the referred patient is an
essential component of the comprehensive continuing care.

G. Health education
This is the job of every member of the health care team.

In-text Question: Explain 2 features of primary health care.

Answer: 1. Acceptability: Care can accommodate provider and consumer

characteristics, both from social and economic point of view. A female doctor is
certainly more acceptable to provide prenatal care from the sociocultural point of
view.
2. Accessibility: Care can be used when and where people needs
arise. Distance, cost and administrative arrangements should not act as barriers
to the use of health care services.

2.3 Principles of Primary Health Care

The Declaration of Alma Ata outlined the following principles of primary health
care:

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A. Equitable Distribution
Health services must be shared equally by all people irrespective of their ability to
pay and all (rich or poor, urban or rural) must have access to health services.
Primary health care aims to address the current imbalance in health care by shifting
the centre of gravity from cities where a majority of the health budget is spent to
rural areas where a majority of people live in most countries.

B. Community Participation
There must be a continuing effort to secure meaningful involvement of the
community in the planning, implementation and maintenance of health services,
besides maximum reliance on local resources such as manpower, money and
materials.

C. Inter-sectoral Coordination
Primary health care involves in addition to the health sector, all related sectors and
aspects of national and community development, in particular agriculture, animal
husbandry, food, industry, education, housing, public works, communication and
other sectors.

D. Appropriate Technology
Medical technology should be provided that is accessible, affordable, feasible and
culturally acceptable to the community. Examples of appropriate technology
include refrigerators for cold vaccine storage. Less appropriate examples of
medical technology could include, in many settings, body scanners or heart-lung
machines, which benefit only a small minority concentrated in urban areas. They
are generally not accessible to the poor, but draw a large share of resources.

E. Preventive and Promotive Approach

Health services should not be only curative, but also should be promotive to the
population’s understanding of health and healthy style of life, and reach toward the
root causes of diseases with preventive emphasis. Treatment of illness and
rehabilitation are important as well.

F. Decentralisation
It is sharing and transferring power and decision away from the centre to the
periphery. It brings decision closer to the communities served and the field level
providers of services. It leads to greater efficiency in service provision.

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In-text Question: Explain any of the primary health care principles.

Answer: Inter-sectoral Coordination: Primary health care involves in addition to

the health sector, all related sectors and aspects of national and community
development, in particular agriculture, animal husbandry, food, industry,
education, housing, public works, communication and other sectors.

2.4 Strategies of Primary Health Care

A. Reducing excess mortality of poor marginalized populations
Primary health care must ensure access to health services for the most
disadvantaged populations, and focus on interventions which will directly impact
on the major causes of mortality, morbidity and disability for those populations.

B. Reducing the leading risk factors to human health

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

C. Developing sustainable health systems

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

D. Developing an enabling policy and institutional environment

Primary health care policy must be integrated with other policy domains, and play
its part in the pursuit of wider social, economic, environmental and development
policy.
In-text Question: Briefly explain one of the primary health care strategies.

Answer: 1. Developing sustainable health systems: Primary health care as a

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

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2.5 Skills of Workers of Primary Health Care

A doctor working in a primary health care setting is described as “the five star
doctor” who is expected to be:
A. Care provider, who considers a patient as an integral of a family and the
community and provides high quality care.

B. Decision-maker. The work of doctors is a series of decision making; starting

from the decision on kinds of questions asked in history, steps in physical
examination, laboratory tests to be done, label of diagnosis, type and duration of
treatment, when to stop or change treatment, indicators of prognosis, …etc. Correct
decision making to deal with issues of individuals or population groups requires
relevant data. These data may be obtained from routine records or from surveys.
The handling of such data effectively needs basic skills in epidemiology and
statistics. A doctor must be able to choose which technology to apply ethically and
cost effectively while enhancing the care he or she provides.

C. Communicator, who is able to promote healthy lifestyles by effective

explanation and advocacy and careful and effective listening to people.

D. Community leader. This needs the winning of the trust of people first, then a
doctor can reconcile individual and community health requirements and initiate
action on behalf of the community. A doctor should not dictate or shout but need to
sell ideas and share the decisions with others.

E. Team member, who can work in harmony with other individuals and
organisations to facilitate the work of his team and institution.
“A five star doctor” literally must be as good as a five star hotel. The difference
between the two is that a five star doctor must provide services to the poor and rich
while a five star hotel provides services to the rich only.

In-text Question: Do you like to be called a five star doctor? Why? How can you
make yourself a real five star doctor?

Answer: Yes because I can provide health services to the poor and rich. I can make
myself a real five star doctor by: Providing care, Making decision, Communicating,
Becoming a community leader and Becoming a team member.

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2.6 Supportive Programmes of Primary Health Care

A strong primary health care system supports citizens and communities to be
healthy, build partnerships and flourish and enables them to receive the right type
of care when and where it is needed most and over time, reducing demand for
hospital-based care. Primary health care system support Family Physicians in
providing patient care through a number of programmes which include:

A. Community Health Teams

Community Health Teams offer a wide range of free health and wellness
programmes that support
individuals and families to
build knowledge, confidence
and skills to make positive
lifestyle choices and better
prevent and manage risk
factors that are common across
chronic conditions.

The Community Health Teams

also offer wellness navigation,
working collaboratively with
family physicians, community www.caipe.org
groups, specialty programmes and other providers and groups to support
individuals and families to make
linkages with the appropriate
services, supports, or
programmes that are needed to
achieve optimal health.

B. Your Way to Wellness

Your Way to Wellness is a free
chronic disease self-
management programme that
helps people with chronic
conditions (and their caregivers)
overcome daily challenges, take

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action and live a healthy life. Groups meet weekly for two and half hours for six
weeks and are led by trained volunteers (most of whom have chronic conditions
themselves). Family and friends are welcome to attend as well.

C. Family Practice Nurse Programme

The Family Practice Nurse Programme supports family physicians to integrate a
registered nurse into their practice. Working in a family practice setting as part of a
www.stcatherines.chsli.org
collaborative team, a registered nurse improves patient access, enhances quality of
service from both a patient and a provider perspective, provides comprehensive
patient care and improves health outcomes.

D. Nurse Practitioners
Primary Health Care has worked to develop and implement new and enhanced
primary health care teams that include interdisciplinary providers, such as nurse
practitioners. A nurse practitioner is a registered nurse who has completed
advanced education and training to provide a broad range of primary care services.
Working collaboratively with family physicians, a nurse practitioner provides
primary care for common medical conditions, with a focus on wellness, prevention
and education.

Over time, as resources are reallocated to primary health care, it is envisioned that
there will be potentially new opportunities to support the role of nurse practitioners
in primary care, working with family physicians and others to reach people who do
not traditionally access health services and those with complex chronic conditions.

E. Building a Better Tomorrow Together (BBTT)

Collaborative interdisciplinary teams working to full scope of practice are better
for patients, families, communities and providers. The BBTT provincial initiative
is a series of continuing education modules for health care providers that
encourage the development, integration and support of interdisciplinary teams.

The modules are aimed at enhancing interprofessional collaboration and patient-

centered practice. Core modules reflect competencies for interprofessional
collaborative practice: Conflict resolution, decision making and leadership,
Enhancing collaboration, Interpersonal and communications skills, Roles and
responsibilities, Team functioning. Supplementary modules reflect priorities for
quality primary health care service delivery: Building community partnerships,
Chronic disease self-management support, Generations and learning styles at work,
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introduction to cultural competence in health care, Program planning and

evaluation, Understanding primary health care.

F. Integrated Chronic Care Service (ICCS)

The ICCS is a treatment facility for environmental sensitivities and complex
chronic conditions. The ICCS partners with family physicians, local Community
Health Teams and other health providers and caregivers in the community to
integrate care for individuals with various types of chronic conditions in a
multidisciplinary care approach.

2.7 Misconceptions about Primary Health Care

A. Relevance to poor developing countries
Primary health care is believed to be only relevant to poor developing countries
which cannot afford modern medical care.

B. Second best medicine

Primary health care is also believed to be the second medicine acceptable only to
the rural poor and urban slum dwellers.

C. Stopgap solution
Primary health care is a stopgap solution to be replaced by something better at a
later stage.

D. Separate stand-alone service

Primary health care is seen as a
separate stand-alone service
isolated from the main health care
system.
2.8 Strategy for the Delivery of
Primary Health Care Services
Ward Health System represents the
current national strategy for the
delivery of primary health care
services. This system utilises the
electoral ward from which a
representative councillor is elected
as the basic operational unit.

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The aims of Ward Health System include:

1. To promote full and active community participation at the grass root level.
2. To improve access to quality health care and ensure equity.
3. To promote local initiatives and encourage poverty alleviation activities in the
ward.
4. To reinforce political commitment at grass root level.
5. To reduce morbidity and mortality especially amongst women and children
under five years. www.slideshare.net

In-text Question: State the aims of Ward Health System as national strategy for delivery
of primary health care services.

Answer: The aims of Ward Health System are:

i. To promote full and active community participation at the grass root level.

ii. To improve access to quality health care and ensure equity.

iii. To promote local initiatives and encourage poverty alleviation activities in the ward.

iv. To reinforce political commitment at grass root level.

v. To reduce morbidity and mortality especially amongst women and children under five
years.

3.0 Conclusion
In this session, we have been able to look at various features, principles and
strategies of primary health care. As you can also see, there are quite a number of
qualities of workers of primary health care. Furthermore, the session likewise
looked at the supportive programmes of primary health care as well as mistaken
belief about primary health care. In addition, we also have dealt with strategies for
the delivery of primary health care services. I believe that you are now ready to
look at activities of primary health care stakeholders in maintaining health care.

4.0 Session Summary

In this session, we have learnt:
1. Historical development of primary health care;
2. Features of Primary Health Care;
3. Principles of Primary Health Care;
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4. Strategies of Primary Health Care;

5. Skills of Workers of Primary Health Care;
6. Supportive Programmes of Primary Health Care;
7. Misconceptions about Primary Health Care; and
8. Strategies for the Delivery of Primary Health Care Services.
Hope you enjoyed your studies. Now let us attempt the questions below.

5.0 Self-Assessment Questions

1. Explain the following in relation to primary health care:
a. Community participation
b. Appropriate technology
c. Preventive and promotive approach
2. Discuss the supportive programmes of primary health care.
6.0 Additional Activities

a. Visit YouTube: https://www.youtube.com/watch?v=38Q-_DGrYtc and

https://www.youtube.com/watch?v=EbHY1YHVd6w. Watch the videos
and summarise in 1 page.
b. Take a walk and engage any 5 people on how they perceive primary
health care and summarise their opinions in 2 paragraphs.

7.0 References/Further Readings

World Health Organization (1978). Declaration of Alma-Ata. Adopted at the
International Conference on Primary Health Care, Alma-Ata.
Starfield, B. (2011). "Politics, primary healthcare and health." J Epidemiol
Community Health, 65:653–655. doi:10.1136/jech.2009.102780.
Public Health Agency of Canada (2011). About Primary Health Care.
Marcos, C. (2004). "The ORIGINS of Primary Health Care and SELECTIVE
Primary Health Care". Am J Public Health. 22. 94: 1864–1874.
doi:10.2105/ajph.94.11.1864.
White, F. (2015). Primary health care and public health: foundations of universal
health systems. Med Princ Pract. doi:10.1159/000370197.

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Study Session 2
Activities of Primary Health Care Stakeholders in
Maintaining Health Care
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- The Role of Nurses and other Medical Staff in Primary Health Care
Delivery
2.2- The Role of Village Health Workers in Maintaining Primary Health
Care
2.3- Government’s Activities and Contributions towards Effective Primary
Health Care
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
I welcome you to study session 2. In the previous session, we dealt with basic
concepts of primary health care. This session will focus on the activities of primary
health care stakeholders in maintaining health care. The activities of Primary
Health Care are guided by the declaration of Alma-Ata of 1978 which asserted that
the programs should be an essential care, based on practical, scientifically sound
and socially acceptable methods and technology, made universally accessible to
individuals and families in the community through their full participation and at a
cost that the community and country can afford to maintain at every stage of their
development in the spirit of self-reliance and self-determination.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Describe the role of nurses and other medical staff in primary health care
delivery;
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2. Analyse the roles of village health workers in maintaining primary health care;
and
3. Explain government’s activities and contributions towards effective primary
health care.

2.0 Main Content

2.1 The Role of Nurses and other Medical Staff in Primary Health Care
Delivery
The nurses and other medical staff members are involved in the most important
role played by the Primary Health Care system, which is the delivery of the
Expanded Program on Immunisation (EPI). The duties of the nurses and other
medical staff members of the primary health care according to the requirement of
the WHO is to ensure that children are immunised against the initial six target
killer diseases (diphtheria, tetanus, whooping cough, polio, measles and
tuberculosis) during their first year of life, apart from measles. This has made a
great and good impact on the general wellbeing of the communities and on the
health of children as huge numbers of crippled, blind, mentally retarded, or
otherwise disabled children have decreased compared to the past years. The
involvement and intervention of political, religious and community leaders has
even made it easier for the health workers and nurses to do their job.
www.parent24.com

The immunisation contacts by the nurses and medical staff have also opened up
opportunities for other Primary Health
Care interventions, such as health
education for mothers, vitamin and
mineral supplements for children who
need them and routine health checks.
From all indications, EPI has helped
health systems and established a “culture
of prevention” among health workers,
politicians and community members,
which shows that the offering of this
service has an effect on the highest
structure down to the lowest.

The nurses also indicated that they have integrated mental health into primary care.
The primary care for mental health pertain all diagnosable mental disorders, as
well as mental health issues that affect physical and mental well- being. Effective
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primary health workers identified in dealing with mental disorders include medical
doctors, nurses and other clinicians who provide first line general primary health
care services to the community members who are in need of them. First line of
interventions are provided as an integral part of general health care and mental
health care that is provided by primary health workers who are skilled, able and
supported to provide mental health care services. This is the task of skilled
professional nurses to see all patients with mental disorders within the primary care
clinics. This integration has made it possible to identify and manage patients with
depression, anxiety, stress-related problems and severe mental disorders as well as
to offer basic counseling. The regular nurses are assisted as all designated clinics
receive regular visits from dedicated mental health or psychiatric nurses.
In-text Question: What is the basic role of health care providers in primary
health care delivery?

Answer: The basic role of health care providers in primary care delivery is to
immunise children against the initial six target killer diseases.

2.2 The Role of Village Health Workers in Maintaining Primary Health Care
The village health workers are those people who have been educated on how to
assist community members and to alleviate the health problems that are found at
community level so as to promote health for all. Many village health workers
pointed out that they have many roles to play in maintaining the health of the
community members, which
clearly shows that their
most important role in the
villages is to be concerned
with the health of the village
members. Through health
education and information
dissemination they function
to help prevent people from
being infected by certain www.concernusa.org
diseases as they treat and
control local endemic disease. They do this by giving medication and injections to
people who are infected and also conduct regular checkups on the patients
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whenever it is necessary. They also engage in the services of family planning by

distributing contraceptives. Besides, they attend to minor injuries and visit sick
people at their homes to give them essential drugs and all the necessary
requirements.

The community health workers usually write reports about the health status of their
patients and even refer patients whose health statuses seem to be beyond their
control. These reports help tremendously in times of referrals because the nurses or
doctors at the hospital are able to follow the illness history of the patients. It is
obviously easier to deal with patients who have records than those who never made
initiatives to consult the health centres about their illness. When a patient requires
laboratory or other diagnostic techniques which are not available at the health
centre level (for instance X-ray, sophisticated tests and other medical services),
patients are referred to the hospitals where they can obtain such services.

Also, when an individual’s illness requires skills beyond the level of competence
of the personnel at the first contact level, patients are referred for professional
advice and also when a patient cannot be cared for in an ambulatory setting and
hospitalisation is necessary patients are referred. The community health workers
have been taught how to detect when a person is in dire or critical condition and
needs professional care.

Out-patients and Chiefs stated that they also make sure that those who have to
attend the hospitals for check-ups do so. They pay them home visits in order to tell
them about the importance of check-ups so that they can ultimately live healthy
lives. The Chiefs pointed out that the village health workers provide health
education to the members of the community. They are able to do this easily
because they attend externally organised workshops which equip them with the
necessary skills to educate people and to treat them. The health education they
provide makes it possible to know how to reduce the community members’
susceptibility to locally endemic diseases, how to perceive infections and the steps
they should take if they are infected, as well as the options they have. They also
educate people about the ways of meeting their nutritional needs which is healthy
in sustainable ways.

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In-text Question: What are the tools used by village health workers to curtail
endemic diseases?

Answer: The tools are health education and information dissemination.

2.3 Government’s Activities and Contributions towards Effective Primary

Health Care
The ultimate responsibility of shaping the primary health care programmes lies
with the government of a Nation. Politically, the legitimacy of government and
their popular support depends on their ability to protect their citizens and play a
redistributive role. Some government agencies, therefore, act as brokers of the
primary health care reform. The government supports the programme in different
ways. In most cases, the government does not show their support directly to the
programme; instead most benefits are given to the hospital. It is from there that the
programme receives its share of the allocation. When the programme has received
the benefits and allocations, it shares them with the community health centres as to
fulfill its promise of being distributive and to make it possible for those health
centres to deliver the health services. It is in rare cases, people find that the
government helps the programme directly but those cases of indirect support still
make a big difference.

Another avenue of receiving funds is from the State Primary Health Care Sector.
However, it is apparent that the support that government shows is conditional
because they can only support the programme if it is protecting the citizenry and if
it is able to redistribute the benefits that it receives to the lowest level, being the
citizens. The hospital management makes efficient use of the monetary allocation
that it receives from the government. Most of the nurses and the director of the
programme believed that, “With this amount of money that the government gives,
they are able to enlighten the public in different ways about the prevailing diseases
by holding workshops, campaigning, placing posters at populated areas, by
advertising, holding road shows and dramatizing. Also, Oral Rehydration Therapy
(ORT) is also offered. This money even helps to hold workshops for village health
workers to train them on how to treat people.”

The government also formulates policies that promote Primary Health Care
programmes even though not directly. In addition, the government subsidizes for
the health services people get in the hospital regardless of whether it is a public
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hospital or religious organisation owned, as it was previously the case with the
hospital. The fact that the government gives many people job opportunities in the
health sectors, the health workers who are needed to attend to many people’s
health problems in a day increase. In other words, the implementation of the
programme has made jobs available to many citizens who are engaged in the
services of the programme. Furthermore, the government supplies health centres
with drugs, medical kits, equipment which they only give when the programme is
active. For the government to support this program, regular reports are sent, which
are usually replied as soon as possible because the health of people needs
immediate attention.

Moreover, the government supports Primary Health Care by pleading for donations
such as food, drugs and financial resources, especially from external bodies like
Non-Governmental Organisations (NGOs). The government does this on behalf of
the program because interested countries, their governments and organisations
want to help the country as a whole not a certain programme only.
3.0 Conclusion
In this session, you have dealt with the roles of the health care providers in primary
health care delivery. You also have looked at the roles of village health workers in
maintaining primary health care. Furthermore, you also learnt contributions of
government at all levels towards effective primary health care service delivery. In
the next session, we shall look at the challenges of primary health care centres and
other role-players in primary health care service delivery.

4.0 Session Summary

In this session, the following were discussed:
1. The roles of nurses and other medical staff in primary health care delivery;
2. The roles of village health workers in maintaining primary health care;
3. Government’s activities and contributions towards effective primary health
care.
We hope you enjoyed your studies. Now let us attempt the question below.

5.0Self-Assessment Questions
1. Discuss how government’s activities have contributed towards effective and
efficient primary health care service delivery in your Nation.

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6.0 Additional Activities

a. Visit YouTube: https://www.youtube.com/watch?v=69csBE4y1Uo

and https://www.youtube.com/watch?v=V6cfT2jbOts. Watch the videos
and summarise in 1 page.

7.0 References/Further Readings

Dennil, K. (1999). Aspects of Primary Health Care. Cape Town: Oxford
University Press.
Fendall, N. R. (1978). Declaration of Alma-Ata. The Lancet, 2 (8103):1308.
Matsela, M. (2008). Social Costs and Benefits of Community Home-based Health
Care Delivery System in Lesotho: The Case Study of Roma Valley, Lesotho.
B.A Social Work Project, Unpublished. Roma: National University of
Lesotho.
Mckenzie, J. (2002). An Introduction to Community Health. New York: Theo
Press.
Obioha, E. E., Ajala, A. S., Matobo, T. A. (2006). Report of Comparative Research
Network (CRN) CRN/03/2004. The Influence of Socio-political Environment on
Primary Health Care Delivery Patterns in Contemporary Sub-Sahara Africa:
Expanded Program on Immunisation in Lesotho. CODESRIA Comparative
Research Network 2004. Dakar: CODESRIA.
UNICEF, (1986). Primary Health Care Technologies at the Family and
Community Levels. New York. UNICEF
Webb, P. (1994). Health Promotion and Patient Education. London: Chapman and
Hall.
William, J. (1995). Education for Empowerment: Implications for Professional
Development and Training in Health Promotion. Health Education Journal,
54: 37–47.
World Health Organisation, (1978). Primary Health Care. Report of the
International Conference on Primary Health Care, Alma-Ata, USSR. 6-12
September 1978.
World Health Organisation, (2008). Primary Health Care: The World Health.
Switzerland: WHO.

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Study Session 3
Challenges of Primary Health Care Centres and other
Role-players in Primary Health Care Service Delivery
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- The Challenges Faced by Primary Health Care Centres
2.2- Problems Encountered by Village Health Workers
2.3- Problems Encountered by the Community Members
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
I welcome you to study session 3. In the preceding session, we discussed activities
of primary health care stakeholders in maintaining health care. This session will
focus on challenges of primary health care centres and other role-players in
primary health care service delivery. There are problems which all role-players
come across in trying to make the Primary Health Care an effective and efficient
system as it tries to be as inclusive and dynamic as possible. These problems
include challenges faced by Primary Health Care centres, the personnel involved
and the communities themselves. So sit tight and enjoy your studies.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Describe the challenges faced by primary health care centres;
2. Explain the problems encountered by village health workers; and
3. State the problems encountered by the community members.

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2.0 Main Content

2.1 The Challenges Faced by Primary Health Care Centres
A. Financial Problem
The expansion of the objectives of the health care system under the strategy of
primary health care with the establishment of extensive network of health centres
and other outreach services certainly requires much more money than that is
needed for the concentrated hospital care when no such network exists. Of the
implications of such a strategy are the needs for alternative and sustainable sources
of finance, the choice between charged or free at the time of use of services, and
the need for an effective referral system with all its requirements.

B. Administrative and Technical Problem

Primary health care centres require larger amount of supplies, equipment, drugs,
transportation means etc. In addition, their work must be closely supervised.
Guidelines must be available to all levels of health personnel. These guidelines
facilitate the execution of duties and evaluation of performance.

C. Political Problem
It is true to say that political will and political commitments are two crucial
aspects without them primary health care strategy is unlikely to achieve its
objectives. Such issues are particularly important in countries where financing of
health care services is heavily dependent on centrally controlled resources. It needs
not to be stressed that unless politicians realize the importance of healthy people
for socioeconomic development and for political support, they are unlikely to be
ready to allocate sufficient resources to the health care sector. This is equally true
in all countries regardless of their political system.

2.2 Problems Encountered by Village Health Workers

Many patients or their relatives do not have trust on the village health workers
and this makes it difficult for them to help those people who are ill. In most cases,
this lack of trust emanates from unsubstantiated belief that they will bewitch them.
There have been cases of village health workers who were expelled when trying to
pay home visits to patients because the health workers were alleged of witchcraft.
This alleged witchcraft by some community members against the village health
workers reflects the inner suspicion of the people on those who also care for them,
which has not substantially been proved in any scholarly research in African
societies. It should not be taken for granted because of the huge adverse
implications that it portends to the working relationship between community
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members and their care-givers and the overall health care system. Also, there have
been other series of misunderstandings between the patients and village health
workers.

Village health workers also face the problem of recipients who do not want to
comply or participate in treating their illnesses. Most patients do not want to take
their medications properly and they are easily annoyed when they are forced to do
so, even those patients of HIV/AIDS who are still ashamed of being seen to take
their daily medication. The village health workers also highlighted the internal
frustration and pain that they receive as a result of their services to the community
members. Most of the times, they get stressed and depressed by the problems they
come across when dealing with the patients who are not willing to cooperate.

Patients sometimes get moody and hostile, which causes stress and depression for
them because patients have their own myths which have root and needs to be taken
out of their minds. They also come across a problem of the obstruction by the
Chief in doing their work. In this case, there is a tendency for Chiefs to believe
that he has the authority to make decisions or control how things should work.
They sometimes ask for drugs even when they are not feeling ill and many of the
Chiefs also force the health workers to treat even those people who can afford the
health services elsewhere. Some community members expect the health care
workers to favour them in the course of discharging their duties. They believe that
just because a particular village health worker is related to them, he or she should
give them more attention than other patients at the health centre or in the outreach
centre, even when not necessary.

Lack of facilities or essential equipment is another problem encountered by the

village health workers. First of all, they have bad health centre infrastructure,
unhealthy toilets and there are no refrigerators for the storage of strong vaccines.
Village health workers indicated that this problem of no refrigerator results to
problems such as having to throw away some of the drugs, even as it is very hard
to be supplied by the government sources. There are also instances when there are
conflicts as the village health workers misunderstand one another, which lead to
the process of confusion and poor service delivery. Some of the village health
workers expressed their anger against the system. They complained that the way
the programme sometimes runs causes conflicts among the care-givers. At times,
they are promised very meager wages which take months or years for them to get.

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In-text Question: State 2 problems encountered by the village health workers.

Answer: 1. Lack of trust on the village health workers.
2. Lack of facilities or essential equipment.

2.3 Problems Encountered by the Community Members

The community members also have problems and experiences that affect their
health condition always, which are imposed by their problems in life and those that
they get from the health centres. Some patients explained, “At times when they
need medication which they have been told they would get in the outreach sites in
the communities, they are told that they are finished yet they are in pain. This
makes them to lose hope in the promise that Primary Health Care used to hold for
them because these problems seem to be increasing rather than decreasing.” In
relation to the above, there are some problems that are created by the health
workers, though most often indirectly. The community members perceive it as a
problem when the village health workers do not feel any need for them to value
confidentiality when it comes to diseases that are affecting the people. They always
accuse the health workers as being impolite and lack respect in their approach.

In-text Question: State the major problem often encountered by the community
members.
Answer: The basic problem usually encountered by the community members is the
exposure of their health status to the public by the village health workers.

3.0 Conclusion
In this session, you have dealt with the challenges faced by primary health care
centres. You also have looked at the problems encountered by both village health
workers and community members. I believe that you are now ready to study the
principles of health management.

4.0 Session Summary

In this session, the following were discussed:
1. The challenges faced by primary health care centres;
2. Problems encountered by village health workers;
3. Problems encountered by the community members; and
We hope you enjoyed your studies. Now let us attempt the questions below.

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5.0Self-Assessment Question
1. Discuss the challenges faced by primary health care centres in your Nation. Add
a note on how to overcome these challenges.

6.0 Additional Activities

a. Visit YouTube: https://www.youtube.com/watch?v=dQD3b43dMsE.

Watch the videos and summarise in 1 page.
b. Visit all the primary health care centres in your community and write a
comprehensive report on the challenges they are encountering.

7.0 References/Further Readings

Marcos, C. (2004). "The ORIGINS of Primary Health Care and SELECTIVE
Primary Health Care". Am J Public Health. 22. 94: 1864–1874.
doi:10.2105/ajph.94.11.1864.
Matsela, M. (2008). Social Costs and Benefits of Community Home-based Health Care
Delivery System in Lesotho: The Case Study of Roma Valley, Lesotho. B.A Social
Work Project, Unpublished. Roma: National University of Lesotho.
Nyaphisi, B. M. (2008). Problems and Prospects of Community Home-Based Health
Care Delivery System: The Case Study of Roma Valley, Lesotho. B.A Social Work
Project, Unpublished. Roma: National University of Lesotho.
Obioha, E. E., Ajala, A. S., Matobo, T. A. (2006). Report of Comparative Research
Network (CRN) CRN/03/2004. The Influence of Socio-political Environment
on Primary Health Care Delivery Patterns in Contemporary Sub-Sahara Africa:
Expanded Program on Immunisation in Lesotho. CODESRIA Comparative
Research Network 2004. Dakar: CODESRIA.
Starfield, B. (2011). "Politics, primary healthcare and health." J Epidemiol Community
Health, 65:653–655. doi:10.1136/jech.2009.102780.
World Health Organisation, (1978). Primary Health Care. Report of the International
Conference on Primary Health Care, Alma-Ata, USSR. 6-12 September 1978.

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Study Modules
Principles of Health Management
Contents:
Study Session 1: Understanding Health Management
Study Session 2: Human Resources Management
Study Session 3: Physical Resources Management
Study Session 4: Financial Management
Study Session 5: Health System Management: Community Involvement

Study Session 1
Understanding Health Management
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- What is Management?
2.2- Management: Theoretical Scope
2.3- Overview of Contemporary Theories in Management
2.4- Central Principles of Management
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
In the previous modules, we discussed health and Primary health care. Here, we
are going to introduce theoretical scope of management as well as an overview of
contemporary theories in management. Enjoy your studies.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
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1. Describe management;
2. Identify and explain the theoretical scope of management;
3. Outline some contemporary theories in management;
4. Explain the central principles of management.

2.0 Main Content

2.1 What is Management?
Management is defined as organisation and coordination of the activities of an
enterprise in accordance with certain policies and in achievement of clearly
defined objectives. Management is
often included as a factor of
production along with machines,
materials, and money. According to
the management guru Peter Drucker
(1909–2005), the basic task of a
manager is two-fold: marketing and
innovation. Practice of modern
manager owes its origin to the 16th
century enquiry into low-efficiency
and failures of certain enterprises,
conducted by the English statesman Sir Thomas More (1478–1535), (Wikipedia,
2009).

Management is also perceived as directors and managers who have the power and
responsibility to make decisions to manage an enterprise. As a discipline,
management comprises the interlocking functions of formulating corporate policy
and organising, planning, controlling, and directing the firm’s resources to achieve
the policy's objectives. The size of management can range from one person in a
small firm to hundreds or thousands of managers in multinational companies. In
large firms, the board of directors formulates the policy which is implemented by
the chief executive officer (Wikipedia, 2009).

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In-text Question: What is management?

Answer: Management is defined as organisation and coordination of the

activities of an enterprise in accordance with certain policies and in
achievement of clearly defined objectives.

2.2 Management: Theoretical Scope

Mary Parker Follett (1868–1933), who wrote on the topic in the early 20th century,
defined management as "the art of getting things done through people". She also
described management as philosophy (Barrel, 2003). One can also think of
management functionally, as the action of measuring quantity on a regular basis
and of adjusting some initial plan; or as the actions taken to reach one's intended
goal. This applies even in situations where planning does not take place. From this
perspective, Frenchman Henri Fayol (Dunord, 1966), considers management to
consist of six functions:

1. Planning
2. Organising
3. Leading/Directing
4. Coordinating
5. Controlling
6. Staffing

1. Planning
Planning in organisations and public policy is
both the organisational process of creating
and maintaining a plan; and the www.hoessayfwux.andradexcobain.com
psychological process of thinking about the activities required to create a desired
goal on some scale. As such, it is a fundamental property of intelligent behaviours.
This thought process is essential to the creation and refinement of a plan, or
integration of it with other plans, that is, it combines forecasting of developments
with the preparation of scenarios of how to react to them.

The term is also used to describe the formal procedures used in such an endeavour,
such as the creation of documents, diagrams, or meetings to discuss the important
issues to be addressed, the objectives to be met, and the strategy to be followed.
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Beyond this, planning has a different meaning depending on the political or

economic context in which it is used.

2. Organising
Organising is the act of rearranging elements following one or more rules.
Anything is commonly considered organised when it looks like everything has a
correct order of placement. But it is only ultimately organised if any element has
no difference on time taken to find it. In that sense, organising can also be defined
as - to place different objects in logical arrangement for better searching.

3. Leading/Directing
The word leadership can refer to:
- Those entities that perform one or more acts of leading;
- The ability to affect human behaviour so as to accomplish a mission;
- Influencing a group of people to move towards its goal setting or goal
achievement (Stogdill, 1950).

Leadership has a formal aspect (as in most political or business leadership) or an

informal one (as in most friendships). Speaking of "leadership" (the abstract term)
rather than of "leading" (the action) usually it implies that the entities doing the
leading have some "leadership skills" or competencies.

4. Coordinating
Coordination is the act of coordinating, making different people or things work
together for a goal or effect.

5. Controlling
Control is one of the managerial functions like planning, organising, staffing and
directing. It is an important function because it helps to check the errors and to
take the corrective action so that deviation from standards are minimised and stated
goals of the organisation are achieved in a desired manner.

According to modern concepts, control is a foreseeing action whereas earlier

concept of control was used only when errors were detected. Control in
management means setting standards, measuring actual performance and taking
corrective action. Thus, control comprises these three main activities (Johnson,
1976).

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6. Staffing
Human resources are terms with which many organisations describe the
combination of traditionally administrative personnel functions with performance,
Employee relations and resource planning.

In-text Question: State the roles of control in management.

Answer: Setting standards, Measuring actual performance and Taking
corrective action.

2.3 Overview of Contemporary Theories in Management

Contemporary theories of management, (McNamara, 2005), tend to account for
and help interpret the rapidly changing nature of today’s organisational
environments. As before in management history, these theories are prevalent in
other sciences as well.

A. Contingency Theory
Basically, contingency theory asserts that when managers make a decision, they
must take into account all aspects of the current situation and act on those aspects
that are key to the situation at hand. Basically, it is the approach that “it depends.”
For example, the continuing effort to identify the best leadership or management
style might now conclude that the best style depends on the situation. If one is
leading troops in the Persian Gulf, an autocratic style is probably best (of course,
many might argue here, too). If one is leading a hospital or university, a more
participative and facilitative leadership style is probably best.

B. Systems Theory
Systems theory has had a significant effect on management science and
understanding organisations. First, let us look at “what is a system?” A system is a
collection of parts unified to accomplish an overall goal. If one part of the system
is removed, the nature of the system is changed as well. For example, a pile of sand
is not a system. If one removes a sand particle, you have still got a pile of sand.
However, a functioning car is a system. Remove the carburetor and you have no
longer got a working car. A system can be looked at as having inputs, processes,
outputs and outcomes. Systems share feedback among each of these four aspects of
the systems.

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Let us look at an organisation. Inputs would include resources such as raw

materials, money, technologies and people. These inputs go through a process
where they are planned, organised, motivated and controlled, ultimately to meet
the organisation’s goals. Outputs would be products or services to a market.
Outcomes would be, e.g., enhanced quality of life or productivity for
customers/clients, productivity. Feedback would be information from human
resources carrying out the process, customers/clients using the products, etc.
Feedback also comes from the larger environment of the organisation, e.g.,
influences from government, society, economics, and technologies. This overall
system framework applies to any system, including subsystems (departments,
programmes, etc.) in the overall organisation.

Systems theory may seem quite basic. Yet, decades of management training and
practices in the workplace have not followed this theory. Only recently, with
tremendous changes facing organisations and how they operate, have educators
and managers come to face this new way of looking at things. This interpretation
has brought about a significant change (or paradigm shift) in the way management
studies and approaches organisations.

The effect of systems theory on management is that writers, educators, consultants,

etc. are helping managers to look at the organisation from a broader perspective.
Systems theory has brought a new perspective for managers to interpret patterns
and events in the workplace. They recognise the various parts of the organisation,
and, in particular, the interrelations of the parts, e.g., the coordination of central
administration with its programmes, engineering with manufacturing, supervisors
with workers, etc. This is a major development. In the past, managers typically
took one part and focused on that. Then they moved all attention to another part.
The problem was that an organisation could, e.g., have a wonderful central
administration and wonderful set of teachers, but the departments did not
synchronise at all (McNamara, 2005).

C. Chaos Theory
As chaotic and random as world events seem today, they seem as chaotic in
organisations too. Yet for decades, managers have acted on the basis that
organisational events can always be controlled. A new theory (or some say
“science”), chaos theory, recognises that events indeed are rarely controlled. Many
chaos theorists (as do systems theorists) refer to biological systems when
explaining their theory. They suggest that systems naturally go to more
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complexity, and as they do so, these systems become more volatile (or susceptible
to cataclysmic events) and must expend more energy to maintain that complexity.

As they expend more energy, they seek more structure to maintain stability. This
trend continues until the system splits, combines with another complex system or
falls apart entirely. This trend is what many see as the trend in life, in organisations
and the world in general (McNamara, 2005).
In-text Question: What is the role of system theory of management?

Answer: The role of system theory of management is that it helps managers to

interpret patterns and events in the workplace.

2.4 Central Principles of Management

Two basic principles of management practice provide the foundation for carrying
out the functions described.

The first principle is: management by objectives. This requires that the
organisation defines its aims clearly and explicitly. Recent management thinking
further emphasises the importance of a democratic process in which those who are
to be responsible for achieving the objectives are involved in setting them in the
first place (Drucker, 1974). It is thought that as a consequence the objectives will
be realistic and widely understood. In addition, members of the organisation who
gain a sense of ownership and function as a team are expected to be more highly
motivated and productive (Merson et al, 2001).

The second principle, management by exception, recognises that management

effort is too valuable to be squandered on oversight of routine activities; attention
should be focused instead on areas of exceptional concern, such as an individual
worker or health unit that has an especially high absentee rate. Obviously,
application of the management by exception principle requires advance
specification of objectives and standards if meaningful departures from expected
levels of conduct are to be identified. This in turn requires a reliable information
system to signal the emergence of problems (Merson et al, 2001).

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3.0 Conclusion
In this session, you have learnt different facets of management. By definition,
management was viewed as the organisation and coordination of the activities of
an enterprise in accordance with certain policies and in achievement of clearly
defined objectives. Theoretical scope of management identified include: planning,
organising, leading, coordinating, controlling and staffing. This indicates that
management, no matter how it is perceived, is inclusive of all aforementioned
variables. Some contemporary theories of management such as chaos theory,
systems theory and contingency theory, as well as basic principles of management,
management by objectives and management by exception, all served to broaden
our understanding of this concept. I believe that you are now set to study human
resources management.

4.0 Session Summary

In this session, the following were discussed:
1. Management
2. Theoretical scope of management
3. Contemporary theories of management
4. Central principles of management.
Hope you enjoyed your studies. Now let us attempt the questions below.

5.0 Self-Assessment Questions

1. Explain the functions of management.
2. Discuss the contemporary theories in management.

6.0 Additional Activities

a. Visit YouTube: https://www.youtube.com/watch?v=Cl4GhjSALsI and
https://www.youtube.com/watch?v=6e4s_AmOl_k. Watch the videos and
summarise in 1 page.

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7.0 References/Further Readings

Abel-Smith, B. (1994). An Introduction to Health: Policy, Planning and Financing.
London: Addison Wesley Longman Ltd.
Arvid, R. J. (1976). Management, Systems, and Society: An Introduction. Pacific
Palisades, Calif.: Goodyear Pub. Co.
Barrett, R. (2003). Vocational Business: Training, Developing and Motivating
People. Business and Economics. - Page 51.
Campbell, C. (2007). Essentials of Health Management Planning and Policy. Lagos:
University of Lagos press.
Donaldson, C. and Gerard, K. (1993). Economics of Health Care Financing: The
Visible Hand. London: McMillan.
Druker, P. F. (1974). Management: Tasks, Responsibilities and Practices. NY:
Harper and Row.
Dunod, (1966). Administration Industrielle et générale – prévoyance organisation
commandement, coordination – contrôle, Paris
Encyclopedia of Public Health; Social Health. Answers.com Retrieved from
http://www.answers.com/topic/social-health. Site Accessed on 20th July 2009.
Gomez-Mejia, Luis R.; David B. Balkin and Robert L. Cardy (2008).Management:
People, Performance, Change, (3rd ed.). New York USA: McGraw-Hill.
Korten, D. C. (1979). Toward a Technology for Managing Social Development. In:
D. C. Korten (ed.). Population and Social development Management.
Caracas: Population and Social Development Centre.
McNamara, C. (2005). Contemporary Theories in Management. Free Management
Library.
Merson, M. H.; Black, R. E and Mill, A. J. (2001). International Public Health:
Disease, Programmes, Systems and Policies. Maryland: Aspen Publishers.
Mills, A. J. and Ranson, M. K. (2001). The Design of the Health System. In: M. H.
Merson, R. E. Black & A. J. Mills (eds.). International public health,
Disease, Programmes, Systems and Policies. Maryland: Aspen Publishers.
Mitchell, J. and Haroun, L. (2001). Introduction to Health Care. Canada: Delmar
Oxford English Dictionary.
Reinke, W. A. (2001). Health Systems Management. In M. H. Merson, R. E. Black,
and A. J. Mill, (eds.). International Public Health: Disease, Programmes
Systems and Policies. Maryland: Aspen Pub.
Stogdill, R.M. (1950). 'Leadership, Membership and Organisation', Psychological
Bulletin, 47: 1 14.
Wikipedia (2009). Management. Site visited on 22nd July, 2009. Page was Last
Modified on 19 July 2009 at 15:00.

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Study Session 2
Human Resources Management
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- What is Human Resources Management?
2.2- Functions of Human Resources Management
2.3- Managing Human Resources in the Health System
2.4- Shifting Emphases in Personnel Management
2.5- Framework for Functional Analysis
2.6- Human Resources Performance Monitoring and Evaluation
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
In the previous session, we dealt with theoretical scope of management,
contemporary theories of management as well as central principles of management.
This session focuses on human resources management in the health system, its
functions, functional analysis, performance and evaluation. Enjoy your studies.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Describe the concept of ‘human resources management’;
2. State the functions of human resources management;
3. Explain how human resources can be managed in the health system;
4. Illustrate shifting emphases in personnel management;
5. Illustrate framework for functional analysis; and
6. Identify the need for performance evaluation in human resources.

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2.0 Main Content

2.1 Human Resources Management: Definition of Term
Human Resources Management (HRM) is the strategic and coherent approach
to the management of an organisation’s most valued assets -the people
working there who individually and collectively contribute to the achievement
of the objectives of the business (Michael, 2006).

Human Resource Management

(HRM) is also the function within
an organisation that focuses on
recruitment of, management of,
and providing direction for the
people who work in the
organisation. Human Resource
Management is further defined as
the organisational function that
deals with issues related to people
such as compensation, hiring,
performance management,
organisation development, safety, wellness, benefits, employee motivation,
communication, administration, and training (Heathfield, 2000).

The terms “human resource management” and “human resources” (HR) have
largely replaced the term “personnel management” as a description of the
processes involved in managing people in organisations (Michael, 2006). In simple
sense, and as applied to health system management, HRM means www.medium.com
employing health
professionals, developing their resources, utilising, maintaining and compensating
their services in tune with the job and organisational requirement.
In-text Question: What is human resources management?

Answer: Human Resources Management (HRM) is the strategic and coherent

approach to the management of an organisation’s staff who individually and
collectively contribute to the achievement of the objectives of the business.

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2.2 Functions of Human Resources Management

The Human Resources Management (HRM) functions include a variety of
activities, and key among them are:
1. Deciding what staffing needs are and whether to use independent contractors or
hire employees to fill these needs;
2. Recruiting and training the best employees (health professionals);
3. Ensuring that employees are high performers;
4. Dealing with performance issues;
5. Ensuring that personnel and management practices conform to various
regulations;
6. Managing the approach to employee’s benefits
and compensation;
7. Managing employee’s records and personnel
policies.
Usually small businesses (for-profit or nonprofit)
have to carry out these activities themselves
because they cannot yet afford part- or fulltime
help. However, they should always ensure that
employees have -- and are aware of -- personnel
policies which conform to current regulations.
These policies are often in the form of
employee’s manuals, which all employees must have (McNamara, 2009).
In-text Question: List 5 functions of human resources management.

Answer: 1. Recruiting and training the best employees.

2. Ensuring that employees are high performers.
3. Dealing with performance issues.
4. Ensuring that personnel and management practices conform to
various regulations.
5. Managing the approach to employee’s benefits and compensation.

2.3 Managing Human Resources in the Health System

The most important resources in the labour intensive health sector are its
personnel; they account for up to two-thirds of total expenditures, and even then
remuneration is often inadequate because of budget limitations. But to function
effectively, personnel and organisational units must have access to drugs and
supplies, medical equipment, transport, and other physical resources (WHO, 1990).
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These in turn require adequate funding. Problems occur when countries are forced
to curtail public health budgets during periods of economic decline. When budgets
were severely reduced in Nigeria, for example, it was not feasible politically to
reduce staffing levels correspondingly (World Bank, 1991). Instead, non-personnel
expenditures on such things as drugs and maintenance were drastically curtailed,
becoming less than 20% of the limited budget. Patients, who soon realised that
they would not find necessary drugs and laboratory services at the health centres,
stopped using those facilities, which in turn became increasingly inefficient as a
result of enforced staff idleness. Because of the separate and combined importance
of human, physical, and financial resources, the management of each is taken up in
turn, in subsequent units.

In-text Question: State how human resources can be managed in the health system.

Answer: Human resources are the most important resources in the labour intensive
health sector. It can be managed by providing drugs, medical equipment, transport and
other physical resources for the personnel and organisational units.

2.4 Shifting Emphases in Personnel Management

In the early years following World War II, principal attention was focused on
training increased numbers of doctors, nurses, pharmacists, and other health
personnel. This emphasis was especially evident in countries that had recently
achieved independence and were bent upon making health care widely available as
an essential human right (Fulop and Roerner, 1982). By the 1970s it was becoming
apparent that a mere increase in the number of personnel was not sufficient to
guarantee health improvement. It was also essential that personnel be used
effectively, especially in view of the increasing cost of supporting fully staffed
facilities.

Thus, attention shifted to the content of training and its relevance to subsequent
practice in addressing community health needs. Two divergent studies of national
health manpower needs in the 1960s reflect the needed change in emphases. One
study found that Turkey had twice as many doctors as nurses and two-third of the
physicians were practicing in three urban centres (Taylor et al., 1968). By contrast,
another study found that Nigeria had approximately 10 times as many nurses and
midwives as doctors, especially in rural areas.
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It seems unlikely that conditions in the two countries were so different that the
manpower situation in each was optimal. Undoubtedly, urban doctors in Turkey
were performing “nursing” tasks, and Nigerian nurse/midwives were acting as
doctors, even though they were not trained to fill this role. Although Turkey
evidently needed more nurses and Nigeria needed more doctors, the desired
content of the training was unclear in view of existing role differences and ill-
defined unmet needs (Merson, et al, 2001).

Methods of functional analysis (elaborated below) for assessing job content will be
very informative here, (The Functional Analysis of Health Needs and Services,
1976).

In-text Question: Give reason why emphases in personnel management were shifted
to training.

Answer: The basic reason for the shift is to improve health care services.

2.5 Framework for Functional Analysis

The conceptual framework for functional analysis is depicted in Figure 1. On the
one hand, we have a target population with its defined demographic characteristic,
health needs, and demands for care. On the other hand, human, physical, and
financial resources are available or can be mobilised to meet population needs. The
needs are usually defined demographically and epidemiologically in terms of birth
rates, disease incidence rates, and similar indicators, whereas resource levels are
described in economic terms, such as health expenditures per capita, or in
administrative units, such as doctor-population or bed-population ratios. One is left
with the question. What is the relation between 20 doctors, 50 midwives, 200
Community Health Workers, 10,000 cases of diarrhea and 1,500 pregnancies per
year? The first task of functional analysis is the development of mutually
compatible measures that link needs and resources.

Service units and associated standards of service and productivity form this link.
Using the example above, if qualified midwives are expected to be present at 80%
of all deliveries, this service standard calls for 1,200 units of service in the form of
deliveries by qualified personnel. If 1 midwife working full time assisting
deliveries (or, more realistically, 10 midwives each devoting 10% of the time to the

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task) can handle 200 deliveries per year, this productivity standard translates into a
need for 6 Full-Time Equivalent (FTE) midwives to assist in deliveries.

The mobilisation of resources to provide needed service capacity requires

development of personnel competencies and the provision of support for the
appropriate use of those competencies. Services programmes designed to improve
health status and thereby reduce the level of need can fail because:
1. Persons with health needs do not seek care;
2. Resources to meet service needs are inadequate;
3. Available resources are not organised most efficiently and effectively to address
those needs; or
4. Workers are not motivated or otherwise prepared to use available resources
properly.
Below is a presentation of the link between health needs and resources.

Health Status

 Mortality
 Morbidity
 Disability

Health Needs Service Functions and Health Resources

Programme
 population  Human
 problems  Physical
 Demand  Financial

Service Capacity

 Provider
Competence

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Figure 3.2.1: Link between Health Needs and Resources (Merson, et al., 2001)
From the presentation above, mortality, morbidity and disability rates of a given
country influences its health needs, which in turn influences the health service
functions and programmes. Sustainable and effective health system is also a
product of competent human resources and service capacity.

In-text Question: List 3 factors that can contribute to failure of services

programmes designed to improve health status.
Answer: 1. inadequate resources to meet service needs.
2. Lack of organisation of available resources to address those
needs.
3. Lack of motivation of workers to use available resources
properly.

2.6 Human Resources Performance Monitoring and Evaluation

A number of evaluative comments have appeared throughout the discussion of
personnel management. Rather than treating evaluation as a separate endeavour, it
is important to perform ongoing monitoring in the interest of process improvement.
Thus, evaluation is a forward looking endeavour, not a periodic backward
reflection to cast blame for past failures. Consonant with this view are the two
important concepts associated with evaluation of performance: selective
supervision and continuing education.

A. Selective Supervision
Selective supervision is based upon the principle of management by exception.
Because individuals and work units inevitably experience differing degrees of
difficulty in performing their tasks, supervisory attention should be focused on
those units in greatest need of support.

This is contrary to the conventional wisdom that declares all field units should be
visited at the same regular intervals.

B. Continuing Education
Continuing education often received little systematic attention despite changing
circumstances in which health workers are continually called upon to perform
unanticipated tasks for which they have received little or no training. When
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training courses or workshops are conducted, the subject is often based upon the
specialised interests of a particular health officer or the availability of funds for a
specified training purpose. It was also observed that the most important resource in
the health system is its personnel, thus to function effectively, personnel and
organisational units must have access to drugs and supplies, medical equipment,
transport, and other physical resources (WHO, 1990).

In-text Question: State the concepts associated with evaluation of performance

and explain any one.
Answer: Selective supervision and Continuing education

3.0 Conclusion
In this session, Human Resources Management (HRM) in the health system was
viewed as the strategic and coherent approach to the management of an
organisation’s most valued assets - the people (health professionals), working there
who individually and collectively contribute to the achievement of the objectives
of the business (Michael, 2006). Several functions were identified among which
are: deciding what staffing needs are and whether to use independent contractors or
hire employees to fill these needs and recruiting and training the best employees.
In the next session, we shall look at management of physical resources.
4.0 Session Summary
In this session, the following were discussed:
1. Human resources;
2. Functions of human resources management;
3. Shifting emphases in personnel management;
4. Framework for functional analysis;
5. Human resources performance monitoring and evaluation.
Hope you enjoyed your studies. Now let us attempt the questions below.
5.0 Self-Assessment Questions
1. Is HIV/AIDS effectively managed in your country or community? Discuss in
line with the following:
a. Health status
b. Health needs
c. Service functions
d. Health resources
e. Service capacity
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2. Explain the concepts associated with evaluation of performance.

6.0 Additional Activities

a. Visit YouTube: https://www.youtube.com/watch?v=Gz0470G03qU and

https://www.youtube.com/watch?v=1k3Vg4dZs3w. Watch the videos and
summarise in 1 page.
b. Visit 3 health care centres in your community and engage 5 of their
staffs on how they are being managed.

7.0 References/Further Readings

Abel-Smith, B. (1994). An Introduction to Health: Policy, Planning and
Financing. London: Addison Wesley Longman Ltd.
Arvid, R. J. (1976). Management, Systems, and Society: An Introduction. Pacific
Palisades, Calif.: Goodyear Pub. Co.
Campbell, C. (2007). Essentials of Health Management Planning and Policy.
Lagos: University of Lagos press.
Cassel, A. and Janovsky, K. (1996). Strengthening Health Management in District
and Provinces. Handbook for Facilitators. Geneva: Switzerland: WHO.
Druker, B. F. (1974). Management: Tasks, Responsibilities, Practices. NY: Harper
and Row.
Donaldson, C. and Gerard, K. (1993). Economics of Health Care Financing: The
Visible Hand. London: McMillan.
Encyclopedia of Public Health; Social Health. Answers.com Retrieved from
http://www.answers.com/topic/social-health. Site Accessed on 20th July
2009.
Fulop, T. and Roemer, M. I. (1982). International Development of Health
Manpower Management. Geneva: WHO.
Gomez-Mejia, Luis R.; David B. Balkin and Robert L. Cardy (2008).
Management: People, Performance, Change, (3rd ed.). New York, New
York USA: McGraw-Hill.
Heathfield, S. M. (2000). What is Human Resource Management? About.com.
Janovsky, K. (1988). The Challenge of Implementation: District Health Services
for Primary Health Care. Geneva: WHO.

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McNamara, C. (2009). Human Resources Management. Retrieved from

http://managementhelp.org/hr_mgmnt/hr_mgmnt.htm. Site visited on
24th July 2009.
Merson, M. H., Black, R. E and Mill, A. J. (2001). International Public Health:
Disease, Programmes, Systems and Policies. Maryland: Aspen
Publishers.
Michael, A. (2006). A Handbook of Human Resources Management Practice (10th
ed.). London: Kogan.
Mitchell, J. and Haroun, L. (2001). Introduction to Health Care. Canada: Delmar.

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Study Session 3
Physical Resources Management
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- Transport and Equipment Use and Maintenance
2.2- The Logistics Cycle
2.3- Stock Replenishment and Decision Rules
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
In the previous session, we discussed management of human resources. Here, we
are going to deal with management of physical resources. The provision of quality
health care is increasingly demanding on the physical infrastructure. The way in
which physical resources such as buildings, equipment and supply systems are
managed largely affects the lifetime of investments and the performance of the
health system as a whole. Appropriate buildings and equipment are a major
motivation factor for health workers. Yet, in many countries the physical assets are
in a poor functional condition or not appropriate for the interventions to be
delivered. Engineering support services have frequently been neglected which
explains in part the poor performance of health services. Well performing systems
require an array of technical support services, that is, strategic technology
planning, procurement and logistics as well as efficient clinical equipment
maintenance. This session thus elaborates more on the role of physical resource
management in health system management.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Illustrate the techniques of transport management and maintenance;
2. Explain the logistics cycle;
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3. Discuss the rudiments of stock replenishment and decision rules.

2.0 Main Content

2.1 Transport Equipment Use and Maintenance
Much has been said about methods for developing work force capabilities and for
motivating individuals to use their capabilities fully. All is for naught, however, if
staff do not have the drugs and supplies, functioning equipment, and transport
needed to perform their jobs satisfactorily. Because the cost of drugs and supplies
is usually second only to personnel costs, it deserves particular management
attention and discussion, but first some observations are offered on the subjects of
transport and equipment use and maintenance.

The classic example of overcentralised management is in the control of transport.

Procedures that require headquarters approval to purchase fuel and spare parts
increase administrative costs and result in excessive and costly downtime for
ambulances and other vehicles. On the other hand, authorised private use of
vehicles under local control is, unfortunately, commonplace. What is needed, of
course, is a set of locally relevant rules and procedures that are competently
enforced. It is hard to generalise how to achieve this management structure but
decentralized authority coupled with strict rules of accountability is paramount,
along with a large measure of good will (Reinke, 2001).

As community outreach efforts expand in an effort to satisfy the needs of

underserved areas, travel time and costs mount, unnecessary costs of a different
sort are incurred when inoperative vehicles make impossible the transport of
emergency cases from the periphery to the district hospital. These two
considerations draw attention to the use of appropriate modes of transport.
Motorised vehicles used in place of bicycles save travel time of field personnel;
hence they might be justified despite their higher cost. The benefits are lost,
however, when spare parts are not locally available or mechanics familiar with the
particular vehicle are not present. Again, it is difficult to generalise, but clearly,
considerations of appropriate technology must receive the attention they deserve
(Merson, 2001; Reinke, 2001).

In the usual situation where funds are severely limited, there is a temptation to
postpone needed maintenance in order to satisfy more immediate budgetary
demands, despite the clear implication for increased costs in the long run. It is
often more rational to move in the opposite direction by performing early
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preventive maintenance. Because of the potential cost savings in this regard (not
unlike the benefits from preventive health care), mathematical models have been
developed to determine optimum preventive maintenance policies. The models
themselves are beyond the scope of concern here, but the principle behind them is
worth noting (Morse, 1958).

Take the classic case of light bulb replacement. When a bulb failure is reported,
maintenance personnel must make a special trip to the failure site. Once there, they
can replace other bulbs that are about to fail at relatively little additional cost. The
question is: which ones are about to fail? The answer cannot be determined
precisely, but appropriate record keeping can yield a probability distribution of
survival times from which the cost of early replacement can be ascertained.
Specifically, one must weigh the added cost of light bulb purchases due to more
frequent replacement against the reduction in personnel costs obtained from the
simultaneous replacement of multiple units (Morse, 1958).

In-text Question: Why is it necessary to decentralise transport and equipment

maintenance?

Answer: It is necessary to decentralise transport and equipment use and

maintenance because procedures that require headquarters approval to purchase
fuel and spare parts increase administrative costs and result in time-wasting and
inefficiency.

2.2 The Logistics Cycle

An even richer potential for gain is available from the mathematical modeling of
drug usage because of the costs involved. Before elaborating on this point,
however, the four basic elements of the logistics cycle must be outlined:
1. Selection of items to stock
2. Procurement of those items
3. Distribution to the sites of use
4. Disbursement and replenishment (Management Sciences for Health, 1997).

With regard to selection, the value of a limited list of essential drugs is well
established. Considering price and efficacy, the list should contain only materials
shown to be cost effective. Where several varieties serve essentially the same
purpose and are similarly cost effective the choice of a single item can result in a
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price advantage gained from large volume purchase and can simplify
administrative stock control procedures as well.

Procurement decisions are important, but may be beyond the control of local
institutions and agencies. The decision might be made to:
1. Manufacture drugs domestically;
2. Import raw materials and process them domestically; or
3. Purchase the finished product in the international market.
Although the decisions are sometimes made on political grounds they should be
based on considerations of manufacturing capacity, price, quality control, and
foreign exchange requirements (Merson, 2001; Reinke, 2001).

Procurement decisions at the district or institutional level can relate to purchase

locally in the open market versus procurement through the national depot system.
This issue is then closely tied to questions of distribution. To secure price
advantages and other controls from volume purchasing, items are often procured at
the national level, then distributed to regional warehouses and on to local
institutions such as hospitals for further reallocations. The longer the chain of
distribution, the more opportunity there is for bottlenecks and shortages to develop.
For this reason, the flexibility of local purchase is sometimes preferred even at the
expense of higher prices.

The increasing number of drug revolving funds (DRFs) further complicates the
matter. The funds are designed to broaden the distribution base by making
commodities available for sale to all patients, even those at the periphery, and
using the revenues thus generated to replenish the initial supply. If the DRF serves
to extend the national network to one lower level, the shortage problems described
above can be made worse. If on the other hand, the DRF is strictly a local
enterprise, difference concerns arise with respect to price, availability, control, and
corruption. These funds have enjoyed considerable success and have served a
useful purpose, but their management is a matter of continuing concern (Merson,
2001; Reinke, 2001).

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In-text Question: State 3 reasons for making procurement decision in health system
management

Answer: The reasons for making procurement decision in health system

management are to enable:
1. Manufacturing of drugs domestically
2. Importation of raw materials
3. Purchasing of finished product in the international market.

2.3 Stock Replenishment and Decision Rules

Effective procedures are essential for the selection, procurement, and distribution
of drugs and supplies, but drug availability ultimately depends upon stock control
procedures employed at the point of usage. Shortages can cause costly
interruptions in service delivery, but excessively high inventory levels can also be
costly, especially when the items stocked are perishable. Because of these cost
implications in the industry, mathematical models prescribing optimal stock
replenishment decision rules were among the earliest contributions of operations
research to management practice (Morse, 1958). Inventory cost –saving rules are
available in the health field as well.
The rule specifies that stock levels be reviewed periodically (say monthly) in order
to identify items that have fallen below their individually determined minimum
(order trigger) values, s. orders are placed for these items to bring their stock levels
up to the maximum value S established for each. Minimum and maximum values
are determined by frequency of review, lead time needed between placement of the
order and actual replenishment, average usage during the lead time, variation in
usage, and economic order quantity considerations.

In-text Question: State 2 importance of stock replenishment and decision rules in

health system management.

Answer: 1. It prevents costly interruptions in service delivery.

2. It prevents mismanagement of financial resources.

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3.0 Conclusion
In this session, you saw that the provision of quality health care is increasingly
demanding on the physical infrastructure. The way in which physical resources
such as buildings, equipment and supply systems are managed largely affects the
lifetime of investments and the performance of the health system as a whole. Thus,
appropriate buildings and equipment are a major motivation factor for health
workers. I believe that you are now set to deal with management of finances.

4.0 Session Summary

This session has described the following:
1. Transport, equipment use and maintenance;
2. The logistics cycle;
3. Stock replenishment and decision rules.
Hope this session was not too complicated for you. For test of understanding, let us
attempt the question below.

5.0 Self-Assessment Question

1. Describe how physical resources management affects the performance of the
health system.

6.0 Additional Activities

a. Visit the head of works department of all the health care centres in your
community and engage them on how their unit is being managed.

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7.0 References/Further Readings

Abel-Smith, B. (1994). An Introduction to Health: Policy, Planning and
Financing. London: Addison Wesley Longman Ltd.
Arvid, R. J. (1976). Management, Systems, and Society: An Introduction. Pacific
Palisades, Calif.: Goodyear Pub. Co.
Campbell, C. (2007). Essentials of Health Management Planning and Policy.
Lagos: University of Lagos Press.
Encyclopedia of Public Health; Social Health. Answers.com Retrieved from
http://www.answers.com/topic/social-health. Site Accessed on 20th July
2009.
Gomez-Mejia, Luis R.; David B. Balkin and Robert L. Cardy (2008).
Management: People, Performance, Change, (3rd ed.). New York USA:
McGraw-Hill.
Management Science for Health (1997). Managing Drug Supply: The Selection,
Procurement and Distribution Use of Pharmaceuticals (2nd ed.). West
Hartford, Ct: Kumarian Press.
Merson, M. H., Black, R. E and Mill, A. J. (2001). International Public Health:
Disease, Programmes, Systems and Policies. Maryland: Aspen
Publishers.
Michael, A. (2006). A Handbook of Human Resources Management Practice (10th
ed.). London: Kogan.
Mitchell, J. and Haroun, L. (2001). Introduction to Health Care. Canada: Delmar
Oxford English Dictionary.
Morse, P. M. (1958). Queues, Inventories and Maintenance. NY: John Wiley and
Sons.
Reinke, W. A. (2001). Health Systems Management. In: M. H. Merson, R. E.
Black, and A. J. Mill, (eds.). International Public Health: Disease,
Programmes Systems and Policies. Maryland: Aspen Pub.
World Health Organisation (1990). Coordinated Health and Human Resources
Development (Technical Report Series, No. 801), Geneva: WHO.

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Study Session 4
Financial Management
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – What is Financial Management?
2.2- Objectives of Financial management
2.3- Elements of Financial Management
2.4- Financial Management Levels
2.5- The Practice of Financial Management
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
No system or institution can run optimally without a logical and systematic
management of its personnel, its physical resources as well as its finances. The
management of the finances of a business/organisation in order to achieve financial
objectives is very crucial. Financial management in health entails planning for the
future of a health enterprise to ensure a positive cash flow. This will be elaborated
on in this session.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Describe financial management;
2. Illustrate the objectives of financial management;
3. Illustrate the elements of financial management;
4. Explain the levels of financial management;
5. Describe specific terms associated with financial management.

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2.0 Main Content

2.1 Financial Management: Definition of Term
Financial management is defined as: the management of the finances of a
business/organisation (health institution) in order to achieve financial
objectives (Tutor2u, 2009). Financial management entails planning for the future
of a person or a business enterprise to ensure a positive cash flow. It includes the
administration and maintenance of financial assets. Besides, financial management
covers the process of identifying and managing risks.

The primary concern of financial management is the assessment rather than the
techniques of financial quantification. A financial manager looks at the available
data to judge the performance of enterprises. Managerial finance is an
interdisciplinary approach that borrows from both managerial accounting and
corporate finance.

Some experts refer to financial management as the science of money management.

The primary usage of this term is in the world of financing business activities.
However, financial management is important at all levels of human existence
because every entity needs to look after its finances (Tutor2u, 2009).

In-text Question: What is financial management?

Answer: Financial management is defined as the management of the finances
of a business/organisation (health institution) in order to achieve financial
objectives.

2.2 Objectives of Financial Management

Taking a health enterprise as the most common organisational structure, the key
objectives of financial management would be to:
1. Create wealth for the business;
2. Generate cash; and
3. Provide an adequate return on investment bearing in mind the risks that the
business is taking and the resources invested.

2.3 Elements of Financial Management

There are three key elements in the process of financial management:

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A. Financial Planning
Management needs to ensure that enough funding is available at the right time to
meet the needs of the business. In the short term, funding may be needed to invest
in equipment and stocks, pay employees and fund sales made on credit.
In the medium and long term, funding may be required for significant additions to
the productive capacity of the business or to make acquisitions.

B. Financial Control
Financial control is a critically important activity to help ensure that the business is
meeting its objectives. Financial control addresses questions such as:
1. Are assets being used efficiently?
2. Are the businesses assets secure?
3. Does management act in the best interest of shareholders and in accordance with
business rules?

C. Financial Decision-making
The key aspects of financial decision-making relate to investment, financing and
dividends:
1. Investments must be financed in some way – however, there are always
financing alternatives that can be considered. For example, it is possible to raise
finance from selling new shares, borrowing from banks or taking credit from
suppliers
2. A key financing decision is whether profits earned by the business should be
retained rather than distributed to shareholders via dividends. If dividends are too
high, the business may be starved of funding to reinvest in growing revenues and
profits further.

In-text Question: What are the elements of financial management?

Answer: The elements of financial management are financial planning,

financial control and Financial Decision-making.

2.4. Financial Management Levels

Broadly speaking, the process of financial management takes place at two levels.
At the individual level, financial management involves tailoring expenses
according to the financial resources of an individual. Individuals with surplus cash
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or access to funding invest their money to make up for the impact of taxation and
inflation. Else, they spend it on discretionary items. They need to be able to take
the financial decisions that are intended to benefit them in the long run and help
them achieve their financial goals.

From an organisational point of view, the process of financial management is

associated with financial planning and financial control. Financial planning seeks
to quantify various financial resources available and plan the size and timing
of expenditures. Financial control refers to monitoring cash flow. Inflow is the
amount of money coming into a particular company, while outflow is a record of
the expenditure being made by the company. Managing this movement of funds in
relation to the budget is essential for a business (Economy watch, 2009).

In-text Question: Differentiate between financial planning and financial control.

Answer: Financial planning quantifies available financial resources and plans

the size and timing of expenditures while financial control monitors cash flow.

2.5 Financial Management Practice

The financial management of an enterprise first requires appraisal of alternative
strategies for allocating the limited resources available. Once a preferred strategy is
identified, a detailed budget is prepared to carry it out. Then in the course of
implementation, expenditures are monitored in relation to budgeted levels (Mills,
1990a, 1990b). Financial management practice, therefore, is discussed under three
headings:
A. Resource allocation decisions
B. Performance budgeting
C. Cost analysis

A. Resource Allocation Decisions

The fundamental aim of the design of health programmes is to achieve desired
results at minimum cost. This is the essence of Cost Effectiveness Analysis (CEA)
(Reynolds and Gaspari, 1985). In recognition of the special importance of
intangible benefits in connection with health and other social services, the
economic orientation of CEA has been broadened to form Cost Utility Analysis
(CUA) (Gold et al., 1996; Torrance, 1986).
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The notion of health for all has further directed attention to the distribution of
benefits along with overall levels of achievement. Thus, equity has become a prime
concern (Musgrove, 1986). More recently, we have come to appreciate the labour
intensive nature of health care and its effect on recurrent costs. One-time
development costs incurred with donor support to improve service coverage leads
to an ongoing recurrent cost commitment normally borne by the host country
government to maintain the capability that has been developed. Issues of
programme sustainability and affordability have, therefore, come to the forefront
(Abel-Smith and Creese, 1989, Bossert, 1990; Lafond, 1995; Olsen, 1998; Prescott
and De Ferranti, 1985). This interest has been heightened by growing concern over
quality issues which can be costly. The question is raised whether improved
quality, achieved at a cost, carries with it a level of client satisfaction that results in
a willingness to pay for the added costs. Thus, issues of cost recovery enter the
equation (Creese and Kutzin, 1995; Kanji, 1989; Knippenberg et al., 1997).

These multiple desires are not necessarily mutually compatible. For example, the
most cost effective strategy in a given situation might focus on a readily accessible
urban population, but this approach would be unlikely to satisfy even minimum
criteria of equity. Sound and reliable appraisals of the trade-off between cost-
effectiveness and equity require explicit comparisons of each evaluative indicator.

Although cost-effectiveness measures have been well defined, the meanings of

equity, quality, and sustainability are still somewhat vague. Financial analysis
methods must be defined to clarify the various evaluative measures and lastly,
facilitate integrated analysis of the trade-offs required among them (Reinke, 2001).

B. Performance Budgeting
Too often, budgeting is merely an exercise in which planners take last year’s
allocation and project a certain percentage increase this year as reasonable or
feasible. Or perhaps, a 15% increase in the personnel budgets is considered
necessary, while a 10% increase in the transport budget would be satisfactory.
Budgets based upon line item inputs like personnel, transport, drugs, and
maintenance, apart from the outputs expected, are necessarily arbitrary and not
easily justified.
Programme budgets are somewhat more satisfactory because the inputs are related
to areas of activity. Thus, the judgment might be made to give higher priority to
family planning and increase that programme budget by 20% while holding the
budget for communicable disease control to last year’s level. Still, as a budget of
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resources only, albeit for selected purposes, the programme budget is of limited
value to programme managers for tracking performance during the budget year,
family planning expenditures have consumed 40% of budgeted funds for family
planning, or 80% (40/50) of expected levels for the period. Perhaps cost savings
have accrued as a result of efficient use of resources, but what if only 30% of
planned contacts for the year have been made during the first 6 months. This
presents a picture of relative inefficiency, in which 40% of budgeted resources
were consumed in providing 30% of intended services. For management action
purposes, it is clearly preferable to relate inputs and outputs explicitly (Reinke,
1988b).

C. Cost Analysis
Although cost analysis techniques comparing actual experiences with budgeted
expectations have been introduced, further elaboration of costing methods is
needed. First, it is necessary to understand how costs are interpreted differently at
various stages of budgeting and cost accounting (Creese and Parker, 1994). To
illustrate, consider a presently used piece of equipment that is to be replaced by a
more automatic labour-saving instrument. Specifically, the old equipment was
purchased 2 years ago for N48, 000 and was expected to last for 6 years, and the
new instrument costs N70, 000 and is expected to remain serviceable for 5 years.
In the resource allocation decision to purchase, the capital cost of the new
equipment enters into the calculation, but not the initial cost of the existing
instrument, as this expenditure has already been expended and is not subject to
reversal. An issue in the allocation decision is whether the superior performance of
the new instrument justifies its purchase.
If purchase of the new equipment requires full payment in advance, the next
budget must include the entire cost of the new equipment, but nothing for the old.
In contrast, the accounting records will show entries for both instruments. One-
sixth (N8,000) of the original cost of the old equipment is to be accounted for
during each year of its expected life, and now N14,000 will be added during each
of the 5 years that the new instrument is expected to be in use. The thinking behind
this procedure is that because the equipment is anticipated to produce service
benefits over time, its cost should be similarly allocated in order to permit
determination of cost per unit of service. Cost calculations, then, must suit the
purpose for which the determination of cost is being made. In particular,
accounting records are of limited value in analysis of cost effectiveness.

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In-text Question: What is the role of cost analysis in financial

management?
Answer: The role of cost analysis in financial management is to permit
determination of cost per unit of service.

3.0 Conclusion
It is hoped that you have gained a better understanding of financial management
which was defined as: the management of the finances of a business/organisation
in order to achieve financial objectives. Its objectives among many include:
creating wealth for the business, generating cash and providing an adequate return
on investment. Financial planning, control and decision were also recognised as
key elements of financial management. Also, the level of financial management
can be at the individual or organisational levels. This session concluded with
descriptions of the following: financial management practices; resource allocation
decision; performance budgeting and cost analysis. In the next session, we shall
look at community participation in health system management.

4.0 Session Summary

This session outlined the following:
1. Financial management;
2. Objectives of financial management;
3. Elements of financial management;
4. Financial management levels; and
5. The practice of financial management.

5.0 Self-Assessment Question

1. Explain how the following concepts affect the performance of the health system:
1. Financial planning
2. Resource allocation decision
3. Financial decision-making

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6.0 Additional Activities

a. Visit You-tube: https://www.youtube.com/watch?v=8k-v1EtAYXU and
https://www.youtube.com/watch?v=mX9nd0eQ-6g. Watch the videos and
summarise in 2 pages.
b. Visit the head of finance department of all the health care centres in your
community and engage them on how their unit is being managed.

7.0 References/Further Readings

Abel-Smith, B. and Creese, A. (eds.). (1989). Recurrent Costs in the Health
Sector: Problems and Policy Options in three Countries. Geneva: WHO.
Abel-Smith, B. (1994). An Introduction to Health: Policy, Planning and
Financing. London: Addison Wesley Longman Ltd.
Arvid, R. J. (1976). Management, Systems, and Society: An Introduction.
Pacific Palisades, Calif.: Goodyear Pub. Co.
Bossert, T. J. (1990). Can they get along without us? Social Science and Medicine,
30(90), 105 1032.
Campbell, C. (2007). Essentials of Health Management Planning and Policy.
Lagos: University of Lagos press.
Creese, A. and Parker, D. (1994). Cost Analysis in Primary Health Care: A
Training Manual for Programme Managers. Geneva: WHO.
Creese, A. and Kutzin, J. (1995). Lessons from cost Recovery in Health.
Discussion paper No. 2. Geneva: WHO.
Economy watch, 2009. Financial management. Retrieved from:
http://www.economywatch.com/finance/financial-management.html. Site
th
visited on 27 July, 2009.
Encyclopedia of Public Health; Social Health. Answers.com Retrieved from
http://www.answers.com/topic/social-health. Site Accessed on 20th July
2009.
Gold, M. R., Russell, L. B., Siegel, J. E. and Weinstein, M. C. (1996). Cost
effective in Health and Medicine. NY: Oxford Univ. Press.
Kanji, N. (1989). Charging for Drugs in Africa. UNICEF’s “Bamako Initiative”.
Health Policy and Planning, 4(2), 110-120.
Knippennberg, R., Reinke, W. A. and Hopwood, I. (1997). Sustanability of
Primary Health Care including Immunisation in Bamako Initiative
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Programmes in West Africa. Health Planning and Management, 12

(suppl.1).
Lafond, A. K. (1995). Research on Sustainability in the Health Sector. Health
Policy and Planning, 10 (suppl), 1-7.
Reinke, W. A. (2001). Health Systems Management. In: M. H. Merson, R. E.
Black, and A. J. Mill, (eds.). International Public Health: Disease,
Programmes Systems and Policies. Maryland: Aspen Pub.
Tutor2U (2009). What is Financial Management? Retrieved from
http://tutor2u.net/business/accounts/finance_management_intro.htm. Site
visited on 27th July 2009.

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Study Session 5
Health System Management: Community Involvement
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- What is Community?
2.2- What is Participation?
2.3- Specific Activities in a Community
2.4- Why Community Participation in Health System
2.5- Guidelines for Overcoming Obstacles to Active Community
Participation
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Additional Activities
7.0 References/Further Readings

Introduction
The rationale for decentralisation in health system management logically extends
to consideration of community involvement. If decentralised decision making
makes locally relevant actions more likely, participation of the communities
themselves should offer further assurance of relevance. Because both terms:
community and participation are ambiguous, the subject deserves separate
attention. These and more will be discussed in this session.

1.0 Study Session Learning Outcomes

At the end of this session, you should be able to:
1. Say the meaning of community;
2. Explain what community participation is;
3. Identify the specific activities in community participation;
4. Illustrate the need for community participation in health system;
5. Describe the guidelines for overcoming obstacles in community participation in
health system.

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2.0 Main Content

2.1 What is Community?
It is misleading to think of community in strictly geographical terms, for those
living within defined boundaries are often divided into several factions with
conflicting goals. It is more useful, therefore, to define communities in terms of
common culture, traditions, interests, and needs (Madan, 1987). In this sense, an
association of geographically dispersed nurses/doctors is a community. Although
community considerations in health services management often have a geographic
base, we must bear in mind that separate community interests exist within the
geographic area of concern. Leadership questions arise within this framework
because designated leaders may reflect the interests of a single influential faction
that is not prepared to support broader reforms. In this case, the central authority
that fails to serve local needs is simply replaced by an equally unrepresentative
local authority (Reinke, 2001).

2.2. What is Participation?

The initiative for community collaboration usually comes from outside the
community. This raises the question: Is the aim to enlist community support in
order to satisfy project objectives? Or is project support sought to satisfy
community wants and needs? Whereas the latter approach is usually specified or
implied, it seems that the former is more practiced. The meaning of partnership is
coloured accordingly.

Communities can contribute physical resources (as when a room in a village home
is used as a health post), funds (for example, establishment of a drug revolving
fund), or personnel. The latter can offer ideas and advice, be empowered to make
decisions, or take actions, as in providing care or conducting surveys of health
needs. The appropriate form of involvement depends upon what decisions are to be
made and what action is to be taken, at what level, and when. These activities run
the gamut from policy analysis to planning, implementation, and evaluation. If a
policy of charging for drugs dispensed by community health workers (CHWs) is
under consideration, should the fee scheduled be established by a village health
committee (VHC) with community membership (in part or exclusively), or should
the CHWs merely collect the fees that have been set by district health authorities?
In any case, the presence of truly functional VHC decision-making bodies and
respected CHW service providers has been found to be crucial to effective
community participation.

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2.3 Specific Activities in a Community

Nine specific sets of activity have been identified for which community roles
should be defined (Taylor, 1988). They are as follows:
1. Establishing community representation
2. Setting community organisation objectives
3. Determining community organisation strategies and functions
4. Determining community structures
5. Identifying appropriate incentives for participation
6. Managing the community organisation
7. Providing supervision and support
8. Implementing community organisation activities
9. Monitoring and evaluating community performance

2.4 Why Community Participation in Health System

Community participation is beneficial to the extent that it contributes to usual
health service objectives of effectiveness, efficiency, equity, and sustainability
(Newell, 1975). One of the most successful community-based efforts, the Jamkhed
Project in India (Arole and Arole, 1994), illustrates community participation in
numerous ways. For example, a 40-bed hospital set up under project auspices
provides quality care at low cost because village people take care of all non-
technical hotel functions, and project professional staff focus limited resources on
the technical aspects of care. Functioning at the grassroots level, the project also
has been able to achieve equity by, for example, concentrating the funding of water
sources in low caste residential areas, thereby making advantaged segments of the
population dependent upon the disadvantaged for an important contribution to
well-being.
Also, a village health project in Somalia provides striking evidence of
sustainability. According to informal reports from WHO staff closely associated
with the project, community “ownership” of the enterprise was so well established
when armed conflict escalated and most government services of all types were
curtailed, that health care in the project villages continued virtually uninterrupted.
Although the circumstances make it impossible to document the experience in
detail, the anecdotal evidence in informative.
The value of community health projects is not limited to the health sector. More
generally, they encourage community cohesion and empowerment. The theology
of liberation movements in Latin America has been especially notable in
emphasising conscientisation, whereby traditionally subservient individuals and
groups are emboldened to demand their rightful place in society.
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In-text Question: Why is community participation necessary in health

system management?

Answer: Community participation is necessary because:

1. It contributes to usual health service objectives of effectiveness,
efficiency, equity and sustainability.
2. It encourages community cohesion and empowerment.

2.5 Guidelines for Overcoming Obstacles to Active Community Participation

Numerous roadblocks to effective community participation in health system must
be overcome (Korten, 1981). Even in the absence of overt threats to success,
certain actions can be taken to make the partnership more rewarding. Several of the
more important considerations are summarised below.

A. Official Commitment
Official commitment is needed at all levels to provide a favorable climate for
collaboration. Because community-level decisions and actions cannot be carried
out in isolation, support throughout the health system is important and takes the
form of stated policy at central and district levels, as well as consequent evidence
of willingness to relinquish control as necessary.

B. Positive Leadership
Much care is required in the formation of effective community links. Although
external change agents can provide the needed initial stimulus, they must not be
dictatorial. This approach requires exceptional sensitivity on their part. Leadership
within the community must be established to fit the circumstances. Does the
community role require democratically determined representation? Or should the
leader be someone chosen because of specialised technical competence or
community respect? All these are very important.

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C. Good Partnership between Community Representatives and Health

Experts
The evolving partnership between staff and community representative should
provide mutual learning opportunities that establish common terms of reference.
Staff members should become sensitive to community needs and priorities.
Community participants should become acquainted with local epidemiologic
conditions and intervention possibilities. When a survey of health professional and
residents of certain area in Nepal enumerated local health problems, it was found
that half of the problems were independently recognised by both professionals and
community, indicating substantial congruence in perspective (De Sweemer et al.,
1979). Equally revealing was that, among the items initially identified by only one
of the parties and later accepted by the other, the number of items contributed by
the community exceeded that put forward by the professionals, making clear the
value of exchange of views.

D. Broad Perspective to Health Management

Individuals tend not to place their problems into neat categories; moreover, the
usual priorities involving food, shelter, employment, and education are not seen to
have direct health implications. Health workers therefore face a challenge in
entering into a dialogue with the community (Flavier, 1970). The Jamkhed project
began the effort by organising volleyball contests. These were followed by chat
sessions that eventually led to formation of women’s clubs and Young Farmers
Clubs for men. When health-related projects were initiated with community
support, they usually dealt at first with broad issues of safe water and nutrition.
Only later were specific problems like immunisation and contraception tackled. In
contrast, others have found advantage in launching clearly targeted immunisation
or diarrhea diseases control programme capable of producing visible results in a
relatively short period of time (Taylor and Waldman, 1998).

E. Democratisation of the Selection and Training of Community Health

Workers (CHW)
The CHW is the critical link in providing services. Much of the programme
success therefore hinges upon CHW selection and, training recruitment decisions
made solely by the community can lead to the nomination of unqualified members
of the headman’s family.

Selection by health staff, on the other hand, is contrary to the notion of community
participation. A workable solution allows the community to nominate three
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acceptable candidates, one of whom is chosen by the health team having

responsibility for the training (Were, 1982).

Competency-based training then mixes considerable practice with essential theory

in preparing candidates to carry out at most five or six priority tasks. Once these
are consistently and satisfactorily carried out, other tasks can be added. Too often,
in an attempt to improve coverage, CHWs are assigned responsibility for an
overwhelming array of activities that they have neither the time nor the
competence to undertake.

F. Detailed Data Gathering Technique

While limiting the number of activities, the importance of data gathering in the
CHW job description should not be underestimated, as village-based workers are
in an excellent position to track their neighbours’ problems. The Jamkhed found,
for example, that whereas health centre workers typically identified two or three
leprosy cases in community surveys, the CHWs were able to uncover 10 times as
many.

G. Full Support of CHWs

Once trained, CHWs should be fully supported in their daily activities. An
attractive work site and adequate levels of supportive supervision should be
provided. Although some programmes try to rely on volunteer effort, experience
suggests that some form of remuneration in money or in kind is highly
recommended. Funding may come from the community directly, or from fees
collected. If funds come directly from the government, the community loses
control, and CHWs become in effect government workers co-opted from the
community. Remuneration through collection of fees for drugs dispensed has the
disadvantage of encouraging curative care at the expense of health promotion and
disease prevention activities. Regardless of the financial arrangements, the risk of
corruption exists. Under decentralisation, special care must be taken to prevent past
corrupt practices at the central level from multiplying across communities, where
they can be especially damaging (Reinke, 2001).

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In-text Question: State 5 guidelines for overcoming obstacles to active

community participation.
Answer: 1. Official commitment
2. Positive leadership.
3. Broad perspective to health management.
4. Detailed data gathering technique.
5. Full support of community health workers.

3.0 Conclusion
It is obvious that a community is much more than strictly a geographical entity, for
those living within defined boundaries are often divided into several factions with
conflicting goals. It is thus more useful to define communities in terms of common
culture, traditions, interests, and needs. Community participation in health care and
management can be in the area of physical resources, funds or personnel. This
session also observed ways of surmounting obstacles to community participation in
health care namely: positive leadership, flexibility, support of community health
workers and full participation in health care.

4.0 Session Summary

This session described the following:
1. Community
2. Community participation
3. Specific activities in community participation
4. Need for community participation in health system management
5. Guidelines for overcoming obstacles to active community participation in health
system management.

5.0 Self-Assessment Questions

1. Explain 5 guidelines for overcoming obstacles to active community
participation in health system management.

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6.0 Additional Activities

a. Visit You-tube: https://www.youtube.com/watch?v=sMzAmbttHsY.

Watch the videos and summarise in 1 paragraph.
b. Visit a health care centre in your community and engage 3 primary care
providers on their take about community participation in health system
management.

7.0 References/Further Readings

Abel-smith, B. & Creese, A. (eds.). (1989). Recurrent Costs in the Health Sector:
Problems and Policy Options in three Countries. Geneva: WHO.
Abel-Smith, B. (1994). An Introduction to Health: Policy, Planning and
Financing. London: Addison Wesley Longman Ltd.
Arole, J. L. and Arole, R. (1994). Jamkhed. Bombay: Archana Art Printers.
Arvid, R. J. (1976). Management, Systems, and Society: An Introduction. Pacific
Palisades, Calif.: Goodyear Pub. Co.
Reinke, W. A. (1988). Health Planning for Effective Management. NY: Oxford
Univ. Press.
Reinke, W. A. (2001). Health Systems Management. In: M. H. Merson, R. E.
Black, and A. J. Mill, (eds.). International Public Health: Disease,
Programmes Systems and Policies. Maryland: Aspen Pub.
Taylor, C. E. (1988). Community Involvement. In: W. A. Reinke (Ed), Health
Planning for Effective Management. NY: Oxford Univ. Press.
Taylor, C. E. and Waldman, R. J. (1998). Designing Eradication Programme to
Strengthen PHC. In: R. Dowdle & D. R. Hopkins (eds.). The Eradication
of Infectious Diseases. NY: John Wiley and Sons.
Were, M. (1982). Organization and Management of Community-Based Health
Care. Kenya: UNICEF.

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Glossary
 Ambulatory care. All types of health services provided to patients who are
not confined to an institutional bed as inpatients during the time services are
rendered.
 Day care. Medical and paramedical services delivered to patients who are
formally admitted for diagnosis, treatment or other types of health care with
the intention of discharging the patient the same day.
 Dentists. All graduates of any faculty or school of dentistry, odontology or
stomatology, actually working in the country in any dental field.
 District/first-level referral hospital. A hospital at the first referral level that
is responsible for a district or a defined geographical area containing a
defined population and governed by a politico-administrative organization
such as a district health management team.
 General hospital. A hospital that provides a range of different services for
patients of various age groups and with varying disease conditions.
 Hiring. The process of appointing the candidate selected to the post/job
which is vacant.
 Inpatient. A person who is formally admitted to a health-care facility and
who is discharged after one or more days.
 Long-term care. Long-term care encompasses a broad range of help with
daily activities that chronically disabled individuals need for a prolonged
period of time.
 Midwives. All persons who have completed a programme of midwifery
education and have acquired the requisite qualifications to be registered
and/or legally licensed to practise midwifery, and are actually working in the
country. The person may or may not have prior nursing education.
 Nurses. All persons who have completed a programme of basic nursing
education and are qualified and registered or authorized to provide
responsible and competent service for the promotion of health, prevention of
illness, the care of the sick, and rehabilitation, and are actually working in
the country.
 Organization. A formal group of two or more people who function in an
official structure that was set purposefully to accomplish a certain goal or
goals (common).

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COMM 834: PRIMARY HEALTH CARE AND PRINCIPLES OF MANAGEMENT

 Other health-care providers (including community health workers). All

workers who respond to the national definition of health-care providers and
are neither physicians/doctors, midwives, nurses, pharmacists, or dentists.
 Outpatient. A person who goes to a health-care facility for a consultation,
and who leaves the facility within three hours of the start of consultation. An
outpatient is not formally admitted to the facility.
 Pharmacists. All graduates of any faculty or school of pharmacy, actually
working in the country in pharmacies, hospitals, laboratories, industry, etc.
 Physicians/doctors. All graduates of any faculty or school of medicine,
actually working in the country in any medical field (practice, teaching,
administration, research, laboratory, etc.).
 Primary health-care centre. A centre that provides services which are
usually the first point of contact with a health professional. They include
services provided by general practitioners, dentists, community nurses,
pharmacists and midwives, among others.
 Recruitment. The process of finding and attracting suitably qualified people
to apply for employment.
 Rewards. A generic term to include wages and salaries, incentives, and
welfare facilities and benefits. Compensation and remuneration are two
alternative terms.
 Social care. Services related to long-term inpatient care plus community
care services, such as day care centres and social services for the chronically
ill, the elderly and other groups with special needs such as the mentally ill,
mentally handicapped, and the physically handicapped.
 Specialised hospital. A hospital admitting primarily patients suffering from
a specific disease or affection of one system, or reserved for the diagnosis
and treatment of conditions affecting a specific age group or of a long-term
nature.
 Strategy. The organisation’s long-term plan (strategic plan) for how it will
match its internal strengths and weaknesses with its external opportunities
and threats to achieve or maintain or enhance a competitive advantage.
 Training. Making the employee ready to perform the current job.

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