COMMUNITY HEALTH SERVICE Ppt.pptx [Autosaved].pptx

community health for Ethiopia is mandatory

1. 12/24/2022 1 Moges S

2. Chapter one Understand health policy and service delivery system Historical development of health service in Ethiopia The challenges through the process brought the development and application of primary health care in rural part . Ethiopia is a country with:- 83% of its population living in rural areas and About nearly 80% of the disease that affect its population are communicable disease that can easily prevented through the change of behavioral practices. 12/24/2022 Moges S 2

3. Ethiopia previously had a health policy that focused on curative and urban centered health services until the government launched its new health policy in 1993. During the past 15 years , the FMOH has built an impressive frame work for improving the health for all. 12/24/2022 Moges S 3

4. There are also strategies on:- F ree service for key maternal and child health services T he training and deployment of HWs for promotion of institutional delivery and Emergency surgery officers at primary hospital to manage obstetric and other surgical procedures . In recent time primary health service coverage reached 92% of total population with 125 hospitals , 2999 health centers , 15668 health posts and >4000 private for profit and not for profit clinics 12/24/2022 Moges S 4

5. Health policy in Ethiopia T he first health policy in Ethiopia was developed in 1993 and it mainly focuses on prevention and control of this communicable disease. Prevention and promotion components of health care were given more attention by the new health policy. 12/24/2022 Moges S 5

6. The main features of 1993 Health policy of Ethiopia include: Decentralization expanding the PHC system , and encouraging partnerships the participation of the whole community in health activities . 12/24/2022 Moges S 6

7. The strategy of the policy has been to expand healthcare delivery at the grass roots level through implementation of the HSEP. The primary aim of the HSEP approach is to bring health service delivery to the rural community at family level where such a big percentage of the total population lives. 12/24/2022 7

8. Organizational structure of health service delivery In order to provide health services for the community in the large the population and, Ethiopia used three tier(organizational structure) system 1.Level one is a Woreda /District health system comprised of :- P rimary hospital (to cover 60,000- 100,000 people ), H ealth centers (15,000-25,000 population) and S atellite Health Posts (3,000-5,000 population ) Moges S 8 12/24/2022

9. The primary hospital, health center and health posts form a Primary Health Care Unit (PHCU). 2.Level two is a General Hospital covering a population of 1-1.5 million people. 3.Level three is a Specialized Hospital covering a population of 3.5-5 million people. 12/24/2022 Moges S 9

10. 12/24/2022 Specialized Hospital 3.5- 5 million General Hospital 1-1.5 million Primary hospital - 60,000-100,000 + Health center – 15,000- 25,000 + Five satellite health post – each 3,000- 5,000 Referral system Primary health care unit PHCU Moges S 10

11. The bottom structure of health service delivery is networked as 1 HC with 5 satellite health post . The five satellite health posts were mainly accountable for the cluster health center . They identify problems together, map the problem together, plan the cluster health problem together, implement and evaluate together. This will strength the system and help the implementation of preventive , promotive and curative health service in more integrated and complete manner . 12/24/2022 Moges S 11

12. Woreda Health Office _____ Cluster Health Center_________ HP1 HP2 HP3 HP4 HP5 12/24/2022 service report will be sent for the woreda through the cluster health center. Moges S 12

13. The referral system was also managed in such a way that the satellite health post were refer their client for further service for their cluster health center and if the case is also above the ability of the health center then the case will be referred to the primary hospital. 12/24/2022 Moges S 13

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15. Primary health care (PHC) T he essential health care that is universally accessible to individuals and is acceptable to them with fulfilling certain principles. It gained the world’s attention after the 1978 International conference on PHC held at ALMA ATA . It focuses on disease prevention and health promotion . It is the type of health care delivery, can be described as “by the people, of the people and for the people”. 12/24/2022 Moges S 15

16. Ethiopia is one of the countries in the world which has adopted PHC as a national strategy since 1976. This strategy focuses on fair access to health services by all people throughout the country, with special attention on prevention and control of common disease, self- reliance and community participation . 12/24/2022 Moges S 16

17. To achieve these principles of PHC the government of Ethiopia started to decentralize the health service delivery system from regional to woreda and kebeles level since 1997 through vertical health program approach. Vertical health program are centralized, non- integrated and disease specific health programs. 12/24/2022 Moges S 17

18. Principles of primary health care Accessibility (equal distribution). Community participation Health promotion Appropriate technology Inter- sectoral collaboration . 12/24/2022 Moges S 18

19. Elements of Primary Health Care Education on health problems and how to prevent and control them. Dev’t of effective food supply and proper nutrition. Maternal and child healthcare, including family planni Adequate and safe water supply and basic sanitation. Immunization against major infectious diseases . Local endemic diseases control. Appropriate treatment of common diseases and injuries. Provision of essential basic medication 12/24/2022 Moges S 19

20. Health service extension program (HSEP) HSEP was a tool developed to effectively implement primary health care unit in Ethiopia. It is an innovative , community- based programme that was first introduced in Ethiopia in 2003 . It is used to improve equitable access to mainly preventive health service through community based services by applying the five principles of primary health care. 12/24/2022 Moges S 20

21. The principle behind this programme is to make the community produce their health by themselves. is so an approach by which health services will bring to the house hold level. 12/24/2022 Moges S 21

22. CHAPTER TWO PLAN,MANAGE,MONITOR AND EVALUATE HEALTH SYSTEM Management :- Is the process of directing,coordinating,and influencing the operations of an organization so as to obtain desired results and enhance total performance. is the process of forecasting and planning, leading , coordinating and evaluating the resource of an organization in the efficient and effective manner to achieve organizational goal . 12/24/2022 Moges S 22

23. Who is the Manager? is the person who has the responsibility of achieving certain outcomes having been given the authority to utilize the resources of the organization. These resources consist of human , financial , information and physical assets . a person who can organize people to work harmoniously together and make effective use of resources to achieve laid-down objectives . 12/24/2022 Moges S 23

24. Concept and principles of management Management is simply doing things through people. As a health workers you will involve in supporting individuals to produce their own health, in doing these job knowingly or unknowingly you practice management in every daily activity. C oncept of management is issue of:- 1.Effectiveness is how well an organization, or a person in an organization is meeting their goal. 12/24/2022 Moges S 24

25. 2. Efficiency is a measure of how well the health sector is using its resource to achieve that goal Efficiency is the question of cost effectiveness. 3.Equity is a matter of distributing resources as well as service for all segment of the population equally. Equity is a question of right, because every citizen has a full right to get health service 12/24/2022 Moges S 25

26. Principle of management Team spirit Division of labor Focusing on the result not activities 12/24/2022 Moges S 26

27. Team spirit is creating an atmosphere of mutual trust and understanding between members of a team so that you can develop and ensure morale of your team member. In order to utilize resource among each individual of a team member and get benefit of working as team, as health extension worker you have to create a team spirit. 12/24/2022 Moges S 27

28. D ivision of labor ; it is an act of distributing work, among all member of the team in equal manner . So the role of you as a manager requires assigning a balanced proportion of each type of worker to the work to be done . 12/24/2022 Moges S 28

29. Focusing on the result not activities ; is to make sure that everybody within the organization has a clear understanding of the goals and objectives , and makes each person aware of their own roles and responsibilities in achieving those objectives. Goals are the outcomes you intend to achieve. Objectives are the specific actions and measurable steps that you need to take to achieve a goal . 12/24/2022 Moges S 29

30. Management functions P lanning Organizing Leading Coordination Monitoring and Evaluation 12/24/2022 Moges S 30

31. P lanning ; it is forecasting and thinking about things that you want to happen in the future and then working to achieve that. O rganizing ; is an act of assigning duties, grouping tasks(put related tasks together) and allocating resources for the planned activities. Leading ; is an act of directing , influencing and motivating( alesasa alekaka ) team members in that community towards the plan to be implemented. 12/24/2022 Moges S 31

32. C oordination ; is an act of creating team spirit between team members towards the set plan and activities to be performed. Monitoring is a regular observation and recording of activities. Evaluation is ensuring that the planned activities were achieved. 12/24/2022 Moges S 32

33. How can you build a team ? Team is two or more people who work together to achieve a common goal . A heath team is a group of people who share common health goal and common objectives determine by community need to the achievement of which each member of the team contribute in according to his or her competent and skills and in coordination with the function of others. 12/24/2022 Moges S 33

34. Cont.. Each member of the team contributes to the achievement of the common goal. Team comprises health promoters , model households , community leaders respected community members , representatives of varies community associations. 12/24/2022 Moges S 34

35. Team building is a process of selecting and creating a team within a community. Stages of Team building :- Forming Storming Norming Performing 12/24/2022 Moges S 35

36. Management roles and levels A health manager is someone who spends a substantial proportion of their time managing areas of healthcare provision such as: coverage of services (planning, implementation and evaluation) resources (staff, budgets, drugs, equipment, buildings, information) external relations with partners including service users . 12/24/2022 Moges S 36

37. A manager’s effectiveness is significantly influenced by their insight into their own work. Health sector managers often become managers after working in a technical role within healthcare . 12/24/2022 Moges S 37

38. Management levels In healthcare mgt there are 3 levels of managers:- Top middle , and frontline. Together they are responsible for the work and performance of the health sector. These managers have formal authority to use health sector resources and to make decisions appropriate to their level. 12/24/2022 Moges S 38

39. Top-level managers called senior management or executives they hold titles such as Minister , Head of Regional Health Bureau , and Director . make decisions affecting the entirety of the health sector. do not direct the day-to-day activities of the sector; rather, they set goals for the health sector and direct others to achieve them. 12/24/2022 Moges S 39

40. Middle-level managers are those in the levels below top managers. are responsible for carrying out the goals set by top management. They also set goals at their level and perhaps for other units they are responsible for. can motivate and assist frontline managers to achieve the sector objectives. They may also communicate upwards, by offering suggestions and feedback to top managers. 12/24/2022 Moges S 40

41. Frontline managers are responsible for the daily management of health activities in the community. are frontline managers of the primary health care services they have a very strong influence on the sector and do have to set goals for their own work. are the managers that interact most with the larger community on a daily basis. 12/24/2022 Moges S 41

42. What level of management is each of these ? Top level:- MOH,Head of Regional HB Midle level:-HC Director Frontline:- HEWs,HEPs Health Volunteer Has not managerial level. 12/24/2022 Moges S 42

43. Planning health programme Planning i s the process of defining community health problems , identifying needs and resources , establishing priority goals , and setting out the administrative action needed to reach those goals. It is also important to know why you need a health care plan. 12/24/2022 Moges S 43

44. Characteristics of planning All plans in different situation share 3 different features: A good plan should give clear vision/mission, goal and objective , a clear picture of the tasks to be accomplished, the resource needed to accomplish the tasks like human,material,money,time and information . Planning takes place at all levels. Planning must be collective undertaking ; means planning should involve different stake holders in your work area. 12/24/2022 Moges S 44

45. Types of Planning 1.Strategic planning 2.Tactical/operational planning/activity planning 12/24/2022 Moges S 45

46. 1.Strategic planning; is the process of determining what an organization intends to be in the future and how it will go there. It is finding the best future for your organization and the best path to reach that destination. It is planned for long years like for example for five years. It should be subdivided in to yearly plan . 12/24/2022 Moges S 46

47. 2.Tactical/operational planning/activity planning is a short range planning that emphasize the current operations of various parts . It is specific to mostly one year 12/24/2022 Moges S 47

48. Stages of operational planning . Once the Ethiopian FMOH sets a strategic plan, you may be involved in the district ( woreda ) planning process to develop operational plans for improving the health of your community. An operational plan outlines important answers to such fundamental questions as : What needs to be done? How will it be done & Who will do it? By when must it be done &What resources are needed to do it? 12/24/2022 Moges S 48

49. Stages in planning process Situational analysis Problem identification and prioritisation Setting objectives Strategy formulation Identify and sequence activities Identify resources Prepare action plans and schedules 12/24/2022 Moges S 49

50. SWOT analysis : is a strategic planning tool that matches internal organizational strength and weakness with external opportunities and threats a useful strategy for achieving objectives will become evident. S = strength of the organization W = weakness of the organization O = opportunities that an organization will have to achieve that objective. T = threats that an organization might face in the implementation process . 12/24/2022 Moges S 50

51. Manage resources at a Health facility An important aspect of your work at your health service is getting the best use out of the supplies and equipment that you are in charge of. The successful performance of your health service activities will depend on using your resource in the most efficien way. 12/24/2022 Moges S 51

52. Implementing your Health Plans Implementation is a central part of healthcare management. It is the stage where you translate planned activities into action . help you determine how best to use your group activities and resources , and motivate members of your team to work in the best interests of the health of the community. 12/24/2022 Moges S 52

53. To do this you need basic skills and knowledge on getting organised, setting up activities, finding resources, building a team, and leading, motivating and training that team. 12/24/2022 Moges S 53

54. Getting organised is the first stage in bringing together the right combination of human , physical and financial resources to successfully undertake your planned activities. Organising is the means by which :- the right things are done ( what) in the right place ( where) at the right time ( when) & in the right way ( how) by the right people (by whom). 12/24/2022 Moges S 54

55. Organising your team means 1.Organising activities: What is to be done and Where will the action take place? When will the action take place and What equipment is needed? How will the activity be arranged? 2.Organising people : Which members of the health team will be involved? Who outside the health team will be involved? Who will do what and lead? 12/24/2022 Moges S 55

56. 3.Communicating : Is all necessary information available? Has the information been communicated? 12/24/2022 Moges S 56

57. Chapter -three Lead and build individual’s and team’s capacity Building a team A team is two or more people who work together to achieve a common goal. A health team is a group of people who share common objectives, determined by community need. Each member of the team contributes to the achievement of the common goal. 12/24/2022 Moges S 57

58. Types of health team Formal team :- are teams assembled to address a specific problem or issue, or to achieve specific health goals. An example of a formal team is a task force or committee. Informal team- emerge whenever people come together and interact regularly; develop with the formal organization . 12/24/2022 Moges S 58

59. Four major functions of informal teams: Maintain and strengthen the norms (expected behaviour) and values of members. Give members feelings of social satisfaction, status and security. Help members communicate; create channels. Help to solve problems . 12/24/2022 Moges S 59

60. Team building usually refers to the process of selecting and creating a team within a community. Stages of team building Forming Storming Norming Performing 12/24/2022 Moges S 60

61. Forming The first stage in team development is the forming stage. T eam members get to know each other and find out which behaviours will be acceptable to the rest of the group members. Members establish initial rules and ways of working with each other 12/24/2022 Moges S 61

62. Storming Team members are encouraged to participate and engage with the issues and decisions that are key to the success of the community health team in achieving its goals. It is the stage when health team members may challenge, disagree with, and question one another. This stage can be uncomfortable for some members, but it is an important stage in tackling problems 12/24/2022 Moges S 62

63. Norming At this stage the team comes to an agreement on its purpose and plans. Members are clear what their roles and responsibilities are and how they fit into the team. The team has a sense of identity and tries to work together 12/24/2022 Moges S 63

64. Performing Group structure, norms and behaviour are understood and accepted. Members know how to work with each other and can effectively handle disagreements and misunderstandings. Differences have minimised and members have dealt with them. The group is now focused on accomplishing its purpose. 12/24/2022 Moges S 64

65. Leading a team Leading is the management function that you will use when influencing, motivating and directing people in your team towards the achievement of your organisational goals. Different styles of leading a team. autocratic, anarchic and democratic 12/24/2022 Moges S 65

66. Autocratic leaders tend to be dictatorial, saying for example ‘Do what you are told , and don’t ask questions !’ Anarchic leaders tend to say things like, ‘ I don’t care what you do, so long as you keep out of my way !’ A consultative or democratic style is most suitable for any team work that demands creativity and community involvement 12/24/2022 Moges S 66

67. Motivating a team Motivation of team members play an important role in the success of any health plan for your community . During motivation Involve teams in decisions Give members of the team the opportunity to grow and develop new skills Provide team members with a sense of ownership Encourage new ideas, suggestions and initiatives. Celebrate individuals’ successes 12/24/2022 Moges S 67

68. Training your team Training as a means of solving health problems must be closely related to work in the field, and to the management of priority health problems . Training a local health team is one of the health profetinals responsibilities . The quality of healthcare and its equitable distribution in a population depends upon the staff employed by the health services, and upon community members trained with some knowledge and skills of health 12/24/2022 Moges S 68

69. Conducting meetings Meetings are a necessary part of the Health Programme because meetings are the way in which health teams communicate with people in their locality. 12/24/2022 Moges S 69

70. When preparing for a meeting it is useful to plan the following : Purpose of meeting Main subject matter Type of meeting Size of meeting Place, time and duration of meeting Who is convening and organising the meeting Announcement or information about the meeting. 12/24/2022 Moges S 70

71. Purpose to communicate information, others to exchange views and ideas, and others to make decisions about plans or activities. 12/24/2022 Moges S 71

72. Have an agenda Distribute the agenda to participants before the meeting so participants can be prepared for the meeting . Start on time and end on time Every meeting should have established start and end times. Be sure to start your meetings at the appointed time and run no longer than the end time 12/24/2022 Moges S 72

73. Maintain focus Stay on topic and avoid the temptation to get diverted by interesting but unproductive points of view. Stick to the topic and the timelines you set for each item on the agenda. Capture action points Have a system for capturing, summarising and assigning action points to individual team members. Get feedback Get feedback on your meeting management 12/24/2022 Moges S 73

74. Monitoring and Control Monitoring is about collecting information that will help you answer questions about the health-related performance of you and your team. is the regular observation and recording of activities that will help you answer questions about your team’s performance. It involves giving information to your supervisors and managers about the health services that you are providing. 12/24/2022 Moges S 74

75. The purpose of monitoring Monitoring is very important in Primary Health Care service planning and implementation. Determining whether the resources in the health services are being well used . Ensuring that all activities are carried out properly by the right people and at the right time. Ensuring that activities and tasks are performed in accordance with set standards . 12/24/2022 Moges S 75

76. Identifying health problems facing the community and starting to find solutions. Ensuring community groups and local individuals participate appropriately in health activities. Understanding the health situation in your community and how the health services are performing . 12/24/2022 Moges S 76

77. Methods of gathering information for monitoring Y ou need to collect information from some of the sources Examining records : for example health service records, financial and administrative records. Documentation : for e.g letters , reports, plans, attendance lists, forms, invoices , receipts, minutes of meetings and official reports. Continually observing work progress , staff performance and service achievements . Discussing progress and any problems with staff and with the community . 12/24/2022 Moges S 77

78. Information obtained from monitoring can be used to identify day-to-day problems & for regular planning of the health work in your community. It is essential to be aware of the significance of the information you collect and to be confident of its correctness. Records must be reviewed at regular intervals and information must be verified 12/24/2022 Moges S 78

79. Using a checklist is a set of criteria that you can prepare to assist you in monitoring your own activities. A checklist can also be a record or a reminder of what has been happening so that you can follow the progress you are making. Is Used to observe performance and recognise problems in work standards 12/24/2022 Moges S 79

80. Supervision Monitoring information can also be gathered through supervision. It is usually a meeting at which you are able to sit down with a senior colleague and discuss issues that are important in your work. It is way to make sure that your objectives correspond( tesemama ) to the health needs of your community . 12/24/2022 Moges S 80

81. A good supervision session is part of your monitoring work. It should help you understand how your work is progressing and determine ways of helping if there are any problems . (Photo: I-Tech/Julia Sherburne ) 12/24/2022 Moges S 81

82. During supervision you can discuss, explain, justify, and obtain the commitment of community workers to the objectives of the programme. It makes sure that there are no divergences between the objectives and the team’s standard of performance. It seeks solutions to any conflict that may have arisen regarding the programme objectives . It is one way to discover how tasks entrusted( adera sete ) to different categories of worker are carried out, and under what conditions 12/24/2022 Moges S 82

83. Steps of managerial control Control is a basic managerial function involving setting standards, evaluating against standards and taking corrective action. It is the process of regulating service activities It ensures that your health work is accomplished according to agreed action plans. It is a process of ensuring that the work that you do produces the desired results. I s a continuous activity 12/24/2022 Moges S 83

84. Steps of managerial control Establishing standards of performance Measuring performance Comparing performance with standards Taking corrective action 12/24/2022 Moges S 84

85. Establishing standards of performance first step in the control process must be established and expressed easily understandable and the outcomes can be measured without difficulty for people concerned standards of performance should be simple and capable of achievement with a reasonable commitment of cost, effort and time. 12/24/2022 Moges S 85

86. Measuring performance The second step in the control process. Measurement should b/n actual performance and compare it with the standards. It can be done in quantitative or qualitative. 12/24/2022 Moges S 86

87. Comparing performance with standards third step in the control process. summarise the outcomes as planned versus actual results. 12/24/2022 Moges S 87

88. Taking corrective action The fourth and final step in the control process. It involves those in management roles taking appropriate decisions such as:- re-planning or redrawing of goals or standards perhaps changing the way that things are done 12/24/2022 Moges S 88

89. Constructive and effective feedback We all need feedback to help us improve. If a member of your team does something well you want to praise and reward them, but if they are performing poorly you should let them know so they can improve. Try to be specific. 12/24/2022 Moges S 89

90. Giving effective feedback F eedback to individuals must be based on the evidence gathered from the monitoring and controlling process. Feedback must also be timely – it is no good giving the feedback after the opportunity for improvement has already passed . If feedback is a routine part of management ,it should become easier , with experience, to deliver feedback 12/24/2022 Moges S 90

91. Effective feedback should be :- based on previously established performance goals/standards timely regularly given specific constructive motivating a routine part of your management function. 12/24/2022 Moges S 91

92. Giving constructive criticism Main steps Giving effective, constructive criticism:- 1.Provide feedback in a one-to-one meeting G ive your feedback during a one-to-one, private session. Deliver the message in a single,focused conversation and go directly to the point. E.g. ‘ I want to give you some feedback on your work,.…. I want to help you to perform better in the coming quarter,…… 12/24/2022 Moges S 92

93. 2.Be specific Be specific about what’s wrong and how it can be improved. Constructive criticism should focus on specific actions or behaviours that the person can change or do something about 12/24/2022 Moges S 93

94. 3.Reinforce the relationship Criticism needs to focus on an action or level of performance, not on the person. Effective feedback requires direct, truthful communication which will help build honest, open relationships between you and your team. 12/24/2022 Moges S 94

95. THANK YOU!!!!! 12/24/2022 Moges S 95