HEALTH SERVICES MANAGEMENT AND LEADERSHIP (HEALTH

ADMINISTRATION)
Diploma health students:

Course Objectives:
By the end of this course unit the trainees will be able to:
1.Develop and plan health services.
2.Implement planned activities according to policy guidelines.
3.Identify required resources in a health unit.
4.Mobilize resources for the health unit.
5.Utilize resources effectively and efficiently
6.Monitor and evaluate health care services.
7.Describe the health management information system.
8.Discuss the process of maintaining and evaluating health services.
9.Discuss the process used in mobilization and utilization of resources in a health
facility.
10.Outline the required resources for a health facility.
11.Explain the process of planning and implementing health service activities
according to policy guidelines.
Course outline:
Introduction:
Concept of HSM.
Nursing's role in today's health care system.
Roles and functions of nursing managers.
Challenges for nurse managers.
Definitions, concepts in management and leadership:
Who is a manager?
Who is a leader?
What management means.
What managers manage and do.
What leadership means.
Formal and Informal leadership.
An effective and efficient manager or leader.

What an organization means and characteristics of an organization.

…..................................................................................................................................
..............
Differences,similarities and relationship between management and leadership.
Action centered leadership concept.
Qualifications of a leader.
Management/leadership styles.
National health policy and the health sector strategic plan.
…..................................................................................................................................
..................
Functions of management:
Planning
Organizing
Staffing
Directing
Controlling
Coordinating
Records and reporting.
Budgeting

Human resource management and staffing:

The concept, philosophy, role of Human resource management.
Staffing in nursing care management.
Staffing (recruitment and selection) process
Staff motivation
Staff turnover and retention
Staff development
Staff appraisal
Staff Delegation
Team work (Building effective teams)
…......................................................................................................
Management of equipment and health care supplies
Health care financing and management
Health Information management system
Transport management
Maintenance of infrastructure
Key Government policies

By Geoffrey Wavamunno .S.

(BHA (hon), DHA, DIP Nurs)
Introduction
Concept of HSM:
Health care management is a profession that provides leadership and direction to
organizations that deliver personal health services, and to devisions, departments,
units, or services within those organizations.

Health managers are appointed to positions of authority where they shape the
organization by making important decisions. Such decisions for example relate to
recruitment and development of staff, acquisition of technology, service addition
and reductions, and allocation and spending of financial resources.

Decisions made by health care managers not only focus on ensuring that the patient
receives the most appropriate, timely and effective services possible, but also
address achievement of performance targets that are desired by the manager.
Ultimately decisions made by an individual manager affect the organization’s
overall performance.

Nursings role in today's health care system:

Because there are fewer registered nurses(RNS)in relation to assistive personnel, all
nurses today are managers-They manage the care of a defined group of patients,
doing some of the care them themselves, directing others to provide care, and
collaborating with still others.

Nurses participate in teams of care providers.

Nurses lead teams of professionals and non-professionals.
Nurses therefore need new skills, especially management skills-Nurses must know
how to delegate, supervise, evaluate, motivate and communicate with practitioners
of other disciplines, other nurses, and licensed personnel.
They must be skilled in negotiation, conflict resolution and collaboration.

Specific training there for in management skills is needed in nursing schools and
work setting:-Most important however nurses should be able to transfer their new
acquired skills to the job itself. Nurse Managers must be experienced in
management themselves and assist their staff in developing adequate management
skills. Management training for nurses at all levels is essential for any organization
to be efficient and effective in today’s cost conscious and competitive environment.

Roles and Functions of nursing managers:

AONE(America Organization of Nurse Executives) An American organization for
the top nursing Administrators describes six roles and functions of the nurse
manager.(Eleanor.J.Sullivan etal 2005,effective leadership and management in
nursing chpt 4,pg 59)

1.The nurse manager is accountable for excellence in the clinical practice of nursing
and the delivery of patient care on a selected unit or area within the health care
institution. This function is the primary focus of the nurse manager.
2.The Nurse Manager is accountable for managing human, fiscal, and other
resources needed to manage clinical nursing practice and patient care.
With good awareness of the cost of health care, because nurses are the primary
providers of patient care, nursing accounts for use of most of the resources.
Therefore, nurse managers are accountable for efficient use of personnel,
equipment, and supplies. Skill mix is important in meeting patient needs.
1.The nurse manager is accountable for facilitating development of nursing and
other staff/subordinates of the health care system. The manager is responsible for
seeing that competency levels of staff are maintained and that staff acquire new
skills as needed. The nurse manager also plays an important role in providing a
supportive environment for nursing and other health profession students.
2.The nurse manager is accountable for ensuring institutional compliance with
professional, regulatory and government standards of care. The nurse manager must
be informed and be able to translate pertinent standards of care to staff and
implement required programs.
3.The nurse manager is accountable for strategic planning as it relates to the unit(s)
or area(s), department and organization as a whole. The nurse manager is
responsible for developing and implementing a strategic plan for the unit that
supports a department’s and organization’s plan. She is also responsible for
facilitating staff support for the strategic plan and modifying the plan as needed in
response to changes in the environment.
4.The nurse manager is accountable for facilitating cooperative and collaborative
relationships among disciplines/departments to ensure effective quality patient care
delivery. The nurse manager plays an important role in developing collegial
relationships based on mutual respect and support.
Challenges for Nurse Managers:

•The challenge for nurse managers and administrators is how to manage in a

constantly changing system.

•Working with teams of administrators and providers to deliver quality health care
in the most cost effective manner. Nurse' unique skills in communication,
negotiation and collaboration position them well for the system of today and for the
the future.

•Since one constant of today's heath care system is that tomorrow it will change,
nursing leaders are challenged to help staff close the door on allegiance to past
practices and turn toward emerging practice opportunities-Leaders themselves must
learn new skills as well as convey enthusiasm and commitment for change.
Everyone in health care must learn to live with ambiguity and be flexible enough to
adapt to the changes it brings.

•Nurse managers today are challenged to manage the decreasing resources,

•To help design new systems of professionals and non-professionals from a variety
of cultures, and,
•To teach personnel on how to function well in a new system.

In order for the nurse managers to meet and live to the above challenges, it requires
that the nurses and their managers be committed,involved,enthusiastic,flexible,and
innovative. And above all it requires that they have good health.
Definitions, concepts in management and leadership:

A manager: A manager is an individual employed by an organization who is

responsible for efficiently accomplishing the goals of the organization.
To manage simply means to be In charge of, run or control something or somebody.
A manager is formally and officially responsible for the work of a given group.
For example, the nurse manager of an unit, or Nursing officer/Director or Dean/
principal of a college and a medical superintendent of a hospital, etc
They are responsible to ensure that the unit accomplishes its tasks well.

A leader: A leader is anyone who uses interpersonal skills to influence others to

accomplish a specific goal.
A leader exerts influence by using a flexible repertoire of personal behavior and
strategies.

What management means:

1.Management is getting things done.
2.Management is getting things done through other people.
3.Management is the efficient use of resources.
4.Management is to make decisions.

•Management is getting people to work harmoniously together and make efficient

use of resources to achieve objectives.

•Management is the art of securing maximum results with minimum of efforts so as

to secure maximum prosperity and happiness for both the employer and employee
and give the public the best possible service(John me 1963).

•Management is the art of making things done with and through others to attain the
organizational goals.
This definition stresses the need that people work well and cooperatively together.
Management involves:

•A manager who must lead and guide others.

•Followers.

•Organizational resources.

•Organizational goals.

What do managers manage?

Managers manage resources; and the resources are: 4M +S.

•Man-Human resource-the employees/workers/staff/labor.

•Material-Inanimate resources e.g. Health care equipment, medicines/drugs and

supplies, Fleet.

•Money-Finances/Funds.

•Moment-Time

•Space-working space/shelter/infrastructure/Buildings.

Resources are either Humans, Materials, Money, Moment plus Space that are
utilized by the organization to achieve its goals.
What do managers do? What are their responsibilities or roles?

•Managers work with and through others.

•Managers are responsible for and accountable for the resources.

•Managers balance competing goals and set priorities.

•Managers solve problems.

•Managers take decisions,

•Managers are mediators, motivators, negotiators.

•Managers communicate to those above and below them in hierarchy.

•Managers are coordinators, controllers, monitors, evaluators.

•Managers are also leaders and supervisors who are therefore engaged in:

•Guiding and counseling employees.

•Directing-Giving orders and instructions to employees.

•Influencing employees.

•Team building.

•Empowering others. Task roles; responsible of achieving the specific tasks of the
organization.

•Group maintenance roles; responsible of ensuring that there is harmony within the
group members in the organization(industrial harmony)

What leadership means:

•Leadership has been described as a process of social influence in which one person
can enlist the aid and support of others in the accomplishment of a common task.

•Leadership is the activity of influencing people to cooperate toward some goal

which they find desirable.(definition by Mr. Tead Ordway, the art of leadership)

•Leadership is a form of mutual cooperation through which the skill of one person
enables certain ends to be achieved and motives satisfied(definition by Dr Charles
bird a social psychologist)

•Leadership is defined as the process of influencing others toward a goal(Bennie

and Nanas, 1985,Rebecca samson-2009,leadership and management in nursing
practice and education)
These definitions emphasize that:

Activity is involved in leadership; and part of that activity is influencing people.

And at first the personnel may not see the desirability of certain objectives, yet they
are still willing to cooperate.

The leader has considerable imagination and initiative in looking ahead as well as a
background of experience on which to draw for the planning, both of which the
personnel may not have.

That leadership is a mutual enterprise that the leader is cooperating as well as

expecting the personnel to cooperate.

The leader is an individual who is able to direct activities of other people because
he or she possesses the qualities and skills that the followers may not have.

And that leadership has two main goals:

The one to achieve certain objectives and the others:
To help people to satisfy certain basic motives.
This means that, in order to be a success, the heath care leader will be judged not
only by how well she and the personnel together are able to achieve the objective of
good patient care, but also by the morale among those who are actually giving the
care.
A leader may be formal or informal.

Formal leadership: A leader is formal if he has legitimate authority conferred to

him by position in organization and described in job description.

Informal leadership: leadership is informal when a staff member who does not
have a specified management role, not appointed, exercises leadership.
An effective and efficient leader or manager:
Effectiveness means: Effectiveness is the degree to which an objective is being or
has been achieved.
E.g., if a health unit sets 100 children to be immunized against measles in a
particular week and achieves 95%, we shall say the work has been managed
effectively. The effective manager is one who achieves the set objective or target.
Efficiency means: Efficiency is the measure of the relationship between the results
obtained (output) and the effort-resources (input) expended.
This concept has a focus on people, or human resources, and on the way they work.
It also involves time put in and money and other resources to perform a particular
task.

Efficiency can also mean, the ability to produce satisfactory results with an
economy of effort and a minimum wastage.

We can simply put it that an efficient manager is one who achieves his targets with
the planned available resources.
The more minimal the resources (input) the manager uses to achieve the maximum
results (output) the more efficient he is.
Power and Authority:
Power:
Power is the ability to induce people to accept your orders. (Etzion, organizational
behavior)
Power is the potential ability to influence, or the potential to achieve goals. (Hersey,
Blanchard, & Johnson, 2001 in effective leadership and management in nursing by
Eleanor Sullivan 2005).
Power is to influence others to act, and it’s the most important ingredient of a leader
or manager in an organization. Its the ability to impose the will on others to bring
about certain behaviors. (Rebecca Samson 2009, leadership and management in
nursing practice)
Legitimacy-Is the acceptance of the exercised power because it seems to be in line
with ones values.
Authority:
Authority is the combination of Power (potential ability to give orders/induce
people to accept your orders) + Legitimacy (The acceptance of the exercised power-
given orders. That is to say,
Authority is the potential ability to induce people to accept your orders because the
orders given seem to be in line with their values. OR
Authority is the ability to give orders and induce their acceptance by the people for
whom these orders (they) seem to be in line with their values (beliefs, virtues,
expectations)
The main three types /Basis of authority managers and leaders use to induce people
to accept their orders as were put across by Max Webber in 1920 are:
 • Bureaucratic-rational -legal authority.-This the authority someone has
because of the formal position he has in the organization. He is in that
position because he has demonstrated he knowledge, skills and ability to
fulfill the position.

• Traditional authority.-This is authority accepted by subordinates because it

seems things have always been that way such as the rule of a king in a
monarchy.

• Charismatic authority.-people accept the leader's/ manager's orders because

he has a natural strong influential personality.
Webber the German psychologist-Father of organizational theory recognized that if
subordinates do not believe a person qualified for that position they may not accept
that person's authority.
In any organization authority and power must be given proportionately to carry out
the responsibilities. It is the legitimate right to give commands to act in the interest
of the organization.
The different types of power which need to be exercised by a leader or manager are:
Types of Basis/Based How to use power
power on
Legitimate Given by an • Make polite
power organization requests.
according to
the position. • Use clear and
simple
E.g:principal/ language.
Nursing
Director • Explain the
reason.

• Follow-up to
check
compliance
Reward Incentives the • Do not over
power. leader can emphasis
provide for the incentives
subordinates
and value by • Rein force good
the group behavior, don't
bribe.

• Size of the
reward should
 reflect total
performance.
Money is not only the reward, other
means of appreciation may be used.
E.g:wards,certificates,etc.
Coercive Found in fear. • Avoid it except
power E.g:Oral or when absolutely
written needed.
warnings,
suspension or • Determine
termination genuine fault.

• Discipline
promptly
without
favoritism

• State warnings
without hostility

• Fit the
punishment to
the seriousness
of the fault.

• Warn before
punishing.

Expert Special ability, • Avoid careless

power skills and decisions, rash
knowledge by statements.
virtue of
education and • Keep abreast
experience. with current
E.g: Mastery developments.
over the
subject and • Remain calm in
emotional crisis and act
stability. confidently.

• Respect staff
ideas and
include them.
 Do not threaten staff self-esteem,
respect staff concern and explain
why the change is needed.
Referent Administratio • Treat them
power n and respect fairly.
the staff feels
towards a • Avoid hostility,
leader. rejection
Personal distrust, and
qualities indifference.
influence
charisma. • Explain reliance
on staff support
and
cooperation.

• Make requests
reasonable.
Be a good role model.

What an organization means:

Organizations are planned social units deliberately structured for the Purpose of
attaining specific goals.

Organizations are social units (groups of people) that peruse specific goals which
they are structured to serve.
This brings the issue of:
Organizational goals.
Organizational structure.
Organizations and their social environment.

Organizations are social units (human groupings) deliberately constructed and

reconstructed to seek specific goals. Example of organizations: schools, armies,
Hospital, churches.
However tribe, ethnic groups, friendship groups, families, classes are not
organizations.
Characteristics of organizations:
1
1.1Division of labor.
1.2There is power.
1.3Communication responsibilities.
1.4Divisions which are not traditionary patterned but deliberately planned to
enhance the realization of specific goals.
2 There is presence of power centers that control the efforts of the
organization and direct them towards its goals.
These power centers MUST review continuously its performance and pattern its
structure, where necessary to increase its efficiency.
3 Substitution of personnel: - Unsatisfactory personnel can be removed and others
assigned their tasks. The organization can recombine its personnel through transfer,
promotion and sacking.
Though other social units are also marked with some degree of:

•Conscious planning e.g. budgeting,

•Existence of power centers e.g. tribal chiefs,

•Replacable membership e.g. through divorce, but the extent to which these social
units are deliberately structured and restructured with a membership which is rudely
changed is much less than in the case of those social units called organizations.
That is to say organizations are more in control of their nature and destiny than any
other social groupings.
Differences, similarities and relationship between management and leadership:
Differences
Leadership/Leaders Management/
managers
A leader may or may not have an official Appointed
appointment officially to the
position.
Leaders have the power and authority to enforce Have power and authority to
decisions as long as followers are willing to be enforce decisions.
lead.
Leaders influence others either formally or Managers carry out
informally. predetermined policies, rules
and regulations.
Interested in risk- taking and exploring new ideas. Maintain an orderly,
controlled, rational and
equitable structure.
Relate to people personally in an emphatic Relate to people according to
manner. their roles.
Leaders feel rewarded from personal Managers feel rewarded
achievements. when full filling
organizational goals or
mission.
Leaders may or may not be successful as They are managers as long
manager. as they hold the
appointment.
Addresses “why”-Why are things going on that Addresses “how”. How can
way, Why such results. the things, results be
achieved? How can an
activity be done?
Leadership inspires Management clarifies
Leadership is service focused Management is profit
focused
Leadership is strategy focused. Concerned with Management is focused on
bigger; long-term objectives. day to day operations.
Leadership is concerned with fulfillment of goals. Management is concerned
with performance of
 activities that leads to
fulfillment of goals.
Leadership is concerned with versatility/creativity Management is concerned
of employees. and preoccupied by
consistency to standards of
operations and procedures.
Leadership is concerned with alignment of Management is concerned
whatever goes on in the organization to policy with accountability to the
and set standards. leadership of what is
achieved and whether it’s
achieved to the required
standard and expectation.

Similarities:
Both leadership and management have aspects of:

•Both set direction.

•Both set and work with object and focus.

•Both guide where necessary.

•Both judge performance against goals.

Relationship between Management and Leadership:

A Pure manager may be focused upon the achievement of task and be excellent at
coordinating action to meet organizational outputs and targets. This manager may
not however pay much attention to the people aspects of work.

A pure Leader may be focused on the people, galvanizing them to action and
motivating, guiding and supporting them. However attention to task and
organization-business output or achievement may not be very strong.

Where people are really effective, though a manager will undertake task
supervision, but in the context of attention to people involvement and the support
and guidance they need, a leader will undertake some planning and control to
ensure that the empowered and motivated people will achieve the required
organization -business output.

The relationship between management and leadership is therefore complex and

overlapping. You can be a manager without leading, and vise versa. However, the
best managers also lead to a certain extent, and the best leaders also engage in
management for maximum effectiveness.

The role of leadership therefore is about relationships and people focus, but also
includes decision making, which, in turn, leads to action planning.

Many leaders and managers fall into the trap of focusing on task achievement and
forget that this isn’t really the key to effectiveness as a manager or leader. The task
must be achieved but what characterizes an effective leader is how this is achieved
rather than the achievement itself. This means paying attention to the people and
team aspects as well as the task.
Management is a formal, specially designated position within the organization.
To be a good manager; it’s absolutely necessary to be an effective leader.
In fact all nurses (health professionals) should at times assume some leadership
roles, but not everyone needs to be a manager.

Action centered leadership:

Action centered leadership model recognizes that: Effective leaders should keep the
three areas/components of:
Task-activity or work to be done.
Individual-The employee as a person,
Team-The group of all the individuals
In balance. The leader should ensure that motivating individual is done in the
context of building and maintaining the team; all with a focus of achieving the task.

Miss out on any one of these essential components, or allow them to get out of
balance; and effectiveness, efficiency and motivation are likely to reduce, until you
have unhappy people not pulling together and not being productive.
 Qualification or qualities of a leader:
If a leader (head nurse) is to be successful, she herself must have appealing
qualities.
A leader should:

•Be fair-equity-Attending to the needs of the people-workers appropriately without

discrimination or favoritism.

•Should be intelligent-Think through things quickly and appropriately.

•They should have initiative-Always willing to discover and invent the best
alternative way of performing a task or solving a problem.

•They should be honest-Truthful

•They should be dependable-Morally upright, trust able, reliable, and easy to

confide in.

•They should be ready to assume responsibility.

•They should be interested in people.

•They should have a good wholesome outlook on life.

•They should possess a sense of humor-positive and possibility thinkers.

•They should be experts in their field.

•They should have good physical stamina and emotional stability-high emotional
intelligence.

•They develop work relationships that are supportive, caring, sensitive and
appreciative.

•Effective leaders are forward thinking.

•They are willing to take risks.

•They advocate for others and support professional standards and growth.

•They do not avoid conflict but are skilled in resolving it and solving problems.
•They are courageous.

•They are authentic-Factual.

•They have outstanding decision making ability.

•They pay attention to details.

•They are prolific learners. They have great communication skills.

•They have a high level of integrity.

•They have attendance towards action.

•They are good listeners.

•They have wisdom, Vision, character, confidence, persistence, determination,

charisma, extreme focus and commitment.

•They have loyalty, love, faith, compassion, humility, transparency, generosity,

passion, empathy, positive attitude, love.
To be sure no one human being can achieve a high degree of perfection in all these
desirable qualities, and yet it’s rather interesting that we expect of our leaders a
great deal more than we expect of ourselves. We expect them to be more perfect,
and yet we know fully well human beings never are.
Because of this therefore Dr Edward streaker gave some criteria for maturity which
seems to be pertinent to the situation of the leader (head nurse).

•A mature person is one who has the ability to see a job through.

This means that in spite of discouragement and obstacles, the leader as a mature
person will persist until a certain goal is reached. She never gives up easily nor
develops the I can’t win attitude

•The mature person also has the quality of being able to give more than she/he is
asked.
This means that the leader would be the type of a person who would be willing and
ready to help another person whenever necessary and who would not be satisfied
with just doing the bare minimum essentials of a job, but who could go on to the
stage of realizing that we are happiest when we do our best rather than when we do
the required amount only.

•The mature person is a dependable individual.

In other wards the mature person (head nurse) is one who would do what she said
she would do at a time she told she would do it.
•A mature person is independent in thought and action.

This implies the ability to look at a situation critically and to evaluate it in light of
objective evidence and one's own accepted philosophy rather than to be willing and
satisfied to follow the crowd. The mature person is not only capable of independent
thought and action, but also she has the ability to cooperate. Not a person who will
not play if she doesn’t have her own way. This quality is important as she will need
to cooperate with many people if she is going to achieve success as a leader.

•The mature individual is a flexible person-

This means the individual does not get into a rut (a situation) from which she will
not budge (Come out).

•The mature person is tolerant.

Tolerance is difficult to achieve, particularly for people who have strong ideas
which they have thought through carefully. It also emphasizes the point that
tolerance of another person's opinion implies that we realize that we do not know it
all and that we are aware that we cannot handle everything alone.

•The mature person is patient.

The leader will be saved many unhappy moments if she can learn that people do not
respond immediately even to strong forms of influence and that she may have to
wait a long time before she sees results in a positive direction.
Maturity as described above by Dr striker is not easily achieved, but the fact
remains that the leader who is a mature individual will be able to guide her/his own
behavior and also to direct the activities of other people with much more skill than
an individual who has never grown up emotionally.
In summary:
A head nurse(leader) to be successful, needs to make up the qualities and
techniques of democratic leadership a part of her philosophy of leading(head
nursing).
She should be concerned with specific aims relating to work (e.g. relating to care of
patients) and to build positive morale amongst the workers (staff
The head nurse (leader) must have good understanding of human behavior and of
the psychological technics of motivating people to do their best work.
She might well ask herself the following questions at periodic intervals:
i.Am I willing to follow the standards I wish others to achieve?
ii.Do I put off making decisions?
iii.How many times have I lost my temper this week?
iv.Do I really like people? Am I interested in helping them?
v.Can I adjust my pace to that of others?
vi.Do I listen to and act upon other people's ideas?
The individual who can answer all these questions in the positive is probably
headed in the direction of becoming a successful leader. (Randall, 1949, Ward
Administration)

Management/ leadership styles:

Leadership is first and foremost about influencing. But most people take the view
that leadership style is the manner in which a leader approaches and deals with
people in the context of one or more tasks to be addressed. Therefore we can say by
definition that:
A leadership style is the manner and approach of providing direction, implementing
plans and motivating people all to achieve a desired goal or objective.
A leadership style is about how decisions are made in an organization or unit. The
way the decisions will be made will depend on circumstances present.-present
situation in relation to the results to be achieved.
For example: some situations will deserve a leader to make the decision and
informs the employees to follow what he has decided. e.g in case of an emergence.
This style where the leader makes the decision is known as Authoritarian-
Autocratic-Dictatorial leadership style.
Kurt lawing in 1939 led a group of researchers to identify different styles of
leadership, and established three major leadership styles. (US. Army Handbook,
1973, http://w.w.w.nwlink.com/~donclark/leader/leadstl.html)
The three major leadership styles are:
Authoritarian (Autocratic, Dictatorial) leadership style-I want both of you to do
what I say
This leadership style is used when the leaders make the decision and tell their
employees what they want done and how they want it accomplished, without
getting the advice of their followers.
Some of the appropriate conditions to use it are:

• When you have all the information to solve the problem.

• You are short on time.

• The situation or problem is an emergency.

• When your employees are well motivated so they won’t feel as if you are
pushing them around.
Some people think of this style as a vehicle for yelling, Using demeaning language,
and leading by threats and abusing their power. This is not the authoritarian style,
rather it is an abusive, unprofessional style called “BOSSING PEOPLE
AROUND. “It has no place in a leader's repertoire.
That authoritarian style should only normally be used on rare occasions. If you have
the time and to gain more commitment and motivation from your employees, then
you should use the participative style.
Democratic (Participative, consultative) leadership style-Let us agree on what we
are to do, Lets work together to solve this problem.
This style involves the leader including one or more employees in the decision
making process (determining what to do and how to do it).
However, the leader maintains the final decision making authority. Using this style
is not a sign of weakness, rather it is a sign of strength that your employees will
respect.
Some of the appropriate conditions to use it are:

• When the leader has part of the information, and the employees have the
other parts to solve a problem. Note that the leader is not expected to know
everything-this is why the leader employs knowledgeable and skillful
employees. Using this style is a mutual benefit-it allows them become part
of the team and allows the leader to make better decisions.

• The leader has enough time at his disposal to consult.

• The situation is not an emergency.

Delegate (free reign, laissez faire, permissive, Anarchic) leadership style. Do

what you like, you take care of the problem while I go.
In this style the leader allows the employees to make decisions.
However the leader is still responsible for the decisions that are made.

• This is used when employees are able to analyze the situation and determine
what needs to be done and how to do it. The leader cannot do everything!
You must set priorities and delegate certain tasks.
This is not a style for you to use so that you can blame others when things go
wrong, rather this is a style to be used when you fully trust and have confidence in
the people bellow you. Do not be afraid to use it, however use it wisely!
Bureaucratic leadership style: This leadership style was later discovered-put
across by Anderson and Jenkins in 1984. (Eleanor Sullivan 2005, Effective
Leadership and management in nursing)
This is a leadership style in which a leader trusts neither followers nor self in
making decisions and therefore relies on organizational policies and rules.
In this style:

• A leader lacks a sense of security and depends on established policies and

and rules.

• A leader exercises power by applying fixed, relatively inflexible rules.

• A leader tends to relate impersonally to staff.

• Avoids decision making without standards or norms for guidance.

 Comparison of leadership styles
Leadership style Assumed
employee
motivators
Authoritarian(Autocratic) External
forces, e.g.
power and
authority,
needs for
approval
Democratic(Participative) Internal drives and
impulses
Laissez-faire(permissive) Internal drives and
impulses
Bureaucratic External forces
 Advantages and Disadvantages of the leadership styles:
Leadership Advantages Disadvantages
style
Authoritarian • Decision will • People will
be focused feel
upon task controlled.
needs.
• People will
• Everyone not be
will be clear empowered,
about what is and as a result
to be done, not take
when and responsibility
how. for work and
mistakes.
• Roles and
responsibiliti • No buy-in,
es will be people will do
clear. it because
they are told
• Compromise to.
s are always
not • Relationships
necessary or may not be
tolerated. strong.

Democratic • Good buy-in • Time and

and feeling energy
of consuming.
involvement.
• Results may
• Strong be below what
participation, is achievable
which will due to some
build compromises
relationships. along the way.

• Many ideas Easy to get sidetracked and lose

explored. focus.

• Innovation is
possible.
Laissez-faire • Strong sense • Manager may
 of be seen as
ownership, opting out.
buy-in and
responsibilit • Chaos could
y. ensue if no
one is keeping
• Manager is an eye on
freed up to what happens.
follow other
issues. Without guidance, staff might pull
together or pull in different
• Staff given direction.
free reign to
use their
experience
and skills to
good effect.

Note: Good leaders use all the styles, with one of them normally dominant, an
effective leader is one who will be able to choose and use a leadership style that is
appropriate for the prevailing condition or situation that will yield the desired
results or outcomes.
Characteristics of an effective leadership style:
Any leadership style a leader decides to employee or use at a particular time in a
particular situation, it should bear the following characteristics in order for it to be
effective-to cause -yield the desired outcomes without killing the morale of the
employees.
1: Effective communication skills.

• Creating rapport

• appropriate questioning(closed, open, probing ,evocative questions)

• Appropriate body language and nonverbal signals.(gestures, actions,)

• Active, empathic listening

• Summarizing and paraphrasing.

• Good presenting at meetings and briefings.

2: Vision building:

• Shared goals between leader and workers/subordinates.

 • Shared values and approaches.

• Agreed aims and objectives.

3: Support:

• Empathy of the leader towards employees.

• Understanding

• Assistance when needed or requested.

• Identification of development opportunities.

• Encouragement.

• Influencing and negotiation skills.

• Attention to integrity, fairness and equality.

Factors that influence a leader to choose or use a certain leadership style:

To achieve the possible out puts and outcomes, an effective leader and manager will
need to be skilled in using a flexible style, which they should select from the
circumstances as a deliberate choice and not as a result of any preconceived ideas or
habitual behaviors. He/she will be guided of influenced by the factors below to
choose a certain style:

• The context: what’s happening and where, the number of people involved
and who they are, the urgency of the situation, what’s required and any rules
and regulations that apply.

• The Individuals involved: Their roles and responsibilities, skills, knowledge

and qualifications, attitudes and behaviors’ emotional awareness and
control, experience and motivations.

• The team: Its size and make up, existing skills and attributes, development
needs, motivations and internal relationships.

• The task itself: expectations of customers or clients and other stakeholders,

required outputs or outcomes,complexity,resources needed and available,
health and safety issues and time frames.

• The decisions: The extent to which they are simple or complex, critical or
urgent, need to be made by the leader or can be delegated, need significant
knowledge or experience, or need significant ownership or buy-in from
those involved.
If you are not yet confident that you can use the full range of styles, or not sure
which style others perceive as your normal range, you should consider asking for
detailed feedback you’re your manager, your colleagues and your staff. They should
be able to describe to you the styles they think you are using, and the effects upon
them of that use. This is an important development step for leaders who truly wish
to become fully effective.
 Functions of a manager/Management:
According to Luther Gulick (1937) the manager is an executive who has people
down in the hierarchy working in departments or subdivisions;
And the manager's work is. What does he do?
The answer is POSDCORB. This was adapted and expanded from functional
analysis elaborated by Henri Fayol the French industrialist in his “Industrial and
General Administration”1916.(Jaym.shafritz 1992, classics of organization theory
cut 1 pg. 94),(Rebecca Samson,2009,leadership and management in nursing
practice and education)
P-Planning.
O-Organizing.
S-Staffing.
D-Directing.
CO]-Coordinating and
-Controlling.
R-Recording and Reporting.
B-Budgeting
Planning: Planning is the basic process of setting and selecting goals and
determining how to achieve them.
It is the process of thinking before doing or having a framework of what is to be
accomplished in future to achieve the organizational goals.
It means to decide in advance what is to be done. It charts a course of actions for the
future. It is an intellectual process and it aims to achieve a coordinated and
consistent set of operations aimed at desired objectives.
Planning is essential or useful because:

• It yields reasonable organizational objectives and develops alternative

approaches to meet these objectives.

• Planning helps to eliminate or reduce the future uncertainty and chance.

• Planning lays a foundation for organizing people with organizational

objectives and work.

• Planning facilitates coordination within an organization.

 • Planning helps to facilitate and maintain good control.

Organizing: Organizing is establishing of the formal structure of authority through

which work subdivisions are arranged, defined and coordinated for a defined
objective.
It involves relating people with the set objectives and coordinating the work to be
done. Work activities required for the organizational performance is divided based
on specialization or differentiation-Vertical differentiation (based on hierarchy-
position one has in the organization) and horizontal differentiation (based on the
knowledge and skills of an individual).
Staffing: Staffing is the whole personnel function of bringing in staff, manage their
stay in and exit out of the organization.
It involves pre-entry, post-entry, succession and exit management of the staff.
The goal of personnel/ staffing is to attract, select and hire the right people in the
right positions (vacancies) at the right time and retain a well-motivated, effective
and efficient staff/work force/team.
Directing: Directing is the continuous task of making decisions and embodying
them in specific and general orders and instructions and serving as a leader of the
enterprise or organization.
This involves the process of getting the organization’s work done.
The manager who owns power, authority and leadership styles is one who will have
the ability to direct the organization’s work well.
Communicational abilities, motivational techniques and delegation skills are also
very important.
The manager coaches and counsels to direct people to achieve the organization
goals.
Directing is giving orders, assignments and instructions that permit the subordinate
to understand what is expected of him, and the guidance and overseeing of the of
the subordinate so that he can contribute effectively and efficiently to the attainment
of organizational objectives.
Directing includes the following activities:
Giving orders: The central task in directing is giving orders. The order is the
technical means through which a subordinate understands what is to be done. To
facilitate this there are certain characteristics of good orders which manager should
be aware of?

• The order should be clear, concise and consistent to give sufficient

information to ensure understanding.
 • Order should be based on obvious demands of a particular situation, it seems
logical to the subordinates and not just an arbitrary whim of the manager.

• The tone of the order is very important. The manner in which the manager
delivers the order has a great deal to do with its acceptance by the
subordinate.

• Whenever possible the reason for the order should be given. A subordinate
will accept an order more readily if he understands the need for it.

• In some instances the manager uses delegation of authority instead of

issuance of orders for avoiding too many specific orders.
Supervision: Supervision is the activity of management that is concerned with the
training and discipline of the worker force. It includes follow up to ensure the
prompt and proper execution of orders.
Supervision is the art of overseeing, watching and directing with authority, the work
and behavior of other.
Leading: Leading is the ability to inspire and influence others to contribute to the
attainment of the objectives.
Successful leadership is the result of interaction between leader and subordinates in
a particular organizational situation. The leader uses the different styles of
leadership to do this, ranging from completely authoritarian to free reign.
Motivating: motivation refers to the way in which the needs (Urges, desires, and
aspirations) control, direct or explain the behavior of human beings. The manager
must motivate, or cause, the employee to follow directives.
Communicating: Communication is the passing of information and understanding
from the sender to receiver. Communication is vital for the directing function of the
management.
Communication is the means the manager has of reaching to the subordinates to
attain work group activity.
Coordinating: This is the all-important duty of interrelating the various parts of
work with people. Synchronizing people with activities so that they function well
for the attainment of the set objectives and achieve desired goals.
Coordination is more important in the health services organization, because
functionally they are departmentalized. Different kinds of organization require
different amount of coordination. The approaches of coordination used can be:
Corrective coordination (Comprises of those coordinative activities that rectify the
present error or corrective dysfunction in the organization)
Preventive coordination (Comprises of those coordinative activities that are aimed
at preventing the occurrence of anticipated problems of coordination, or at least
minimizing the impact of these problems.
Regulatory coordination (Comprises of those coordinative activities that are aimed
at the maintenance of existing structural and functional arrangements in the
organization.
Primitive coordination (Comprises of those coordinative activities that are aimed at
attempting to improve the articulation of the parts of the organization or to improve
the existing organizational arrangements without regard for specific problems.
Controlling: Controlling can be defined as the regulation of activities in
accordance with the requirements of plans.
The control function whether applied to cash, medical care, employee morale or
anything else, involves four steps:
1. Establishments of standards of performance; and determining means(how)
to be used in measuring performance-The indicators that the standards of
performance are being or have been adhered to.
2. Measuring performance; The actual performance-results or outcomes or
output of work and individuals
3. Comparing the actual results with the standards.-Evaluating performance.
Relating actual results, outcomes or output with the set standards of
performance or achievement -indicators of achievement.
4. Correcting deviations from standards.
The efficient manager constantly attempts to improve productivity by incorporating
techniques of quality management, evaluating outcomes and performance and
instituting change as necessary.
Recording and Reporting:That is keeping those to whom the executive/ manager
is responsible informed as to what is going on, which thus includes keeping himself
and his subordinates informed through records,research,inspection.
Reports are oral or written exchanges of information shared between caregivers or
workers in a number of ways.
A report summarizes the services of a person, personnel and of the
agency/organization or unit.
Reports are usually written daily, weekly, monthly, quarterly or annually.
Purposes of reporting :( Why report?)

• To show the kind and amount of services over a specified period of time.

• To illustrate progress in reaching goals.

 • As an aid in studying health conditions.

• As an aid in planning.

• To interpreted services to the public and to the other interested parties.

Records and reports must be: Functional-relevant and important, accurate,

complete, current, organized and confidential-Given only to those that legitimately
require and need them.
Budgeting: Budgeting is a process of planning and controlling future operations by
comparing actual results (actual budgetary performance) with planned expectations.
A budget is a quantitative statement, usually in monetary terms, of the plans and
expectations of a defined area over a specific period of time.
Budgeting:

• Is based on expected income and expenditure.

• Is the heart of administration/management.

• It serves as a power tool for coordination and an effective device of eliminating

duplicating and wastage.

• It is a major process of planning.

Features of a budget:

• Should be flexible.

• Should be synthesis of past, present and future.

• Should be a product of joint venture and cooperation of

executives/department heads at different levels of management.

• It should be in the form of statistical standard laid down in specific

numerical terms.

• It should have support of top management throughout the period of its

planning and supplementation.
 PRINCIPLES OF PLANNING:
Introduction: planning is the first step/function in management process and every
manager is expected to understand the essence of planning in true sense in order to
be successful in their managerial role.

Definitions:
1: Planning is the process of thinking about and organizing the activities required to
achieve a desired goal. (Wikipedia, planning 11 Jan 2014).
2: planning is the basic process of setting and selecting goals and determining how
to achieve them.
3: planning is the process of thinking before doing or having a frame work of what
is to be accomplished in future to achieve the organizational goals.
4: planning is the art of thinking ahead of time or well in advance with regard to
what needs to be done in an organized way to minimize the confusions in carrying
out future actions.
Planning also means deciding in advance what is to be done or achieved and
mapping out a program or a method beforehand and for accomplishment of goals. It
charts a course of action for the future. It’s an intellectual process and it aims to
achieve a coordinated and consistent set of operations aimed at desired objectives.
Planning has a relationship with forecasting, though this fact is often ignored.
Forecasting can be described as predicting what the future will look like, whereas
planning predicts what the future should look like.
Planning is to identify what the organization (person) wants to do by using the four
questions:

• Where are we today? In terms of our business strategy.

• Where are we going?

• Where do we want to go?

• How are we going there?

Planning requires vision, creativity, flexibility and energy in the planner. The
nurse(health)manager needs to be familiar with the decision making process and
tools. so that he/she can identify the purpose of the institution, state the
philosophy(values,beliefs,norms,vision and mission) and policies, define goals and
objectives, prepare budgets to implement plans, and effectively manage his/her time
and that of the organization.
Types of planning:
There are so many types of plans E.g:Business plan, contingency planning, family
planning, land use planning, Event use and production planning, Environmental
planning, Strategic planning(long-term planning-3-5 years plan),Tactical
planning(short-term planning-related to fiscal year(yearly planning),Urban
planning, succession planning,E.t.c.
Why plan? What is the importance, essentials or purpose of planning?

• Planning yields reasonable organizational objectives and develop alternative

approaches to meet these objectives.

• Planning helps to eliminate or reduce the future uncertainty or chance.

• Planning lays a foundation for organizing people with organizational

objectives and work.

• Planning facilitates proper coordination within the organization.

• Planning helps to facilitate and maintain good control-determines who is

going to do what and to what standard?

• Planning increases the efficiency of an organization or unit-The extent to

which resources are utilized to yield maximum output.

• Planning reduces the risks involved in modern management or business

activities.

• Planning aids in organizing all available resources.

• Planning helps to achieve objectives of the organization.

• Planning gives the right direction to the organization. Planning motivates the
personnel of the organization.

• Planning encourages managers ‘creativity and innovation.

• Planning helps in decision making.

• Planning dictates those activities to which employers are directed.

• Planning is a road map and a guide to the organization towards the set
objectives.
 Strategic planning:
Definitions:
1: strategic planning is an organization’s process of defining its strategy, or
direction, and making decisions on allocating its resources to pursue this strategy.
(Eleanor.J.Sullivan, 2005, Effective leadership and management in nursing)
2: Strategic planning is a process of long range and ongoing planning for the future.
3:Strategic planning is a continuous systematic process of making risk-taking
decisions to-day with the greatest possible knowledge of their effects on the future.
Organizing efforts necessary to carry out these decisions and evaluating results of
these decisions against expected outcome through reliable feedback mechanisms.
(Rebecca Samson,2009,leadership and management in nursing practice and
education)
Planning process:
The key components of strategic planning are an understanding of an entity’s
(organization, company, firm, unit, and department) vision, mission, values and
strategies.
The planning process includes:
1. The vision and mission
2. Situation analysis-SWOT (Strengths,Weaknesses,Opportunities,Threats)
analysis and PEST/PESTE(Political,Economical,Social,Ecological,legal-
Environments)analysis
3. The Goal(s)
4. The Objectives
5. The Strategies
6. The Activities/operations-Who is responsible, which are the resources, what
is the source of these resources?
7. The Indicators/Mile stones
8. Financial plan/Budget.
Vision admission:
In the commercial world, a mission or vision statement may encapsulate, vision and
mission.
A vision statement is a description of the goal to which an organization aspires.
A vision outlines what the organization wants to be, or how it wants the world in
which it operates to be. (An idealized view of the world)
It outlines what an institution is trying to achieve.
A mission statement is a general statement of the purpose of an organization.
It defines the fundamental purpose of the organization or enterprise, describing why
it exists (what it stands for and and what it does to achieve its vision)
The mission embodies the main purpose and core values of an organization.
Values-Are beliefs, norms that form the organization’s culture that are shared
among the stakeholders of the organization.
Organizations sometimes summaries goals and objectives into the mission or vision
statement. Others begin with a vision and mission and use them to formulate goals
and objectives.

The new approach is to use a visual strategic plan (visual model) in which a vision
and mission are top layers of the strategic plan (Wikipedia strategic plan.ogv)
Situation Analysis:
This means-Where are we now?
The current position of the business/organization/unit. Involves assessing the
internal and external environment of the organization or unit.
The tools used to assess these internal and external environments are:

• SWOT Analysis(for assessing both internal and external environments)

• PEST/PESTEL Analysis(For mainly assessing the external environment of

the organization)
SWOT ANALYSIS:
S-strengths
W-Weaknesses
O-Opportunities
T-Threats.
A SWOT Analysis is a structured planning method/Tool/approach used to evaluate
the strengths, weaknesses, opportunities and threats involved in the project/business
venture/organization.
SWOT Analysis groups key pieces of information into two main categories:
 1. Internal factors-The strengths and weaknesses internal to the organization.
2. External factors-The opportunities and threats presented by the environment
external to the organization.
3. Analysis may view the internal factors as strengths or as weaknesses
depending upon their effect on the organization’s objective. What may
represent strengths with respect to one objective may be a weakness
(destruction, competition) for another objective.
The external factors to the organization may include:
Macroeconomic matters,technological,technological change, legislation(laws),and
social cultural changes, changes in the market place or changes in competitive
position, customers(market),supplier markets(suppliers), labor markets(workers).
It’s rare to find that all these factors have critical importance to the
organization/business. But it’s common that markets (labor and supplier, customer
markets) are of critical importance.
A SWOT Analysis can be carried out for a product, place, industry, or person.
SWOT Analysis involves specifying the objective of the business venture or
organization or project and identifying the internal and external factors that are
favorable and unfavorable to achieving the objectives.
The degree to which the internal environment of the organization/firm matches with
the external environment is expressed by the concept-Strategic Fit.
Strengths:-Are the characteristics of an organization/firm that give it an advantage
over others.
Weakness:-Characteristics that place the organization/firm/business at disadvantage
relative to others.
Opportunities:-elements (out of the organization) that the organization/firm could
exploit to its advantage.
Threats:-Elements in the environment (out of the organization) that cause trouble
for the organization/firm/project.
Impotence of using SWOT Analysis:
Identifying of SWOTs is important because they can inform later steps in planning
to achieve the objective.
First the de3cision makers should consider whether the objective is attainable-given
the SWOTs.If the objective is not attainable, a different objective must be selected
and the process is repeated.
Users of SWOT analysis need to ask and answer questions that generate meaningful
information for each category, i.e (strengths, weaknesses, opportunities, Threats) to
make the analysis useful and find their competitive advantage.

The usefulness of SWOT analysis is not limited to profit seeking-organizations.

SWOT analysis maybe used in any decision making situation when a desired end-
state (objective) has been defined.
EXAMPLES where SWOT analysis can be used: Non-profit organizations E.g:
PNFP hospitals, Government organizations/units, and individuals.
SWOT analysis may also be used in pre-crisis planning and preventive crisis
management.
SWOT analysis may also be used in creating a recommendation during
viability/feasibility study/survey.

SWOT can be used along with PESTEL Analysis.

Goal :( where do you want to be?)
The goals define in general the changes or improvements an organization or firm
needs to make in order to achieve the mission.
Goals are specific statements of what is to be achieved. They follow the vision and
mission of the organization.
Goals are measurable and precise. “Every patient will be satisfied with his or her
care” is an example of a goal.
Goals always apply to the entire organization because it is the organization that sets
the goals from which departments (units) make their departmental goals.
Objectives:
Objectives are statements of achievement specific to abilities within the
organization.
They further refine an organization’s goals and how they will be met.
Objectives must be SMART:
S-Specific (and simple)
M-Measurable-can be quantified.
Achievable (Accurate)
Realistic (Reasonable)
T-Time bound (Time frame)
The objective to meet the above goal -Every patient will be satisfied with his or her
care, might be “provide appropriate information and education to patients from pre-
admission to discharge.
The strategy/strategies:
Strategies are actions by which objectives are to be achieved.
How are you going to get there?-To achieve the above objective?
Strategies are different services or intervention methods that an organization will
adopt in order to achieve its objectives. Eg. “Implement patient education classes
for prenatal patients” is an example of a strategy to meet the above objective-
provide appropriate information and education to patients from pre-admission to
discharge” hence achieve the above goal-Meet every patient's satisfaction”.
Activities: Activities are specific interventions to be done.
Under activities, the strategic plan will include:

• The personnel responsible for each activity.

• Time frame-The expected date of completion and the current status.

• Resources E.g, Estimated cost for the activity, manpower, materials.

• Source of the resources.

Indicators:
How you will know that you have implemented according to your plan.

• The criteria to establish that the goal has been met.

Indicators are important for monitoring and evaluation of activities, strategies,

objectives and Goal.
Indicators should be SMART (specific, measurable, Appropriate (accurate,
achievable), Realistic (Reasonable), Time bound.
Financial plan/Budget: This is a statement of the income and expenditure, or the
expected capital and recurrent expenses to be incurred.
Knowing the vision, mission goal, and the plan is made to direct managers or
leaders on how they will implement
 Implementation plan/Work plan.
Objective strategies activities Responsible Resources Source of Time Indicators assumpti Fina
personnel the frame ons/prec ncial
(what resources onditions plan/
resources, /remarks bud
the no (Funding) get
needed, or
amount in
terms of
money)

Activities of planning:

• Planning involves gathering a planning committee of at least: To-level

administrators, Representatives of those closest to the work, staff to collect
data and distribute information. It’s best to use those people who are
enthusiastic, willing, experienced and committed members of the
organization/unit. Nay Sayers can be included once some parts of the plan
have been formulated.
It’s important to involve everyone in the organization/unit, however carefully.
“Buy-in is critical to the plan's success.

• Assessment; collect relevant data, classify, analyses, interpret and translate

the data's a meaningful whole.

• Identification of needs.

• Priority setting

• Development of strategies.

• Management of objectives: Formulation of policies, rules, regulations,

methods and procedures.
Note: The planning group assess the environment and the organization’s assets and
areas of weakness and balances those with the organization’s values and goals. This
is time consuming and demanding process and should not be undertaken hurriedly.
Put in use however, a well-thought out strategic plan guides the organization
towards its goals, helps staff stay directed, and prevents the organization from
responding to inappropriate requests.
Strategic planning is an ongoing process, it’s not an end in itself.
It requires a continual focus on the goal and meticulous attention on to progress; the
organization’s mission and vision must always guide activities.
What is the role of nursing division/department in strategic planning?

• To improve allocation of resources, time and money and to manage the

division of nursing performance.

• Participants in planning should include from the TOP nursing management

including clinical nursing personnel.
How can strategic planning be useful in improving nursing management?

• To provide accountability and monitoring of performance, tie-merit to

performance.

• To set up more formal planning programs that require divisional/unit

planning.

• To integrate plans with operational and financial plans.

• To think more and concentrate on strategic issues.

• To improve knowledge of, and training in strategic planning.

• To increase top management involvement and commitment.

• To improve focus on completion, market segment and external factors.

• To improve communication from top administration and nursing

management.

• To allow better execution of plans.

• To use more realism and less rationalizing and vacillating.

• To improve the development of nursing management strategies.

• To improve the development and communication of nursing management

goals.
Kinds of data that must be collected and analyzed for planning:

• Daily average patient census.

• Average length of stay

• Bed capacity and percent of occupancy.

• Number of births/operations.

• Trends in patient's population; age,diagnosis,physical dependence,etc

 • trends in technology;diagnostic/therapeutic

• Environmental; Nursing personnel,education,accreditation,

• Trends in health care systematic Trends in nursing; opportunities of nursing

profession.
Day-today activities of the nursing (Health) manager.
A practical day-today planning by the nurse manager has a great value in managing
her unit.

• At the beginning of each day make a list of actions to be completed for the
day(To -do list)
Cross off the actions as they are accomplished or at the end of the day.
Carry over actions which are not completed to the next day, either do them first or
decide whether those need to be done at all.

• Plan ahead for the meetings. Distribute agenda in advance.

• For organizational meetings send the nursing items to be included in the

agenda and prepare for the meeting

• Identify developing problems and put them in appropriate portion of the

management plans.

• Review the plan on a scheduled basis with the key managers so that each
knows the personal responsibilities for the activities.

• Review the appropriate portions of the development plan with the

subordinate managers when they are counseled. Department, unit or clinic
plans be reviewed at the same time.

• Seven day plan for the discussion of ideas from professional journals to
integrate research results in to practice. Plan for educational programs for
student educational experiences in the division/department of nursing.

• Plan for evaluation of clinical administrative practices to decide whether the

objectives are achieved.
HUMAN RESOURCE MANAGEMENT AND STAFFING (managing people)
Definition: Human resource management is getting people and team to do what is
expected out them.
It’s the getting of staff to contribute to mission objectives of the organization while
upholding its values.
Human resource management is enabling staff to use their qualities talents to do
their work.
The Genesis of Human resource management:
Human resource management is a product of human relations movements of early
20th century when research began documenting ways of creating business value
through the strategic work force.
This started when Fredrick Taylor 1856-1950 who explored what he termed as
scientific management movement, but latter referred to as by others Taylors striving
to improve economic efficiency in manufacturing Jobs.
Philosophy of human resource management (why HRM, importance)
Human resource management is based on the following convictions:
1. Human beings are the most important resource in the organization.
2. Employees are not recurrent costs but valuable assets of the organization;
unlike other resources.
3. Unlike other resources, employees feel, act, interact and react.
4. People are “actually” not managed, they are led and developed.
5. There is a need of creating a meaningful partnership between management
and employees; management by agreement rather than by command.
6. Intelligent people prefer to agree rather than obey.

The three main functions of human resource management:

• Managing the entry of employees into the organization-Managing employee

entry means properly conducting staff recruitment, selection and
induction/orientation.

• Managing their stay-means motivating them, rewarding them, developing

them, facilitating them and enabling them to perform.

• Managing their exit-Managing employee exit involves issues of gratuity,

 pension, retirement and death while serving, which have a motivating or
discouraging effect on employees.
Human resource management (manager's/department) responsibilities:

• It’s first charged with attracting the right employees through employer
branding and adverts.

• Selecting the right employees through recruitment-hiring.

• Training and developing new hires (employees) during tenure (stay) in an

organization.

• Assessing talents through use of performance appraisal (evaluation) of

employees.

• Human resource management is involved in employee terminations:

including resignation, performance related dismissals and redundancies.

• Human resource management also ensures compliance with employment

and labor laws.

• Human resource management oversees health, safety and security.

• Human resource management act as a primary liaison between company and

and employee representatives(in companies where collaborative
bargaining(trade union is recognized)

• Human resource management helps to lobby for workers through working

with government agencies.
NB: Human resource management is generally viewed as a support function to the
business, helping to minimize costs and reduce risks (http://e.n
wikipedia.org/wiki/Human resource-management)
 STAFFING
Definition:
Staffing is an orderly, systematic process based upon sound rationale applied to
determine

• The number and kind of “nursing” staff to provide “nursing “care of

predetermined standard to group of patients in a particular in a particular
setting.
Staffing refers to the means of getting people that will do the required work/job.
Staffing is the selection, training, motivating and retaining of personnel in the
organization.
Staffing is to determine how many people of what specific skills are needed when
they are needed, and ensuring their availability.
The goal/Objective of nurse staffing (why staff?)

• The goal of staffing is to provide the appropriate number and mix of nursing
staff to match actual or projected patient care needs.

• To ensure adequate, safe nursing care for all patients 24 hrs. A day, 7 days a
week, and 52 weeks a year.
Factors which affect staffing (factors to consider while determining staff
requirements)
The factors that affect staffing are either organization philosophy or objective
related, client related, personnel/staff related or work environment related.
To determine staffing requirements, nurse managers must examine workload
patterns for the designated unit, department, and clinic.
For the hospital, this means determining the level of care, average daily census, and
hours of care provided 24 hrs. a day,7 days a week,52 weeks a year.
These factors are:

• Philosophy and objective of the organization-clearly defined objectives will

help in planning the staff required to provide patient care adequately and
ensures quality patient care (nurse-patient care;1:1 for critical care)

• Level of care-services offered at that level of care. (HCII, HCIII, HCIV?)

• Workload patterns for the unit, department, hospital-therefore which time of

the day a certain type /group of clients come to the unit/hospital and their
number /census. Is the work load more during day or night, and when is the
 number of a certain type of clients big? -so allocate more staff.

• Average number of patients served daily, weekly, monthly.

• The kind of clients the organization/unit serves.-Are they HIV clients, VVF
clients, Burns unit? This will determine the skill mix needed.

• The hours of patient care-so hours of staff engagement.

• The skill mix of the existing staff in relation to the services offered.

The three major steps of staffing:

1. Recruitment.
2. Selection.
3. Orientation.
Recruitment:
This is the process of attempting to attract the right candidates for the available
vacancies.
Aims at getting sufficient number of suitable candidates (not too many, not too few)
Attempts to establish mutual satisfaction of the needs of prospective employer and
employee.
Steps of recruitment:
1. Decide on whom to recruit using the job description-be specific on the required
person characteristics E.g.

• Qualifications

• work experience and achievements

• Ability to learn and change.

• Other skills.

2. Decide on where (source) and how (method) to look for candidates.

3. Implement the recruitment strategy-advertisements, Newspapers, Head hunt etc.
4. Evaluate the process for future reference.
Sources of candidates:
This may be external (from outside the organization) or internal (from within the
organization)
Advantages of internal sources:

• Boosts morale and gives some hope to the current employees.

• There is better knowledge about the candidate. Since she is already working
in the organization.

• Can reduce on staff turnover due to hope of promotion.

• It is less costly.

Advantages of external sources: E.g

• Easier to get someone with the required specifications because there is a

wider variety to choose from.

• Brings in new ideas, talent and experience to the organization.

• Gives an opportunity to qualified unemployed/under employed individuals.

Selection: A process of finding the most suitable applicant for the right and
available vacancy.

• The main aim is to find a candidate whose abilities and interests most match
the needs of the organization.

• The ability to attract and select top quality people is considered to be among
the most important factors contributing to an organization’s effectiveness.

• Selection involves judgment-Available evidence (Facts-data-information) is

used to predict the future performance.

• However the available information is commonly imperfect.

• Some steps need to be followed in trying to get the candidate(s)

Steps in selection:
1. Review the job description and the specifications of the required person.
2. Screen the CVs-preliminary clarifications can be sought from the applicants.
3. Prepare a shortlist-all those listed should have the same chance of being
selected based on fair judgment.
4. Arrange and interview the candidates in a calm and friendly manner,
5. Offer (appoint) the job to the best candidate.
6. Evaluate the selection process: this should be on going for some time.
Selection techniques-strategies.
Note:

• One or more techniques-strategies could be used, usually depending on

importance/level of the available job in the hierarchy of the organization.

• Each technique has advantage and disadvantages.

Some of the techniques-strategies used in selection are as bellow:

1. Using bio data(Application forms or CV)
2. Interviewing: Most commonly used but has its shortcomings-disadvantages
like:

• Premature judgment-interviewers may be biased within the first few

minutes of the interview.

• Inadequate preparations of the panel.

• Poor Pernell team work.

• Poor listening and questioning techniques and skills.

• Inadequate interviewing conditions.

• Poor cooperation by one or both parties-interviewer and interviewee.

Advantages of interviewing as a technique-strategy for selection of right applicant.

• Can obtain more information about the person seen physically.

• Applicants have an opportunity to defend themselves.

• Information gaps can be filled.

Conducting the interview:

1. Before the interview preparations:

• Collect all important facts and points to be covered in the interview.

• Determine the objectives of the interview.-what do you want to

achieve from the interview?

• Determine which method to use. Will it be, structured interview,

unstructured, panel interviews, group discussion interviews, etc?

• Know adequate information about the candidates e.g. from

application letters, CVS-resumes, reference checks, etc.
 • Determine the number of interviewers-with regard to the level of the
job.

• Determine the physical setting (venue), Interview needs a conducive

environment.

• Research widely about issues around the job and organization.

• Prepare standardized mark sheets and give to all panelists.

2. During the interview:

As interviewer:

• keep time

• Be smart

• Develop good rapport with the candidate.

• Make candidate to feel at ease.

• Start with general questions concerning the candidate and his

interests.

• Candidates should not be hurried through but they should be

controlled.

• Communicate clearly to the candidate.

• Take down the notes as an interviewer.

• Actively listen to the candidate.

• Give an opportunity to the candidate to ask any questions.

• Close the interview in a friendly and diplomatic manner. Be

courteous, thank the candidate.
As an interviewee:

• Plan for the interview;

• Research about the organization-prospective employer.

• Get to know what the job is all about(duties,tasks,roles)

• Get to know the location of the organization.

• If possible try to know the interviewers-but not to influence them.

 • Keep time if very late at most 30 minutes late.

• Research the place in advance.

• Get where to sit.

• When enter the room, introduce yourself and be offered where to sit.

• Be smart-Do not under or over dress; check your hair, check your finger
nails.

• Be seated and wait for a call.

• Take with you a bottle of water

• When called in, introduce yourself, put on a smile. If have a chance, shake
their hands firmly.

• Take a deep breath. Sit upright.

• Listen attentively.

• Use body expressions and symbols .e.g. nodding, affirmations.

• Be audible and clear.

• Be straight forward and to the point. Ask relevant questions when given
opportunity; E.g.what should you expect from them.

• Thank the panel.

What interviewers look for from the candidate?

1. Personal characteristics:

• Dressing

• smartness

• health

• Alertness

• self confidence

• communication skills

• Way of expressions Organization of Ideas.

• Facial expression and mannerism.

 • Emotional maturity and stability.

2. Education

• Technical and professional confidence.

• Look at the papers to see the following: Exams passed, Division

obtained, year of passing, subjects offered, specialization, extracurricular
activities.
3. Capability to get along with other people/members.

• Leisure activities(hobbies)

• Relationship with family members

• Type of friends

4. Potential for growth

• Long term expectations for the candidate.

• Career goals and objectives e.g. is he just after money?

3. Psychological tests selection technique/ strategy:

Done by experts and can be used to get more information about:

• what you are as a person (personality)

• The potential to learn how to do things.(aptitude)

• The ability to do things.

• What you think of and how you might respond to something (attitude)

4. Assessment centers: combined techniques where candidates are observed

as they take part in a series of activities similar to those of the job to be
done.
5. Reference reports: Information is sought from people who may have
lived or worked with the candidate.
Orientation/Induction:
Orientation is the process of making the new employee get in cultured into the
organization culture.
Aims at helping new employees to cope, feel at home and become productive as
soon as possible.
Orientation is required when;

• Employee starts working for the first time.

• Comes to a new organization.

• Comes to a new department of the same organization.

Why should orientation be done? Orientation should be done because:

• A new employee usually has strong feelings of uncertainty and discomfort.

• There are expectations from both employee and employer that may require
sorting out soon.

• If done properly, orientation can:

1. Reduce on staff turn over-the rate at which new hires (employees) come
in and out of the organization. through strengthening the psychological
contract between employee and employer.
2. Reduce stress in new comers (e.g. due to uncertainty, mixed
expectations, reality shock, social disruptions ...)
3. Make new employees productive as soon as possible.
Orientation process:
Orientation involves sharing of the organization’s information with the new
employee.
Orientation has three phases, namely: pre-entry, entry and post-entry phases. All
phases are equally important though there may be organizational or personal
variations.
Pre-entry phase:

• Starts when one is still an applicant.

• Applicant tries to get as much accurate information about the organization

as possible e.g. type, size, location etc.
Entry phase:

• Starts when the employee first reports for work.

• Involves a comprehensive information session (even the -ve, social) and tour
of the work place/organization.
Post-entry phase:

• Mainly directed towards normalizing the performance at the job.

• There is also ongoing socialization.

Orientation is a form of on-the-job training and may last up to 6 months.

Who does the orientation?

• Human resource department.

• Immediate supervisor.

• Incumbent-someone who has been or is still doing the same job. Essentially,
all employees.
In summary: what staffing process involves:
Human resource planning:

• HRP is the process of getting the right people into the right jobs at the right
time.

• It is the process for ensuring that the human resource requirements of an

organization are identified and plans are made for satisfying them.(bulla and
Scott)

• It is the process that identifies current and future human resources needs for
an organization to achieve its goals.

• HRP is a process in which an organization attempts to estimate the demand

for labor and evaluate the size, nature and sources of supply which will be
required to meet the demand.(Reilly)

• A process of ensuring that the organization at all times has the right number
of people with the the right qualification and skills doing the right jobs for
which they are most technically competent.
The planning process of most best practice organizations not only define
(determine) what will be accomplished with in a given time-frame, but also the
number and types of human resources that will be needed to achieve the defined
busier (organization) goals. e.g no of human resources required, the required
knowledge and skills (competencies) the human resources should have, when the
resources will be needed.
The objective of HRP is to ensure the best fit between employees and jobs, while
avoiding workforce shortages or spares.
To determine the number and mix of personnel needed in relation to care (patient
and non-patient care)
Job Analysis:
1. Making a job description- A job description is an exhaustive description of
the main duties and responsibilities of the job, conditions under which it’s
performed and the reporting relationship.
It refers to the duties and responsibilities of a specific job and the characteristics of
the individual needed to perform it successfully.
The job description also contains; the job title, job grade, the location of the job and
department, the name of the organization and main purpose of the job and the date
on which it will be given to the new employee.
The job description answers what the main roles and responsibilities of the job are.
2. Determining the job/person specifications.-the characteristics of the person
fit for the job.
3. Job evaluation-what the job is worth; Fixing a price tag on the job.
Recruitment:
The process of attempting to attract the right candidates for the right/available
vacancy at the right time. May be done through advertisement, Newspapers, Head
hunt, etc.
Selection:
The process of finding the most suitable applicant for the right/available vacancy.
May be internal (from within the organization) or external (from out of the
organization).May be done through shortlist and interview; Document analysis of
CVs, cover letters, application letters; Assessment centers-where candidates are put
together and given a task to perform that is related to the one they will perform if
successful/employed and observed, given marks; Information seeking from the
people the candidates were working for or lived with.
Appointment:
The formal offer of the job to the successful, most suitable candidate through an
appointment letter.
A job description baring details of employment (Job tittle, job grade ,location-place
of job and department, relationships(accountability)-Reports to and those reporting
to the employee, main purpose of the job, main duties and responsibilities/key result
areas, conditions under which the job is to be performed and date of employment.
Purposes of preparing job description -Job description is used for:
1. Job analysis and classification.
2. Recruitment-hiring Delegation of responsibilities
3. staff development
4. staff appraisal
Orientation/Induction/Socialization:
Orientation is the process of acquainting a new staff with the existing work
environment so that she/he can relate quickly to his/her new surroundings.
The process of making the new employee get in cultured into the organization’s
culture.
The employee and employer's expectations are known during
socialization/orientation.
The objective of orientation is to help new staff to adjust to new organisation,
environment, duties, etc through a planned introduction of her/his responsibilities so
that she/he can become efficient as soon as possible.
The orientation program is given at the initial stage of employment or when a staff
takes on new responsibilities. It’s designed to newly assigned staff. It consists of
two parts: those instructions that must be given to any employee to be acquainted
with overall purposes and functions and that relate to the specific job tasks that
she/he must perform.
It is important that that the new staff member does not assume full service
responsibilities until orientation program has been carried through.
Pre-entry phase-Information given/got about the organization immediately the
candidate gets interested in the organization.
Entry- phase-Information given/got about the organization on the first day the
employee reports on duty e.g, location of office, salary, accommodation, meals, etc.
Post -entry phase-Information given/got about the organization during the
probationary period. Probationary period always takes 3-6 months depending on the
hierarchy of the job.
Staff development:
Staff development is a broad spectrum of activities undertaken by an organization
or a manager to add value to its/his employees in terms of knowledge, skills and
competencies.
This is done through education, training, coaching, job rotation, delegation, open
appraisal, attending workshops-seminars-conferences.
Objectives of medical staff development:
Main objective: The main objective of staff development is to improve employee's
occupational knowledge, skills and attitudes (ASK-Attitudes, knowledge, skills)
and to provide the employee with the opportunity to grow professionally.
Other objectives of medical staff orientation:

• To assist each employee to improve performance in present position/level.

• To keep in pace with medical sciences.

• To keep in touch with new development in medical science and technology.

• To keep in touch with new diagnostic and treatment techniques.

• To motivate each staff member and create a sense of security and loyalty.

• To improve work productivity and for promotion.

• To reduce staff turnover, absenteeism and tardiness()

• To acquire personal and professional abilities that maximize the possibility

of career advancement.

Types of staff development:

Staff development includes formal and informal, group or individual training and
education.
Staff development activities include:
1. Induction training,
2. Orientation,
3. In-service education,
4. Continuing education, and
5. Training for special functions such as management, team building, and
budgeting method.
Induction Training (3days): is a brief introduction to organization philosophy,
purpose, administrators, programs, policies and regulations that is given to new
employee during the first three days of employment.
Orientation (2-24 weeks): Is individualized training given each employee during the
first period of his job to familiarize him with his job's duties, work place, clients
and coworkers.
In-service education. (2-8hrs): Includes all on-the-job instruction and training that is
given to enhance employee's present job performance.
Continuing education (1-5 days): Includes all planned learning that is intended to
increase employee’s knowledge or skills beyond that needed for satisfactory
performance in the present job.
Staff development model:
The basic model of staff development process is similar to the management process
and nursing process and includes:

• Assessment-This is the process of investigation that provides knowledge

about the learner's readiness to learn and learn and her or his specific
learning needs, such as skills, knowledge are ability.

• Planning: Is the process of obtaining learning resources to present to the

learner and the matching of educational needs and methods.

• Implementation: Is the gathering together of the customers, the learners and

all of the materials and methods needed for the education program(s)
including the application of the principles of learning.

• Evaluation: Is the investigative process in which to determine whether the

education was cost-effective, the objectives were achieved and the learning
was transferred from the learning site to actual use on the job.
Staff compensation management, motivation and staff retention:

• Money is important in people's lives in several ways. Though pay levels are
modest causes of leaving organizations, however organizations with high
pay and reward packages lead in preventing employees to look elsewhere.

• Compensation management is how organizations decide how much

(monetary and non-monetary) and how to pay their employees, and how
they try to manage this process to the mutual satisfaction of the employees
and employer-organization.

• Staff compensation management includes:

 Monetary and non-monetary ways to reward.

  To provide incentives to work harder and smarter

 To help the staff acquire their desired standard of living

• Includes not only extrinsic rewards, such as salary benefits, but also intrinsic
rewards,e.g.

 Recognition

 The chance for promotion

 More challenging jobs.

 Vocational hours to seniors

 Bonus payments

 Increased decision making autonomy

Goals for compensation:

• Attracting good employees.

• Retaining good employees

• Staff motivation.

• Satisfying external requirements.

Staff motivation is an inner drive/impulse a staff has that makes him do things in a
certain way and not the other way.
Motivation is “inner impulse or an internal force that initiates and directs the
individual to act in ascertain manner to satisfy a need” (Rebecca Samson 2009,
leadership and management in nursing practice and education)
Staff motivation can also be defined as-a set of factors that push the staff or
individual to undertake a certain course of action expecting to achieve a desired
goal or need. Examples of motivating factors at work are:achievement,career
advancement, good leadership,affiliation(chance to
affiliate,compensation(remuneration) and rewards,recognition,responsibility,work
itself, self-improvement/development(WHO, Geneva 2001,On being In charge)

Staff retention refers to the ability of an organization/manager to retain its/his

employee.
It also means the efforts put in by the employer to attempt to retain employees in
their work place.
Employee retention =No of employees retained in a year x 100
No of employees employed in a year +
No of those started the year with
The employer/manager should put in place measures, e.g. Incentives, good
leadership, good communication, good working conditions, Competitive
remuneration etc. to help retain workers to prevent continuous human resource
costs e.g. recruitment,training costs. At each stage of staffing (recruitment,
selection, orientation, development and motivation-compensation) something can
be done to encourage staff retention. Factors like; management recognition,
continual training and development, career development/advancement, comfortable
work place, salary, information sharing etc; can help retain staff.
Staff performance appraisal:
The process of interaction, written documentation, formal interview, and following
up that occurs between managers and their employees to give feedback, make
decisions, and cover fair employment practice law (Eleanor J Sullivan 2005,
effective management and leadership in nursing).
It is a periodic formal evaluation of how well personnel have performed their duties
during a specific period, it is a systematic, interpersonal, continuous process
between manager, and employee involving job guidelines and objectives and job
description. (Rebecca Samson 2009, leadership and management in nursing practice
and education)
The staff performance appraisal process includes; Day – today manager-employee
interaction(coaching,counseling,dealing with policy/procedure violations and
disciplining).Making notes about an employee's behavior,completing the
performance appraisal form, The formal appraisal interview that is carried out every
six months or at least once a year, and at the end of the probationary period. Follow
up sessions that may involve coaching and or discipline when needed.
As far as possible, the performance appraisal should focus on employee behavior
and results rather than on personal traits or characteristics such as initiative, attitude
and personality. This makes it satisfy legal requirements, on discriminatory and
demonstrate its validity (job relatedness).
Employee performance is the product of: ability, motivation and environment, and
the performance appraisal addresses the first two (ability and motivation).Accurate
appraisal is an effective means for increasing productivity, and people learn best
when they receive immediate feedback.
Who should evaluate?
The direct supervisors, so it’s the in charge nurses/health workers responsibility to
evaluate all nurses/health working in the unit with her/him, and to evaluate correctly
she should be in frequent, direct and prolonged contact, so she can observe an
adequate sample of all aspects of nurses/health workers/subordinates performance.
Objectives/ purpose/importance of staff performance appraisal:
1. To determine job competence.
2. To select qualified individuals for promotion or transfer.
3. To establish and improve:

• Communication supervisor and subordinates.

• Staff performance.

4. To determine:

• Training and developmental needs of staff

• Salary standards and to award merit.

5. To provide staff with recognition for accomplishment.

6. To discover the aspirations and talents of the staff.
7. To check the efficacy of staff development programs.

8. To identify unsatisfactory staff for demotion or termination.

9. To aid the manager in coaching and counseling.
Principles of staff evaluation/appraisal:
First, the employees evaluation should be based on behaviorally stated performance
standards, which should be reflected in the job description and related performance
standards, and the employees should be aware of them as their desirable
performance goals.
Second, an adequate representative sample of the staff's job should be observed to
provide the basis of evaluation.
Third, the staff should be given copy of the job description, performance standards
and performance evaluation form to understand how she was evaluated.
Fourth, when documenting the evaluation, the manager should indicate the
satisfactory and the unsatisfactory areas of performance.
Fifth, areas of performance that need improvement should be stated according to
priority.
Sixth, the evaluation interview should be scheduled in proper time and
environment.
Seventh, the goal of evaluation should improve performance and satisfaction, rather
than punish.
Qualities of staff to be evaluated:
The qualities most frequently evaluated fall under five major headings:
1. Quality of performance, i.e. the evaluation of both the quantity and quality
of work.,neatness,orderliness,reliability,accuracy, knowledge of
work,execution,etc
2. Mental qualities, i.e the ability to learn, adaptability, reasoning power,
judgment, memory, etc.
3. Supervisory qualities, i.e leadership and organizational ability,
communication skill, cooperation.
4. Personnel qualities,honesty,self-control, self-confidence,initiative,attitude
towards others, team work,appearance,etc
5. Capacity of further development, i.e.intelligence, acceptance of
responsibility and other features inherent in leadership.
Problems in performance Appraisal:

• Halo effect, is the tendency to overrate a person because of his pleasant

personality, strong social skills, he performed well in past, recent good
performance not the whole year, or share the interest of the manager.

• Horn effect, is the tendency to rate employees lower than what he deserves
because: She/he committed a serious error recently, disagrees with the
manager, fails to meet manager's standards of dress and behavior or poor
performing peers.

• The central tendency error, is the tendency to rate the employee in the
middle of the range for each dimension.

• Self-aggregating effect, when the manager deliberately crafts ratings to

create an image of their own leadership style.

Staff Evaluation Tools and Techniques

Tools and techniques are used to compare output (staff performance) to goals (job
description and individual goals)
The characteristics of evaluation tool.
An evaluation tool, to be effective, should be designed to reduce bias, increase
objectivity and ensure validity and reliability.
1. Objectivity: is the ability to remove oneself emotionally from a situation so
as to consider the facts without distortion by personnel feelings.
2. Validity is the degree to which a tool measures what it intends to measure.
3. Reliability concerns consistence of results,that is whether several raters
using the same tool to rate an employee produce the same or similar ratings
or results. This is called the inter-rater reliability. Another reliability
measure,intra-rater reliability,is whether the same rater rates an employee
with the same or similar ratings or results on two or more different
occasions assuming that the employee's performance has not changed.
reliability is important because a tool must be reliable before it can be valid.
Some of the most commonly used evaluation tools:
1. Rating scale:The most common only used tool in medical service.it consists
of set objective behaviors or characteristics to be rated and same types of
scales for indicating the degree to which each presents .The scale may take
several forms,numerical,graphic or descriptive.
2. Management by objective(MBO):The rater(appraiser) evaluates the staff
according to predetermined goals or objective that have been jointly arrived
at by her/him and the individual staff. Comparing the staff's output to goals
is an inherent part of the MBO concept. In MBO the source from which
behaviors are to be rated come from individual employee's goals/objectives
and while others from the job description of the individual staff.
3. The essay:The rater(Appraiser) writes one or more paragraphs about how
well the employee performs his/her and strength and weaknesses in relation
to tasks identified in the job description,this method needs time and efforts.
On the other hand, it can give data about an employee's developmental
needs.
The Appraisal Interview.
The objective of a personal interview is to evaluate the past,present, and future
potential of an individual.
General guidelines for the appraiser(Nurse manager):
1. Establish a friendly atmosphere by selecting the right time and place for the
interview. Be sure the interview will be free of interruptions.
2. Ensure freedom from work assignment. Arrange for coverage during the
time of meeting. Begin and end the session on time.
 3. Establish rapport-a few brief chit-chat before the actual interview.
4. Let the individual talk first. Include all important issues in the discussion.
Be alert,present criticism carefully. Never combine positive and negative
comments and use the guidance approach. Use a concerned tone of voice.
Discuss the work and not the worker.
5. Make a final overall judgment about the individual's progress,as well as any
recommendations on the evaluation form.
6. Let the individual sign the report and explain that the signature does not
necessarily signify that she/he agrees with content,but it indicates that she/he
has seen it.
7. Prepare a list of objectives for modifying or improving behaviors for the
next operational period.
8. Never create a threating or bargaining environment.

Succession plan:
Succession planning is a deliberate exercise aimed at identifying and preparing
those who will replace the incumbents,should posts fall vacant.
This involves the steps of: Identifying the projected vacancies,Identifying the
replacement candidates,Draw up replacement charts that indicate replacement
possibilities,Design and implement development plans for the selected
candidates,conduct a bi-annual succession plan review making relevant changes and
adjustments where necessary.
Developing exit strategies, such as per-retirement counseling, exit interviews,and
out placement.
 STAFF MOTIVATION
Definitions:
staff motivation is an inner drive/impulse a staff has that makes him do things in a
certain way and not the other way.
Motivation is “inner impulse or an internal force that initiates and directs the
individual to act in a certain manner to satisfy a need”(Rebeka Samson
2009,leadership and management in nursing practice and education)
Staff motivation can also be defined as-a set of factors that push the staff or
individual to under take a certain course of action expecting to achieve a desired
goal or need. Examples of motivating factors at work are:achievement,career
advancement,good leadership,affiliation(chance to
affiliate,compensation(remuneration) and rewards,recognition,responsibility,work it
self,self improvement/development(WHO,Geneva 2001,On being In charge)
Motivation is an inner impulse that induces a person to act in a certain way.Its a
series of internal drives within a person at different levels.
Level 1:To obtain the necessities of life-food, shelter,clothing,rest and safety,sex
etc.
Level 2: To satisfy social needs such as those for companionship,love,and a
position of respect.
Level 3:To ensure some degree of personal satisfaction and pursue ideas. People
need to feel reasonably satisfied with themselves,with what they make of their lives
and with talents and abilities.
Using personal motivation to achieve work objectives:
A leader should understand what encourages people to apply their ability and
energy to work(motivators) and what makes people dissatisfied at
work(dissatisfiers).
The six main motivators at work are:
1. Achievement-The leader should help people to achieve work objectives.
2. Recognition-The leader should give praise where its due;recognise
individual's efforts and capabilities.
3. The work itself-explain the value of work. interesting and challenging
work,good working conditions;motivate workers.
4. Responsibility-The leader should help others take responsibility,this helps
them get empowered and become more effective and efficient.
5. Career advancement-The leader should help others train for promotion.
 6. Self improvement-The should provide opportunities for personal/self
development.
Other motivating factors at work are:

• Competent leadership-leaders who know what to do.

• Happy friendly atmosphere-atmosphere with good interpersonal

relations/affiliations.

• Job security

• Good earning

• Social welfare-Assured of gratuity,health care social security.

• Feeling “in on things”(feeling part of the things done)-Being “in the thing”.

• Organization policies.

• Freedom to act.

The six common causes of dissatisfaction (demotivators) at work are:

1. Inefficient administration

• people want to work for an administration that efficient and just.

• Wasting time and other resources irritates people and makes them
angry.

• Even if people don't complain,they dislike being kept waiting-To

keep people waiting is a sign of disrespect;its the opposite of
recognition. Administrators who fail to pay salaries on time,to send
transport when it has been arranged,or to distribute supplies, causes
serious dissatisfaction and discourage their staff.
2. Incompetent supervision: Supervisors are expected to be
technically competent. They must be thoroughly familiar with the
details of the work they are supervising. Thus midwife's supervisor
who cannot help with a difficult diagnosis will lose the midwife's
respect.
3. Poor personal relations:People should be treated fairly supervisors who have
favorites, or who are dishonest in reporting on the work of the staff,are disliked and
the work suffers
People like to be consulted about their work. “She never consults me” are the
complaints that indicate poor personal relations.
4 . Poor leadership qualities: People respond more to example than exhortation “Do
as I say, not as I do” is a poor method of leading. Without the personal
authority(moral authority) that comes from integrity,fairness and thorough
understanding of the work, the authority of the position of the leader will not
impress those who are led.
5. Low pay: The absolute level of salary is less important than its relative level.
A salary is satisfactory when the workers get what they expect, what others doing
the same sort of work are getting and what is generally regarded as being fair.
6.Bad working conditions: The good leader takes care that the conditions of work
are such that they permit staff to do their best work.
When there are difficulties/bad conditions caused by nature or unavoidable
conditions, the leader inspires the members of the health team to do their best under
difficult circumstances. Its normal for health(personnel) to feel and express
dissatisfaction with bad working conditions when these are caused by incompetent
administration and leadership and could be put right.
Motivation theories:
Abraham Maslow’s pyramid of needs(hierarchy of needs):
People usually have different needs for which they strive(be motivated)to work
towards achieving.
Maslow's hierarchy of needs is a theory in psychology proposed by Abraham M. in
his 1943 paper “ A theory of human motivation”
Maslow's hierarchy of needs is often portrayed in the shape of a pyramid with the
largest most fundamental levels of needs at the bottom and the need for self-
actualization at the top.
The most fundamental and basic four layers of the pyramid contain what Maslow
called “deficiency needs” or d-needs:esteem,friendship and love,security and
physical needs. If these deficiency needs are not met-with the exception of the the
most fundamental(physiological) need-there may not be a physical
indication(sign),but the individual will feel anxious and tense. Maslow's theory
suggests that the most basic level of needs must be met before the individual will
strongly desire(or focus motivation upon) the secondary or higher level.

Physiological needs:
The need for continuity of life. These are physical requirements for human survival.
If these requirements(needs) are not met,the human body can not function properly
and will ultimately fail. Physiological needs are thought to be the most
important;they should be met first.
Safety/security needs:
The need of being free from physical danger or threat. With the individual'(s)
physical needs relatively satisfied,their safety needs now take precedence and
dominate behavior.
These include: personal security, financial security, Health and wellbeing and safety
net against accidents, Illness and their adverse impacts.
Love and belonging:(social,or belonging,acceptance).
The need to be loved,to be accepted by others,to belong to a group.
After physiological and safety needs are fulfilled,the third level of human needs is
interpersonal and involves feelings of belongingness. Deficiencies within this level
of Maslow’s hierarchy-Due to hospitalization,neglect,shunning,ostracism() etc-can
impact the individual's ability to form and maintain emotionally significant
relationships in general such as friendship,intimacy,family.
According to Maslow,humans need to feel a sense of belonging and acceptance
among their social groups,regardless if these groups are large e.g clubs,religious
groups,co-workers etc and small groups e.g family members,intimate
partners,mentors etc.
Humans need to love and be loved both sexually and non-sexually.
In absence of this love or belonging element ,many people become susceptible to
loneliness,social anxiety,and clinical depression.
Esteem needs:
The need to be held in esteem by themselves and by others;self respect and
recognition.
All humans have a need to feel respected;this includes the need to have self esteem
and self respect.
Esteem presents the typical human desire to be accepted and valued by others.
People often engage in a profession or hobby to gain recognition. These activities
give a person a sense of contribution or value.
Self Actualization/Achievement:
The need for self fulfillment,for continuous improvement,the need to maximize
one's potential,to become what we can become.
“what a man can be he must be”
This level of need refers to what a person's full potential is and the realization of
that potential. Maslow describes this level as the desire to accomplish everything
that one can,to become the most that one can be.
To understand/achieve this level of need,the person must not only achieve the
previous needs,but master them.
Note: While originally thought the needs of humans had strict guidelines,Maslow
states that”hierarchies are interrelated rather than sharply separated. This means
esteem and the following(subsequent)levels are not strictly separated;instead,the
levels are closely related.
Assignment:
1. Log on Web:http://en.wikipedia.org/wiki/maslow%27s_hierarchy. And
draw the Maslow's pyramid of needs.
2. Read about: the McCelland's basic needs theory of motivation-The basic
needs of,Achievement,power
and affiliation.
Herzbergerg's hygiene motivation theory:demotivators and motivators.
Douglas McGregor's x and y motivation theory.
Ref:leadership and management in nursing practice and education by Rebecca
Samson(2009),Effective leadership and management in nursing by
Eleanor.J.Sullivan(2005)
 STAFF DELEGATION:
Definitions:
Delegation is the assignment/transfer of authority and responsibility to another
person to carry out specific activities.
Delegation is the transfer of authority and responsibility for the performance of a
task from one person to another.
Delegation is a contractual agreement in which authority and responsibility for a
task is transferred by the person accountable for the task to another individual.
Delegation is appointing a person to act on one’s behalf.
Delegation-“the act of empowering to act for another”
While delegating, the delegator transfers to a competent individual (delegate) the
authority and responsibility to perform a selected task (nursing task) in a selected
situation (nursing situation).while retaining accountability for the outcome.(Eleanor
.J. Sullivan 2005).
Rights to delegation:
The following five rights to delegation are presented from the perspectives of both
nursing service administrator and staff nurse
Delegate to:
The Right person,
The Right task, in
The Right Circumstances, With
The Right Direction/communication, and carry out
The Right supervision and evaluation
Delegation process:
1. Define the task:
Delegate only an aspect of your own work/task for which you have responsibility
and authority.
Delegate routine tasks, tasks for which you don’t have time, tasks that have moved
down in priority
Does the task involve technical skills or cognitive abilities, specific qualifications,
what are the restrictions; e.g practice acts. How complex is the task, is training or
education required?
 2. Decide on the delegate:
Match the task to an/the individual basing on skills
level,capability,experience,character,initiative,intelligence,enthusiasm. Is the would
be delegate available or going somewhere, then get another person.
3. Determine the task:
Clearly define your expectations for the delegate, key behaviors in delegation:
describe the task using I e.g, I would like, provide the delegate with a reason for the
task-its importance to the organization,you,to the delegate; inform the delegate the
standards for evaluation, provide an incentive for accepting responsibility and
authority ,identify any constraints for completing the task and risks involved,
validate understanding of the task and your expectations by eliciting questions and
providing feedback.
4. Reach an agreement:
After outlining your expectations, you must be sure that the delegate agrees to
accept responsibility and authority of the task.
Be prepared to equip the delegate to complete the task successfully .e.g, with
additional information, resources, or informing others about the arrangement.
Before meeting the individual anticipate negotiation and identify what you are
prepared and able to provide.
5. Monitor performance and
6. Provide feedback: Monitoring performance and provides a mechanism for
feedback and control that ensures that the delegated tasks are carried out as
agreed.
When defining the task and expectations, clearly establish the where, when, and
how.
Remain accessible. Support builds confidence and reassures the delegate of your
interest and negates any concerns about dumping undesirable tasks. However
monitoring the delegate so closely distrust. Analyze performance with established
goals. If problem areas are identified, privately investigate and explain the problem,
provide an opportunity for feedback, and inform the individual on how to correct
the mistake in the future. Be sure to give praise, due recognition, can do this
publicly.
Strategies for effective delegation(How can one make delegation achieve the
desired objective?)

• Plan a head

• Identify necessary skill levels

 • Select most capable person

• Communicate the goal clearly

• Empower the delegate

• Set deadlines and monitor progress

• Model the role; provide guidance

• Evaluate performance

• Reward accomplishment

Benefits of delegation:
To the manager/In charge:

• The manager will be able to devote more time to those tasks that
cannot be delegated.

• With more time created due to delegation, a manager can be able to

develop new skills and abilities facilitating career advancement.
To the delegate:
o The delegate gains new skills and abilities that can facilitate
upward mobility.
o Delegation can bring trust and support between delegate and
manager, hence building self-esteem and confidence.
o Delegation brings job satisfaction and motivation as individuals
feel stimulated by new challenges.
o Delegation improves a sense of belonging and awareness of
responsibility of the delegate.
o Individuals feel more appreciated and learn to appreciate the
roles and responsibilities of others, increasing cooperation and
enhancing team work.
o To the organization:

o Team work created by delegation makes the organization achieve its

goals more efficiently,this
o Increases productivity, this

o Improves the financial position of the organization.

 o Efficiency increases the quality of care and hence improving client
(patient) satisfaction
Common errors in delegation (ineffective delegation):
Under delegation:
Under delegation occurs when:
The delegator fails to transfer full authority to the delegate.
The delegator takes back responsibility for aspects of the task, or
The delegator fails to equip and direct the delegate.
As a result, the delegate is unable to complete the task, and the delegator must
resume responsibility for its completion.
Over delegation:
Over delegation occurs when the delegator loses control over a situation by
providing the delegate with too much authority (Right to act) and responsibility
(obligation to accomplish a task).
Reverse delegation:
In reverse delegation, someone with a lower rank delegates to someone with more
authority. E.g,Celina,a staff who says to her manager “I’m really swapped today.
Can you hang Mr. Morino's I.V fluid so I go for lunch”. Though the manager could
assist Celina, this is not an efficient use of her time. Instead the manager could help
Celina organize her own time and efficiently delegate some responsibilities.
Un necessary duplication:
If staff are duplicating the work of others, the manager may have given related tasks
to too many people. To avoid unnecessary duplication, try to delegate associated
tasks to as few people as possible. This allows the person to complete the
assignment without spending time negotiating with others about which task should
be done by which person.
And this makes reporting simplified for both the employee and manager.
Barriers to delegation (constraints to delegation)Reasons for absence of
delegation.

• The belief that “I can do it better myself”

• Lack of confidence and trust in workers

• Low self confidence-feeling of insecurity in the manager

• Vague job description-Manager doesn’t know what tasks are

already in the worker’s job description and so obliged to do them
but not as delegated task.

• Inadequate training on both the side of the manager and

subordinate-The manager doesn’t know how to delegate and the
worker may lack skills and so can’t be delegated to.

• Lack of adequate recruitment and selection-So no competent

people( would be delegator and delegate)

• Time involved in explaining the task-manager feels it will

consume time explaining the task,so better does it himself. The
more competent the worker is, the less time will be taken to
explain the task to the worker.

• Reluctance to take the risks involved in depending on others.-

manager fears to take risks in case the worker doesn’t messes up-
the manager fears blame after role he remains accountable(owns
the results or lack of them) for the delegated tasks

• Fear of loss of power.

• Subordinates resistance to delegation-workers may just refuse to

take up responsibilities.

• Failure of the delegator to see the subordinates perspectives-This

discourages them to accept responsibility and authority.

• Work load assigned are highly challenging both physically and

mentally.

• Belief of employees that they are incapable of completing the

delegated task.-lack of trust in themselves-low self esteem in
workers

• Inherent resistance to authority.- When worker lack respect for

authority.

• Due to over delegation-sometimes the manager may be seen

 delegating too much.
Ref: Eleanor.J.ullivan 2005, effective leadership and management in nursing.
http://current nursing.com/nursing management/delegation.html.
Management principles of delegation. The principles a manager uses in
delegation:
Responsibility and accountability:Although responsibility is and accountability are
often used synonymously,the two words represent different concepts that go hand in
hand. Responsibility denotes; an obligation to accomplish a task or an obligation to
carry out the activities needed to accomplish the assigned task. Where as
accountability is accepting ownership or being taken answerable for the result or
lack there of.
Responsibility is the first principle to remember about delegation. You can delegate
only those tasks for which you are responsible. If you have no direct responsibility
for the task,then you cant delegate that task. For instance, if a manager is
responsible for filling holes in the staffing schedule, the manager can delegate this
responsibility to another individual. However if staffing is a responsibility of a
central coordinator,the manager can make suggestions or other wise assist the
staffing coordinator,but cannot delegate the task.
To understand understand clearly who is responsible for what,look at: Practice
acts,standards of care,Job descriptions,and policy statements. The
nursing/Midwifery act,Allied health professionals act,Dental and medical
practitioners acts etc in each state define the scope of the respective professionals'
practice. These regulations however, seldom provide a list of tasks that may or may
not be delegated because medical professions are knowledge based not task based.
Responsibility is transferred whereas accountability is shared. The manager may
delegate tasks to another individual but she and the delegate are both
answerable/accountable for the results or lack of it.
Authority:The second principle of delegation is that along with responsibility,You
must transfer Authority. Authority is the right to act:The power to make final
decisions and command.(Eleanor.J.Sullivan 2005,Rebecca Samson 2009).
There fore by transferring authority,the delegator is empowering the delegate to
accomplish the task. So often this principle of delegation is neglected by
managers;Managers retain authority,crippling the delegate's ability to accomplish
the task,setting up the individual for failure,and minimizing efficiency and
productivity.
TEAM WORK(Team building):
Definition:
According to Katzenbach and smith 1993,A team is a small number of people with
complementary skills who are committed to a common purpose,set of performance
goals, and approach for which they hold themselves mutually
accountable(O'Sullivan,2005,Effective leadership and management in nursing)
Most work teams have a leader who maintains the integrity of the team's function
and guides the team's activities,performances and development.
Teams have command or line authority to perform tasks,and membership is based
on specific skills required to accomplish the task.
Teams may be self-directed,that is,led jointly by group members who decide
together about work objectives and activities on an ongoing basis.
Small number-5-10 people
Complementary skills-Appropriate balance or mix of skills and traits.
Commitment to a common purpose and performance goals-Specific
performance goals are an integral part of the purpose.
Commitment to a common approach-Team members must agree on who will do
a particular job and develop a common approach.
Mutual accountability-Team accountability is about the sincere promise we make
to others and ourselves;these are the basis of commitment and trust.
What are the differences between a Group and a Team?
Group Team
Strong clearly focused Shared leadership roles
Individual Individual and mutual accountability
accountability
The group's purpose is Specific team purpose that the team delivers
the same as the broader
organizational mission
Individual work Collective work products
products
Runs efficient meetings Encourages open-ended discussions,active problem solving
meetings.
Measures performance Measures its effectiveness directly by collective work products
 indirectly by its
influence on others
Discusses,decides,and Discusses,decides,and does real work together.
delegates

Team work values:

Often we use the word “Team work” in our organizational context without perhaps
fully understanding what we mean. Team work is an abstract concept that
represents a set of values. These values are:

• Encouraging behaviors such as listening,responding to the view points of others,and

giving others the benefit of the doubt.

• Providing support to those who need it.

• Recognizing the interests and achievements of others

• Promoting performance as individuals and the performance of the entire

organization/unit.
Team Development and performance.
“Great people don't equal great teams”.-Tom peters.

Stages of Team building:

Stage: Characteristics:
1 Forming Team acquaints and establishes ground rules. There is awareness
creation,commitment to task and team culture,and acceptance.
2 Storming Members resist control by group leaders and show hositility. There is
conflicts,the leaders clarify on things,Belonging to the cliques of members
whom they find being on their side.
3 Norming Members work together developing close relationships and feeling of
camaraderies. There is cooperation,Involvement,support.
4 Performing Team members work towards getting their job done. There are tangible
results,achievement of goals and pride.
5 Adjourning Team may disband on achieving their goals or because members leave. There
is separation,recognition of achievements by members,satisfaction because of
the achievements and recognition.
Resistance to Teams in Organizations.
Though a very large number of people believe in the argument for greater focus on teams,when it
comes to using the team approach,some people are reluctant to rely on teams.
Two primary sources for people's reluctance to work in teams are:
1. Perceived lack of conviction:Some people do not believe that teams really do perform
better than individuals. Others think that teams are probably useful from a human
relations point of view, but are a hindrance when it comes to work productivity and
decisive action.
2. Personal discomfort and risk:Many people fear or do not like to work in teams,because
they believe that the team approach is too time consuming,too uncertain, or too risky.
Characteristics of an Effective Team:

• Members feel that their participation is important and personally beneficial to them.

• Remains intact only as long as it is working on a particular problem.

• Includes some of the people who will be responsible for implementing the decision.

• Includes an appropriate balance/mix of skills and traits.

• Has 5-10 members(15 maximum).

• Has knowledge that is relevant to the problem and task.

• Selects a leader together.

• Influence of members on decisions in teams is based on their capacity to

contribute(relevant expertise) and not on the authority they possess in the organization.

• Integrates decisions with the normal or regular decisions of the departments/units from
which the members are drawn.

• Confronts and resolves conflicts that develop with a problem-solving approach,instead of

avoiding them or smoothing over.
Characteristics of an Effective Team Members:
In addition to studying the characteristics of effective and ineffective teams,Its useful to examine
the characteristics of effective team members. Organizational failures are often not the result of
poor leadership,but a poor “follower ship” An effective team member is someone who:

• Understands and is committed to the team's goals.

• Is friendly,concerned,and interested in the other team members.

• Acknowledges and confronts conflict openly.

• Listens to other team members with understanding.

• Includes other team members in the decision making- process.

• Recognizes and respects individual differences.

• Values the ideas and contributions of other team members.

• Recognizes and rewards team efforts.

• Encourages and appreciates comments about team performance.

Characteristics of an Ineffective Team.

• Cannot easily describe the team's mission.

• Meetings are formal,stuffy, or tense

• Great deal of participation,but little accomplishment.

• A lot of talking occurs,but not much communication.

• Disagreements are aired in private conversations.

• Decisions tend to be made by the formal leader with little meaningful involvement of
other team members.

• Members are not open with each other because trust is low.

• Confusion or disagreement about roles or work.

• People in other parts of the organization who are critical to the success of the team are
not cooperating.

• Overloaded with people who have the same team-player style;style diversity leads to
looking at all aspects of team effectiveness.

• Has existed for at least 3 months,but has never assessed its functioning.
 MANAGING MEDICAL EQUIPMENT AND SUPPLIES(Materials)

The two main types of medical equipments are:

1. Expendable(consumable or recurrent),
2. Non-expendable(capital or non-recurrent)
Expendable equipment is equipment that is used within a short period of time,e.g matches,cotton
wool,laboratory stains,paper,disposable syringes.

Non-expendable equipment is equipment that lasts for several years and needs care and
maintenance, e.g microscopes,scalpels,furniture,weighing scales,vehicles,bedpans.
The four main procedures in the management of equipments are:
1. Ordering:Tis is the process of obtaining equipment from stores e.g NMS,JMS or shops.
2. Storing:This is recording,labeling and holding equipment in a stock or store room.
3. Issuing:This is giving out,recording the issue and the balancing of the remaining stock
and receiving a signed issue voucher.
4. Controlling/Maintaining:This is controlling expendable equipment,maintaining and
repairing non-expendable equipment.
Ordering:(procurement)
Usually senior staff are involved or authorized to order equipment. Ordering involves:

 Listing(selecting/selection) requirements,from a knowledge of past use and estimates of

the present to determine future need.

 Quantification-Putting numbers of each equipment needed.(Unit and total units)

 costing(cost-estimate)-Putting the price per unit, and total price in tabulation form.

 Balancing requirements with available resources/funds(vetting)

 Completion of order forms or requisition forms.NB-During ordering,we use a

catalogue,essential Medicines and Health Supplies(EMHS) list of Uganda and Uganda
Clinical Guidelines(UCG) and catalogue.

 Making a commitment to buy.-commit the amount of funds for purchase and remove it
from the allocated funds.

 Forwarding the order to DHO- Authority to authorize.

Making a list:
Several lists of required items should be made,according to the expected place of purchase;e.g
matches are bought from a local shop,Thermometers are bought from a pharmacy or medical
store. The exact required type of each item should be written down;e.g Touch battery,1.5
volts;syringe 5ml luer fitting.
The quantity of each item should be estimated which makes it necessary to know:

 How frequently the order can be purchased(purchasing interval) e.g kerosene-local

purchase,a weekly order, Thermometers from NMS/JMS,order every 6 months.

 How much is normally used during the purchasing interval.

 Whether the amount used is reasonable or extravagant.

NB:The quantity of an item used depends on the number of people using it (consumption) and
can be estimated by asking an experienced person or from own experience-Using inventory list
can tell you which non-expendable equipment needs to be ordered,stock cards and stock books
are used to show the expendable(consumable)equipments needed to be ordered.
Balancing needs and resources-Funds:
Health services all over the world are short of resources-funds. Priorities therefore must be
established among needs,and the needs must be balanced against resources (available funds)

Usually the amounts or kinds of materials that a health worker wants to order must be reduced
until they correspond with the funds available to purchase them. For this,vetting,cost
estimation,must be made before completing the order-form.
Use VEN concept:
V-Vital-If not available the patients can die.
E-Essential-discomfort to the patient continues if not available.
N-Necessary-cost:benefit ratio usually high and effectiveness doubtable.
This concept/tool works for prioritizing/vetting especially drugs but can also work for supplies
and equipments.
Using a catalogue:
A catalogue is a book that contains a list of articles available for purchase from a certain place.
It's used whenever things are ordered at a distance.
A catalogue may be published by Government store (NMS) or by a private
firm(JMS),manufacturer or shop.
Uses of a catalogue:

• A catalogue is used because village shops do not stock required equipments.

• A catalogue ordering is also used when purchasing through Government stores or

departments.
Disadvantage of purchasing from a catalogue:

 The purchaser doesn't see the item(articles) ordered. The catalogue therefore must be
studied carefully and the exact item number, description and price carefully noted. If care
is not carefully taken, there is a possibility of errors and hence ordering a wrong item or
quantity or putting a wrong price.
Completing an order -form or requisition:
An order-form or requisition form is usually supplied together with the catalogue. Different
stores or firms have their own particular order-form.
Example of an order-form:
ITEM(REFE NAME OF UNIT PRICE TOTAL TOTAL
RENCE)CO ITEM(DESCRIPTI PER UNIT QTY AMOUNT
DE NO ON)

Receiving new items of equipment into store:

A new item is usually delivered with a document;either a tax invoice(if item is not paid for) or
delivery note if payment has been made.
Some times both papers are delivered( a tax invoice is a cost of an article-item)
The receipt of the item is then noted in the stock book or ledger(stock card).which usually has a
separate page for each item stocked.
Usually there are two ledgers(stock cards), one for expendable and one for non-expendable
equipment.
The record is devided in columns containing date received,Reference(code) number of the item
and place of purchase; The tax invoice number or statement of accounts,The quantity of items.
Example of the stock book-ledger or card:
ITEM DATE RECEIVED INVOICE NO QTY QTY BAL IN
FROM RECEIVED ISSUED STOCK

Each item is recorded on a separate page of the ledger-book-card. Every time an item is
delivered,the quantity received is added to the total in stock. Each time an item is issued, the
quantity is subtracted from the total Stock. The resulting number is the balance in stock-at hand.
Storing Equipment:
Equipment is stored in two places:

 A main or reserve store where stocks are kept but not used.

 The place of use,after issue from store.

To store equipment the following skills are necessary:

 Recording the receipt of new items and the issue of items

 Keeping a stock book(Inventory book,ledger book,stock card in balance)

Issuing Equipment:
A health center may have several sections,the head(In charge) for each section is responsible for
the equipment in that section. Maternity Nurse-responsible for weighing scales,syringes and
vaccines,delivery kits,etc.
A laboratory worker-responsible for microscopes,test-tubes,glass slides and stains,etc.
After equipment has been ordered,received and recorded in the stock book-Inventory book or
ledger-card,its issued for use when needed.
Three paper work procedures are involved in issuing equipment:

 A ledger record(writing the issue in the stock ledger-card-book)

 Issue of a voucher(Issue voucher) which must be signed.

 An inventory-item record of the section receiving and using the equipment.

Ledger record:
When an issue is entered in the stock ledger-book-card,the balance of items remaining in stock is
calculated by subtracting the quantity issued from the total in stock(stock in hand),when a
balance reaches a certain low point,its time to order new equipment/supplies.
Note:Unless issues are recorded in the stock ledger and balance of stock remaining is
calculated,its very difficult to know when to order more stock.
Inventory:
An inventory is a list of items that are kept in a certain place. Each section of a health centre
keeps an inventory of its non-expendable equipment.
Note:The health centre setting,inventory list for all sections,For hospital setting each
department/section keeps the inventory list.
Controlling and maintaining equipment:
Expendable equipment must be controlled to avoid wastage. Non-expendable equipment must be
maintained. I.e Kept in good working condition.
Skills necessary/How to control and maintain equipment.

 Encouraging/convincing staff that equipment must be cleaned,Inspected,and kept in good

order,that defects must be reported immediately,and that equipment must be returned to
its correct place after use.

 Using an inspection check list and inspection schedule .E.g every month.

 Detecting discrepancies and explaining them.

ENB: As a supervisor or manager you have to set a good example and to emphasize that
equipment must be cared for;and
why should equipment be cared for:

 To prevent transmission of infections,E.g by dirty instruments.

 To keep it in good condition( Dirty or damp equipment deteriorates more rapidly than
equipment that is kept clean and dry)

 To economize-Its economical to make the best use of equipment and supplies.-The

equipment that is well cared for lasts longer,materials used correctly is not wasted.
Examples of wasting equipment/supplies are:

 Using cotton wool for cleaning purposes.

 Not turning lamps down, or not turning off lights when they are not needed,Equipment
should be returned clean and in good order to its correct place after use;in this way it lasts
longer and has to be replaced less often.
Inspection check list

 Equipment in a department/section is inspected by checking what is present and

comparing it with the inventory book. How often the equipment should be checked
depends on whether it is consumable or long-lasting and whether it is liable to break
down.

 Consumable items need to be checked frequently to avoid wastage and extravagance.

 Long lasting equipment such as beds,tables, and chairs need to be checked only once a
month or year depending on the organization's inventory/health supplies management
system.

 Equipment ad machinery that is liable to break down Eg. Sphygmomanometers,electric

 sterilizers,vehicles) need regular and more frequent check-ups.
Note: Inspection is uninteresting work and therefore often forgotten or overlooked. As a
reminder to the manager or supervisor, it is useful to have special set times for
inspection,detailed on an inspection schedule.
Detecting and interpreting discrepancies.
Discrepancy is a difference between what is reported and what is found, for instance a difference
between the amount of something actually used,and the amount normally expected to be used,or
a difference between the equipment entered on the inventory list/book and the equipment
actually present.
FINANCIAL MANAGEMENT-MANAGING HEALTH CARE FINANCES.
Health care financing-Funding in Uganda:source of funds.
Introduction:
Health care financing is complex and the financial flows from sources of health care funds to
where health services are delivered are dynamic.
The sources of health financing are:
1. Public-Funds coming from central and local Government, including funds from Health
Development Development partners(HDPs) channeled through central central and local
Government budget support mechanisms, and through project mechanisms.
2. Private- Funds coming from private or non-Government sources, including out-of pocket
payments(payment from a sick person or relative's pocket) for health services,Insurance
Pre-payment scheme premiums,donations and projects and programmes funded and
implemented by and through NGOs. However public health providers are not entirely
funded by public sources and often receive a mix of public and private funding. At the
same time private providers, which are funded mainly by private sources, in some cases
receive and utilize public funds. The partnership between public and private health
providers can together mobilize additional resources to improve the health of the
population.
The total per capita(per person per year) expenditure on health in Uganda is estimated at about us
$20(50000=) with approximately us$ 10.4(26250=) contributed by Government and
development partners,and the rest is from private sector.
The present level of funding is inadequate to cover the estimated per capita cost of us
$41.2(103000=) to deliver the minimum health care package(MHCP)
Service sectors Sources of Funding and support

Public services Public Funding sources Private Funding sources

Government health 1. Government of • Private wings

centres,hospitals and Uganda (central
community health and local NGO-supported projects and
workers. government programmes
taxation)
2. Development
partners

• central budget
support
 • District Budget
supporting Multi
lateral and bilateral
projects and
programmes
channeled through
central or local
government

Private services • Govt subsidies or • House hold(user fees)

cost support to
• Facility-based private • Insurance(employer-
PNFPs facilities,including based,community-
infrastructure based,national-based and
• Non-facility- private)
development.
based PNFPs
• Contractual • Donations(internal and
• private health external)
arrangements with
practitioners private providers.
• Income generating activities
• Traditional and • Participation in
complementar Gvt-funded • Fund raising
y medicine programs
practitioners • commercial marketing
• Multi-lateral and strategies
bilateral projects
• NGO-supported projects
and program
channeled through and pro grammes.
central or local
Govt.

Public health services historically has been funded through taxation as well as donor funds,with
services provided free of charge to the population.
This policy was difficult to sustain in light of the decreasing public funding to the health sector
as a result of economic decline of the 1970s and1980's (Amin and Obote regimes). During this
time,informal charges were levied in public health units. In a bid to relieve funding constraints
by seeking additional sources of revenue(income), a formal user charge was introduced at all
Government facilities in the early 1990's.
The Govt's user fees policy was reviewed in 2000,& user fees at Government facilities were
abolished in march 2001,except in private wings of Government hospitals,in the interest of
ensuring equity and access to health services.
Facility based-private Not For Profit's(FB-PNFPs) are financed by external and internal
donations, income generating projects,user charges, and Government subsidies.

Non Facility Based-private Not For Profit(NFB-PNFPs) are funded from a variety of sources
such as bilateral and multilateral development partners,private donations and fundraisings.
Government financial support to NFB-PNFPs is at present limited and generally adhoc in
nature,depending on individual agreements.

Households and/or private medical insurance finance services provided by Private Health
Practitioners(PHP),although a number of private providers also benefit from Government and
NGO-Funded programs and projects particularly in rural areas(Training,basic equipment etc).
Primarily the house holds fund Traditional and complementary medicine
practice(TCMP),through out of pocket expenditure and payment in kind,although a number of
TCMP,Traditional Birth Attendants(TBAs) in particular, also benefit from Government and
NGO-funded programs and projects(Training,basic equipment,etc).

Health insurance is growing as a form of health financing,although its actual contribution to over
all health sector financing is minimal.
By sharing the cost of health care,insurance schemes recover a substantially higher proportion of
costs than user fees. Employer-based insurance,community based health insurance(prepayment
schemes) and private health insurance schemes are operating in Uganda. A national Health
insurance is ready to be approved.
Ref:National policy on public private partnership in Health 2012,MOH,GOU(sec 2.5-resources
for health care/2.5.1 financing health care pg 9), HSSIP 2010/2011-2014/2015(sec 2.5-financing
of health services,pg 27) produced July 2010
 BUDGETING
Introduction:
“ In today's competitive environment a higher level of performance is necessary. A focus on
efficiency and effectiveness is essential” The manager must help design the work to reduce
extraneous and redundant tasks, making the best use of each individual's time and effort.
Attention to the budgeting process is the first step to understanding how to use resources most
effectively. Porter-o'Gray said in 2003(Eleanor .J.Sullivan 2005)
Definition:
A budget is a quantitative statement,usually in monetary terms, of the plans and expectations of a
defined area over a specific period of time.
It adresses what to be done,where and when.
Why budget?(what's the purpose or importance of a budget?)

• The purpose of the budget is to allow management to project action plans and their
economic impact on the future so that objectives of the organization are coordinated and
met.

• The budget provides a foundation for managing and evaluating financial performance-
Budgets detail how resources will be acquired and used to support planned services with
in the defined time period.

• The budget process also helps ensure that resources necessary to achieve the objectives
are available at the appropriate time and that operations are carried out with in the
resources available.

• The budgeting process increases the awareness of costs and also helps employees
understand the relationships among goals,expenses and revenues-This makes employees
and departments committed to the goals and objectives of the organization and work
diligently to achieving them.

• Budgets also help management control the resources expended through an organizational
awareness of costs.

• Budget provides management with feedback about resource management on their part
and part of employees.

• Budgeting enhances communication. Plans are a top management package and is relayed
to every member of the organization and improves performance.
The budgeting process:
Budgeting is a process of planning and controlling future operations by comparing actual
results(actual budgetary performance) with planned expectations.
Controlling:Is the process of comparing actual results with the results projected in the budget. By
measuring the differences between the projected and the actual results, management is able to
make modifications and corrections. Therefore controlling depends on planning.
Budgeting process preparation
Before the preparation of any budget in an organization,the budget period,a budget
manual,responsibility for the preparation of budget, and a budget committee have to be set or/and
put in place.
Steps of Budgeting process:
The following steps are usually followed:
1. Establishing the beginning position-The baseline situation/position today-Now as the
budget is to be made. E.g the total expenditure and revenue as of today, this month.
2. Spell out the budget assumptions
3. Prepare the sales forecast budget(source of income-revenue)
4. Preparation of production needs budget(resources needed for delivering the services,or
production of goods)This involves:

• Materials usage budget-consumables.

• Machine utilization budget-consumables

• Labor and wages budget.

• Overhead cost budget including cost of services/production,administration,selling

and distribution(for services can be advertisement,service promotion costs)
5. Preparation of a cash budget-attach money on the above.
6. Coordination and review of budgets.
7.Preparation of the master budget and the anticipated proforma income statement and
anticipated balance sheet
To plan,the organization/Manager must anticipate the future by gathering information
Generally the information needed for a good plan/budget is:

• Knowledge of where the organization is “going”.

• Resources available

• Scheduling/Training-economic factors

• Past experience e.g competition.

For a health based organization,To plan the organization must anticipate the future by
gathering information about the following:

• Demographics of the population served.

• Sources of revenue, especially managed care contracts,as well as public payers

Medicaid,and commercial insurance companies,because payment arrangements and
mechanisms determine the projected revenues of the organization.

• Statistical data,including the number of admissions or patient visits,patient days,average

length of stay,and projected occupancy or visits.

• Projected salary increases and price increases,including inflation rate, for supplies and
other costs.

• Information about regulatory charges(e.g,medical regulations)for the budgetary period.

• Organizational changes (e.g expansion or addition of pharmacy,laboratory etc) that may

result in salary and benefit shillings being charged to the budgetary or cost unit.
Management always uses the past as the common starting point for projecting the future.
However in today's unstable economic environment, the past may be a poor predictor of the .In a
rapidly changing industry,basing budgets on historical data often requires readjustment during
the actual budget period.
The organization may use sophisticated and complex forecasting methods,including statistical
techniques to assist in making projections related to the budgetary period.
Challenges in budgeting in the health sector in Uganda:

• Resources for curative and preventive medicines are still inadequate.

• Remuneration of health workers is still very low and has not created sufficient motivation
to attract qualified health workers to work in hard to reach areas.

• Investments for basic infrastructure have not met the need for quality service provision in
the health facilities.

• Increased alignment of donor funds through budget support may reduce the level of
engagement between Ministry of health(MOH) and donors on resource allocation in the
health sector.

• Growth of essential medicines budget is not in line with the increasing needs for
medicines of the population.

• Only a PHC non-wage budgetary allocation in the sector is based on clear

rationale(formula)leaving out the capital development allocation which is based on needs
assessment.(HSSIP2010/11-2014/15,MOH Uganda)
Approaches to budgeting:
Depending on how a department(budgetary center) being budgeted for is viewed,the budgets
may be developed in various formats.
The department may be viewed as:
i. Cost centers. Here managers are responsible for predicting,documenting, and managing
costs-(staffing,supplies) of the department.
ii. Revenue centers. Managers are responsible for generating revenues(patient volumes in
case of hospital)
iii. Profit centers-Managers are responsible for generating revenues and managing costs so
that the department shows profit(revenue exceed costs)
iv. Investment centers_Managers are responsible for generating revenues and managing
costs and capital equipment(assets)
Health(nursing) units are typically considered cost centers(expending centers), but they may also
be viewed as revenue centers,profit centers or,investment centers. How the unit is considered is
crucial in determining the manager's approach to budgeting.

The organization may choose various approaches, or combination of them for requesting
departmental managers to prepare their budget requests.
These approaches are:

 Incremental(line-by-line)budget

 Zero-based budget

 Fixed or variable budget.

Zero-Based Budget.(ZBB)
The Zero-based budget is a budgetary approach that assumes the base for projecting next years
budget is zero. Managers are required to justify activities and programs as if they were being
initiated for the first time. All proposed activities and expenditure must be justified by the
manager under the current environment and its fit with the organization's objectivities.
Regardless of the level of expenditure in previous years, this approach suggests that the cost
center(spending budgeting department),budgets, to make the master budgets, should be
developed from scratch. The cost center budgets for an activity “as if each activity were being
performed for the first time”
ZBB takes away the implied right of existing activities to receive a continued allocation of
resources.
(Each functional budget starts with the assumption that the function does not exist and is at zero
cost. Increments of costs are compared with increments of benefits,culminating in the planning
maximum benefit for a given budgeted cost)
Procedures for zero Based Budget:

 Decision units must be identified .E.g service, departments.(which services/department

are we to spend on/consider)

 Assess alternative levels of activity and provision of service.(To which level or extent
shall we perform the activity or spend on the service/department?)

 Benefit ranking(which services/activities are of 1st,2nd and so on priority.)

 Assessment of those above and below the line.(Analyze and make a final decision on
those with high priority and those with low priority so as to either include or exclude
them in the budget)
Benefits of zero-Based Budget.

• Avoids complacency-Every bit of activity to spend on is thoroughly scrutinized by the

management and explained by the budget maker.

• Enables structured and disciplined review.

• Facilitates good management information

• delegation to decision unit level is increased-The head of department on ground is given

chance to budget for the activity in his department.
Dis advantages of Zero-Based Budget.

• Its time consuming-Because the starting point is zero.

• Requires considerable management skills in drawing up decision packages and for

ranking process.

• Not conducive if participation is inappropriate

• It may emphasize short-term benefits to the detriment of longer term ones.

Incremental Budget
With incremental budget approach the base or starting point for calculating next year's budget
may either be the previous year's actual results or projected expenditure for the current
year( helped by the current year's “year to date” expenditure or results), with expected growth in
activity levels and inflation added to get the next year's budget.
The name “Incremental” is derived from the fact that it's concerned mainly with the increments
in costs and revenues which will occur in the coming period.
This approach is a reasonable procedure if previous and current operations are as efficient,
effective and economical as they can be, which unfortunately is not always possible.
It can as a result easily keep inefficiencies in operations and managers can easily build “slack” in
the budgets. Change is inhibited and relationships between costs,benefits and objectives are
rarely subjected to any searching scrutiny.
Procedure for incremental budget.
With an incremental or line-by-line budget, the finance department distributes a budget work
sheet listing each expense item or category on a separate expense line. The expense line is
usually divided into salary and non salary items. A budget work sheet is commonly used for
mathematical calculations to be submitted for the next year. It may include several columns for
the amount budgeted for the current year, The amount actually spent year-to-date,The projected
total for the year based on the actual amount spent,Increases and decreases in the expense
amount for the new budget, and the request for the next year with an explanation attached.

For (Nurse) managers to complete budget worksheets accurately,they must be familiar with
expense account categories. The manager should understand what type of expenses,such as
instruments and minor equipment,are included under each line item. In addition the manager has
to keep abreast of different factors that have affected the expenditure level for each expense line
during the current year. The projected impact of next year's activities will be translated into
increases or decreases in expense levels of the(nursing) department/unit's expenditures for the
coming year.

Advantage of incremental budget approach.

• Simple to prepare-because there is already a previous year's expenditure results or current

year-to date results that can be used as a base for projecting next year's budget.
Disadvantages

• Can keep inefficiencies in operations as the operations based on to budget may have not
been efficient/effective.

• Change is inhibited and relationships between costs,benefits and objectives are rarely
subjected to searching scrutiny.

• To avoid budget cuts for the next year an astute manager learns to spend the entire budget
amount established for current year,because this amount becomes the base for the next
year.
Fixed and Variable (flexible) Budgets
Budgets also can be categorized as fixed or variable.
Budgets are considered fixed budgets when the budgeted amounts are set without regard to
changes that may occur during the year, such as patient volume or program activities, that have
an impact on the cost assumption originally used for the coming year.
No plans are made for the event that actual level of operation(activity) may differ.

When actual volume of operation ( targeted activities) is achieved during the control period (e.g
month or quarter) a fixed budget is not adjusted to the new levels of activity.
A master budget is an example of a fixed budget.

A variable (flexible) budget in contrast is developed with the understanding that adjustments to
the budget may be made during the year based on changes in revenues,patient census, utilization
of supplies, and other expenses.

It can be defined as” one which is designed to adjust the budgeted cost levels to suit the level of
activity actually attained. Put in other words a flexible budget will budget for (e.g hospital)
when you attend to 50,100,150, or 200 patients a day.
The manager doesn't say” I cant spend more when the patients are 100” yet yet when he was
budgeting he budgeted when the patients the hospital was receiving were 50 by then.
This flexible budget approach enables valid comparisons between actual cost incurred and
realistic budget allowance.
Flexible budgets are therefore are the only feasible type of budgets for control purposes.

When making variable/flexible budgets, the person budgeting must take in consideration:

 Analyze the behavior of costs and separate them into fixed costs(expenses that remain the
same for the budget period regardless of the activity level of the organization) and
variable costs( expenses that depend on and change in direct proportion to patient volume
and acuity).

 The original assumptions underlying the original budget. Examples of such assumptions
are the limiting factors of the rate of inflation, future uncertainty, and demand
projections.
Limitations of Budgets and Budgeting.
There are always numerous potential limitations of budgets and budgetary processes and its the
work of the chief executive (manager) to put in place mechanisms that will overcome these
limitations:

• Can be straight jacket rather than an aid.

• Supporting information is often inadequate.

• Too few controllers and owners.

• Cynical approach by budget holders.

• Lack of good estimating

• Little flexibility applied.

• Based more on history rather than needs.

• Lack of objective formats.

Conditions necessary for successful budgeting.

 The involvement and support of top management.

 Clear cut definitions of long term,corporate objectives within which the budgeting system
will operate.

 A realistic organizational structure with clearly defined responsibilities.

 Genuine and full involvement of line managers.

 An appropriate accounting and information system.

 Frame work for regular revision of budgets and targets.

 Flexibility in the administration of budgets.

Kinds/forms/Types of budgets.
Operating budget: Also known as Annual budget-This is the organization's statement of expected
revenues and expenses for the coming year. It coincides with the fiscal year of the
organization(specified 12 months period) during which the operational and financial
performance of the organization is measured. The fiscal year may correspond with the calendar
year-Jan-Dec-or another time frame.
Many organizations use July-1 to June 30 for some the fiscal year begins in Oct 1(America
Federal Government). The operating budget may further be broken down smaller periods of 6
months,4 quarters, each quarter may further be broken down into three-1-month periods. The
revenues and expenses are organized separately, with the bottom-line net profit or loss
calculated.
i. Revenue budget-This represents the income expected for the budget period(for hospital-
money from the patients that is expected)
ii. Expense budget-The expense budget consists of salary and non salary items. Expenses
should reflect patient care objectives and activity parameters established for the nursing
unit/hospital.
Personnel budget:-Also known as salary budget-This is a budget that projects the salary costs
that will be paid and charged to the cost center in the budget period.
Supply and Non salary expense budget-Identifies input supplies needed to operate the business
or organization-In case of a hospital or nursing unit,This is the patient -related supplies needed to
operate the hospital or nursing unit.
Capital budget-This is a budget made to meet the long term goals of an organization. E.g
physical renovations,new constructions,new replacement of equipment planned within the
budget period.
Note:

 Information searching-Facts from members,data e.t.c is core to budgeting.

 Depending on hierarchy,these budget proposals ascend up(forwarded)to management as

it may go through changes.

 Last step is when the board of governors appropriate it.

 You should be ready to defend your budget and don't expect every thing to be approved.
Assignment:
Read and find out what the following terms mean in relation to budgeting:(Eleanor.J.Sullivan
2005,Effective leadership and management in nursing)

 Cost centers

 profit

 Fixed costs

 Variable costs

 Direct costs

 Indirect costs.
 MANAGING PETTY CASH
Managing money in a health service is done mainly by accountants or finance officers.
The health worker manager of a small health unit such as a health centre usually has very little
responsibility for spending money. Sometimes, however, a health worker may be asked to record
the spending of money(i. e keep accounts)
There are two types of money:
1. Invisible money or Budgetary allocation
2. Visible money or cash.
Invisible Money: This is money that is not seen or handled. It's a “paper credit”given as an
allowance,allocation or warrant of funds.
For example the government may give a health centre an allocation of 3000,000shs(3ms) to draw
drugs from the government medical stores(NMS), with a paper called an order or requisition to
be charged against the allocation(remember credit line for example in GVT and PNFPs).Actual
money does not pass through the health centre or facility, but a written account must be kept of
each order or requisition used against the allocation(in this case 3 Ms)
Visible money or cash:This is money that is seen or handled. It is advanced to the health worker
to spend for the work of the health service. It's called cash. It's not safe to have a large amount of
cash at the health centre as it may be stolen. For this reason visible money is usually small in
amount and is called `petty cash`
Keeping an allocations ledger(or spending invisible money):
The government(or any other organization) may allocate an amount of invisible money to a
health unit. Its usually for a definite purpose(definite purpose fund) and can only be spent for
that purpose. e.g for drugs, equipment or transport. Accurate records of how this allocation is
spent must be kept in an allocations ledger(accounts book).
An allocations ledger should show the amount allocated and the detailed use of the allocation.
Lay out of allocations ledger:
Date Description/ Document Order or Allocation(credit-CR)
purpose reference(folio No) requisition(debit-
DR)
Filling in an Allocations ledger:
The allocation of invisible money may be granted either monthly,quarterly or annually. When
the amount is granted, the date, the purpose and the amount are recorded in the allocations
ledger(accounts book. Can say Vote book).The reference number of the document that confirms
the grant of the money is written in the column headed”Document reference(Folio No)” in order
that the original document can be found again when necessary.
When a purchase is made, the date, the order(or requisition) and the amount are also immediately
recorded. The number of the requisition -form or order- form is written in the Document
reference (Folio NO) column. From this number the order(requisition) can be found in the files
that hold copies of the order-Forms or requisitions.

At certain intervals perhaps monthly or quarterly,the amount paid out is totaled and deducted
from the amount allocated(or received) The un used balance of allocation is then “brought
forward”(B/F) and added to the new allocation for the next month,quarter or year,according to
the interval chosen.
Example:An allocations ledger where a sum of 3 millions(3000,000shs) is granted every three
months for drugs.
Date Description/purpose Doc ref(Folio No) Order or Allocation(CR)
requisition(DR)
1/7/yr Allocation for 36 3000,000=
3mths(July-sept)
3/7/yr Drug requisition 54 1500,000=
1/8/yr Drug requisition 55 500,000=
5/9/yr Drug requisition 56 450,000=
Total 2450,000= 3000,000=
Balance 550,000=
30/9/yr Bal brought 550,000=
forward(B/F)
1/10/yr Allocation for 37 3000,000=
3mths(Oct-Dec)
5/10/yr Drug requisition 57 1500,000=
Note:Drugs that have been ordered will be found by referring to the file containing copies of
requisitions numbers 54 to 57.
Using a petty-Cash imprest system(or spending `visible` money)
“petty cash means a small amount of money. Most work places find it more convenient to have
some petty cash.
Invisible money(allocations) can be used for large purchases such as drugs and equipment, but
there are many small items that cannot be paid for with allocations. E.g Taxi fares.
Petty cash is advanced to the health worker(in charge) to be used extensively for certain
authorized health service needs.
What the health worker is allowed to buy or pay for with petty cash may vary from one place(H-
Facility) to another. Examples of the types of items that are sometimes paid for with petty cash:

• Transport-Taxi fares,mending motor bicycles punctures,fuel.

• Communication-stamps,e-mails,Faxes,Airtime

• Cleaning needs-soap,detergent,antiseptic,furniture polish

• office needs-paper,envelopes,glue,pins,staples,cartridge

• sundries-matches,paraffin,candles,tea,emergency supplies

The Imprest system:

An imprest is an advance of cash given for a particular purpose and replenished as necessary.An
imprest is always restored to its original level. In this way its different from a grant, which is a
definite amount for a definite period. An imprest may be replenished at any time when the cash
balance is low.
Thus if special needs arise,the imprest cash may be spent within a week, but at other times it may
last for one or two months. Whatever the period, the imprest will be replenished (topped up) to
the original level,provided that the money spent has been accounted for.
An imprest is replenished only against original receipts for the money spent;this prevents misuse
of funds.

At any onetime unused cash plus disbursements must add up to the imprest level.
Example:Suppose that a health in charge(worker) is given an imprest of 40,000shs.
He finds his office supplies are low, so he buys some stationery(carbon paper, paper
clips,stamps,glue) all in one week. He spends a total of 30,000= leaving an unspent balance of
10,000=.
He then takes his receipts and petty cash book to his finance officer, who will give him 30,000=
in cash to make the imprest up to 40,000= again. The imprest is now replenished. It may now
take several weeks before he uses all the office supplies he bought,so that he may not need to
replenish the impurest for a month or more.
The petty cash voucher(PCV)
Each time money is spent from the petty-cash box(red box,safe), it MUST be recorded on a
form.
This form is called petty-cash voucher. Each petty-cash voucher is numbered and is kept and
filed in order.
Each petty-cash voucher must have a receipt attached to it from the person who sold the goods. If
this is not possible, the voucher must be signed by the health worker in charge of petty-cash.
Vouchers must be kept carefully because the finance officer, chief cashier or auditor may ask to
see them at any time.
Example of a petty cash voucher(PCV)
Voucher No PCV 17
Date 24/03/2012
PETTY-CASH VOUCHER

Goods Amount(ushs)
1pkt candles 3000=
1 box matches 1000=
Total 4000=
Encl. receipt(to attach to the PCV)
Signed (by health worker who made the purchase)
Passed (by finance officer)

NB: In experience, some organizations can add more details on their vouchers as a means of
strengthening internal finance management controls.
e. g. signed...........
Checked................
authorized..............
Three people sign the voucher.
Keeping petty-cash records
There are two ways of keeping petty-cash books. These are as described bellow.
The simple petty-cash book.
The simple petty-cash book is used to record small amounts and where there is no need to show
the break down of expenditure by category.
A simple petty-cash book has five columns,as shown in the following
Example: A simple petty-cash book.
Date Details/particulars Voucher Amount received= Amount paid=
No
1/4/yr To imprest - 40,000=
(original funding
2/4/yr stamps 1 2000
3/4/yr Bus fares 2 20000
11/4/yr Bicycle puncture 3 5000
repair
15/4/yr kerosene 4 2000
16/4/yr Total 40,000= 29000=
Bal 11,000
17/4/yr Bal B/F 11,000
To imprest 29,000
(replenishment)
In the example above an impurest of 40,000= is established; four payments have been made
totaling 29,000=, using four petty cash vouchers, leaving a balance of 11000=.At this point the
imprest is restored to the original 40,000= by adding the amount replenished (29000=) to the
remaining balance(11000=)
The columnar petty-cash book.
The columnar petty-cash book provides more details than the simple type.
It has the advantage that each type of expenditure is recorded in a separate column. It shows not
only the total spent but also how much is spent on separate items such as stamps,Bus
fares,kerosene,office stationery etc.
An example of a page of a columnar petty-cash book is given bellow. It shows the same items as
the simple petty-cash book example above, but in this case the amount spent is recorded in
separate headed columns according to the type of expenditure. Each column is added vertically.
The totals of the “paid out (details)' columns are added horizontally. These must tally
The original imprest level minus the total expenditure gives the balance in hand. The balance in
the petty-cash book must agree with the cash held in the box
Date Details/ Vouch Amount Amount Paid out details
particulars er No received= paid(Total)
postage Transport sundry
1/4/yr To imprest 40,000
(original
funding)
2/4/yr stamps 1 2000 2000
3/4/yr Bus fares 2 20,000 20,000
11/4/ Bicycle 3 5000 5000
yr puncture repair
15/4/ kerosene 4 2000 2000
yr
16/4/ Total 40,000 29,000 2000 27,000
yr
Balance 11,000
Bal B/F 11,000
To imprest 29,000
(replenishment
)
The imprest level is given in the `received` column. The number of each petty-cash voucher form
is written in the appropriate column. In the example above, the imprest is replenished after 16
days. A large imprest would be a serious responsibility in view of the risk of thefty.
NOTE: KEEP THE PETTY CASH UNDER LOCK AND KEY!
 HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS)
Concept of HMIS:
The Health Management Information System (HMIS) is a set of integrated components and
procedures organized with an objective of generating information which will improve health care
management decisions at all levels of the health system. It is also a routine monitoring system
that plays a specific role in the monitoring and evaluation process intended to provide warning
signals through the use of indicators.

The Health Management Information System (HMIS) is an integrated reporting system used
by the Ministry of Health, Development Partners and Stakeholders to collect relevant and
functional information on a routine basis to monitor the Health Sector Strategic and
Investment Plan (HSSIP) indicators to enable planning, decision making, monitoring and
evaluation of the health care delivery system.
It is designed to assist managers carry out evidence based decision making at all levels of
the health care delivery. At the health Unit level, HMIS is used by the health unit in-charge,
health unit departmental in charge and the Health Unit Management Committee to plan and
coordinate health care services in their catchment area.
Scope of HMIS/ what HMIS covers:
The HMIS covers the collection, use and reporting of information on the following important
areas of activities within a health unit:
1. Planning, meetings and supervision
2. Preventive and Curative Services
3. Maternal and Child Health Services
4. Management of Resources
5. Inpatient and specialty services
6. Community Health (Village Health Teams)
7. Information systems and Routine Reporting
Goals of HMIS:
The major goal of HMIS is to provide quality information to support decision-making at all
levels of the health care system in Uganda.
Objectives of HMIS:
 Provide quality information to support decision-making in the Health Sector
 Aide in setting performance targets at all levels of health service delivery
 Assist in assessing performance at all levels of the Health Sector
 Encourage use of Health information
Uses of HMIS:
Information from the HMIS can be used in the following ways:
 Planning
 Epidemic prediction
 Epidemic detection
 Designing Diseases specific Interventions
 Monitoring Work plan performance
 Resource allocation
HMIS was developed within the framework of the following concepts:
 The information collected is relevant to the policies and goals of the Government of
Uganda, and to the responsibilities of the health professionals at the level of collection.
 The information collected is functional; it is to be used immediately by management
and should not wait for feedback from higher levels.
 Information collection is integrated; there is one set of forms and no duplication of
reporting.
 The information is collected on a routine basis from all levels of health care delivery
in all districts within Uganda.
HMIS provides data collection tools for capturing patient level data, which is aggregated into
summary reports for submission to the next level. The flow of HMIS information is from the
lowest level which is the community, to the health unit, health sub-district, district and finally
to the National Health Data bank /Resource Center of the Ministry of Health.
The frequency of routine HMIS reporting varies from daily, weekly, monthly, quarterly to
annually depending on the health care service offered and the urgency of the information
reported on.
While the amount of routine data to be reported through the HMIS is limited, detailed
information can also be collected through sentinel sites, special studies and surveys.
The HMIS information collected is used to improve the ability of health units to provide
optimal preventive and curative care. HMIS must provide accurate, timely and relevant
information in order to accomplish the long-term goal of optimizing health care delivery thus
achieving health for all.
To ensure accuracy of HMIS information, data must be collected using standard methods,
correctly following procedures for compiling, continuously cross checking to identify and
eliminate errors, make corrections where necessary and store data in a format ready for
analysis at any time.
To ensure timeliness of HMIS information, all levels of reporting should comply with the
agreed deadlines. A DATABASE BOOK is required at the health units, HSDs and the Districts
to record and monitor aggregated information in one central place.
To ensure relevance of HMIS information, HMIS is regularly reviewed to ensure that it is in-
line with the goals and objectives of the major health policies and programmes, and that, the
collected information is actually utilized and or consumed by the stakeholders.
HMIS procedures at the health care delivery levels are presented in form of HMIS forms,
reporting tools and
summary tables.
Types of hospital records:
• Medical records

• confidential records

• personnel records

• Official records

• Public records

• Accountability records

• Budget records

• Administrative records

• Minutes

• Reports
Importance and uses of hospital records and Health statistics.

• Planning and reporting purposes.

• Training ,education and research

• Budgeting

• Monitoring and evaluation of performance

• Administration and management

• Disease surveillance

• Accountability

• communication-stamps

• Medical-legal use

• continuity of patient care

• Future Reference use.

• Comparison of cases,events,incidences etc

 • Teaching
Medical/Health Records:
Medical records is the collection of patients information from the time of arrival to the
time of discharge for future reference and further budgeting and planning for health
facility.
Medical/health records starts at the OPD where the patient's name,the next of kin,the
village,sex, age,registration number,the religion,the tribe,and other patient's information
are being collected by the records Assistants and entered on the face sheet and kept
confidentially.
Characteristics of Quality medical records:
• Organized (logically and sequentially filled)

• Relevant

• Presentable

• Factual

• Accurate

• Understandable

• Comprehensive/complete

• Timely

• Brevity(brief as well as complete

Who creates medical records?

• Medical records personnel

• Doctors

• Mortuary attendants

• Consultants

• Nurses

• Radiologists

• Clinical officers
 • Medical students

• Physicians

• Medical social workers

• Administrators

• Ward in-charges
Who requests for/uses medical records? And Linkages to Records department.

• Administrators

• Nurses

• Doctors

• Insurance companies

• Advocates

• Employers

• Family members. organizational Patients,Clients and Attendants

• social workers

• Accounts staff

• Mortuary Attendants

• Embassies and NGOs.

• Catering officers

• professors

• Researchers

The Roles of medical records personnel/Assistant

• Patient registration

• Patient appointment and booking

• data collection
 • Timely reports

• Classification of diseases

• Coding of diseases

• Master patient Index numbers

• Notification of diseases

• Retrieving information

• Filling

• Assisting researchers

• Ensuring confidentiality

• Training of health workers in records management

• Management of HMIS

• Assist in the medical audits

• Guiding patients

• To provide security and ensure safe custody of the medical records

• Interviewing patients

• Participate in budgetary process

Types of registers
• Radiology day book

• Admission and discharge book

• Operation/Theater Register

• Casualty(Accident and Emergencies register)

• Out patient register

• In patient register

• Laboratory register
 • Antenatal register

• Post natal register

• Dangerous drug records.

• AART register

• Delivery register.
ETC
Medical records Filling system:
Filling is the arrangement of Files in the records room.
Methods of Filling:
• Terminal digit Filling. This is the method of filling where by you follow the last
two patient's figures. E.g.17722, you consider the 22 to be the filling number.
• Alphabetical Filling:This is the method of filling following the alphabetical letters
E.g.Asaba Paul,Abigaba Solomon, and Tusiime Ruth;Abigaba Solomon will be
first followed by Asaba Paul.

• Filling According to Months E.g. Jan,Feb,March etc.

Filling Equipment:

• Shelves

• Cupboards

• Computer in case of computerized data.

Computerized Data

• Its an easier and safer way to store data

• It requires less space

• Makes it easier to retrieve data

• Reduces the risk of damaged or dirty data sheets

• It is easier to change the information

• Timely reporting and making calculations is easier

 • computerized data is more accurate and summarized which makes comparison
easier

• Un readable hand writing is dealt away with.

Research and records:

Research is the conducting out of investigations/survey on a situation, always a

problem with a purpose of understanding and coming up with recommendations to
adress the situation or problem.
The importance of research in records management.(HMIS)
i. It helps the records officer in interviewing of other researchers
ii. It helps in reporting of diseases
iii. It helps in collection of data
iv. It helps in giving clear data
v. It helps in compiling of data
vi. It helps in planning
vii.It helps in drawing programs
viii.It helps in establishing new facts.
Presenting of Medical data.
Medical data is analyzed and presented by use of frequency tables and Figures
like:Graphs,pie charts,etc.
Eng of a table:
Table showing malaria prevalence for children 0-4 yrs 2014
Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
No of 10 20 30 50 5 15 55 30 35 25 20 15
cases
Graphs:
Characteristics of a graph:

• tittle

• Scale

• key

• labels(x&y axis wordings-variables)

• source of data(table besides)

 MANAGING TRANSPORT
Transport is absolutely essential for carrying out both,Facility-Based and Non- Facility-
Based-community health care services.
Transport is as necessary to health care as for example the microscopes and other health
care supplies.

Because good transport is too vital, considerable care must be taken in organizing its use.
Its the only way the health care staff can adequately provide the services at the
health,mobile services ,and supervise dispensaries in their area and therefore serve the
whole of population.

For the case of a health center,its unlikely that it will have more than one vehicle and its
schedule must allow the following:

• Visits by the supervisory team to lower level health units-Dispensaries or Village

Health Teams (VHTs)

• Visits to investigate problems in certain areas, or to hold special meetings E.g with
VHTs and other stakeholders.

• Regular mobile clinics e.g Voluntary counseling and Testing and immunization
out reaches.

• Emergency cases to be transported to hospitals in case of referrals or even

transporting the cases from villages to the health centre.

• Collection of medicines and Health supplies from medical/District/Health sub-

district stores.

• Regular servicing of the vehicle.

There may also be other calls on its services. Its valuable to make a monthly plan for
its(transport) use.
A scheduled out reach or visit that is canceled at the last moment may cause considerable
distress to patients or clients that have come a long way to see the visiting/out reach team.
The driver of the vehicle must be supervised regularly. Is he driving carefully at all
times?
Maintaining the vehicle is his responsibility and at least once every week he must check
the Battery,oil, Radiator water, petro and tyre pressure. The pressure in the spare tyre
should also be tested from time to time,certainly before a long safari. The Jack and wheel
spanner should be in the vehicle at all times. The in charge must know about these things
and investigate them him/herself occasionally.

The driver should also be responsible for seeing that the regular service checks-
preventive maintainable- are done on time.

The driver should keep the vehicle's work ticket(Log Book) up to date, but the in charge
should check that the various entries-places,times,authority,fuel,repairs-are correct.
Drivers are human, like the rest of us, but are exposed to many temptations. Controlling
one of the few vehicles, regularly visiting rural/ other areas can give them a sense of
importance that they may abuse. In general its better to trust the driver (s other staff).
Even giving him extra responsibility that he does not expect,than to check up on him so
closely that he feels like a criminal. If you do he may behave like one. Try to build
mutual confidence with him, but do not forget the temptations he has to make extra
money illegally.

Your health centre/facility may at certain times be without transport. Good relations with
other departments in the organization/ area help when you need transport urgently, E.g to
refer patients.
There may be bicycles and motor cycles assigned to officers in your team for special
programmed E.g community-based health care(CBHC) or water and sanitation.
If you are a team, these vehicles will be available at times of difficulty. For example,
vaccines can be delivered by motorcycle from the supplying center or to the out reach site
instead of canceling the delivery because the land rover/Double cabin/pick up has broken
down, or the in charge can attend a scheduled meeting with the VHTs of community
using the CBHC bicycle.
“Transport is essential:look after it well”
 MANAGING INFRASTRUCTURE
The maintenance of the buildings that make up the unit is the responsibility of the in
charge.
Problems such as leaking roofs,broken toilets and repainting and repairs due should be
reported to the local ministry of works representative or the person who is responsible for
the actual repairs.
Sometimes the ministry of works(MOW) is unable to carry out the necessary repairs and
authority is then given for the work to be sub-contracted to commercial builders. Before
such work can be carried out,it MUST be put out to tender. Tenders are offers by suitably
qualified qualified contractors to carry out the work with a statement of cost and of how
long the work will take. Tenders are submitted in sealed envelopes.
A tender committee, made up of various officers,opens all the tenders at the same time
and compares them. The builder who best meets the requirements,even if the price is not
the lowest,is awarded the contract and asked to carry out the work.

The tender system is used to avoid corruption and favoritism and loss of
government/organizational money through inflated estimates. Work awarded without
tendering will not be paid for by the government/ most organizations even if it involves
small amounts.

Inspect all the buildings including staff quarters (if there are any),once a week or once a
fortnight,with one or two other staff,to check on the general standard of cleanliness.
Necessary maintenance can be considered at the same time.

Fire risk should be considered. Buckets of sand should be available if there are no other
extinguishers. Extinguishers need routine inspection to see if there are intact and up to
date.

Effective security is always difficult in health facilities. It(security) can be improved by

limiting access to doors and gates and under observation by guards. After duty hours
these doors must be closed and locked. Make sure the watch man/Ascari knows who to
inform in case of emergency.
Ref:(C.H.Wood,2007,Community Health Second edition)
 KEY GOVERNMENT POLICIES
What is a policy?-A policy is a statement or set of statements defining a desired direction
of operations or actions that define the interests and values of people its meant to serve.
Statements are conceived to adress a theme, or purpose of actions to
society,institutions,and individuals for present and future guidance.
Such Key Government policies relating to health are:
1. National Health policy 1999(I),2010(II)and Health Sector Strategic Investment
Plan.
2. National policy on public private partnership in Health(PPPH) 2012.
3. Uganda National HIV and AIDS policy 2011
4. policy guidelines for prevention of Mother-To-Child Transmission of HIV,Aug
2006
5. Guidelines for management of private wings of health units in Uganda,June 2010
6. Safe Male Circumcision policy Mar 2010.
7. Uganda HIV counseling and Testing policy,June 2011
8. Local government sector workplace policy on HIV?AIDS, Aug 2009.
9. Ministry of Education,The Education Sector HIV and AIDS work place policy.
10. Guidelines for HIV/AIDS coordination at Decentralized levels in Uganda 2013.
11. Village Health Team. Strategy and operational Guidelines. MOH policy and
Guideline on how to engage and utilize Village Health Teams in CBH services
delivery in Uganda.
National Health policy and HSSIP
The NHP and strategic plan frame work have been formulated with in the context of the
provisions of the constitution of the republic of Uganda 1995 and the local Government's
Act, 1997 which decentralized governance and service delivery. In addition new health
policy derives guidance directly from the national health sector reform programme and
the national poverty Eradication Programme,the Alma Ata Declaration of Health for
all(HFA)
The Mission statement of NH policy:
The over all goal of the health sector is the attainment of a good standard of health by all
people in Uganda in order to promote a healthy and productive life.
The NH policy objective:
The overall objective of health sector policy is to reduce mortality, morbidity ad fertility,
and the disparities therein.
Ensuring access to the minimum health care package.
• Control of communicable diseases-Malaria,STIs/HIV/AIDS,Tuberculosis

• Integrated management Of Childhood Illnesses(IMCI)

• Sexual and Reproductive Health Rights-essential Antenatal and obstetric

care,Family planning,Adolescent reproductive health,violence against women.
• Other public health intervention-Immunization,Environmental health,health
education and promotion,school health,epidemic and disaster
prevention,preparedness and response,Nutrition,interventions against diseases
targeted for eradication e.g guinea worms, river blindness/onchocerciasis,polio
myelitis, Neonatal tetanus and measles.

• Strengthening mental health services.

• Essential clinical care: care of injuries and other common conditions including
non-communicable diseases,Disabilities and rehabilitative health, palliative
care,oral/Dental health;is the central strategy.
The Guiding principles for the NH policy:
The following constitute the guiding principles for the National health Policy:

a) Primary Health Care(PHC) shall remain the basic philosophy and strategy for
national health development. To this end a Minimum health care Package will
form the primary focus of the health care delivery system;
b) Equitable distribution of health services shall be assured throughout the country,
and priority shall be given to further decentralization of the health care delivery
system to ensure effective access by all sections of the population to the national
Minimum Health care package;
c) Good quality health care shall be assured through cost-effective
interventions,targeted at the most important problems of the population,with an
optimal mix of appropriate health technology and trained human resources,which
are affordable and sustainable;
 d) A high level of efficiency and accountability shall be maintained in the
development and management of the national health system.
e) Greater attention and support shall be given to health promotion,disease
prevention and empowerment of individuals and communities for a more active
role in health development.
f) Emerging health problems, including health care for the elderly, shall be given
appropriate attention at all levels.
g) The existing partnership and collaboration shall further be strengthened between
the public and private sectors in health, including NGOs, private and traditional
practitioners, while safeguarding the identity of each.
h) Health being an integral component of overall development, inter sectoral co-
operation and co-ordination between the different health-related ministries,
development agencies, and other relevant institution,shall be strengthened for
stronger solidarity in health development.
i) A gender sensitive and responsive national health system shall be achieved
through mainstreaming gender considerations in planning and implementation of
all the health programmes.
j) Efforts will be intensified to promote sustainable additional health financing
mechanisms.
NHP priorities:
Government will focus on health services that are demonstrably cost-effective and have
the largest impact on reducing mortality and morbidity .The major contributors to the
burden of disease at all levels will be given the highest priority. These include
malaria,STI/HIV/AIDS,tuberculosis,diarrhoeal diseases, acute lower respiratory tract
infections, perinatal and maternal conditions attributable to high fertility and poorly
spaced births,vaccine preventable childhood illnesses,malnutrition,injuries, and physical
and mental dis ability.The cost-effective interventions,which will be implemented in an
integrated manner to address these priority health problems, will together constitute the
Uganda National Minimum Health care package. This package will be reviewed
regularly.
HEALTH SECTOR STRATEGIC AND INVESTMENT PLAN (HSSIP)
The HSSIP 2010/11-2014/15 has been developed to guide the health sector Investments
towards achieving medium term goals for health. This HSSIP provides the medium
strategic frame work, and focus that the Government intends to pursue in regard to
attaining the health goals for the country. Its anchored on the National Health plan(NHP)
II,the National Development plan and the public Investment plan, aimed at achieving the
overall goals and deliverables of the country.
Strategic Direction:
The development of the HSSIP is a medium term plan guiding sector focus towards
attainment of the health policy objectives.

The HSSIP puts the client and the community in the fore front and adopts a “client
centered” approach and it looks at both the supply and demand side of health care.
The key guiding principles of HSSIP are:
• Equity and non-discrimination

• Participation and accountability.

• The right to health elements of availability,accessibility acceptability and quality.

The priority areas of intervention in the HSSIP:

1) Health promotion,Environmental health,Disease prevention and community health
interventions including epidemic and disaster preparedness and response.
2) Prevention,management and control of communicable diseases
3) Prevention,management and control of Non-communicable diseases.
4) Maternal and child Health.
HSSIP investment focus-Investing in:
1) Health promotion, education,Environmental Health and Nutrition.
2) Essential medicines and supplies.
3) Human resource for health.
4) Health infrastructure.
5) Management costs.
Description of the National Health system/structure:
The National Health system (NHS) is made up of the public and private sectors. The
public sector includes all GoU health facilities under the MOH,health services of the
Ministries of defense(ARMY),Education,Internal affairs(police and prisons) and Ministry
of local Government(MoLG).The private heath delivery system consists of Private Not
for profit(PNFPs) providers, Private health practitioners(PHPs), and the traditional and
complementary Medicine practitioners(TCMPs)

The provision of health services in Uganda is decentralize with districts and Health sub
districts (HSDs)
Playing a key roe in the delivery and management of health services at those levels. The
national services are structured into National Referral Hospitals (NRHs) and Regional
Referral Hospitals(RRHPs), General Hospitals,Health Centre (HC)IVs,HCIIIs,HCIIs
and Village Health Teams (VHTs-HCIs)
MoH Headquarters and national level institutions:
The core functions of the MOH headquarters are as follows:

• policy analysis,formulation and dialogue;

• strategic planning;

• setting standards and quality assurance;

• Resource mobilization;

• Advising other ministries,departments and agencies on health- related matters;

• Capacity development and technical support supervision;

• Provision of nationally coordinated services including health emergency

preparedness and response and epidemic prevention and control;Coordination of
health research;and monitoring and evaluation of overall health sector
performance.
National, Regional and general Hospitals:

I. General Hospitals: provide preventive,promotive,curative,maternity, in-patient

services,surgery,blood transfusion, laboratory and medical imaging services,and
clinical support services, training,consultation and operational research in
support of the community-based health programmes.
II. Regional Referral Hospitals:offer specialist clinical services such as
psychiatry,Ear,Nose and Throat(ENT),opthalmology, higher surgical and medical
services, and clinical support services(laboratory,medical imaging and
pathology).They are also involved in teaching and research. This in addition to
 services provide by General hospitals.
III. National Referral Hospitals:Provide comprehensive specialist services and are
involved in health research and teaching in addition to providing services offered
by general hospitals and RRHs.
District Health systems:
The constitution(1995) and local Government Act(1997) mandate the local
Governments(LGs) to plan,budget,implement health policies and health sector plans. The
LGs have the responsibility of: recruitment,deployment, development and management of
human resource(HR) for district health services. Development and passing of health-
related by-laws and monitoring of the overall health sector performance. LGs manage
public general hospitals and HCs also supervise and monitor all health
activities(including those in the private sector) in their respective areas of responsibility.
The public private partnership at district level is still weak.
Health sub-District system:The HSDs are mandated with planning, organization,
budgeting and management of the health services at this and lower health centre
levels.HSDs carry an oversight function of overseeing all curative,preventive,promotive
and rehabilitative health activities including those carried out by the PNFPs and PFP
service providers in the health sub-district. The headquarters of the HSD will and remain
a HCIV or a selected general hospital.
Health centres III,II and village Health Teams(HCI): HCIIIs provide basic
preventive,promotive and curative care. They also provide support supervision of the
community and HCIIs under their jurisdiction. There are provisions for laboratory
services for diagnosis,maternity care and first referral cover for the sub-county. The
HCIIs provide the first level of interaction between the formal health sector and the
communities. HCIIs only provide out patient care,community outreach services and
linkages with the village Health Teams(VHTs).A net work of VHTs has been established
in Uganda which is facilitating health promotion,service delivery,community
participation and empowerment in access to and utilization of health services.
The VHTs are responsible for:
• Identifying the community's health needs and taking appropriate measures;

• Mobilizing community resources and monitoring utilization of all resources for

their health.

• Mobilizing communities for health interventions such as immunization,malaria

control,sanitation and promoting health seeking behavior;

• Maintaining a register of members of house holds and their health status;

 • Maintaining birth and death registration; and

• Serving as the first link between the community and formal health providers.

• Community based management of common childhood illnesses including

malaria,diarrhoea and pneumonia; and management and distribution of any
health commodities availed from time to time.
While VHTs are playing an important role in health care promotion and
provision,coverage of VHTs is however still limited:VHTs by 2010 had been established
in 75% of the districts in Uganda but only 31% of the districts had trained VHTs in all
the villages. Attrition was quite high among VHTs mainly because of lack of emoluments.
(HSSIP 2010/11-2014/15)
NATIONAL POLICY ON PUBLIC PRIVATE PARTNERSHIP in HEALH
This policy on PPP in Health(PPPH) provides a frame work that enables the public and
private sector in health to work together to improve service delivery by exploiting the
comparative advantages that each has, focusing on the common health goals that we are
persuing. It is as a guiding framework for public-private engagement in health.

Government recognizes the need to embrace public- private partnerships to improve

health sector performance, because together we can do more.
The private sector is actively involved in the implementation of the National Health
sector strategic and Investment plan(HSSIP), and participates in the Health policy
Advisory committee of the MOH through the public private partnership sector working
group.
UGANDA NATIONAL HIV AND AIDS POLICY:
The National HIV and AIDS policy stipulate policies and legal requirements that guide
planning and action in all sectors and at the various levels of response. This policy serves
as the basis for the development of national programme priorities.
This AIDS policy based on an assessment of past achievements,,challenges,emerging
issues, and anticipated impacts of the dynamics of the epidemic and the response at local
and global levels, provides a broader policy frame work for delivering HIV/AIDS
services in the country. Its aligned to key national and international policy guidelines in
areas of governance,human rights,HIV and socio- economic development. It hinges on
principles of:

 Multi-sectorality, openness about the epidemic,

  Equal rights for all,greater involvement of people living with HIV/AIDS,Gender
equity and addressing environments as well as factors that predispose people to
HIV infection.
POLICY GUIDLINESFOR PREVENTION OF MOTHER-TO-CHILD
TRANSMISSION OF HIV:
This policy document has been developed for use by planners and managers who are
involved in implementation of activities for prevention of mother-to-child transmission of
HIV at both the national and district levels. It aims at stream lining and setting standards
for the implementation of quality PMTCT interventions in Uganda.
GUIDELINES FOR MANAGEMENT OF PRIVATE WINGS OF HEALTH
UNITS IN UGANDA:
The guidelines for management of the private wings set a minimum management system,
structures, processes and expectations that the health units should have. These are used
by all hospitals as the foundation upon which they manage the private wing services. The
principles promoted here are:

 Proper planning,

 Transparency, accountability

 Patient centered care with fairness of service.

Emphasis has been placed on ensuring uniform technical quality of care between the
private and general wings.

SAFE MALE CIRCUMCISSION POLICY:

This policy is a guide the planning, implementation and monitoring and evaluation of
safe male circumcision scale up activities.

UGANDA HIV COUNSELLING AND TESTING POLICY:

The overall goal of the HCT policy is to contribute to reduction of HIV transmission and
improving the quality of life by enabling persons to know their sero-status and linking
them to prevention, care,treatment and support services.
Objectives of HCT policy:

• To provide a frame work for implementation and regulation of quality HCT

services in Uganda.
 • To contribute to the strengthening of health systems for the provision of quality
HCT services.

• To empower the community to access HCT services and adopt positive behaviors.
LOCAL GOVERNMENT SECTOR WORK PLACE POLICY ON HIV/AIDS:
The policy guides ministry managers,supervisors and employers and NGOs on how to
provide and access HIV/AIDS services. It also out lines the rights of employees and their
responsibilities regarding HIV/AIDS. The policy prescribes how it will contribute to the
national policy frame work on HIV/AIDS, which was approved and coordinated by AIDS
commission.
MOE SECTOR HIV/AIDS WORK PLACE POLICY on HIV/AIDS:
The purpose of the workplace policy is to ensure a consequent and equitable approach to
the prevention of HIV/AIDS amongst the Ministry of Education sector employees and to
the comprehensive management of the consequences of HIV/AIDS, including care and
support for employees living with HIV/AIDS/
VILLAGE HEALTH TEAM.STRATEGY AND OPERATIONAL GUIDELINES:

This is the official guide to individuals and organizations that plan to or are implementing
community-based health activities in Uganda.
The important point to make is that all health activities and interventions must be co-
ordinated through the VHT structure. The MOH will and doesn't allow as per this policy
and document creation of parallel or competing community structures apart from VHTs.
The VHT will and helps to engender community participation in health and link the
communities to the formal health service delivery system. This also will and helps bridge
the current health human resource gap especially in rural or peripheral areas where the
majority of the people live.

Community participation and empowerment is a strategy that enables communities to

take responsibility for their own health and well being and to participate actively in the
management of their local health services. In Uganda context this takes the form of the
VHT.
List of references:
1) C. H.wood , Vaughan, 2007,community health,2nd edition.
2) Eleanor .J. Sullivan,2005,Effective leadership and management in Nursing
3) Health Sector strategic Investment plan 2010/11-2014/15
4) Jaym. Shafritz,1992,Classics of organizational Theory,3rd edition.
5) MOH. The Health management Information system Manual 2014
6) National Health policy 1999,2010.
7) National policy on public private partnership in Health 2012.
8) Rebecca Samson,2009,Leadership and management in Nursing practice and
Education.
9) WHO Geneva,Rosemary McMahon 2001,On being in charge,A guide to
management in primary health care.