HSM. introduction health system management

about healthcare system management

1. ORGANIZATION OF HEALTH CARE
SERVICES
September 2016 class.
Department of Pharmacy.
K.M.T.C,Nairobi

2. ORGANIZATIONAL STRUCTURE

3. Organizational structure
•Objectives
by the end of the lesson, the learner should be
able to;
Define organizational structure (O/S) and
organizational chart (O/C)
State the purpose and functions of O/S
State and explain the types of O/S
Explain the O/S of the health care system

4. Definition
•Organizational structure is the hierarchical
arrangement of lines of authority,
communication and duties of an organization.
•Organizational chart is a graphical or pictorial
presentation of the organizational structure.

5. Definition
•Refers to how work is organized, where
decisions are made and the authority and
responsibility of workers.
•It is a map of communication and decision
making paths in an organization.

6. Definition
•It is an institutional arrangement for
mobilizing human, physical, financial and
information resources at all levels of an
organization.
•Organizational structure is graphically
portrayed by an organizational chart.

7. Purpose of organizational structure
1.It establishes easy accountability within the
organization as it defines how roles, powers
and responsibilities are assigned.
2. Divides work to be done in specific jobs and
department.
3.Assigns tasks and responsibilities associated
with individual jobs.

8. Purpose of organizational structure
4. It shows interdepartmental relationships
within an organization. Establishes
relationships between individuals, groups
and departments.
5.It facilitates easy flow of information between
the different levels of management.
6.It ensures efficient decision making within the
organization.

9. Purpose of organizational structure
7.It enhances coordination and integration of
activities within the organization.Coordinates
diverse organizational tasks.
8.Establishes formal lines of authority.
9. Allocates organizational resources.
10.Cluster jobs into units.
.

10. Functions of Organizational structure
•Determines the mode in which an
organization operates
•Provides the foundation of standard operating
procedures and routines within the
organization
•Determines the participation of individuals in
decision making process
•Provides a clear chain of command.

11. Functions of Organizational structure
•It enables members to know their responsibilities.
•It frees the manager and the individual workers to
concentrate on their respective roles and
responsibilities.
•It coordinates all organization activities so there is
minimal duplication.
•Define which employees report to which managers.

12. Types of organizational structures
•Formal and Informal structure
•Flat and Tall structure
•Bureaucratic structure
•Functional structure
•Divisional structure
•Matrix structure

13. 1.Formal and Informal structure
a) Formal structure – Describes positions, tasks,
responsibilities and relationships among
individuals in their positions in different
departments. Often presented using O/C.
b) Informal structure – Describe personal and
social relationships. They do not appear in the
O/C

14. Advantages of formal structure
•Results in systematic and smooth functioning
of an organization.
•Achievement of organizational objectives
•No overlapping or duplication of work
•Creation of Chain of Command, clearly
defines relationships between managers and
employees.

15. Disadvantages of formal structure
•While following scalar chain and chain of
command ,actions get delayed.
•Does not give importance to psychological
and social need of employees which may lead
to demotivation of employees.
•Gives importance to work only; it ignores
human relations, creativity, talents

16. Advantages of informal structure
1.Faster spread of communication since it does
not follow scalar chain.
2.Gives due importance to psychological and
social needs of employees which motivates
the employees.
3.Gives correct feedback regarding policies and
plans

17. Disadvantages of informal structure
1.Spread rumours
2.More emphasis to Individual Interest as
compared to organizational interest

18. 2. Bureaucratic structures
•In a bureaucratic structure, the authority is at
the top and information flows from top to down.
•It has rigid and tight procedures, policies and
constraints and therefore is reluctant to change.
•Organizational charts exists for all departments
and everyone understands their responsibility in
every situation.

19. Characteristics of Bureaucratic structures
1.Clearly defined roles
2.Hierarchical structure
3.Respect for merit

20. Strengths of bureaucracy
i)Central authority makes it effective in organizing
since there is a clear chain of command
ii)It follows standard operating procedures and
this brings about efficiency and predictability in
results
iii)It allows for merit based hiring and promotion
iv)It sets no room for favouritism since regulations
and procedures reduces the chances of
favouring an individual

21. Weaknesses of bureaucracy
1.It results in passive and rule-based human
beings
2.It can hamper achievement of results in time
with the lots of procedures and chains of
command to be followed before a decision is
made
3.It can result to inefficiency due to less
competition since hiring and promotion is
based on merits and qualifications.

22. 3. Flat and Tall structure
•Flat – very small number of levels and broad
area of responsibility at each level
management
•Tall – power is centralized at the top level of
management

23. 3. Flat and Tall structures

25. 4.Functional structure
•People are classified according to the
function they perform in their professional
line within the organization.

26. Functional structure

27. 5. Divisional structure
•Structure based on different divisions in the
organization e.g product structure, market
structures, geographical structure

28. 6. Matrix structure
•This is a combination of function and product
structures.
•Employees from different departments come
together temporarily to work on a special
project.

29. ORGANIZATIONAL STRUCTURE OF THE
HEALTH CARE SYSTEM.
•Community health services: Community based
health services demand identification
activities, i.e. the identification of cases that
need to be managed at higher levels of care,
as defined by the health sector.

30. Cont…..
•Primary care services: This level is comprised
of all dispensaries, health centers and
maternity homes for both public and private
providers.

31. Cont…..
•County referral services: These are hospitals
operating in, and managed by a given county
and are comprised of former level 4 and level
5 district hospitals in the county and include
public and private facilities.

32. Cont…..
•National referral services: comprise of
facilities that offer highly specialized services
and includes all tertiary referral facilities.

33. Cont…..
•The counties are liable for three levels of
care:
–Community health services,
– primary care services,
– county referral services.
•The national government has responsibility
for national referral services.

34. FUNCTIONS OF THE NATIONAL
GOVERNMENT.
a)Sets health policy whose goal is to ensure
attainment of the highest possible standards of
health in a manner responsive to the needs of
the population
b)Management of referral hospitals i.e. Kenyatta
National Hospital and Moi Referral and Teaching
Hospital.
c)Controls the Ministry of Health which
implements health policies.

35. Functions of the Ministry of Health
1.Implementation of health policies
2.Preventive and promotive health services
3.HIV programs and STDs management
4.Health education
5.Financing of health services.

36. Cont…
6.Quality assurance and standards
7.Monitoring and evaluation of health
services.
8.Planning and budgeting of national
health services.
9.Major disease control

37. FUNCTIONS OF THE COUNTY
GOVERNMENT.
•Managing of county health amenities and
pharmacies.
•Ambulance services
•Promotion of primary health care
•Licensing and control of activities that sell
food to the public
•Veterinary services(excluding regulation of the
profession).

38. FUNCTIONS OF THE COUNTY
GOVERNMENT.
•Refuse removal, refuse dumps and solid waste
clearance.
•Disease surveillance and response.
•Calamity management.
•Public health and sanitation.
•Control of drugs of abuse and pornography.

39. HEALTH SERVICE DELIVERY

40. Objectives
By the end of the lesson, the learner should be
able to;
Describe the levels of health service delivery
in Kenya
Explain the health services offered at each
level
State the actors and cadres of service delivery
Explain the referral system in Kenya

41. Levels of service
•Devolution is the transfer of authorities to
autonomous (independent) lower-level units
legally constituted as separate governance
bodies.

43. HEALTH SERVICE DELIVERY.
•The National Government is responsible for
health care provision in National Referral
hospitals, which is the highest level of hospital
in the public health domain whereas the
County Government is responsible for
provision of services at County hospitals,
Health centres,dispensaries.

44. Health services at each level
LEVEL 1.Community health services
•Comprises of households staffed by volunteer
community health workers.
•The lowest level of the healthcare delivery in Kenya.
•It is in direct contact with the community members.
Services
a)Promotive health through education
b)Treatment of minor ailments
c)Identification of cases for referral to health facilities

45. Community health services
d)Offers preventive services and curative
services with focus on primary care services.
e)Recognize signs and symptoms of conditions
requiring referral.
f)Facilitate community diagnosis, management
and referral.

46. LEVEL 2. Primary care services
•Comprises of former level 2(dispensaries) and
level 3(health centres)
•Facilitate referral of clients from communities
and to referral facilities.
•Comprises of the dispensaries, health centres,
maternity homes for both private and public
providers
•It forms the interface between the community
and higher level facilities

47. Services offered;
Services
a)Offers basic outpatient diagnostics and care.
b) Minor surgical services
c)Maternity and in-patient care.
d)Antenatal care.
e)Immunizations.

48. f)Family planning.
g)Laboratory and consultative services.
h)HIV/AIDS care(c.c.c-comprehensive care
center)

49. LEVEL 3. County referral services
•Former level 4/5 and District hospitals.
•They oversee the implementation of health
policy at county level and coordinate county
health activities.
•They provide some form of specialized care.
• Facilitate and manage referrals from lower
levels and other referrals.

50. County referral services
•Comprises of hospitals operating in and
managed by a given county.
•Offer broad spectrum of curative services and
some are health training centers.

51. County referral services
•They receive referrals from;
a)Primary care facilities within the county referral area
of responsibility
b)Other county referral facilities within the county
c)Community units that are linked to the county
referral facility and for which the county referral
facility provides primary care services.

52. County referral services
•Surgical services-general
•Internal medicine
•Rehabilitative care
•Speciality services e.g. emergency obstetric
care and anaesthesiology.
•Other specialities such as Paediatrics, dental,
psychiatry ,ENT , ophthalmology ,dermatology
but less extensive as National Referral hospital

53. LEVEL 4: National referral services
•Former level 6 hospitals
•They offer full range of specialized services;
sophisticated diagnostics, therapeutic and
rehabilitative services.
•Offers specialized health care including
laboratories, blood banks and research
institutions and specialized training to health
workers.

54. National referral services
•Surgical services.
•Internal medicine.
•Speciality services e.g. emergency obstetric
care and anaesthesiology etc.
•Teaching and research.
Examples:
KNH
MTRH
Mathari Teaching & Referral Hospital

55. Referral system
•It is a mechanism to enable comprehensive
management of clients’ health needs through
resources beyond those available where they
access care

56. Importance of a referral system
1.Ensure coordination and standardization in the
provision of referral services
2.Ensure continuity of care across the different
levels of care
3.Promote universal coverage and equity in the
provision of health services
4.To enhance the system’s ability to transfer
clients, specimens, services and client
parameters between the different levels of the
health care system

57. Challenges of the referral system
1.Ineffective networking of the different levels
2.Inadequate communication and transport
system
3.Inappropriate referrals which include
unnecessary referral, poor quality of
documentation and lack of communication.
4.Inadequate financing for operations and
maintenance of referral services
5.Insufficient human resources and infrastructure
within a facility to offer services for their
standard/level