principles of health administration

Principles of Health Principles of Health AdministrationAdministration

Dr. Rasha SalamaDr. Rasha SalamaPhD. Community MedicinePhD. Community Medicine

Suez Canal UniversitySuez Canal UniversityEgyptEgypt

Health AdministrationHealth Administration

Sound administration is essential for the Sound administration is essential for the success of any public health program whether success of any public health program whether

on the national, intermediate or the local level. on the national, intermediate or the local level.

Definition of Sound AdministrationDefinition of Sound Administration

We can define sound administration as:We can define sound administration as:

““ The process of achieving defined goals at a The process of achieving defined goals at a defined time through the guidance, leadership, defined time through the guidance, leadership, and control of the efforts of a group of and control of the efforts of a group of individuals and the efficient utilization of non-individuals and the efficient utilization of non-human resources bearing in mind adequacy, human resources bearing in mind adequacy, speed, and economy to the utmost possible speed, and economy to the utmost possible level.level.””

Another definitionAnother definition

““Administration is the art and science of Administration is the art and science of guidance, leadership, and control of the efforts guidance, leadership, and control of the efforts of a group of individuals towards some of a group of individuals towards some common goal.common goal.””

ManagementManagement Management is the Management is the operational partoperational part of of

administration.administration. It is defined as:It is defined as:““ It is a set of interactive processes through It is a set of interactive processes through

which the utilization of resources results in the which the utilization of resources results in the accomplishment of organization objectives.accomplishment of organization objectives.””

It is a It is a ““conversion mechanismconversion mechanism””..

Process

Inputs Outputs

A systems view of management:

Human resourcesNon-human resources

Conversionmechanism Objectives

achievement

It is through It is through ““managementmanagement”” that the objectives that the objectives of the health care organization are achieved by of the health care organization are achieved by gathering and positioning of resources.gathering and positioning of resources.

There are several elements for administration. There are several elements for administration. In practice all these elements are interrelated In practice all these elements are interrelated to one another.to one another.

There are also 3 levels of administration.There are also 3 levels of administration.

Elements of AdministrationElements of Administration:: PlanningPlanning OrganizationOrganization StaffingStaffing DirectingDirecting CoordinatingCoordinating

ReportingReporting BudgetingBudgeting Supervising Supervising EvaluationEvaluation

Levels of AdministrationLevels of Administration

Centrallevel

Intermediatelevel

Local Level

Ministry of health

directorates of health

e.g. health office,Hospital, health care unit

Every program must have an overall (general) Every program must have an overall (general) goal which confirms with that of the nationgoal which confirms with that of the nation ’’s s policy, and various objectives to be achieved policy, and various objectives to be achieved according to a definite plan. according to a definite plan.

Goals versus ObjectivesGoals versus Objectives A GOAL: is a long range specified state of A GOAL: is a long range specified state of

accomplishment towards the activity it is directed. accomplishment towards the activity it is directed. Goals are not constrained by time or existing Goals are not constrained by time or existing resources.resources.

AN OBJECTIVE: is a measurable state of AN OBJECTIVE: is a measurable state of accomplishment aimed towards the goal. The accomplishment aimed towards the goal. The objective should include a description of objective should include a description of ““whatwhat”” outcome is desired, outcome is desired, ““whenwhen”” it is expected, and it is expected, and ““wherewhere”” it will take place. it will take place.

PlanningPlanning Planning is considered the most important Planning is considered the most important

element of the administrative process. The element of the administrative process. The higher the level of administration, the more the higher the level of administration, the more the involvement and time devoting to planning. A involvement and time devoting to planning. A good plan is the basis of any successful good plan is the basis of any successful program. Sufficient time should be given to program. Sufficient time should be given to the process of planning. More than one plan the process of planning. More than one plan should be available to choose from to meet the should be available to choose from to meet the existing plan.existing plan.

Definition of PlanningDefinition of Planning ““Planning is a projected or predetermined Planning is a projected or predetermined

course of action designed to achieve a specific course of action designed to achieve a specific goal or objective.goal or objective.””

Planning determines What? When? Where? Planning determines What? When? Where? How? Why? And by whom? Things will be How? Why? And by whom? Things will be done.done.

It involves It involves ““decision making for future eventsdecision making for future events””..

Process of systemic planningProcess of systemic planning1. Establishing goals and objectives1. Establishing goals and objectives

2. Designing alternative courses of action 2. Designing alternative courses of action

3. Analysing and predicting the consequences3. Analysing and predicting the consequences

4. Selecting the best course of action4. Selecting the best course of action

5. Implementing the selected plan and performing periodic 5. Implementing the selected plan and performing periodic evaluation to assure success of plan evaluation to assure success of plan

Principles of planningPrinciples of planning Being an intellectual activity it needs Being an intellectual activity it needs

knowledge, experience, foresight, reasoning knowledge, experience, foresight, reasoning and the mastering of special skills and and the mastering of special skills and techniques. Examples of different techniques techniques. Examples of different techniques of planning are:of planning are: PPBS: Planning/Programming/Budgeting systemPPBS: Planning/Programming/Budgeting system PERT: Performance/Evaluation/Review techniquePERT: Performance/Evaluation/Review technique CPM: Critical Path MethodCPM: Critical Path Method

Planning is a dynamic (non-static) processPlanning is a dynamic (non-static) process It is a continuous circular processIt is a continuous circular process

Planning

Execution(implementation)

Evaluation

• Futuristic • Decision making process• Dynamic • Flexible

Participative planning is sharing the program Participative planning is sharing the program planning with other people, staff and agencies planning with other people, staff and agencies concerned with the program.concerned with the program.

Participative planning have advantages and Participative planning have advantages and disadvantages.disadvantages.

Planning of a program is based on:Planning of a program is based on: Needs and demands of the publicNeeds and demands of the public Available resourcesAvailable resources Attitude of the publicAttitude of the public

Constraints (intervening factors) to a plan may Constraints (intervening factors) to a plan may be social, economical or political, and they be social, economical or political, and they may be related to either:may be related to either: External environment (community)External environment (community) Internal environment (the organization)Internal environment (the organization)

Establishing priorities are essential in planningEstablishing priorities are essential in planning(What are these priorities???)(What are these priorities???)

OrganizationOrganization Definitions:Definitions:

““ Organization is any collection of persons, materials, Organization is any collection of persons, materials, procedures, ideas or facts arranged and ordered that the procedures, ideas or facts arranged and ordered that the combination of parts makes a meaningful whole that combination of parts makes a meaningful whole that works towards achieving organizational objectives.works towards achieving organizational objectives.””

““The process of organization implies to the arrangement The process of organization implies to the arrangement of human and non-human resources in an orderly of human and non-human resources in an orderly fashion to make a meaningful whole that accomplishes fashion to make a meaningful whole that accomplishes organizational objectives.organizational objectives.””

The organizational process is classified into:The organizational process is classified into: Structural organizationStructural organization Functional organizationFunctional organization

Principles of organization:Principles of organization: DepartmentationDepartmentation Acquisition of human and non-human resourcesAcquisition of human and non-human resources Specialization and division of laborSpecialization and division of labor CoordinationCoordination Authority and responsibilityAuthority and responsibility Centralization and de-centralizationCentralization and de-centralization Unity of commandUnity of command Line and staffLine and staff

StaffingStaffing It is the process of It is the process of ““personnelizingpersonnelizing”” the organization, the organization,

by hiring the right type and adequate number of by hiring the right type and adequate number of workers to each unit for the time required for the workers to each unit for the time required for the program, through the following steps: program, through the following steps: Identifying the type and number of personnel Identifying the type and number of personnel RecruitmentRecruitment Selection and appointmentSelection and appointment OrientationOrientation

Job analysisJob analysis Job descriptionJob description Job specificationJob specification

BudgetingBudgeting Financial administration consists of a series Financial administration consists of a series

activities were funds are made available for activities were funds are made available for certain people in the organization under certain people in the organization under procedures that will ensure their efficient use. procedures that will ensure their efficient use.

The main activities are: The main activities are: BudgetingBudgeting AccountingAccounting AuditingAuditing Purchasing Purchasing

DefinitionsDefinitions Budgeting:Budgeting:

It is the allocation of financial resources in It is the allocation of financial resources in support for programs or projects for a special support for programs or projects for a special period of time. A budget is defined as period of time. A budget is defined as ““a a balanced estimate of expenditures and receipts balanced estimate of expenditures and receipts for a given period of timefor a given period of time””..

Accounting:Accounting: ““It is recording assembly and summarization It is recording assembly and summarization

of financial effects of executive actionof financial effects of executive action. . a a harmonious relationship between budget and harmonious relationship between budget and account is important to current comparisons, account is important to current comparisons, between goals set in and accomplished.between goals set in and accomplished.””

Auditing:Auditing:

““It is the investigation and report on the fidelity It is the investigation and report on the fidelity and legality of all financial transactionsand legality of all financial transactions””. .

Purchasing: Purchasing: ““It is the acquisition of the property and It is the acquisition of the property and

materials needed in administrationmaterials needed in administration””..

SupervisionSupervision Supervision refers to the day-to-day Supervision refers to the day-to-day

relationship between an executive and his relationship between an executive and his immediate subordinates.immediate subordinates.

Supervision aims at satisfying both:Supervision aims at satisfying both: WorkWork Workers Workers

SupervisionSupervision Motivation is defined as: Motivation is defined as: ““an externally an externally

induced behaviour which occurs in order to induced behaviour which occurs in order to bring about or maintain need fulfillmentbring about or maintain need fulfillment””..

The following conditions if present build high The following conditions if present build high levels of motivation: levels of motivation:

•Achievement•Recognition•Advancement•Working conditions•Responsibility

•Organizational policy•Technical supervision •Interpersonal relations•Salary and compansations•Job security

SupervisionSupervision Styles of leader authority: Styles of leader authority:

AutocraticAutocratic ConsultativeConsultative ParticipativeParticipative DemocraticDemocratic Free rein Free rein

SupervisionSupervision Factors affecting style of supervision:Factors affecting style of supervision:

Condition presentCondition present Type of workType of work Subordinates characteristicsSubordinates characteristics Personal characteristic of managerPersonal characteristic of manager

EvaluationEvaluation Definition:Definition: ““systemic collection of information about the systemic collection of information about the

activities, characteristics and outcomes of activities, characteristics and outcomes of programs, personnel, and products fpr use by programs, personnel, and products fpr use by specific people to reduce uncertainties, specific people to reduce uncertainties, improve effectiveness and make decision with improve effectiveness and make decision with regard to what those programs, personnel or regard to what those programs, personnel or products are doing and affecting.products are doing and affecting.””

Types of EvaluationTypes of Evaluation

Process Outcome /impact

Structure

Types of EvaluationTypes of Evaluation

Program Implementation

Programplanning

Program impact

Structureevaluation

Process orFormative evaluation

Impact or summative

Evaluation

Facilities /Equipment/Manpower/

organization

Performanceof staff/ way

procedures are done

MeasurableIndicators +

Health related impacts

Elements of EvaluationElements of Evaluation RelevanceRelevance AdequacyAdequacy AccessibilityAccessibility AcceptabilityAcceptability EffectivenessEffectiveness EfficiencyEfficiency Impact Impact

Steps of EvaluationSteps of Evaluation (1) Describe the program in terms of objectives (1) Describe the program in terms of objectives

expected. Objectives can be either outcome or expected. Objectives can be either outcome or process objectives.process objectives.

Outcome objectives: Outcome objectives: ““a statement of the amount of a statement of the amount of change expected for a given health problem for a change expected for a given health problem for a specified population within a given time framespecified population within a given time frame””

Process objectives: Process objectives: ““a statement of the amount of a statement of the amount of change expected in the performance and utilization of change expected in the performance and utilization of interventions that impact on the outcome.interventions that impact on the outcome.””

(2) specify the evaluation design.(2) specify the evaluation design. Define the purpose of evaluationDefine the purpose of evaluation Define the methodology of evaluation Define the methodology of evaluation

(census/ client records/ interviews/ surveys/ (census/ client records/ interviews/ surveys/ expenditures reports).expenditures reports).

Define who will be making use of the dataDefine who will be making use of the data (audience/ policy makers).(audience/ policy makers).

(3) gather credible evidence (information):(3) gather credible evidence (information):Types of data include:Types of data include:

Demographic descriptionDemographic description Indicators of health status (morbidity, mortality, Indicators of health status (morbidity, mortality,

disability)disability) Qualitative indicators ( community values, public Qualitative indicators ( community values, public

and private policies)and private policies) Utilization indicatorsUtilization indicators Expenditures Expenditures

(4) Analysis and justification of results(4) Analysis and justification of results

What does the findings mean?What does the findings mean? How do they compare to the objectives?How do they compare to the objectives? What is the degree of success of the program?What is the degree of success of the program? What recommendations are indicated for What recommendations are indicated for

program improvement?program improvement?

((55 ) )Taking actionTaking actionEvaluation findings has to be used and shred for Evaluation findings has to be used and shred for the purpose of improvement of the effectiveness the purpose of improvement of the effectiveness of the program. of the program. ““evaluations that are not or evaluations that are not or inadequately used are simply not worth of inadequately used are simply not worth of

doingdoing””..

((66 ) )Re-evaluationRe-evaluation Evaluation is an ongoing processEvaluation is an ongoing process..

Thank youThank you