Health Systems Management 2023

HEALTH SYSTEMS MANAGEMENT
What is Health System Management?
 Refers to the overall leadership and management of both public and private
healthcare organizations
i.e the leadership and management of hospitals , their networks and other
health delivery establishments.
 The totality of the required resources, including human, mechanical, material,
and financial
 The formal and informal organization interactions or conversions of these
resources in the provision of direct services to individuals and populations to
help them maintain good health status or improve their health status
Objectives of a health system
According to WHO (2000), 3 objectives are:

1.Improving the health of the population they serve;
2.Responding to people’s expectations; and
3.Providing financial protection against the costs of
ill-health.
Functions of the Health System
Stewardship: oversight of the other functions of the health system

and it is the one function that is undeniably best done by national
governments.
Creation of resources: investment in health care infrastructure and
training of health professionals, which is commonly undertaken by
the public sector
Delivery of services: starts with sound planning and
effective/efficient organization.
 Financing:
Six Building Blocks
Constitutes the overarching WHO health system
framework
1.Service Delivery
2.Health workforce
3.Information
4.Medical Products, vaccines, and technologies
5.Financing
6.Leadership and governance (Stewardship)
Six Building Blocks/Goals/Outcomes
How do we strengthen them so that they
are aligned to achieve positive health
outcomes
Health Service Delivery: That is supported by quality management
processes and that addresses the basic health needs of the
population to be served
Health workforce: Human resource policies and procedures that
produce a supported and motivated workforce
Information: Health information and associated monitoring and
evaluation practices that facilitate effective problem solving,
informed decision making, and the formulation of policy based
on evidence
How do we strengthen them so that they are
aligned to achieve positive health outcomes
 Cont.
 Medical products, vaccines and technology: Management of medicines
and medical supplies so that the right products are delivered in the right
quantities, at the right time, and in the right place and then used
appropriately.
 Financing: Financial management, which is concerned with accounting
and budgeting, along with the related reporting and analysis that make it
possible to ensure that the organization’s resources are used to in the
service of its mission, for maximum impact in compliance with laws and
donor requirements, and in accordance with ethical standards and sound
operation practices.
 Leadership and governance: Procedures and practices including planning
that engenderment and accountability
The Performance of Health Systems: Six
Core Domains
Six core performance domains:

1. Access
2. Utilization
3. Efficiency
4. Quality
5. Sustainability
6. Learning
 Six core performance domains:
1. Access
 physical access, financial access, linguistic access, and information access—that
are supplemented by service availability and the provision of nondiscriminatory
services. Equitable treatment should be provided regardless of gender, race,
ethnicity, religion, age, or any other physical or socioeconomic condition
2. Utilization
 Utilization includes dimensions of patient or procedure volume relative to capacity
or population health characteristics.
3. . Efficiency
 Efficiency is determined by cost- or staff-to-service ratios and by patient or
procedure volume.
 Cont. Six core performance domains:
4. Quality
 Quality includes clinical and management quality, as well as patient experience.
5. Sustainability
 in healthcare can be defined as “the capacity of health services to function with efficiency,
including the financial, environment and social interaction that guaranties an effective
service now and in the future, with a minimum of external intervention and without limiting
the capacity of future generations to fulfill their needs”
6. Learning
 Using the feedback form audits, surveys etc and learning from them.
 Develop action point from facts, practice, evidence and research
Structure and organization of
health services,
MINISTRY OF HEALTH (MOH)

Structure and organization of health
services,
 Organizational Chart for the Ministry

of Health Division of Nursing.
THREE LEVELS OF MANAGEMENT
1. Strategic Management (Top Level Management)

 Professionals who is at executive level who control and supervise the entire institution
 Responsible for creating and implementing policies
 Determining broad objectives of the organization
 Long range planning and strategy
 Organizing for action
 Developing major resources
 Selecting key personnel
 The function of coordinating and controlling
 Responsible towards the shareholders for the performance of the organization
. Tactical Management (Mid-Level Health Managers)

2
o Branch and department managers

o Devote time to organizational and directional
functions
o Based on the size of organization there could be
one layer of mid-level management or may have
senior and junior levels of mid level managers
especially in big organizations
Roles of Mid-Level Management

 Execute plans of the organization in accordance with policies and directives of
management
 Make plans for the sub-units of the department
 Participate in training of mid lower level management
 Interpret and explain policies from top management to the lower management
 Responsible for coordinating activities within the departments
 Evaluate performance of junior managers
 Responsible for inspiring lower level managers towards better performance
3. Operational Management ( Front Line Health Management)

 Also known as supervisory or operative level of management
 Consists of supervisors, section heads or foremen
Roes of operational Management

 Assigning jobs and tasks to other workers
 Instruct and guide workers for day to day activities
 Responsible for quality and quantity of production
 Ensure discipline in the organization
 Motivate workers
Cont. Roes of operational Management

o Responsible for training the workers
 Arrange for materials and resources for getting things done
 Help to solve grievances of workers
 Supervise and guide the workers
 Entrusted with maintaining good relations in the organization
 Prepare and give periodical reports about the performance of workers
 The build the image of the organization as they are in direct contact with the workers
 Communicate workers’ problems, suggestions and recommendation to higher level and
also higher level goals and objectives to the workers
Health care delivery models,
Health care delivery models
a service delivery model is what describes who provides the

service and where it’s delivered. A healthcare service delivery
model is an approach to delivering healthcare.
It’s a series of services that include health services and support for
the community, like education about preventive care and health
promotion.
Health Care Delivery types in Health care
 It’s important to note that both public and private healthcare service
delivery models can be integrated into the same system or country.
 The most common example of this is Canada. In Canada, both the
public and private systems coexist with each other. They complement
each other instead of competing with each other.
 A public model is used by a government to provide health services for
its citizens. It’s financed through taxes or social insurance schemes.
 On the other hand, a private model is provided by for-profit companies
or non-profit companies.
Cont
 The most common example of this is hospitals and health clinics owned by a
company that provides medical services to individuals who pay for them.
 Although some companies combine the two models, it’s still better to have
them coexist separately with each other.
 For one thing, they have different roles when it comes to providing health
services for people who need them.
 A public healthcare delivery model has a role in being part of the national
health insurance scheme. So, it gives free medical care and financing
medical research among others.
 On the other hand, a private one has a role in providing quality medical care
to those who need it while generating profit for its owners and investors.
Importance of health care delivery
 It helps give attention to primary health care and preventive care. In addition, it also
helps in identifying health problems and providing medical aid to those who need
it.
 It’s also important to note that a model in healthcare is necessary because it ensures
that medical services are available to everyone.
 This is especially true for those who can’t afford it or those who don’t have access to
it.
 Moreover, a healthcare model provides a way for various medical institutions and
health professionals to work with each other and provide the best medical services
that they can.
 Indeed, a service delivery model is an approach that contributes to people’s overall
health.
DEVOLUTION
DEVOLUTION
Dfn: Devolution is a form of decentralization or the transfer of

authority and responsibility from central to lower levels of
government for a range of public functions.
In 2013, Kenya transitioned into a devolved system of governance
comprising two levels: the national government and 47
semiautonomous county governments.
Under devolution, the health service delivery function was
transferred to county governments while the national government
retained policy and regulatory functions. County government
holds responsibility for planning, management and budgeting.
DEVOLUTION: National government
 Assignment: SDL
1. Outline the organizational structure for national health service in Kenya?
2. What are the functions of the national health service
DEVOLUTION: County Governments
 Cont. Assignment: SDL

1. Outline the organization structure for the county health service?
2. What are the functions of the different levels of the organizational structure of county
health service?

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HEALTH SYSTEMS MANAGEMENT

What is Health System Management?

According to WHO (2000), 3 objectives are:

Stewardship: oversight of the other functions of the health system

Six core performance domains:

MINISTRY OF HEALTH (MOH)

 Organizational Chart for the Ministry

1. Strategic Management (Top Level Management)

. Tactical Management (Mid-Level Health Managers)

o Branch and department managers

Roles of Mid-Level Management

3. Operational Management ( Front Line Health Management)

Roes of operational Management

Cont. Roes of operational Management

a service delivery model is what describes who provides the

Dfn: Devolution is a form of decentralization or the transfer of

 Cont. Assignment: SDL

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