Department of Health Service Management

BY
ABINET GIRMA MASRESHA

May /2023
HAWASSA
 1- Evolution of Primary Health Care
In early 1950s the vertical health service strategy was
started to be implemented. But, it was found expensive
and unsuccessful. So, concept/ strategy of Basic health
Service come to introduce in health system. Hence, it
needs high cost and technological advancements it failed
to reach the desired goal.
So, idea of primary health care (PHC) emerged in the
1960s, in recognition of health system shortcomings
inherited by developing countries after independence. This
also founded unsuccessful due to the fallowing problems.
 Evolution…cont
 high cost of establishing health institutions
 Curative health services predominated other health
services
 Inadequate health budget
 Prevailing of attitude was for hospitals
 Unclear health policy
 No community participation & intersect oral collaboration
 Mal distribution of available resources seen
 Evolution…cont
 Thus, a joint WHO-UNICEF international conference
was held in 1978 in Alma Ata (USSR), commonly
known as Alma-Ata conference. The conference
included governmental and different agency
participants from 134 countries called for a
revolutionary approach to the health care. The
conference declared ‘The existing gross inequality in
the health status of people particularly between
developed and developing countries as well as within
countries is politically, socially and economically
unacceptable’.
 Evolution…cont
The four major pillars of PHC of Alma Ata was
 Community Participation
 Inter-sectorial Coordination
 Appropriate Technology
 Support Mechanism Made Available
 Evolution…cont
 The Alma-Ata Declaration was criticized for being too
broad, idealistic, having an unrealistic timetable and
“Health for All by 2000” goal. So, concerning about
identification of the most cost-effective health strategies,
in 1979 the Rockefeller Foundation sponsored a small
conference entitled “Health and Population in
Development” at its Bellagio Conference Canter in Italy.
 Evolution…cont
Later on the four interventions of Selective PHC best
known as GOBI have been come to introduced on the
PH system, these were
 Growth monitoring,
 Oral rehydration techniques,
 Breastfeeding, and
 Immunization.
 2- Current Approach of PHC
The 2008 WHO report indicated creation of a new
opportunity for the reinvigoration of PHC more than
ever. However, in the following years, health
development assistance became more disease-focused &
opportunity to work across sectors, programs &
community involvement in health care decision-making
was lost.
Astana declaration with its political focus on the right to
integrated, quality, personal and population-level
primary care on health as a multispectral social and
economic construct, dependent on many sectors; and on
community engagement in health, and empowerment
with respect to health services.
 Current Approach….
As a new approach, the 2018 Conference declaration of
Astana introduced the following commitments:
 Making bold political choices for health across all sectors,
 Building sustainable primary health care,
 Empowering individuals and communities, and
 Strengthening alignment of stakeholder support to
national policies, strategies and plans
 Current Approach….
After careful evaluation of reliable key facts of current
global health care situation, WHO has identified the
following three strategic areas of work that used as current
approach of strengthening PHC worldwide:
 Providing 'one-stop' mechanism for PHC implementation
support to Member States, tailored to country context
and priorities.
 Producing PHC-oriented evidence and innovation, with a
sharper focus on people left behind.
 Promoting PHC renewal through policy leadership,
advocacy and strategic partnerships with stakeholders
 3- Advantages of PHC
The international community has been renewing PHC and
placing it at the center of health and well-being improving
efforts due to the following major reasons.
 The features of PHC allow the health system to adapt
and respond to a complex and rapidly changing world
 High emphasis on promotion and prevention, addressing
determinants, and a people centered approach.
 UHC and the health-related SDGs can only be
sustainably achieved with a stronger emphasis on PHC.
 Advantages….
In general, PHC has the following three inter-related
synergistic components:
 Meeting people’s health needs through comprehensive
promotive, protective, preventive, curative,
rehabilitative & palliative care throughout life course
 Systematically address broader determinants of health
(including social, economic and environmental factors,
individual character and behavior) through evidence-
informed policies and actions across all sectors;
 Empowering individuals, families, and communities to
optimize their health, as advocacy
 Advantages….
Generally, PHC have the following advantages
 Focuses more on quality health service & cost-effectiveness.
 Promotes equity and equality and “Health for all”
 Integrates preventive, promotive, curative, rehabilitative &
palliative health care services.
 Encourages new connection and community participation.
 Includes services readily accessible & available to community
 Easily accessible by all as it includes simple and efficient
services with respect to cost, techniques and organization.
 Improves safety, performance, and accountability.
 Advocates prevention, screening & early intervention of
health disparities.
 Used as integral part of country’s socio-economic devel`t.
 LEADERSHIP THEORIES….
D) CONTINGENCY (SITUATIONAL) THEORY (Early1960s to Present)
argue that effective leadership is function of the interaction of several variables, such as
superior-subordinate relationship, power distribution between superior and subordinate, job
structure, expectations and behavior of superiors, subordinate characteristics, anticipation
and behavior and organizational culture and policies. Major theories contributing towards
this school of thought are
o Fiedler's contingency theory Assumes there is no single best way for managers to
lead. Situations will create different leadership style requirements for a manager.
o Path-goal theory:- Effective leaders increase motivation and satisfaction among
subordinates when they help them pursue important goals and see the goal.
o The Hersey-Blanchard Leadership Model :- points that subordinates play greatest role
in determining which leadership styles (leader behaviors) are most appropriate.
o Tannenbaum & Schmidt’s Leadership Continuum:- States that autocratic and
democratic styles or task-oriented and relationship-oriented styles are extremes, whereas
in practice the behavior of many, perhaps most, leaders will be somewhere in between .
o Adair’s Action-Centered Leadership Model:- action-centered leader gets the job done
through the work team and relationships with fellow managers and staff.
 Transformational, transactional and servant leaders
This models called by researchers a "new paradigm for leadership" (Bryman, 1992).
A) Transformational Leadership
occurs when one or more persons engage with others in such a way that leaders and
followers raise one another to higher levels of motivation and morality” factors are
I) Charismatic Leadership:- charisma means "an inspired and divine gift."
Charismatic leaders have divinely endowed gift of grace and talent to capture the
imagination and inspire their followers' devotion and allegiance.
II) Intellectual Stimulation:- leader's ability to motivate followers to solve problems
by challenging intellectually and encourage to come up with creative solutions.
III) Individual Consideration:- The leader treats each follower differently but
equitably, providing all with individual attention. As a result, followers feel special,
encouraged, motivated, developed, and perform better.
B) Transactional Leadership
Mostly explained as a cost-benefit exchange b/n leaders and their followers. Transaction
or exchange involves something of value between what the leader possesses or controls
and what the follower wants in return for his/her services. Transactional leaders clarify
goals and objectives, communicating to organize tasks and activities with the cooperation
of their employees to ensure that wider organizational goals are met.
 Leadership skills and competencies
• Skills are abilities to do something expertly and well, and they are necessary to operate activities
successfully. Skills are not necessarily inborn but can be developed/ acquired. Leaders need
mental capacity to understand the overall workings of the organization and its environment; to
grasp how all the parts of the organization fit together, and to view the organization in a holistic
manner.
• Competencies are the underlying characteristics of people that lead to superior performance.
These include the person’s knowledge, natural and learned abilities, values, and personality
traits. Generally, leaders need to have the following competencies.
o Understanding the Needs and Characteristics of the Post
o Knowing and Using the Resources of the Group
o Communicating
o Planning
o Controlling Group Performance
o Evaluating
o Setting the Example
o Representing the Group
 Good Vs Bad leaders
Good Leadership
good leadership requires treating employees with great respect and care; the better the respect
and caring, the better the outcome. Remember this is a Natural Law (inexorable, inescapable).
Treat employees as if they are very important and valuable and you will cause them to feel and
become this way. They will then treat their work, customers, peers and management this way.
They will follow your lead. What then characterizes good (or great!) leadership?
 Listening employees including subordinate managers/bosses addressing their complaints,
suggestions, concerns, and personal issues at work.
 Coaching people when necessary to raise them to a higher standard.
 Allowing everyone to put in their two cents.
 Trusting employees to do the work.
 Not giving orders or setting visions, goals and objectives, but instead soliciting this from
them so that everyone is fully involved in how the company will be successful.
 Providing direction when needed to ensure that everyone is on the same page (the one they
devised). A good leader communicates the vision that was set by all. If it is a vision of little
interest, then another one must be found.
 Bad Leadership
is characterized by attempting to control employees through orders, policies, rules, goals, targets, reports,
visions, bureaucracy, and changes designed to force employees to deliver what management considers
satisfactory. In this mode, the management decides what, when and how to do it on its own and employees
only listens perfunctorily. Bad leadership characterized by
 Dishing out orders, policies, rules, goals, targets, reports, visions and changes to force employees to work

the way management believes it should be done.