Code: HSM 1006: Health Service Management

 The Concepts of management in health Systems delivery

 Concept and Principles and function of management in health system delivery to include:
 Planning and forecasting
 process of planning
 Importance of planning
 Techniques used in planning
 Strategic planning
 South Sudan Health System
 South Sudan National Health Policy Development:
 The Structure of the health system of South Sudan and their functions,
 Concept of the health system Management
 Primary health Care
 Concept of governance of the health system;
 The Components of primary Health care system (Elements):
 Health system management
 Structure of health system, and service delivery
 The six building blocks of the health system (WHO):
 Challenges and emerging health systems issues
 Factors that affect functions of a health system,
 Health System strengthening
 The Functions of management, Levels of management,
 Overview of management:
 Role of manager in directing organizational activities
 Role of mangers in organizations
 Process of management
 Importance of management in organization
 Techniques of coordination
 Circumstances of choosing basis
 Merits and elements of each basis
 Techniques of coordination:
 Process of coordination
 Role of manger in directing organizational activities
 Techniques used in coordination
 Different types of leadership in health system, Management and leadership in health systems,
 The differences between management and leadership in health systems,
 Managing medical technology and other resources for health; (finance, budget, documents,
spaqce, time etc.)
 Management of human resource for health
 Structuring the system (analyzing and designing jobs)

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  Recruitment, selection, placement and internal mobility
 Separation, death, retirement or resignation.
 Performance appraisal
 Preparing for advancement
 Techniques of management:
 Meaning of conflicts
 Advantages and disadvantages of conflicts in an organization
 Techniques of managing conflicts.

 Stress management:
 Meaning of stress
 Causes of stress
 Techniques of managing stress
 Techniques of control in an organization:
 Importance and nature of control
 Types of control systems
 Control techniques.
 Health financing
 Managing Health information system;
 Design of implementation,
 Data collection and analysis, report writing;
 Monitoring and evaluation health system;

Code: HSM 1006: Health Service Management

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Broad Objectives: at the end of this course students will be able to define health and the management.

Supporting Objectives:
At the end of this course students will be able to
1-Describe various principles and theories of management which apply to the management of
health facilities and training institutions.
2-Formulate a human resource development plan within and outside the organization.
3-Mange financial resources in health service organization and training institution.
4- Mange change
5-Mange conflicts and crisis.
6-Participate in project proposal development.

INTRODUCTION TO HEALTH SERVICES MANAGEMENT:

Health is a state of complete physical, mental and social well-being and not merely the absence
of disease or infirmity (WHO-1948).

The Ottawa amended definition1986 defined health promotion as “the process of enabling
people to increase control over and to improve their health.”

The Ottawa charter identified five priority action areas:

1. Build healthy public policy

2. Create supportive environments
3. Strengthen community action
4. Develop personal skills
5. Re-orient health services.

The population health concept is commonly used as a tool for public health (whose focus in
Ontario has shifted away from one-on-one care to more broad education and health surveillance
activities) and for others interested in health promotion activities.

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Population health starts from the premise of understanding and then improving the health
status of a particular population or the population of a community as a whole.

Health services aimed at meeting broad health needs of the population provided by multiple
stakeholders, which includes:
- Different levels of government,
- Private,
- Non-government
- Other agencies, in a variety of settings. Responsibility for policy, funding and service
provision varies across stakeholders and the relationships between service providers can be
complex.

Strategic planning for population health usually focuses on macro issue identification and
related strategy development. The federal government uses health status information to
prioritizes and target interventions (e.g. teenage smokers) and to develop strategies for broad
proactive public awareness (e.g. social marketing campaigns about lifestyle).

Prior to Ottawa amended health definition 1986,an international conference on primary health
care organized by WHO in Alma Ata in the former US in 1978 resulted in Alma Ata
declaration, expressing the needs to involve nations, governments, workers and communities
in various initiatives to improve and promote health for all people in the world.

A social target was to be the attainment of health for all people of the world by the year
[Link] meant a level of health that will permit them to lead a socially and economically
productive life.
Primary health care was adopted as the key strategy for attaining this goal (Health for all by the
year 2000).

Effective management of health service is a crucial issue in PHCC implementation and delivery
of health services, hence health managers at all levels and in all institutions of health care system

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should apply the knowledge of management to achieve the goals of health care system in general
and individuals health institutions in particular.

This implies that the teacher of health worker is a manager in his/her own right. He/she manages
students, space, time and other resources, and to do this well, he/she should understand,
appreciate and apply the art and science of management.

Definition of Management: management is defined as getting things done through, and with
people. The manger participates and provide leadership in getting things done, he/she is
responsible for creating and maintaining a conducive environment in which the workers (health
workers, tutors etc.), and consumers of services (patients and clients, students etc. perform and
achieve maximally.

Other Definitions of Management according to the scholars:

• Henry Fayol: to manage is to forecast and plan, to organize, to command, to coordinate and
to control.
• Donald J. Clough: Management is the art and science of decision making and leadership.
A distinct process consisting of planning, organizing, directing, and controlling and evaluating
to accomplish the predetermined objectives of an institution through the coordinated use of
human and material resources.
 Is the accomplishment of results through the efforts of other people. In order to realize the
prime goals of every Health programs of an institution there is the need of co-ordination in
management.
The Person in charge of the administration is to be ready with many physical, social and
economic aspects which should be exercised and administered by him for smooth management
of the program
Therefore, effective management of Health care systems requires Coordination. And here are
some importances of Coordination in achieving Health Care system Goals:
• Co-ordination is required in the field of administration such as; planning, organization, as far
the management of Health programs is concerned.

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• It is also needed in respect of purpose, time and place of the various activities like laying
down policies, preparing the budget, selection of staff and development of the curriculum etc.
• Co-ordination depends upon the nature of the particular problem, circumstances and
availability of resources and the final goal. The administrator should possess good and useful
skills for harmonizing all these diverse relationships.

Principles of management: these serves as a guide posts to good management behavior i.e.
management which will bring desired results, they provide the manager with many alternatives
approaches in attaining the goals of the health care system in general or one institution in
particular.
Some of these approaches are:

a) Principle 1: Management by objectives: management by objectives is a management

approaches which is consciously directed towards the effective and efficient achievement of
the objectives of the health care system, its encourage better management in that it forces
mangers to think of planning for results, and to ensure that the objectives are realistic and
attainable.

There are two types of objectives, long term and short terms:
1-Long term objectives: these are objectives which take a long time (2 or more years)
2-Short terms objectives: these reflect the intended daily and weekly activities (operational
activities).

b) Principle 2: Division of labour: these means different peoples are specialized in different
fields and exercising their skills towards the achievement of the objectives.

c) Principle 3: Management by exceptions: this implies that the manger should be selective,
and deal with the most critical issues first in order to minimize overloading, being
overloaded with petty decisions may means neglect of more important ones.

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d) Principle 4: Work designing: the activities of health care institution should be designed in
such a way that they support each other towards the achievement of objectives. Team work
should be encouraged to enhance the success of each activity and hence the overall
effectiveness of the institution.

e) Principle 5: Efficient use and substitution of resources: the management must make
efficient use of resources and to get people to work together harmoniously in order to achieve
the organizational goal, these resources comprises materials, money, manpower and time.

Many institutions often experience serious shortage of these resources, and it is therefore
necessary for the manger to use available efficiently, and to use different resources or a different
balance of resources to produce the intended results.

The Management functions:

Management consists of what a manger should ideally do, irrespective of the level of manger in
the organization hierarchy.
The main functions of management are:
1. Planning,
2. Organizing,
3. Implementing,
4. Controlling,
5. Staffing
6. Motivating
7. Evaluating.
1. Planning. Planning is a process of setting objectives and determines what should be done to
accomplish them. Planning sketches a complete mental picture of something.
2. Organising. The organizing of an activities is based on a differentiation of task.
Integration of differentiated tasks by assigning activities responsibilities to staff,
Structuring task and coordinating activities in a logical and meaningful order.

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3. Leading - There is distinction between managers and leaders. Leadership is path finding and
manager is path following
4. Satffing --- Formulating staff personal policies, Recruitment of staff., Selecting, orienting
and assigning duties to staff. Providing staff welfare measures.
5. Controlling— Control is regulation of operation in accordance with the objectives specified
in plans. Control is essential to ensures that operations are directed towards the attainment of
organizational objectives.

Planning & forecasting: planning entails deciding how the predetermined objectives of an
organization, department or its section will be achieved in the most efficient and economical
way and in accordance with the policy.

Planning is the activity concerned with making or formulating plans, which are routes to
objectives. Once the objectives of an organization have been set, planning is necessary to work
out how to achieve the objectives in practice within the framework of the policies formulated.

Planning defines where one wants to go, how to get there and with the timetable for the
journey. It’s also identify the milestones, Indicators and measure results

The below are the broad elements of planning:

1- Identifying a vision and goals
2- Undertaking strategic planning
3- Carry out evaluation.
Forecasting:
Forecasting is to determine as accurately as possible the probable course of future event which
may affect an organization and its activities. it is an assessment of the expected pattern of future
events and the way in which it might effects on the operation of an organization or it section.

Forecasting provides guidance for planning as to what might occur in the future, both short and
long term planning, without forecasting planning would be no more than mere guest work.

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It is not possible to anticipate or foresee the future exactly, but the more accurate the forecasting
the lower will be the degree of uncertainty and the greater the possibilities of formulating reliable
plans, and consequently the greater the chances of achieving the objectives.

Process of planning:
Health planning is a process to produce health. It does this by creating an actionable link
between needs and Resources. Its nature and scope will depend upon the time allowable, and
the number of answerable questions to be addressed within the process “answerable
questions” comprises questions that are worth asking and for which there is evidence to allow
them to be answered.

Assessing Need and evidence based planning for insights into approaches and tools used in
answering questions), the resources available to support the process, and the broader political
and social environment.
There are three broad elements in a planning process; Identifying the vision and goals,
undertaking the Strategic plan and evaluation.

Planning occurs within four potential constraints, creating a tension in many planning processes
a tension between what ought to be done and what can be done.

Importance of planning:
(1) Planning Provides Direction:
The objectives of the organization are defined in simple and clear words. The obvious outcome
of this is that all the employees get a direction and all their efforts are focused towards a
particular end. In this way, planning has an important role in the attainment of the objectives of
the organization.

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(2) Planning Reduces Risks of Uncertainty:
Planning is constantly done for the future and future is always uncertain, and with the help of
planning possible changes in future is anticipated and various activities are planned in the best
possible way such that uncertainties future risk can be minimized.

(3) Planning Reduces Overlapping and Wasteful Activities:

Under planning, future activities are planned in order to achieve objectives. Consequently, the
problems of when, where, what and why are almost decided. This puts an end to disorder and
suspicion. In such a situation coordination is established among different activities and
departments. It puts an end to overlapping and wasteful activities.

Consequently, wastages moves towards nil, efficiency increases and costs get to the lowest level.
For example, if it is decided that a particular amount of money will be required in a particular
month, the finance manager will arrange for it in time.

In the absence of this information, the amount of money can be more or less than the requirement
in that particular month. These situations are undesirable, and in case, the money is less than the
requirement, the work will not be completed and if it is more than the requirement, the amount
will remain unused thus cause a loss of interest.

(4) Planning Promotes Innovative Ideas:

It is clear that planning selects the best alternative out of the many available. All these
alternatives do not come to the manager on their own, but they have to be discovered. While
making such an effort of discovery, many new ideas emerge and they are studied intensively in
order to determine the best out of them.

In this way, planning imparts a real power of thinking in the managers. It leads to the birth of
innovative and creative ideas. For example, a health institution wants to expand its activities.
This idea leads to the beginning of the planning activity in the mind of the manager.

In this way, many new ideas will emerge one after the other. By doing so, he/she will become
habituated to them. He will always be thinking about doing something new and creative. Thus, it
is a happy situation for a health facility which is born through the medium of planning.

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(5) Planning Facilitates Decision Making:
Decision making means the process of taking decisions. Under it, a variety of alternatives are
discovered and the best alternative is chosen. The planning sets the target for decision making. It
also lays down the criteria for evaluating courses of action. In this way, planning facilitates
decision making.

(6) Planning Establishes Standards for Controlling:

By determining the objectives of the organization through planning all the people working in the
organization and all the departments are informed about ‘when’, ‘what’ and ‘how’ to do things.

Standards are laid down about their work, time and cost, etc. Under controlling, at the time of
completing the work, the actual work done is compared with the standard work and deviations
are found out and if the work has not been done as desired the person concerned are held
responsible.

PROCESS OF INSTITUTIONAL PLANNING

Step 1- Analysis

Making an analysis of the present position; the staff will analyze the present situation in respect
of the needs.

Step 2 – Setting objectives

Here the institution engages with internal stakeholders and senior leadership to create a focused
set of goals and objectives. They facilitate focus groups and meet with subject matter experts to
come up with strategies, indicators, and desired outcomes for each goal. They use existing
processes.

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Step 3 – Developing premises

• A premise in this context refer to the background or foundation on which a plan is

developed. The institutions therefore need to develop a foundation on which they would
want the plan to be developed. The foundation laid should be strong enough to allow the
development of the plan.

Step 4 – Implementing

This requires clear communication across the institution to:

• Set responsibilities,
• make investments,
• Adjust policies and processes, and establish measurement and reporting the level of
success.

Implementation typically includes proper management with regular strategic reviews to

ensure that plans stay on track. The staff will make a selection of the projects that are to be
undertaken during the ensuring session and prepare full length outline of the same. The
execution must be done through the co-operation of all. The projects responsibilities must be
shared between head and staff.

Step 5 – Evaluation:

• At the completion of the project the end product the output or the results must be assessed
quantitatively and qualitatively.

Basic Principles of Planning:

Planning requires scientific thinking and it should spell out in clear terms the definition of the
purpose, analyse the problem and make a careful and diligent search for all the facts bearing
upon it. The task of planning will be well-accomplished if some fundamental principles are
followed in the process.

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Table showing Basic Principles of Planning:

These important principles may be stated as follows:

1. Principle of Commitment: This means that certain resources must be committed or pledged
for the purpose of planning. Planning is not an easy task. So, necessary help is to be taken from
experts. The institution must be ready to exhaust the available resources for the achievement of a
plan.
2. Principle of the Limiting Factor: A plan involves varied factors of different importance.
This principle implies that more emphasis has to be put on that factor which is scarce or limited
in supply or extremely costly. This will help in selecting the most favorable alternative.
3. Principle of Reflective Thinking: Planning, being an intellectual activity is based on rational
considerations. These involve reflective thinking which signifies problem-solving thought

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process—a process by which past experiences are superimposed on the facts of the present
situation and possible future trends. None can be a planner whose mind is not active, who does
not possess any deliberate power and whose sense of judgement is not strong.
4. Principle of Flexibility: Though a plan is prepared after reflective thinking, this does not
mean that no departure can be made in the course of its operation. The plan should be so
prepared that there is sufficient scope for changing it from time to time. Changes must
necessarily be effected in the plan for taking into account new developments that may take
place in the course of the operation of the plan.
5. Principle of Contribution to Enterprise Objectives: A major plan is prepared and it is
supported by many derivative plans. But all plans must contribute in a positive way towards
the achievement of the institution objectives.
6. Principle of Efficiency: A plan should be made efficient to attain the objectives of the
enterprise at the minimum cost and least effort. It must also achieve better results with the
minimum of unexpected happenings. Therefore, it is to be seen that what is expected is likely
to be achieved.
7. Principle of Selection of Alternatives: Planning is basically a problem of choosing. The
essence of planning is the choice among alternative courses of action. There is no need for
planning if there is only one way for doing something. In choosing from alternatives, the best
alternative will be that which contributes most efficiently and effectively to the
accomplishment of a desired goal.
8. Principle of Planning Premises: A plan is prepared against some foundations or
backgrounds known as ‘Planning Premises’. There must be complete agreement among the
managers in respect of planning premises over which the structure of plan is to be framed.
9. Principle of Timing and Sequence of Operations: Timing and sequence of operations
determine the starting and finishing time for each piece of work according to some definite
schedule and give practical and concrete shape and form to work performance.
10. Principle of Securing Participation: To secure participation of the employees with whole-
hearted co-operation in execution of the plan, it is necessary that the plan must be
communicated and explained to them for their full understanding. This understanding
provides the basis for additional knowledge about new facts and matters to the employees.

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 This is needed for improvement in the quality of planning. It also ensures an obligation of the
personnel of the enterprise to execute the plan by individual and joint participation.
11. Principle of Pervasiveness: Though major planning function is entrusted to the top
management, it is not restricted to the top level only. It is a function of every manager at
every level in the organization.
11. Principle of Strategic Planning: Strategic planning is essential where there is competition.
It is prepared in the light of what the competitors are intending to do. Planners must take into
account the strategies of the rival organizations; otherwise the planning projection may land
them in trouble.
12. Principle of Innovation: A good system of planning should be responsive to the
opportunities for innovation. Innovation consists in creating something new for increasing
satisfaction of the consumers. This may also be stated as an important strategy of institutions.
Innovation is a necessity for its sustaining growth in this dynamic world. Innovation is achieved
through research and development and planning is required to provide such scope.

13. Principle of Follow-up: In the course of execution of a plan, certain obstacles may crop up
in midway and planning may require revision, alteration or correction. This is why there must be
a follow-up system in the planning process itself. This allows timely changes in the planning and
makes it more effective.

TYPES OF PLANS
There are majorly four types of planning:
a. Operational Planning:
Operational plans are about how things need to happen,” “Guidelines of how to accomplish the
mission are set.” This type of planning typically describes the day-to-day running of the
institution. Operational plans are often described as:
 single use plans
 Ongoing plans.
• Single use plans are created for events and activities with a single occurrence (such as a
graduation event).

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• Ongoing plans include policies for approaching problems e,g clinical placement, rules for
specific regulations e.g examination regulations and procedures for a step-by-step process
e.g registration for accomplishing particular objectives.

b. Strategic Planning:
• “Strategic plans are all about why things need to happen, It’s big picture, long-term thinking.
It starts at the highest level with defining a mission and casting a vision.”
• Strategic planning includes a high-level overview of the entire institution. It’s the
foundational basis of the institution and will dictate long-term decisions. The scope of
strategic planning can be anywhere from the next two years to the next 10 years. Important
components of a strategic plan are vision, mission and values.
c. Tactical Planning:
• “Tactical plans are about what is going to happen, at the tactical level, there are many
focused, specific, and short-term plans, where the actual work is being done, that support the
high-level strategic plans.”
• Tactical planning supports strategic planning. It includes tactics that the institution plans to
use to achieve what’s outlined in the strategic plan.
d. Contingency Planning:
Contingency plans are made when something unexpected happens or when something needs to
be changed

STRATEGIC PLANNING
What is strategic planning?
Strategic planning is an organization's process of defining its strategy, or direction, and making
decisions on allocating its resources to pursue the strategy. It may also extend to control
mechanisms for guiding the implementation of the strategy.
Strategic planning became prominent in corporations during the 1960s and remains an important
aspect of strategic management. It is executed by strategic planners or strategists, who involve
many parties and research sources in their analysis of the organization and its relationship to the
environment in which it competes.

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Strategy has many definitions, but generally involves setting goals, determining actions to
achieve the goals, and mobilizing resources to execute the actions. A strategy describes how the
ends (goals) will be achieved by the means (resources). The senior leadership of an organization
is generally tasked with determining strategy. Strategy can be planned (intended) or can be
observed as a pattern of activity.
Strategic planning is a process in which management of an institution define their vision for the
future and identify their organization's goals and objectives. The process includes establishing
the sequence in which those goals should be realized so that the organization can reach its stated
vision. Strategic planning typically represents mid- to long-term goals with a life span of three to
five years, though it can go longer.
The product of strategic planning is a strategic plan. It is often reflected in a plan document or
other media. These plans can be easily shared, understood and followed by various people
including employees, business partners, and investors.

TYPES OF STRATEGIC PLANS

• Strategic planning activities typically focus on three areas: business, corporate or
functional. They break out as follows:
a. Business Strategic plan: A business-centric strategic plan focuses on the competitive
aspects of the organization -- creating competitive advantages and opportunities for growth.
These plans adopt a mission evaluating the external business environment, setting goals, and
allocating financial, human and technological resources to meet those goals.
b. Corporate Strategic Plan: A corporate-centric plan defines how the company works. It
focuses on organizing and aligning the structure of the business, its policies and processes
and its senior leadership to meet desired goals. For example, the management of a research
might be structured to function dynamically and on an adhoc basis. It would look different
from the management team in finance or HR.
c. Functional Strategic Plan: Function-centric strategic plans fit within corporate-level
strategies and provide a granular examination of specific departments or segments such as
marketing, HR, finance and development. Functional plans focus on policy and process --
such as security and compliance -- while setting budgets and resource allocations. In most
cases, a strategic plan will involve elements of all three focus areas. But the plan may lean
toward one focus area depending on the needs and type of business.

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THE STEPS IN THE STRATEGIC PLANNING PROCESS:
There are many different ways to approach strategic planning depending on the type of
institution and the granularity required.
Most strategic planning cycles can be summarized in these four steps:
 Step 1: Identify: A strategic planning cycle starts with the determination of an institution
current strategic position. This is where stakeholders use the existing strategic plan --
including the mission statement and long-term strategic goals -- to perform assessments of
the business and its environment. These assessments can include a needs assessment or a
SWOT (strengths, weaknesses, opportunities and threats) analysis to understand the state of
the institution and the path ahead.

 Step 2: Prioritize. Next, strategic planners set objectives and initiatives that line up with the
institution mission and goals and will move the institution toward achieving its goals. There
may be many potential goals, so planning prioritizes the most important, relevant and urgent
ones. Goals may include a consideration of resource requirements -- such as budgets and
equipment -- and they often involve a timeline.
 Step 3: Develop. This is the main thrust of strategic planning in which stakeholders
collaborate to formulate the steps or tactics necessary to attain a stated strategic objective.
This may involve creating numerous short-term tactical institution plans that fit into the
overarching strategy. Stakeholders involved in plan development use various tools such as a
strategy map to help visualize and tweak (fine tune) the plan. Developing the plan may
involve cost and opportunity trade-offs.
 Step 4: Update. A strategic plan is periodically reviewed and revised to adjust priorities and
re-evaluate goals as business conditions change and new opportunities emerge.

The outcome of an effective health planning process should be an actionable link between
needs and resources. The health planning process itself can be a deliverable.

A good planning process reflects necessary perspectives and engages key stakeholders in the
development of strategies. Through that process, some of the initial marketing of the changes
required will be accomplished maximally

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Health planning comprises a range of activities that share the goal of improving health
outcomes, or improving the efficiency of health services provision, or both. Health Planning
occurs within the pressured environment of political direction, changing public expectation,
new information and evidence about outcome.
A solid and well designed health planning process will be resilient enough to accommodate
these pressures and to use them as levers to go forward to dialogue and solutions for improved
health care provision and health outcomes in the population
The Four types of health planning:
1-Health system planning
2- Health services planning
3- Health goals planning
4-Population health planning.
Techniques/steps used in health Planning:
1-Surveying the Environment:
This often involves extensive information gathering to determine the health or illness profiles
and experiences of the population of interest. It is meant to identify the current state of the issue
under consideration.

2- Setting Directions:
This involves setting goals and objectives, and it also involves establishing the standards against
which current health/illness profiles, or current organizational or system performance, will be
compared. This step is meant to identify the desirable future state (expressed as outcomes if
possible) for the issue under consideration.

3- Problems and Challenges: This involves identifying and quantifying the shortfalls (if any)
between what is and what ought to be.

4- Range of Solutions: This involves identifying the range of solutions to each identified
problem or challenge, and includes assessing each possible solution in terms of its feasibility,
cost and effectiveness so that alternative solutions can be compared with each other.

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5- Best Solution(s): This step involves a choice of the solution, or set of solutions, that
Should be implemented to address the problems or challenges identified in step three. The choice
may need to take into account fiscal, political and other limitations.
6- Implementation: The chosen solutions are implemented, and often begin with the
development of an implementation plan. This step may begin with development of an evaluation
plan well before evaluation actually takes place.
It may also involve development of ongoing monitoring methods to be used to continuously
identify and assess the intended and unintended consequences of implementation action
7- Evaluation: This involves assessment of the implementation results to determine whether the
implemented solutions are effective in achieving their goals. It also involves evaluating the
environment to see if it has changed, thereby rendering the solutions less effective, more
effective or irrelevant.
Steps in Health Planning Process:
Health planning follows the same basic steps that any planning process follows. In health
planning these steps constitute a cycle that is normally repeated in terms of planning for
programs, Systems, populations or health goals. Repetition of the cycle is usually necessary
because any or all of the following conditions prevail:

1- Definitions of what constitutes “health” will change, necessitating planning to take into
account the effect of the new definition on society’s health goals.

2- New techniques and technologies to create, restore or support health emerge continually, so
planning must be cyclical to integrate these emerging innovations into the planning process.

3- Unforeseen health conditions emerge (a rapidly spreading infectious disease for example),
requiring a new planning cycle to factor in these conditions. Similarly, emerging social
conditions (an increase in child poverty for example) can have implications that require a new
planning cycle to deal with the health effects of the change.

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4- Changed economic conditions may necessitate a new cycle of planning. If a major economic
downturn occurs, for instance, a population’s health may decline at the same time as
governments constrain their spending on health – making a new “lean times” planning cycle
necessary.

5-Evaluation of the results of a planning cycle will often show weak spots in the initial planning,
necessitating new cycles to correct for past oversights and miscalculations.

Most planning cycles (health or non-health) comprise seven basic steps that can be shown
graphically.

Strategic planning:
Strategic planning is an organization's process of defining its strategy, or direction, and
making decisions on allocating its resources to pursue this strategy. It may also extend to
control mechanisms for guiding the implementation of the strategy, and usually extend up to 5
years and more.

Strategy has many definitions, but generally involves setting goals, determining actions to
achieve the goals, and mobilizing resources to execute the actions.

A strategy describes how the ends (goals) will be achieved by the means (resources). The senior
leadership of an organization is generally tasked with determining strategy. Strategy can be
planned (intended) or can be observed as a pattern of activity (emergent) as the organization
adapts to its environment or competes.

Strategy includes processes of formulation and implementation; strategic planning helps

coordinate both. However, strategic planning is analytical in nature.

The Key to any strategic planning exercise is the development of a vision and a clear mission
statement.

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Vision usually address the big picture, what the organization aims to be and look like within a
stated period typically might be three, five years or more, its refers to future state or condition
which is better than which is presently exists e.g.
The Vision of the Ministry of Health Government of South Sudan is:
A Healthy and productive population in South Sudan living a dignified life
The mission statement must express to all – employees, clients and other Stakeholders – what
the organization’s current purpose is.
It should be expressed at a high level, yet be rich in Portraying purpose, and values .e.g
The Mission statement of the Ministry of Health, Government of South Sudan
Is:
To improve health status of people by effective delivery of the basic package of health and
nutrition services (BPHNS), through provision of health promotion, disease, injury, and
disability prevention, treatment and rehabilitation services, with full participation of the people.

The policy objective is to address the current challenges in human resource development through
strategies that include developing qualified health workers and trainers, developing
appropriate training curricula and continuing education programs.
The Mission statement should:
1-Express an organization’s purpose in a way that inspires support and ongoing commitment
2- Motivate those who are connected to the organization
3- Be articulated in a way that is convincing and easy to grasp
4- Use proactive verbs to describe what the organization does
5- Be free of jargon
6- Short enough so that anyone connected to the organization can easily repeat it.

A strategic planning process is used when there is a broad and open question to be answered,
For example, identifying the desired model for delivery of children’s mental health service in
rural settings and determining how to move to that model.

Usually a strategic planning process assumes a new look at an issue, and an outcome that will
take time to put in place but will exist for a period longer than one year.

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Generally speaking it is assumed that a strategic plan will need to be revised or redone when the
context in which the service exists changes markedly.

A change in context could relate to challenges to sustainability, opportunities to expand, or

newly identified best practices that should be incorporated into the plan.

The Five-Year Strategic Plan sets the overall direction for future health service delivery to the
population. It charts the move toward enhanced integration, responsiveness and innovation for
all health services across the region, and in particular it outlines:
1- Priority issues in the health authority
2- Critical challenges to population health and health service delivery in the region
3- Goals and strategic themes that will guide service health delivery
4- Strategic directions by sector and by geographic area.
The Plan advances strategic thinking to include organizational restructuring, new and innovative
service Delivery models and future capacity forecasts. It is aligned with the strategic direction of
the Ministry of Health, recognizes the significant differences in demographics and health status
throughout the health authority, and reflects clinical input and practical experience.
Strategic Planning Process Components
The components of the health service planning process and the subsections of each include the
following elements:
1. Scope the planning activity
 Define the planning parameters (including exclusions)
 Identify the desired deliverable/output
2. Understand the population and service environment
 Scan the environment
 Profile the population
 Profile and understand the health status of the population
 Profile the geographical context
 Profile the health status
 Profile current service arrangements
 Profile service activity (current and projected)
3. Identify the health service needs

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  Identify health service issues (current and projected)
 Develop an approach to categories and analyze needs
4. Prioritize the health service needs
 Determine prioritization criteria
 Apply the prioritization process
5. Identify the service directions
 Develop possible service directions
 Determine criteria for success (of the planning activity)
6. Identify service options
 Develop service options
 Establish preferred service options
 Consider opportunities for innovations (research service models)
 Analyze feasibility
 Identify indicative resource implications (including for enabling functions)
7. Develop objectives and strategies
 Create Vision and mission
 Develop objectives
 Establish strategic direction
 Understand future service change
 Establish final resource implications
 Establishing strategic directions
 Developing a framework to establish and monitor success – a balanced scorecard
approach
 Creating an implementation plan/timetable.

Although originally developed for the corporate sector, the balanced scorecard has become
popular within the health sector as a tool for both planning and monitoring
. The balanced scorecard suggests that an organization be
Viewed from four perspectives, and that data collection and analysis be carried out relative to
each of these perspectives.

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TYPES OF HEALTH PLANNING:
Health service planning is based on the health needs of users (or potential users) of services and
may take place in different contexts such as: Planning for a particular geographical
catchment relates to heath service planning for a defined population.

The key service areas that may be considered within the health care system are:
1-Preventative, promotion and protection
2-Primary health care
3- Ambulatory care
4- Acute care
5-sub-acute care
6- Mental health
7-Aged care.

1. Planning for a particular population group relates to planning for a health issues for a
specific population cohort (for example, Aboriginal and Torres Strait Islanders).This type of
planning could also target a particular geographical catchment.
2. Planning for clinical or service streams relates to planning for a specific clinical stream or
services (such as cardiac or diagnostic imaging) to provide evidence based, safe high quality
and appropriate clinical services. This type of planning could also target a population or
geographical catchment (for example, statewide).

TOOLS FOR STRATEGIC PLANNING

The best tools for strategic planning are often the ones that the person leading the planning is
most familiar with and has used successfully in previous initiatives. However, there are
commonly accepted tools that bring consistency to strategic planning:

SWOT ANALYSIS:

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This is an outline of strengths, weaknesses, opportunities, and threats to, the organization. It is
usually done at the start of a strategic planning exercise in a group setting, to identify all factors
in each area. The factors are usually organized in a table of four quadrants so participants in the
planning exercise can visually and easily see the context for the planning:
.
1-Strengths include factors like staff capabilities, effective management processes, competitive
advantage and unique programs or products.

2-Weaknesses include factors like gaps in staff skills, financial problems and inadequate
information systems

3-Opportunities include factors like global influences, new policy developments, partnerships
and research

.4-Threats include factors like market demand, loss of key staff and political effects.

PROGRAM LOGIC MODEL:

This model allows the effects of a proposed change to be determined. It is very helpful for
program planning and implementation monitoring. A logic model depicts action by describing
what the program is and what it will do – the sequence of events that links program investments
to results.

THE SIX MODEL COMPONENTS:

1- Situation: Problem or issue that the program is to address sits within a setting or situation
from which priorities are set
2- Inputs: resources, contributions and investments that are made in response to the situation.
3-Outputs: activities, services, events, and products that reach people and users.
4- Outcomes: results or changes for individuals, groups, agencies, communities or systems.
5-Assumptions: beliefs people have about the program, the people, the environment and the way
they think the program is going to work.

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6-External factors: environment in which the program exists includes a variety of external
factors that interact with and influence the program action more information is at

EVALUATION:
Evaluation is defined as a way of determining the effectiveness, efficiency and acceptability of a
program in achieving stated goals. It is an organized way of learning about the program, its
context, goals, objectives, processes, outcomes, strengths and weakness and applying the
knowledge learned to improve the program.

In other way, evaluation is mainly concerned with assessing the achievement of results and the
efficient management of resources. It helps to uncover deviation from the plan so that corrective
measures can be instituted in good time.

THERE ARE TWO TYPES OF EVALUATION:

1- Quantitative evaluation: it attempts to measure or obtain a quantitative fix on what is going
on. For example it counts instances and uses numbers as its baseline for comparison.
2- Qualitative evaluation: it attempts to describe what is going on through observations,
interviews and stories.

ORGANIZING:
Organizing is a management functions which involves putting the theory, the plan into practice,
so arranging the work to be performed that the objectives will be achieved as laid down in the
plan.

The work should be fairly organized and distributed based on the individual’s skills and
potentials. Opportunities should be provided fairly whenever they arise, with the use of job
description to define what each member should be doing.

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Organizing includes the following activities:
Implementing:
This involves the conversion of theoretical plans into action, without implementation the plans
remains theoretical and useless. When implementing the plans, the manager carries out several
sub-functions of the management including organizing, staffing, directing motivating,
supervising, delegating, coordinating, budgeting and communicating.

Resources Management: this is a major challenge for a health worker or a manger, the ability
to appropriately manage the scarce or limited resources under his/her charge at a work place. The
resources at a work place include human and materials resources. Proper and efficiency
management of a limited resources allocated to improve health service delivery is important.

Since resources available for investment in health services are limited, Health service planning
processes will identify needs and service issues (and associated enabling services such as
technology, workforce, funding, capital infrastructure, and information management) over
and above available funding.

Prioritization of needs identified through a rigorous health service planning process will support
resources being directed toward the areas of greatest need.

SYSTEMS APPROACH TO INISTITUTION MANAGEMENT

Originated from the general systems theory, developed by Ludwig Von Berta lanffy, Chester
Barnard was one who applied systems approach to management. He perceived executive as a
part of formal organization and the organization as a part of whole co-operative system with
physical, biological, social and psychological elements.

A SYSTEM is a set of interrelated parts which though separate have a common purpose
towards which they work. Parts form a unified whole. Each and every part is equally important is

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constituting the whole. Example Human body: composed of many sub systems such as
respiratory, digestive, nervous, circulatory, etc

CHARACTERISTCS OF A SYSTEM
 Every system is a part of a larger system called as SUPRA SYSTEM.
 All systems as a rule have subsystems and are also a part of supra system ( eg. School-
secondary boards-state- nation – supra system)
 A system always has specific aims and objectives
 A system may be either closed or open.
Closed systems are subject to entropy- the tendency to run down. Open systems receive inputs
from the environment and so there is no entropy.
A system is separated by boundaries from its environment. System absorbs members from
external environment. Members of an institution possess multiple memberships. There is
resource exchange between an institution and its external environment. The whole system is
greater than its parts.
• In order to achieve dynamic equilibrium, a system must have feedback (informational input)
to indicate that the system is at least going steady and not in the danger of gradual
destruction. The output of one system becomes input for the other system and the chain
continues

TYPES OF SYSTEM
I. Closed system
II. Open system
CHARACERISTICS OF A GOOD SYSTEM
 Effectiveness,
 Efficiency,
 Dependability,
 Flexibility,
 Acceptability
DEFINITIONS OF SYSTEMS APPROACH:

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• Systems approach is a management tool that allows individuals to examine all aspects of the
organization, to interrelate the effects of one set of decisions to another and to optimally use
all the resources at hand to solve the problem.

KESHAV and MICHLEAN Defines Systems approach as one of the techniques which aims in
finding the most efficient and economical intelligent methods for solving the problem of
education scientifically.

Model of SYSTEMS APPROACH

INPUT PROCESS OUTPUT

EXTERNAL ENVIRONMENT

FEEDBACK

SUBSYSTEMS OF HEALTH INSTITUTION

 Technical subsystem
 Social subsystem
 Structural sub system
 Managerial subsystem

IMPORTANCE OF SYSTEM APPROACH IN A HEALTH INSTITUTION:

 Provides framework for planning, decision making control and problem solving

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 Throws light on dynamic nature of management
 Institution is viewed as an adaptive system, which adjusts as per environment changes in
order to survive.
 Provides a unified focus to institutional efforts.
 Helps to look at institution as a whole and not as parts.
 Helps the manager to identify the critical sub systems and their interaction with each other.
The practicing manager learns to see the phenomenon not in isolation but in its relation to
other phenomenon and elements because of constant interactions.
 Helps in improving institution
 Helps in bringing efficiency in school administration and management
 Helps in systematic educational planning
 Maximum utilization of resources
 Maintaining, controlling and improving the guidance services.

FACTORS AFFECTING HEALTH INSTITUTIONAL CLIMATE

1) External factors :
 Government policies
 Time management eg admission tests.
 Salary of Employees
 Competition
 Political and economic scene
 Social and cultural interferences
• Resource and financial factors.
2). Internal factors:
 Competitions among staff
 Biasness
 Adopting unfair means
 Exploitation of staff
 Relationships amongst staff and students, between staff members, staff and authorities.
 Nature of distribution of work
 Policy issues on compensation, incentives and professional growth

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QUALITY MANAGEMENT
Meaning of Quality:
A product or service that meets design specifications is a quality product or service.
• A product or service that satisfies the customer‘s expectations is quality product or service.
So we can say Quality is that perfect control over all processes both technical and
business.
Meaning of Quality Indicator:
Quality indicator provides an indication as to the quality of the progress made by an institution
towards implementing its goals.

INSTITUTIONAL QUALITY
Meaning of Institutional Quality
• Existence of all the attributes that give the institution the stature and the characteristics that
works towards a successful contribution to the promise that the institution stands for.
• The short term and long term goals of an institution along with the achievements of its
defined goals.
Broad Dimensions of institutional quality (Quality Indicators)
• Tangible aspect- Infrastructural facilities and their management.
• Non-tangible aspect-The process of Implementation.

Quality Indicator:
• It measures the quality of progress made by an institution towards implementing its goals.
Quality indicator = Area of focus + evidence

In other words Institutional quality is measured or understood by the identification of indicators

that are definable and measurable.

In Short Institutional quality is ………….

1. Achieving institution‘s mission and goals

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2. Continuous improvements
3. Multifactor concept (reliability, durability, fitness, aesthetics etc)
4. Perfection
5. Totality of features
6. Satisfaction
7. Meeting all standards.

Features of Institutional quality

• Focus on organizational mission
• Continuous improvements
• Staff orientation
• Leadership commitment
• Empowerment
• Collaboration
• Focus on process
• Focus on data and statistical thinking

Importance of Maintaining Institutional Quality:

1. Helps institutions to develop higher level of quality covering even support facilities.
2. Protection and guidance of staffs.
3. Develops an internal quality culture.
4. Facilitates sharing of best practices and the establishment of common standards
procedures and guidelines, leading to mutual recognition.
5. Achieve transparency, comparability, and compatibility of quality assurance systems.
6. Establishes compatible procedures and common standards plus guidelines for quality.

QUALITY ASSESSMENT:
• It is a process that measures the adherence of a program to those standards of quality that
have been agreed upon.

TOOLS FOR QUALITY ASSESSMENT:

• Self evaluation checklists.

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• Analysis of statistical information and use of performance indicators and standards.
• Testing the knowledge, skills and competencies of staffs.
• Observation instruments and surveys.

LEADERSHIP
Leadership is a process of providing direction in group activities and influencing their though,
behaviors and actions positively towards achieving the objectives of the organization willingly
and enthusiastically.

An effective leader guides, direct and moves people towards the attainment of the stated goals of
the organization. The characteristics of a good leader are:
1-The ability to influence the thought, behaviors and action of others (should have power and
authority)
2-Have an understanding of what makes peoples work, what motivate or de-motivate workers.
3-The ability to inspire people to accomplish groups and individuals goals
4-The ability to create a conducive working environment
5The ability to analyses the social situation in which he/she must act. A manger should not
operate by a fixed set of rules but should have a good understanding of the leadership styles
which are appropriate in different social situations.

TYPES OF LEADERSHIP STYLES:

• Authoritarian
• Democratic
• Laissez-faire

1. The Authoritarian:

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Authoritarian Leadership: here a leader maintains strong control over people in the group. This
control may be benevolent and considerate (Paternalistic leadership) or it may be dictatorial, with
the complete disregard for the needs and feelings of group members. Authoritarian leaders give
orders and expect group members to obey these orders. Directions are given as commands, not
suggestions. Criticism is more common from the authoritarian leader than from the other types,
although not necessarily a constant occurrence. Mostly authoritarian leaders are also quite
punitive (like punishing).

The leader alone, not by the group, does decision- making. Some will try to make decisions
congruent with the group's goals. The less benevolent leaders will make decisions that are
directly opposed to the group's needs or goals. The authoritarian leader clearly dominates the
group, making the status of the leader separate from, and higher than, the status of group
members. This reduces the degree of trust and openness between leader and group members,

Authoritarian leadership is particularly suitable in an emergency situation when clear directions

are the highest priority. It is also appropriate when the entire focus is on getting the job done or
in large group when it is difficult to share decision making for some reason. It is often referred to
today as a directive or controlling style of leadership.

2. Democratic leadership Style:

This is based on the following principles:

 Every group member should participate in decision-making

 Freedom of belief and action is allowed within reasonable bounds that are set by society and
by the group.
 Each individual is responsible for himself or herself and for the welfare of the group.
 There should be concern and consideration for each group member as a unique individual.
 Democratic leadership is much more participative and far less controlling than authoritarian
leadership.
 It is not passive, however. The democratic leader actively stimulates and guides the group
toward fulfillment of the principles listed and toward achievement of the group's goals.

35
 Rather than issuing commands, democratic leader offer information, ask stimulating
questions, and make suggestions to guide the work of the group.
 They are catalysts rather than controllers, more likely to say "we" rather than" I" and "you"
when talking about the group.
 They set limits, enforce rules, and encourage productivity.
 Criticism is constructive rather than punitive.
 Control is shared with group members who are expected to participate to the best of their
abilities and experience.

• The democratic style demands a strong faith in the ability of group members to solve
problems and to ultimately make wise choices when setting group goals and deciding how to
accomplish these goals.
• Most studies indicate that democratic leadership is not as efficient as authoritarian leadership.
While the work done by a democratic group is more creative and the group is more self-
motivated, the democratic style is also more burdensome.

DISADVANTAGES OF DEMOCRATIC STYLE OF

LEADERSHIP:
• First, it takes more time to ensure that everyone in the group has participated in making
decision, and this can be very frustrating to people who want to get a job done as fast as
possible.
• Second, disagreements are more likely to arise and must be resolved, which can also require
much effort.

3. LAISSEZ FAIRE/ FREE RANGE:

This type of Leadership style is characterized by:

 The leader is generally inactive, passive, and non-directive.

 The laissez- faire leader leaves virtually all of the control and decision making to the
group and provides little or no direction, guidance, or encouragement.
 Laissez faire leaders offer very little to the group: few commands, questions, suggestions, or
criticism.

36
 They are very permissive, set almost no limits, and allow almost any behavior.
 Some laissez faire leaders are quite supportive of individual group members and will provide
information or suggestions when asked.
 The more extreme Laissez faire leader, however, will turn such a request back to the group.
When the Laissez faire style becomes extreme, no leadership exists at all.
 In a Laissez faire group, members act independently of each other, disinterest will set up,
activity becomes chaotic and the frustration level rises. The goals are unclear and procedures
are confusing or absent altogether. In most situations, however, laissez faire leadership is
unproductive, inefficient, and unsatisfactory. Laissez-faire leadership is often called
permissive or non -directive leadership today.

LEADERSHIP THEORIES:
1. Trait Theories – If you have ever heard the statement that “leaders are born, not made”,
then you have heard someone expressing the fundamental belief underlying a trait theory
of leadership. Trait theories assume that a person must have a certain innate abilities,
personality traits, or other characteristics in order to be a leader. If true, it would mean that
some people are naturally better than others.
2. Behavioral Theories: The behavioral theories, sometimes called the functional theories
of leadership, still focus on the leader. The primary difference between the trait and
behavioral theories is that the behavioral theories are concerned with what a leader does
rather than who the leader is. They are still limited primarily to the leader element in a
leadership situation, but they are far more action oriented and do consider the co-actors.
3. Transformational Leadership theory: this is the leadership theory that believed that,
the leaders are a person that inspire and motivate followers to exceed expectations.
4. Contingency (situational theory): this theory argues that, no single leadership style is best.
But effective leadership depends on the situation.
5. Transactional Theory: this theory is based on exchanges between the leader and the
followers. Rewards and punitive, and focuses on structure and supervision.

Fig- 6.1 comparison of authoritarian, democratic, and Laissez-faire leadership styles

Management Theories

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 Authoritarian Democratic Laissez Faire

Degree of freedom Little Freedom Moderate Freedom Much Freedom

Degree of Control High control Moderate Control No control

Decision Making By the Leader Leader and Group By the group or by no one
Together

South Sudan National Health system:

The national health system policy was developed by the MOH through extensive consultation
with key stakeholders. The policy sets out the principles of health care system of the country and
the priority areas that needs intervention in order to achieve the overall health vision of health for
all. The principles were the basis for setting health targets and consequently developing
strategies and actions.

The Health system development plan (HSDP) present or outline general framework that is
designed to guide strategies and interventions to be implemented by the government and
stakeholders the four level of health system. The national health policy comprises of all
resources institutions, stakeholders, and actors, both public and private, with the primary
purposes of achieving and sustaining good health of south Sudanese.

The public sector includes all government health institutions under the national and states
ministries of health, and health facilities, and health activities managed by other ministries e.g.
the ministry of defense. The private health care system consists mainly of NGOs, and non0profit
and profit practitioners.
The Primary Responsibilities of Ministry Of Health:
The MOH has a primary responsibility for:

- Overseeing the system,

38
- Co-coordinating agencies and stakeholders providing guidance,
- Establishing management and financial tools for good governance, and monitoring
achievements.
- Receives budgets allocation for health and the budget calculation from the states,
- Allocate and distribute financial resources, trains assignments, and manage human resource.

Providing actual health services is the responsibility of the state’s MOHs, county health
department (CHD), Payam and Boma health committee.

The South Sudan transitional constitution recognizes health services as basic human rights to be
respected, promoted, and respected, and ensures access to quality basic health care services to
promote health, economic, productivity, and poverty eradication by strengthening health system.

South Sudan National Health Policy Development:

The development of South Sudan national health policy was bottom up approach, involving
county, states, and the national health systems stakeholders, technical, and political leadership,
health development partners, NGOs, civil society organizations, and special interest groups.
Concepts of Health System Management:
The effective management of health services is crucial issue in primary health care(PHC)
implementation and delivery of health service. All health managers at all levels and the
institution of health care system should apply the knowledge of management to achieve the goal
of health care systems in general, and individual institution in particular.
It is important that health professionals identify the key functions and components of health
service management in the context of an integrated PHC approach in order to apply the
knowledge and skills in practical work situation.

Primary Health care:

Definition:
Primary health care (PHC) is an essential health care based on practical, scientifically sound and
socially acceptable methods, and technology, it should be universally accessible to individuals
and families in the community, at an affordable costs.

39
The community participates in PHC to develop the spirit of self reliance and self-determination.
It forms an integral part of both country health system, of which it is the central function and
main focus, and of overall social, and economic development of the community. It is the first
level of contact for the family and the community of the national health system that brings health
care as close as possible to the people where they live and work.

The concepts of primary health care system:

1- Essential health care: the health care that meets the health needs of the majority of people
2- Scientifically sound and socially acceptable method and technology:
The health service that should be able to care or solve the problems in question without
conflicting with the norms of the community receiving the service
3-Accessibility: If such a service is to promote health in the community then it has to be
accessible to individuals and families in the community [Link] within easy reach.
4- Community participation: The process by which individuals and families assume
responsibilities for their own health and welfare and that of their community. People are
involved in identifying their own health problems. They take part in planning, implementation
and evaluation of their own health service, thus services will be socially acceptable and people
are likely to value it more than if they took a passive role or if it was imposed on them.

5-Affordability: The initial cost of the service and the cost of maintaining it should be
affordable by the community/country.

6-Self-reliance: individuals and families are encouraged to change from the attitude of believing
that a health service will be brought to them by the government and NGOs without working for it
themselves or actively participating in the process.

The Components of primary Health care system (Elements):

The basic components or elements of PHC package that needed action in order to reach the
health for all objective includes:
1-Education: educate the people on the concern or prevailing health problems and targeted to
individuals and communities in each country.
2-Food and nutrition: promotion of adequate supplies and nutrition to the people

40
3-Sanitation and water: promotion of safe water and emphasis on environmental sanitation
among communities.
4-Mother and child health (MCH/family planning service): promotion of mother and child
health through provision of MCH?FP services for communities.
5-Immunization: aimed at protecting vulnerable groups against major infectious diseases.
6-Treatment: appropriate treatment of common diseases and minor injuries.
7-Prevention and control of diseases: prevention and control of diseases that are a constant
threat to many communities.
8-Essential drugs: A list of basic and essential drugs to treat most common conditions
formulated on individual country epidemiological pattern and needs.
9-Mental health/dental health services: promotion of both mental and oral health services for
communities in order to fight mental illness and dental problems prevalent in most communities.
10-Accident prevention: prevention of domestic and motor accidents that claims many lives
worldwide.

Health system management:

The health indicators are considered to be the poorest globally as the maternal mortality rates
(MMR) was estimated at 2, 054 death per 100,000 live deaths, while the infant mortality rate
(IMR) was estimated at 102 deaths per 1,000 live births but recent survey indicates some
improvement.
Structure of health system, and service delivery:
Health service delivery in south Sudan is structured along the following four tiers; primary health
units (PHCUs), primary health care centres (PHCCs), County hospitals (CHs), and State
hospitals (SH),teaching hospitals (THs).These facilities are to a large extent aligned to the
administrative subdivision of the country in which both rural, and urban areas..PHCUs, the first
level of primary health care, provides basic preventive, promotive, and curative services, and are
expected to serve a population of 15,000.

41
PHCCs are the immediate level of referral for the PHCUs. In addition to services provided at the
PHCU, PHCCs deliver diagnostic laboratory services, maternity and in patient care. They are
expected to serves a population up to 50,000.

PHCCs are usually situated at Payam headquarters. However, in urban areas, due to the size of
the population, PHCUs are located at Bomas offering facility based services, and outreaches
organized from PHCCs to Bomas, and villages.

The county hospitals CHs are located at county administrative headquarters of local government.
The CHs serves as a referral level for PHCCs, and provides emergency surgical operations, and
serves the population of 300, 000, while state hospitals serves a population of approximately
500,000.

County and state hospitals represent the secondary health care level, where general medical
specialist such as surgeons, obstetricians, physicians, and pediatricians provide care, training and
monitoring interns..

The organizational structure:

The diagrammatic representation depicts the management structure of the MOH. At the national
level, the ministry provides leadership, develops polices, guidelines and standards, engage in
advocacy and resource mobilization, and supervises the overall health care service delivery in the
country, and manage teaching hospitals.

The state ministries of health SMOH provide leadership for health service delivery and
management in their respective states. The SMOH and CHs are responsible for delivery of
secondary and primary health care services. The CHDs manage the delivery of PHC services at a
Payam, and Boma/village level, and participate in the management of health care facilities in
their locations. in addition there are many PHCUs, and PHCCs run and managed by NGOs
(national, international and faith based) in close collaboration with SMOHs and CHSs.

The Six building blocks of the health system (WHO):

42
1-Improve health service delivery: this is done with emphasis on maternal & child health care
service (MCH),by ensuring relevant services are accessible and acceptable, reducing inequalities
to care, extending coverage through mobilization, communities, developing effective
partnership, implementing the Basic package of health services. (BPHS), capacity building, and
integrating diseases prevention and control programmes.
2- Strengthen human resources development & management: this is done through the MOH
by strengthening HRH healthy policy making, planning and evaluation.
3-Develop evidence based (HMIS) culture: within the MOH by strengthening health policy
making, planning and monitoring and evaluation.
4- Develop a pharmaceutical and medical supplies system: through capacity building,
effective planning and efficient financing mechanism

5-Develop health financing & resources mobilization system: that is fair, efficient, and
provides financial risk protection. Improve the financial management system to ensure
transparent tracking of the flow of funds in the health sector and align spending with priorities in
an integrated budget.

6- Enhance the institutional development: of MOH to provide good leadership & governance
and have effective management through capacity development, improving accountability, and
transparency, and delegation, and decentralization.

Challenges and emerging health systems issues:

The main challenges of health system in South Sudan are as follow:
1. Inaccessibility to Medical care and Health Services: Inaccessibility to medical care and
health services due to geographical, institutional, socio-cultural, and financial barriers.
2. Ineffective referral mechanism: ineffective referral Mechanism between all level of health
service delivery due to inadequate communication, and transport, and weak linkages between
the different level of service delivery
3- Shortage of Technical Human Resource Personnel: Critical shortage of HRP hinder
effective health service delivery
4-Weak management information system
5- Insufficient planning and organizational capacity

43
6- Lack of accountability and transparent between stakeholders
7- Inadequate health budget and difficulty in approving budget
8- Inadequate and poorly managed pharmaceutical storage capacity and networking across
the country.
9- Limited capacity of health training institution.
10- Lack of standardized reporting forms for tracking data between health facilities ,NGOs
or vertical programmes. Etc.

Health System Strengthening:

Health System strengthening is essential for the development of capacity to foster improvement
in health service delivery. The essential six pillars of health system strengthening that contributes
to health System strengthening for effective health service delivery includes:
1-Leadership governance and finance
2-Human resource
3-Pharmaceutical and medical supplies procurement
4-Monitoring and evaluation systems
The availability of sufficient, adequate qualified staffing is essential for quality service delivery
as well as key determinants of cost. HRH is therefore the largest components of health systems
strengthening.

Human Resource for health:

There is critical shortage of health professionals, approximately about 10% position are filled by
qualified health workers, and it was estimated that, about 1.5 physician and 2 nurses/midwives
for every 100,000 citizens. Other less skilled cadres such as Community health worker
(CHWs,),community midwives (CM),maternal and child health worker (MCHWs),and home
health promoters (HHPs) provides health services in the community by promoting and
preventing diseases through community participation for effective access and utilization of
health services. They also support immunization and malaria campaign programs.

The human resource management system is weak, insufficient, lack job description, irregularity
of payment, lack of support supervision and quality control mechanism at all level. Lack of basic

44
information about the number, composition, and geographical distribution of health care
providers in the private, sector, insufficient coordination of human resources development across
different parts of the health system, poor recruitment, lack of clear retention policies, and poor
working [Link]

Supervision: essentially, supervision is the act of watching over the work of another person who
lacks full knowledge of what they are doing, or the concept at hand. This does not mean they
control the other persons, but they simply guide them in work or in a personal context.

To supervise someone properly, you first need to be able to lead them and have them understand
your way of doing things. This may take charisma and several other leadership qualities, but they
have to understand that you are the one in charge and that they are the ones who will follow what
you do and what you teach.
Directing:

Directing is a basic management function that includes building an effective work climate and
creating opportunity for motivation, supervising, scheduling, and disciplining.

Monitoring:

is to observe and check the progress or quality of something over a period of time; keep under
systematic review, to test a sample, especially on a regular ongoing basis or to keep close watch
over; supervise, and monitor an examination.

Motivating:
Motivating: this involves providing leadership for subordinates and requires the ability to inspire
them to give of their best in achieving the objectives by creating a good morale or working spirit
among all employees, and encourage them to work well and willingly in the most economical
manner in the best interest of the organization as well as in their own interests.

The objectives of organization can only be achieve through the efforts of peoples and people
need to be motivated, induced, persuaded, prevailed upon but not by force in a humane and
understanding way to give of their best. However, what motivate one person or a group of people

45
may not motivate others, and therefore for the best result a manager/supervisor should as far as
possible get to know something about each of his/her subordinates.

Coordinating:
coordinating is closely related to organizing and must ensures that although different staff may
perform different work, all their efforts mesh smoothly together and are directed towards the
achievement of common goals.

Communicating:
effective communication is important and must be encourage between members of the team such
that information can easily be disseminated among them, inform those who have excelled in
performance and appreciate and emulate their good work

Regular meetings are useful in bringing members together to work as a team.

Training opportunities should be provided for staff to update their knowledge and improve their
skills and make desirable behaviors changes.

Delegate responsibility and authority to the team members to act as supervisors, and recognize
their accomplishment adequately and remain always positive.

Collaborating:
There is no sector involved in development that can function properly in isolation without
involvement of other sectors. The activities of one sector influence and affect those of the other
sectors, these calls for constant consultation between major social and economic sectors to
ensures development and promote health as part of it.

Support for PHCC can come from others sectors like agriculture, water, community development
[Link] sectors can also serves as an entry points for development and implementation of
PHCC
Evaluating:

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Evaluation is defined as a way of determining the effectiveness, efficiency and acceptability of a
program in achieving stated goals. It is an organized way of learning about the program, its
context, goals, objectives, processes, outcomes, strengths and weakness and applying the
knowledge learned to improve the program.
In other way, evaluation is mainly concerned with assessing the achievement of results and the
efficient management of resources. It helps to uncover deviation from the plan so that corrective
measures can be instituted in good time.
The purpose of Evaluation includes:
1-Finding out what has been achieved
2-Judging the achievement
3-Guiding re-location of resources to improve the program
Steps in evaluating the program:
1. Decide what is to be evaluated
2. Select indicators (variables which help to measure success) acceptable as evidence of
satisfactory achievement.
3. Collect necessary information on actual performance
4. Compare performance results with the targets or objectives
5. Judge the degree to which the results have been of value.
6. Identify and describe the causes of deviation
7. Decide on further courses of action to be taken to correct the deviation
8. Write an evaluation report and circulate copies to the concerned parties.
Program phases evaluation:

A good evaluation should focuses on the program plan, and product (the outcomes), the
evaluator looks at the plans, goals, priorities and their relevance to the needs. The plan must be in
accordance with the country national health plan, and should examine whether what was
supposed to be done was actually done, it also looks at the strengths and weakness in the
implementation plan.

Supervising: supervision involves ensuring that employees perform the work allocated to them
in the way it is laid down, and with no wastage or duplication of time, effort or materials. This

47
involves much more than simply instructing a given number of employees to perform work, they
must be supervised and managed so that their efforts achieve the desired results, and this requires
that they are motivated, checked, guided, taught and encouraged.
All employees are human being with human failing, and their efforts cannot simply be switched
on or off like light bulb, they look forwards upon their supervisors/managers for direction.

Essentially, supervision is the act of watching over the work of another person who lacks full
knowledge of what they are doing, or the concept at hand. This does not mean they control the
other person, but they simply guide them in work or in a personal context.
To supervise someone properly, you first need to be able to lead them and have them understand
your way of doing things. This may take charisma and several other leadership qualities, but they
have to understand that you are the one in charge and that they are the ones who will follow what
you do and what you teach.

Motivating:
Motivating: this involves providing leadership for subordinates and requires the ability to inspire
them to give of their best in achieving the objectives by creating a good morale or working spirit
among all employees, and encourage them to work well and willingly in the most economical
manner in the best interest of the organization as well as in their own interests.
The objectives of organization can only be achieve through the efforts of peoples and people
need to be motivated, induced, persuaded, prevailed upon but not by force in a humane and
understanding way to give of their best.
However, what motivate one person or a group of people may not motivate others, and therefore
for the best result a manager/supervisor should as far as possible get to know something about
each of his/her subordinates

Controlling:
Controlling is the function of management which checks whether what was planned to happen
actually does happen, and if necessary, ensures that correctives action is taken. Within this
framework it can be seen that the work of all staff must be supervised and checked and further
instruction, guidance or training given when required. In addition all operations or processes

48
must be checked or inspected and performances measured against the targets set in the plans
and against set standards.

Controlling comprises supervising the people employed, checking their work, and equipment
used .it ensures that the end products are the desired objectives .it also include the recording of
performances to provide a guide for further similar activities in the future

Leadership:
Leadership is a process of providing direction in group activities and influencing their though,
behaviors and actions positively towards achieving the objectives of the organization willingly
and enthusiastically.
An effective leader guides, directs and moves people towards the achievement of the pronounced
goals of the organization. a good leader should adopt his/her attitudes to the prevailing situation.
Overview of management:
Management involves ensuring that a group of people work together in the most effective and
efficient manner to achieve a stated goal in the best and most economic way.

Management is the most difficult job as it involves dealing not with inanimate objects, services
or theories, but with unpredictable men and women –each of whom has a different and complex
characters, its involves providing leadership for the group and much more.

Role of manager in directing organizational activities:

A manager is a person who is set apart by his training and abilities. his/her role is to guide the
efforts of others, to interpret to his/her team of staff the policies of an organization, and to
plan ,organizes, direct co-ordinate and control their efforts so that the desired objectives of
his/her section, department or the organization are achieved in the most efficient and economical
manner.

The role of manager in organizations

49
  To keep his team organized, connected, and focused on results.
 Organize his/her work, hit more deadlines, and communicates progress.

Process of management:
Management process is a process of setting goals, planning, controlling, organizing and leading
the execution of any type of activity, such as: a project (project management process). A
process (management process) sometimes referred to as the process performance measurement
and management system).

Importance of management in organization:

1- It helps in Achieving Group Goals - It arranges the factors of production, assembles and
organizes the resources, integrates the resources in effective manner to achieve goals, and
directs group efforts towards achievement of pre-determined goals by defining objective of
organization.

Clearly, there would be no wastage of time, money and effort if the management could converts
disorganized resources of men, machines, money etc. into useful organization

These resources are coordinated, directed and controlled in such a manner that an organization
work towards attainment of the set goals.

2- Optimum Utilization of Resources:

The management utilizes all the physical & human resources productively; this leads to efficacy
in management. Management provides maximum utilization of scarceresources by selecting its
best possible alternate use in an organization from out of various uses.

It makes use of experts, professional and these services leads to use of their skills, knowledge,
and proper utilization and avoids wastage. If employees and machines are properly used to
produce maximum results, there would be no under employment of any resources.

3- Costs reduction:

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It gets maximum results through minimum input by proper planning and by using minimum
input & getting maximum output. Management uses physical, human and financial resources in
such a manner which results in best combination which helps in cost reduction.

4- Establishment of a Sound Organization:

Establishment of a sound organizational structure avoids overlapping of efforts (smooth and
coordinated functions) which tune with the attainment of objective of an organization, and for
fulfillment of this, it establishes effective authority & responsibility relationship i.e. who is
accountable to whom, who can give instructions to whom, who are superiors & who are
subordinates. Management fills up various positions with right persons, having right skills,
training and qualification, and all jobs should be clarify to everyone.

5-Establishment of Equilibrium:
Establishment of equilibrium which means (things in balance) enables the organization to
survive in changing environment.

It keeps in touch with the changing environment, both internal and external environment; the
initial co-ordination of organization must be changed Such that it adapts organization to
changing demand of market / changing needs of societies. Equilibrium is responsible for growth
and survival of organization.

6- Essentials for Prosperity of Society:

Efficient management leads to better economical production which helps in turn to increase the
welfare of people. Good management makes a difficult task easier by avoiding wastage of scarce
resource.

It improves standard of living, and increases profit which is beneficial to an organization and the
society will get maximum output at minimum cost by creating employment opportunities which
generate income in hands. Organization comes with new products and researches beneficial for
society

Techniques used in coordination:

51
Coordinating completion of complex tasks in an organization typically requires planning and
organization, with technology advancements, and variety of software application available this
enables managers to manage their organization projects and operations.

Techniques such as effective decision making, process improvement and time management,
allow mangers to get more done in less time to achieve the strategic goals and objectives, this
involves:
1-Establishing Structure
Creating an effective workflow starts by establishing a clear chain of command. Clearly defining
job roles and associated responsibilities ensures that everyone knows what to do.
Establishing an organizational chart lets everyone know who to contact when things go wrong.
This can be distributed by email, newsletter or company website. Each department should
produce regular status reports and communicate with other departments to ensure work flows
from one part of the organization to another. Process improvement initiatives examine workflow
processes to eliminate waste, reduce errors and improve customer satisfaction.

2-Planning Tasks
Project coordinators usually develop comprehensive plans to describe the work involved with
producing a company’s products and services. They use the techniques recommended by
professional organizations, such as the Project Management Institute. For example, these
coordinators use standard templates to complete a stakeholder analysis, develop a project charter,
create a work breakdown structure, assign resources and monitor task completion.
According to the Project Management Institute, during the planning process, the project manager
defines the objectives and gathers stakeholder needs to coordinate the team and direct efforts.
Team members can review the details associated with a project so there is no confusion about
what needs to be done and when it needs to occur.
3-Communicating Decisions
Good communication prevents disputes, conflicts and delays. Project coordinators can foster
effective communication by conducting regular team meetings, distributing status reports and
documenting decisions made. Effective leadership often involves influencing and motivating
team members to adhere to established policies and procedures so operations run smoothly.

52
Coordinating the efforts of many different employees, particularly when they are not located in
the same place or time zone, typically requires arranging regular meetings to exchange
information and using written communication to document procedures.
4-Aligning Activities
Developing and marketing a new product takes time and planning. To achieve an aggressive
deadline, several teams may be working in parallel. Coordinating the efforts requires an effective
liaison, ensuring supplies are ordered and delivered in time to use in production activities.
Volunteers may contribute to completing checklists or formal quality control processes can be
implemented to coordinate work flow effectively.

Circumstances of choosing basis: Staffs are required to make professional judgments in

particular circumstances such that the risks or hazards are mitigated or reduced, particular
attention focus on the following:
1- Risk
Determining that risks have been reduced, risk reduction involves an assessment of the risk to
be avoided, and the sacrifice required in term of ( money, time and trouble) involved in taking
measures to avoid that risk, and a comparison of the two.
2- Sacrifice
The sacrifice under consideration here is that which would be incurred by duty-holders as a
consequence of their taking measures to avert or reduce the risks identified, considering the
sacrifice needed in terms of money, time or trouble. These costs which should be considered are
only those which are necessary and sufficient to implement the measures to reduce risk.
3-Comparison
The basis on which comparison is made is provided by the examination of 'gross
disproportion'. In any assessment as to whether risks have been reduced. Measures to reduce
risk can be ruled out only if the sacrifice involved in taking them would be grossly
disproportionate to the benefits of the risk reduction.

That gross disproportion is required before a measure can be ruled out on the grounds of sacrifice
can be interpreted as applying a bias on the side of safety. "The greater the risk, no doubt, the
less will be the weight to be given to the factor of cost

53
4-Societal concerns
Societal concerns can arise when the realization of a risk impacts on society as a whole. The
impact may produce an adverse socio-political response (which has its origins in the public
aversion to certain characteristics of the hazards concerned).
The harm which results is a loss of confidence by society in the provisions and arrangements in
place for protecting people and, consequently, a loss of trust in the regulator and duty-holders
with respect to control of the particular hazard and hazards more generally.
5- Transfer of risks
Introduction of a health and safety measure to control a hazard may transfer risk to other
employees or members of the public.

If the transferred risk arises from the same hazard, then it should be offset against the benefit
from the measure under consideration. For example, the introduction of mechanical exhaust
ventilation may transfer the risk from the same hazard (fumes) from the employee to the general
public as the fumes are pumped outside the workplace. The added risk to the public should be
offset against the benefits the measure otherwise brings to employees.

If the transferred risk arises from a different hazard, it should be treated as a separate matter for
which control measures must be introduced to reduce its risk.

6- Changed circumstances
Duty-holders may wish to alter the conditions in which equipment is operated or to relax or
otherwise alter some or all control measures in response to changed circumstances. This is
permissible provided that the altered control measures continue to ensure that risks are reduced
7-Good practice
The determination of control measures forms part of the statutory risk assessment duty-holders
are required to undertake. Such assessments involve duty-holders identifying the hazards in their
workplace, determining who might be harmed and how; evaluating the risk from the hazards and
deciding whether the existing control measures are sufficient or whether more should be done
8- Choosing between options
A selection amongst options may be needed at any stage of a particular project: at the design
stage, involving choice between different design concepts for the whole project, and, as the

54
project is developed, between more detailed options. In making these options, duty-holders must
consider the risks involved in the whole life-cycle of a project.
Merits and elements of each basis:
Merit (Meritocracy): Advancement in such a system is based on performance measured through
examination and/or demonstrated achievement in the field where it is implemented
Merit System Principles:
1-Recruitment should be from qualified individuals from appropriate sources in an endeavor to
achieve a work force from all segments of society, and selection and advancement should be
determined solely on the basis of relative ability, knowledge and skills, after fair and open
competition which assures that all receive equal opportunity.

2-All employees and applicants for employment should receive fair and equitable treatment in all
aspects of personnel management without regard to political affiliation, race, color, religion,
national origin, sex, marital status, age, or handicapping condition, and with proper regard for
their privacy and constitutional rights.

3-Equal pay should be provided for work of equal value, with appropriate consideration of both
national and local rates paid by employers in the private sector, and appropriate incentives and
recognition should be provided for excellence in performance.

4-All employees should maintain high standards of integrity, conduct, and concern for the public
interest.
5-The Federal work force should be used efficiently and effectively.
6-Employees should be retained on the basis of adequacy of their performance, inadequate
performance should be corrected, and employees should be separated who cannot or will not
improve their performance to meet required standards.
7-Employees should be provided effective education and training in cases in which such
education and training would result in better organizational and individual performance.
8-Employees should be
a) protected against arbitrary action, personal favoritism, or coercion for partisan political
purposes, and

55
 b) Prohibited from using their official authority or influence for the purpose of interfering
with or affecting the result of an election or a nomination for election.
9-Employees should be protected against reprisal for the lawful disclosure of information which
the employees reasonably believe evidences--
c) a violation of any law, rule, or regulation, or
Mismanagement, a gross waste of funds, an absence of authority, or a substantial and specific
danger to public health or safety

Process of Coordination:
This process of coordination involves determining what work is needed to accomplish the goal,
assigning those tasks to individuals, and arranging those individuals in a decision‐making
framework (organizational structure).

The end result of the organizing process is an organization — a whole consisting of unified
parts acting in harmony to execute tasks to achieve goals, effectively and efficiently.

A properly implemented organizing process should result in a work environment where all team
members are aware of their responsibilities. If the organizing process is not conducted well, the
results may yield confusion, frustration, loss of efficiency, and limited effectiveness.

In general, the organizational process consists of five steps (a flowchart of these steps is shown
in Figure 1):

Properly implemented organizational process takes into consideration:

56
 1-Reviewing plans and objectives: These are specific activities that must be completed to
achieve goals. Managers’ plans shape the activities needed to reach those goals and continue to
do so as plans change and new goals are developed
. [Link] the work activities necessary to accomplish objectives:
Managers list and analyze all the tasks that need to be accomplished in order to reach
organizational goals.

3-Classify and group the necessary work activities into manageable units.
A manager can group activities based on four models of departmentalization: functional,
geographical, product, and customer.
4. Assign activities and delegate authority:
Managers assign the defined work activities to specific individuals, and delegate each individual
the authority (right) to carry out the assigned tasks.
5-Design a hierarchy of relationships:
A manager should determine the vertical (decision‐making) and horizontal (coordinating)
relationships of the organization as a whole. Next, using the organizational chart, a manager
should diagram the relationships.
In a health training institution the process of coordination is driven by a calendar of activities.
This carried out annually and outlined all the activities necessary for the running of an
organization [Link] activity planning for a training institution should take into consideration the
following slots:
 Recruitment of trainees
 Start of the academic year
 First semester
 Formative assessment
 Summative assessment
 Renovation of the entire training institution
 Ordering of training materials
 Workshop/refresher courses
 Inventory/stock taking
 End/closing of the academic year etc.

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 CONFLICT & CONFLICT MANAGEMENT
Define Conflict:

Conflict is a process in which one party perceives that another party has negatively affected or is
about to negatively affects something they care about. In organizations, conflict typically arises
from differences in goals, values, perceptions, interests, resources, roles, or communication
styles.

Conflict can be:

I. Intrapersonal (within an individual)

II. Interpersonal (between individuals)
III. Intra-group (within a team)
IV. Intergroup (between teams or departments)

Importantly, conflict is not always negative. When managed properly, it can stimulate
innovation, clarify issues, and improve decision-making.

Conflict Management:

Conflict management refers to the systematic process of identifying, addressing, and

resolving disagreements in a constructive manner to minimize negative outcomes and enhance
positive results.

Conflict Management normally focuses on:

 It focuses not necessarily on eliminating conflict, but on:

 Controlling its destructive effects
 Encouraging productive dialogue
 Achieving mutually acceptable solutions

Common conflict management approaches (based on the widely recognized Thomas-

Kilmann Conflict Mode Instrument) include:

58
 Avoiding – Ignoring or withdrawing from the conflict
 Accommodating – Yielding to the other party
 Competing – Asserting one’s position at the other’s expense
 Compromising – Finding a middle ground
 Collaborating – Working together for a win-win solution

Principles of Conflict Management in an Organization

Effective conflict management in organizations is guided by the following principles:

1. Early Identification
2. Address conflicts early before they escalate into larger problems.
3. Open Communication
4. Encourage honest, respectful, and transparent communication among employees.
5. Focus on Issues, Not Personalities
6. Separate the problem from the person. Avoid personal attacks and blame.
7. Active Listening.
8. Ensure all parties feel heard and understood before proposing solutions.
9. Fairness and Impartiality.
10. Managers should remain neutral and objective when mediating disputes.
11. Collaborative Problem-Solving.
12. Promote solutions that satisfy all parties rather than imposing authority-based decisions.
13. Clear Policies and Procedures.
14. Organizations should have structured grievance and dispute-resolution systems.
15. Emotional Intelligence.
16. Leaders should manage emotions—both their own and others’—to prevent escalation.
17. Respect and Professionalism.
18. Maintain dignity and respect throughout the conflict resolution process.
19. Continuous Learning.
20. Use conflict as an opportunity to improve systems, relationships, and communication
practices.

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Conclusion

Conflict is inevitable in any organization due to diversity in people and perspectives. However,
when managed effectively through structured approaches and sound principles, it can become a
powerful driver of growth, innovation, and stronger workplace relationships.

HUMAN RESOURCE MANAGEMENT:

Definition of Human Resource Management (HRM)

Human Resource Management (HRM) is the strategic and systematic approach to managing
people in an organization to help achieve its goals and objectives.

It involves recruiting, selecting, training, developing, motivating, and retaining employees while
ensuring compliance with labor laws and organizational policies.

According to Edwin B. Flippo, HRM is the planning, organizing, directing, and controlling of
the procurement, development, compensation, integration, maintenance, and separation of human
resources to accomplish organizational objectives.

In simple terms, HRM ensures that:

 The right people are hired

 Employees are properly trained and motivated
 Performance is managed effectively
 Workplace relationships remain healthy

PRINCIPLES OF HUMAN RESOURCE MANAGEMENT:

The key principles guiding HRM in organizations include:

I. Right Person for the Right Job.

II. Recruit and place employees based on qualifications, skills, and job requirements.
III. Equal Opportunity and Fair Treatment.
IV. Ensure non-discrimination and fairness in recruitment, promotion, and compensation.

60
V. Employee Development.
VI. Provide continuous training and career development opportunities.
VII. Motivation and Engagement.
VIII. Use incentives, recognition, and supportive leadership to improve morale and
productivity.
IX. Effective Communication
X. Maintain open communication between management and employees.
XI. Compliance with Laws.
XII. Follow labor laws, safety regulations, and employment standards.
XIII. Performance Management.
XIV. Regularly evaluate employee performance and provide feedback.
XV. Employee Participation.
XVI. Encourage employees to contribute ideas and participate in decision-making.
XVII. Job Security and Welfare.
XVIII. Promote employee well-being, safety, and job stability.
XIX. Strategic Alignment.
XX. Align HR policies and practices with the organization’s overall strategy and goals.

Procedures for Employee Recruitment Process in an Organization

The recruitment process typically follows these steps:

Step 1: Manpower Planning: Identify the need for new employees based on organizational
goals and workforce analysis.

Step 2: Job Analysis: Define job responsibilities, duties, qualifications, and skills required.

Step 3: Job Description & Specification: Prepare a written document outlining, Duties and
responsibilities (Job Description), required qualifications and skills (Job Specification)

Step 4: Sourcing Candidates: Advertise the job through: Company website. Social media,
Recruitment agencies, internal promotions, Job portals.

Step 5: Screening Applications: Review resumes and shortlist candidates who meet the criteria.

61
Step 6: Selection Process: Conduct, Interviews, Tests (aptitude, technical, personality),
Assessment centers.

Step 7: Background & Reference Checks: Verify qualifications, experience, and references.

 Step 8: Job Offer: Issue an official offer letter with salary, benefits, and terms of
employment.

Step 9: Placement & Orientation: Introduce the new employee to the organization through on-
boarding and training.

Conclusion

Human Resource Management plays a critical role in organizational success by effectively

managing people. Applying sound HR principles and following structured recruitment
procedures ensures that organizations attract, select, and retain competent employees.

STRESS MANAGEMENT

Definition of Stress Management

Stress Management refers to the process of identifying, controlling, and reducing stress to
improve individual well-being and organizational effectiveness.

In an organizational context, stress management involves strategies and practices designed to

help employees cope with work-related pressures in a healthy and productive manner.

According to Hans Selye, stress is the body's non-specific response to any demand placed upon
it. Therefore, stress management aims to regulate these responses to prevent negative physical,
emotional, and behavioral consequences.

In simple terms, stress management helps employees to:

 Handle pressure effectively

 Maintain emotional balance
 Improve performance and productivity
 Prevent burnout and health problems

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Causes of Stress in an Organization

Organizational stress can arise from various internal and external factors. Major causes
include:

1. Work Overload: Too much work, tight deadlines, and long working hours.

2. Role Ambiguity: Unclear job responsibilities or expectations.

3. Role Conflict: Conflicting demands from different supervisors or departments.

4. Lack of Job Security: Fear of job loss, layoffs, or organizational restructuring.

5. Poor Working Conditions: Unsafe environment, inadequate tools, noise, or overcrowding.

6. Interpersonal Conflicts: Conflicts with supervisors, colleagues, or subordinates.

7. Lack of Participation in Decision-Making: Employees feeling ignored or undervalued.

8. Organizational Change: Rapid technological changes, mergers, or restructuring.

9. Poor Leadership: Authoritarian management style or lack of support from management.

10. Work-Life Imbalance: Difficulty balancing job responsibilities with personal life.

Techniques for Stress Management in an Organization

Organizations can apply various strategies to manage and reduce stress:

A) At Individual Level:
 Time Management
 Prioritizing tasks and setting realistic deadlines.
 Relaxation Techniques
 Deep breathing, meditation, and physical exercise.
 Counseling Services
 Skill Development
 Training programs to improve competence and confidence.

63
 Healthy Lifestyle Promotion
 Encouraging proper diet, exercise, and adequate rest.

B. At Organizational-Level Techniques:

 Job Redesign
 Balancing workload and clarifying roles.
 Improved Communication
 Transparent policies and regular feedback systems.
 Participative Management
 Involving employees in decision-making.
 Supportive Leadership
 Managers providing emotional and professional support.
 Flexible Work Arrangements
 Remote work, flexible hours, or compressed workweeks.
 Conflict Management Systems
 Establishing fair grievance-handling procedures.
 Recognition and Reward Systems
 Acknowledging employee efforts and achievements.

Conclusion

Stress is unavoidable in organizational life, but unmanaged stress can reduce productivity,
increase absenteeism, and harm employee health. Effective stress management through both
individual and organizational techniques helps create a healthier, more productive, and positive
work environment.

THE END OF LECTURES

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