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10) Time management skills
TIME MANAGEMENT TIPS
Tip 1: Time, The Most Valuable Resource
Time cannot be bought, stored or stopped - every second that passes is gone forever and can never
be recovered or re-used. In this respect it should be seen as the most valuable of all resources and
the only way to maximize its potential is to manage it well.
Working effectively is all about getting things done, but it is also about planning for the future. It
is very easy to fall into the trap of doing things right, at the expense of doing the right things. This
is the scenario of rearranging the deck chairs on the sinking ship.
Effective time management involves learning to focus on the right things, whilst letting go of some
of the routine and less important tasks.
Tip 2: Common Misconceptions
There are some common misconceptions about time management.
Efficiency and effectiveness are the same
Being efficient means doing things quickly and properly, but efficiency in itself is not good time
management. To get results, you have to be effective, which means knowing what your priorities
are and doing the right things at the right time to achieve your objectives. Efficiency is doing
things right, Effectiveness is doing the right things and good time management will enable you to
do the right things - right.
To do a job properly, do it yourself
The ability and willingness to delegate is central to good time management. Conversely, inability
or unwillingness to delegate is one of the primary causes of poor performance in business. If you
spend time doing tasks that are not central to your objectives, you cannot focus on the things that
will make a difference to your results.
There's only one right way to do a job
It is always worth spending some time thinking about how a particularly time-consuming task
could be done more efficiently. Don't allow yourself to get into a rut. Ask yourself questions like:
What is the required outcome of doing this task?
Time management is a waste of time
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A good time manager spends some time each day thinking and planning. These activities are vital
to long-term success in business, and whilst doing them does not make you look busy, it will pay
big dividends in your effectiveness. Once you have properly planned and scheduled your tasks for
the day, you will be far less troubled by the pressure of time.
A good time manager lacks creativity
Good time management techniques are there to be used when and how you choose. They are
designed to remove unwanted crisis management and last minute panic from your working day and
to allow more time for creativity.
Tip3: The 80/20 Rule
The Italian economist Vilfredo Pareto discovered that within any system the tendency is for some
elements to yield much higher returns than others. Usually, around 20% of the elements will be
high yielder and the remaining 80% will be low yielder.
What is even more interesting is that the 20% of high yielder tend to produce around 80% of the
yield and the 80% of low yielder produce the remaining 20%.
Whilst Pareto’s research was concerned with economics and found, for example, that 20% of an
organizations customers are responsible for 80% of its profits, the 80/20 principle has been found
to apply to a wide variety of areas. In terms of time
management and productivity it implies that 20% of the time that you spend on
something will produce 80% of your final output, while the remaining 80% of your
time will only produce 20% of it.
Tip 4: Identifying Time Wasters
If you want to learn to manage your time better, the first step is to document how you are
currently spending it. Surprisingly, most of us do not have an accurate picture of how we spend our
time. We may think that we know how long we spend on each task, but these impressions usually
turn out to be inaccurate when compared to a detailed time log.
It is useful to carry out an objective review of how you currently spend your time by keeping a log
or journal which details which tasks you did, when and for how long. This time log shouldn't take
more than 10 minutes a day to complete and you will probably need a further 20 minutes or so at
the end of the week to analyze the results.
How long you need to keep the log for will depend on the nature of your work. If you work on a
monthly cycle, then keep the log for a couple of months. If you work on a weekly cycle, then two
or three weeks should provide an accurate picture.
Tip 5: Keeping a Time Log
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Draw up a log that reflects the way, in which you work, dividing your day into representative
blocks of time, for example, 15 minute or half-hour divisions. Complete the log in real time, as
remembering what you did several hours earlier can be very difficult.
At the end of each day, conduct a simple analysis of the activities you have performed under four
simple headings: Priorities, Delegation, Time Wasters and finally Operations and Management.
Priorities are those activities that represent genuine priorities for that working period. This should
include only those activities that make a significant contribution to what you are trying to achieve.
Be disciplined in only identifying real priorities, they are by definition the few rather than the
many tasks.
Delegation indicates those tasks that you could or should have given to someone else to complete,
including priority activities where appropriate. On consideration you may identify priority tasks
that you could have delegated a significant part of, even if you needed to tackle part of the work
personally.
Time Wasters include the things that distracted you from your main objectives, such as
interruptions, as well as those activities that, on reflection, you should have said no to. Time
wasters are often insidious and yet when totalled up will often represent a significant part of the
working day. Again, be disciplined when identifying time wasters. They are an essential
component in regaining control over your working day.
You may find the Operations and Management category to be slightly more difficult to classify.
Here use two letters; an O for operations and an M for management. Operating tasks encompass
the technical or professional part of your job as well as the routine work, much of which could be
delegated. Management tasks relate to achieving results through other people and include activities
such as planning, delegating work and reviewing results.
Tip 6: Analyzing Your Time Log
As you look at your time log at the end of each day, it may draw your attention to some activities
that you wish to record in more detail. For example, if you have identified that much of the time
you spend on the telephone was non-essential, and then you should analyze this area in more
detail. Keep records of whether the call was incoming or outgoing, who it was from or to, and
estimate how much of the time spent was actually productive.
If you feel that you are spending too much time in meetings or in conversation then record details
like whether attendance at the meeting was mandatory and whether the conversation was the result
of an interruption.
When you are happy with your classification of the days activities, add up the number of time
divisions you spent on each of the categories and factor it over the total divisions in the day. This
analysis should provide you with two important pieces of information. Firstly, are you investing
enough of your time in areas that are essential to achieving your goals? Secondly, in which areas
that is not essential to your goals, are you spending significant time.
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Keeping a log over a working week is always revealing, sometimes reassuring but, more
frequently, disturbing. When you perform this exercise you are likely to be surprised by how little
time you actually spend on your real priorities.
It may also highlight how many of the activities you perform could be delegated to others. Finally,
don't be surprised if your log shows that a significant part of your working day is lost to
distractions, typically around 20% of time is identified as being lost in this way.
Tip 7: The Urgency/Important Grid
This section describes: How to use an urgency/importance grid to classify the tasks that you
currently perform, and how to optimize the amount of time that you will spend on each type of task
in the future.
Many people find that they spend a large proportion of their time dealing with tasks that are urgent
but not particularly important. It is very easy to confuse urgency with importance when you are
trying to identify your priorities.
Whilst many factors can change to make any one of your activities more or less important, time is
not one of them. An unimportant job is still unimportant even if the deadline for delivery is in an
hour's time.
You should draw a grid like the one shown then plot and label the activities you have identified
from your time log. You can then add in the percentage of your time spent on each type of activity.
Time Management Skills - Zone 1 - you should put tasks here that are fairly urgent but relatively
low in importance. It is easy to find yourself spending too much time on these tasks because of
their urgency. Ideally they should be completed adequately but above all quickly.
Ask yourself "How can I avoid spending too much time on these tasks?"
Time Management Skills - Zone 2 - you should put tasks here that are neither important nor
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urgent. These tasks represent a particular danger, because if you reduce the time spent doing them,
you may find that you enjoy your working day less. If some of these tasks involve interacting with
others then you may feel that reducing the time spent will distance you from your co-workers. If
you really want to manage time effectively you will need to be disciplined enough to eliminate
some of the things that make your work enjoyable and to persevere in the face of resistance from
colleagues.
Ask yourself "How can I avoid the temptation to do these easy or enjoyable tasks?"
Time Management Skills - Zone 3 - tasks that appear here should be both urgent and important.
The danger is that you fail to properly plan these tasks because of their urgency and then crisis
manage them because of the pressure you're under to complete them.
Tasks that are both urgent and important require immediate attention. Suppose, for example, that
an important customer needs a detailed proposal on their desk for Monday morning. This may
require that you re-arrange existing commitments and prioritize working on the proposal; you may
decide to concentrate on the key parts of the document whilst delegating more straightforward
parts of it to others.
Ask yourself "How can I give myself enough time to do these tasks well?"
Time Management Skills - Zone 4 - tasks that appear here should be important but not urgent.
They may have no specific deadline or a deadline that is a long way off. If there is no deadline you
may never get around to them, or you may wait until the deadline is very close and resort to
applying crisis management to get them done.
Tasks that are important but not urgent are in danger of being deferred. Critical functions that
relate to long-term effectiveness often fall into this category - such as strategic planning and
progress reviews. It is often the non-urgent nature of these tasks, combined with the slightly
daunting prospect of tackling them that leads to them being constantly placed on the back-boiler.
Take control of these tasks, set aside time to address them and break them down into manageable
chunks.
Ask yourself "How can I avoid putting these jobs off?"
Tip 10: Task Typing
A complementary approach to the urgency/importance grid is to allocate a letter to each type of
task; this is also known as ‘Task Typing’.
Type A tasks are those that are important and urgent.
Type B tasks are those that are either important or urgent, but not both. This category will
therefore cover two sections of the grid as shown.
Type C tasks are those that neither important nor urgent, but routine.
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The flowchart shown represents a quick and simple way of classifying each type of task.
When it comes to scheduling tasks into your working day, the following guidelines should be
borne in mind.
Type A Tasks: Try to complete a few of these urgent and important tasks each day.
Type B Tasks: These are likely to represent the majority of your work and should take up most of
your day.
Type C Tasks: These low-priority tasks should be fitted into your schedule, as time allows.
It is very easy to confuse urgency with importance when you are trying to identify your priorities.
Remember that an unimportant job is still unimportant even if the deadline for delivery is in an
hour's time and these tasks are best dealt with as quickly as possible. The urgency/importance grid
is a good way to classify tasks in order to clarify your priorities.
Tip 11: Effective Decision-Making
There are a variety of time management tools that can contribute to more effective decision
making. However, it is essential that you learn to accept that a proportion of your decisions will
turn out to have been incorrect.
Decision making is an important aspect of time management. For example, when classifying
activities on the urgency/importance grid, you will need to be decisive and not procrastinate over
each and every activity. Having decided what is important, you then need to progress these tasks
quickly and efficiently, and once again decision making will be a key factor in your ability to do
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this.
If you want to improve your decision making, you will need to identify the types of job you put off
and the reasons and excuses you give yourself. Many people admit to putting off jobs because:
they find the job daunting or unpleasant; they hope that the job will somehow go away or they just
don't know where to start. They may justify this procrastination by finding routine tasks to do
instead. Alternatively, they may wait until the pressure is really on before starting to take
appropriate action.
Don’t Delay – Do it Today
Putting off jobs we dislike doing is a common trait. Unfortunately, most jobs that are put off don't
go away - they remain waiting to be done, and they tend to stay at the back of our minds, often
causing feelings of guilt and acting as a distraction.
Putting off jobs has another disadvantage in that it tends to lead to an ever increasing number of
jobs that remain outstanding. This growing list becomes increasingly daunting and it then becomes
more and more difficult to make a start on any of them.
Whilst the batching of activities by type, is generally an effective time management strategy,
unpleasant tasks is the one category for which this doesn't hold true. They are far better tackled as
soon as possible - this is the most effective and efficient approach to unpleasant jobs.
Remember the maxim, "the only way to do something is to do it."
How to Overcome Procrastination
Overcoming procrastination involves first coming to terms with the fact that you have a real
problem, which will require you to change how you feel about certain types of job. There are
various CDs for overcoming procrastination.
Do the worst job first
Doing the worst job first, involves making the worst task the one thing that you commit to
completing that day, irrespective of other considerations. This prevents a task from becoming an
ongoing source of anxiety, which can make you less productive until it is completed.
Break daunting tasks down into smaller ones
This can be the only way to tackle long-term tasks where the end seems to be out of sight.
Breaking a task into smaller chunks will allow you to achieve some small successes, which should
give you the motivation necessary to see the job through. Making a series of smaller commitments
is much easier than making a single large one. Ideally each sub-task should have its own deadline.
This gives you a series of short-term targets to aim for and enables you to correct any slippage as it
occurs, rather than struggling to make up all of the accumulated lost time at the end of the project.
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Make a public commitment to do the job
Making a public commitment can be done in a number of ways; you could make your intentions
public by circulating copies to your colleagues. Alternatively, you could display your schedule
discreetly at your workstation, where it will be visible to others.
Plan the evening before
Planning the following days activities, the night before is effective because it avoids this potential
distraction at the start of the day. By identifying a task to get on with first thing in the morning,
you will create the opportunity to achieve something positive at the start of the day that will give
you the incentive to continue in the same way.
Limit phone calls/conversation
Use structured system of day-to-day management by blocking time for each task and scheduling
important events
Prioritize your day, week and month (use and display “do lists”
Use face-to-face communication with staff
No meetings without agenda, timetable and specific objectives
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Module 3 Human Resources Management
Human Resources management (HRM) is the integrated system of policies, and management
practices to recruit, maintain, and develop employees in order to meet the intended goal of the
organization. HRM helps employees find meaningful work and provide them with career
satisfaction. It also can assist an organization, program or facility to improve its level of
performance and increase its effectiveness as well as competitive advantage.
Today, HRM should provide managers with a framework to achieve higher level of staff
performance and employee satisfaction on a sustainable basis. HRM involves linking management
and the development of human resources to the mission, goals and objectives of the organization
and program.
Check your understanding of HRM:
No. Question True False
1 HRM is the same as training
2 Effective HRM is costly
3 HRM is an important leadership issue within an organization
or program
4 HRM not as important, within the context of health reform,
as financial and structural adjustment
5 Between 70 and 80% of an organization’s budget is spent on
personnel
6 HRM is the sole responsibility of HRM department
7 HRM is misunderstood and poorly managed in most
organizations
8 The HRM function should control employees through strict
rules and procedures
9 Improving salaries and providing financial incentives are the
only solutions to increasing employee performance
10 To ensure a proper supply of health workers, the national
level must be involved in policy development
Profile/characteristics of high-performing managers:
1. Competent in his/her field of expertise
2. Strategic thinker and visionary leader
3. Uses facts and not perceptions in making decisions (the three NGOs: jumping to
conclusions, blaming and jumping to the cause)
4. Distinguishes between personal and professional; and essential from nonessential
5. Open-minded, good listener and down-to-earth communicator
6. Inspiring, respectful and role model leader
7. Consistent
8. Task-oriented, goal-oriented, and result-oriented (Focused)
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9. Quick learner
10. Flexible with ability to adapt, and readjust
11. Knows well the needs and expectations of stakeholders, external and internal clients
12. Systematic in giving and taking feedback
13. Uses written means of communication
14. Understands and complying with policies, procedures, rules and regulations
15. Knows inventory procedures and policies related to materials and equipment
16. Uses well-defined planning grids and schedules
17. Skilled in analytical and basic statistical analysis
18. Presentation skills
19. Writing skills
20. Reading skills
21. Documentation skills
22. Ability to start and complete tasks on time
23. Self-disciplined in terms of time management and efficiency (telephone calls, internet
search and e/mailing etc.)
24. Has other life and not just work
25. Culturally-sensitive
26. Tolerant
27. Well-dressed
28. Politically correct
Managers of FMOH/SMOH departments and programs need a well-qualified and motivated staff
to effectively run their facilities and programs at the central, regional and rayon levels. Managers
need special skills to determine what kind of workers are needed, obtain the most qualified staff
and provide appropriate orientation, evaluate their performance to accomplish intended results. As
a manager responsible for specific scope of work, you should know how to:
Select and recruit qualified staff. Managers should ensure that all staff members are committed to
departmental plans implementation, and have a sincere belief in its benefits
Develop clearly the duties and responsibilities of your department or unit.
Assist in drafting operational job descriptions for each staff in line with the overall goals of the
department/program objectives
Develop and use appraisal system for staff performance overtime
Provide staff development to maintain acceptable level of staff competence necessary to achieve
both the short-term and long-term objectives of the department/program
Job Descriptions
Job description is an important instrument of HRM. It should explicitly outlines the tasks and
responsibilities of each staff. If it is for a manager, the job description should describe lines of
communication and authority. Traditionally, it should also state the qualifications and skills
required to perform the job. When job descriptions are not used, it is hard for both employees and
managers to know what is expected in terms of tasks and responsibilities of each employee. All
employees should have copies of their own job descriptions, as well as those of the people they
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supervise. It is recommended also for employees to have copies of the job descriptions of their
supervisors, so that the division of labor between them and their supervisors is clear.
Benefits of developing and using job descriptions:
Well-defined job descriptions help both managers and employees to perform the expected tasks
Assess in performance objective evaluation
Assist in reaching the mission and goals of the organization and program
Ensure the hiring of qualified staff that is capable of doing the work
Improve workplace coordination and teamwork
Comply with legal, financial and other policy requirements, roles and regulations
Major components of a job description:
 Job Title
 Date of most recent revision
 Report to
 Job summary
 Key duties and responsibilities
 Qualifications
 Attitude and personal qualities
Coaching and supervising staff
Effective manager today uses the concept of traditional supervision to guide and coach staff to
perform the assigned tasks. Coaching is essential for two reasons in management:
 To find out what is actually happening
 To renew the enthusiasm of the staff for the work they are doing
Close contact is essential both for the effective operation of the program and for staff morale and
commitment.
Dos and Don’ts in staff supervision
Dos
 Give sufficient instructions (complete and specific)
 Explain targets, deadlines, and dates for activities in advance
 Admit your own mistakes
 Support your staff
 Delegate responsibility appropriately
 Trust your staff
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 Recognize merit when it is warranted
 Supply staff with materials and equipment
 Give staff opportunity to learn, grow and be creative (participate without fear)
 Deal with problems and conflict in a fair, objective and straightforward manner
 Give the real reason for any problem or decision
 Make an extra attempt to listen to the staff’s point of view
Don’ts
 Scold a staff in the presence of others
 Make and show favoritism to any staff
 Blame for your own mistakes
 Intrude in the personal matters of staff
 Provide excessive supervision (micromanagement) by being too vigilant, checking
everything, even unimportant details
 Gossip with one staff member about another
 React negatively to new ideas
The art of feedback and two-way communication
Feedback means communicating to the staff your reaction regarding their work performance.
Feedback provided by managers is crucial to let staff members know if they are in the right track
in terms their tasks are being carried out, what works well, and is not working that well and why.
Subsequently, effective and supportive feedback helps managers and employees alike to discover
any areas needing improvement, and how they can be improved.
Tips for effective feedback:
 Prompt
 Constructive
 Inspiring and motivating
 Task-related
 Action-oriented
Performance Appraisal System (PAS)
PAS is one of the most important components of HRM, and consists of established procedures for
evaluating the performance of staff on a regular basis. PAS is important not only to ensure the
organization or program is achieving its goals and objectives, but also to make sure that each staff
fully understands and is qualified for the work.
Why PAS?
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 Allow managers to identify strengths and weaknesses of each staff
 Have results of systematic review of employees’ overall performance and provide
constructive feedback
 Provide objective information to guide management decisions on promotions
 Establish an objective basis for determining any merit awards
Steps in building an effective SAP:
 Set well-defined tasks linked to performance objectives for each staff member
 Develop a supervisory schedule showing the date and time of supervisory sessions and
distribute it to the staff
 Develop a supervisory checklist that lists what will be observed, the data to be collected,
and program support activities for each supervisory session
 Supervisory sessions, at a minimum, should consist of:
→ A review of the activities for the past six months
→ A plan for future activities
→ A discussion of staff concerns
Review the notes of the supervisory sessions immediately following the sessions, write down the
follow-up activities that were promised during the session, and carry them out
Handle performance problems in a timely and equitable manner, and find reasonable solutions
with the help of the staff in question
Employ conflict resolution techniques and handle conflict in a timely and equitable manner
Pay attention to the quality of the work environment and make adjustments as needed
Use staff motivation techniques
Provide constructive feedback on a regular basis and provide each staff with specific list of
performance related strengths and areas needing improvement along with a timetable for corrective
action for performance improvement
Examples:
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REPUBLIC OF THE SUDAN
DIRECTORATE OF HUMAN RESOURCES AND CONTINUING TRAINING
FMOH-PERFORMANCE PLAN AND REVIEW
FOR THE PERIOD BEGINNING: AND ENDING:
Employee: Position Title:
Assignment: Supervisor:
Professional Home: Duty Station:
SECTION I. PERFORMANCE PLAN SECTION II. PERFORMANCE REVIEW
This Section To Be Completed During The Performance Planning Process This section to be completed at the conclusion of the performance period
A. SPECIFIC PERFORMANCE OBJECTIVES
List specific performance objectives for the next twelve months. Not Met Met Discussed
Yes/No
Comments
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Employee: Position Title:
Key results areas:
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Employee: Position Title:
Planning tools
Familiarizing with CB package and tools
Program planning
Program budget development and monitoring
Verify existing budget and LOE, and make necessary changes in accordance
with the workplan. Be responsible for monitoring the program budgets.
Outcome: number of budgets and LOE
Results framework and program monitoring
Familiarize with results framework and monitoring and reporting requirements,
including department-specific strategic objectives and intermediate results
Key results monitoring
Work wit the FMOH approved monitoring framework. Familiarize with the
directorate/department monitoring template, and develop the required
monitoring quarterly reports
Manage department activities
During the introductory period, act as a team leader and activity manager for
planned activities, including
Reconnaissance trip to
Planning meetings with MOH and SMOH
Presentation skills
Develop a Power Point presentation for the CB sessions on Planning, Policy
Issues based on the CB assessment and best practices in
Skills and tools development
Contribute to refinement and local adaptation of new skills. Revision of the CB
tools: prepare a document summarizing comments of local counterparts/experts
involved in the CB transfer of skills.
Acted as task manager for planned
activities, including:
Reconnaissance trip to
Planning meetings with
Contributed to CB sessions on and
facilitated during the session as
Contributed to the development,
refinement and local adaptation of CB
__________________
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Module 4 Health Financial Management
Health Financial Management (HFM) is the ability to plan, utilize and manage human
and non-human resources to meet pre-established goals and objectives of the
organization or program. For health programs supported by donors and international
assistance, efficient use of resources is crucial to ensure financial stability and
sustainability of planned activities. Managers are increasingly required to prepare
budgets for short-term and long-term costing with rational justification. For TB
related activities, preparing workplans should contain financial requirements to carry
out the planned activities.
What is the key health financial management skills needed for health managers?
Today, health managers are increasingly being challenged to:
1. Meet different reporting and procedural requirements of multiple funding
sources
2. Maintain or expand services in the face of reduced funding from governments
and donors
3. Measure the cost of services in different level and different locations to
compare effectiveness of different treatment approaches
Manager of directorate, department, unit and/or program related activities or needs to
develop the following basic skills:
1. Costing each major planned activity in the workplan
2. Preparing a budget for the workplan
3. Analyzing financial flow at the service delivery level (financial flow analysis).
This skill means the capability of managers to calculate the direct and indirect
cost of TB services
4. Monitoring cash flow and managing funds
5. Monitoring finances by comparing program results with budget projections
6. Meeting internal and donor reporting requirements
7. Using financial reports for decision making
Fiscal Flow Analysis: (please check below steps on how to conduct MFA)
Fiscal Flow Analysis
Financial
Area
Financial
planning
and
forecast
Internal
financial
documenta
tion and
records
Financial
performance:
Budget lines
tracking re
planned
versus
Auditing
Financial evaluation
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Ranking
Priority
projected
cost/spending
Auditing
High-risk
conditions
TB High-
volume
conditions
High-cost
conditions
Determining financial needs and costing analysis
Since the government is the primary provider of health services, managers are usually
given fixed budget allocation. If the allocation is not sufficient, which is the case in
most cases, mangers have limited choices to cover cost and expenses required to run
program activities. As a result, managers need management knowledge and modern
health financial skills not only to effectively allocate available resources, but also to
save money by eliminating unnecessary waste and spending. They understand that
indirect cost should be counted for, and may greatly affect program effectiveness by
taking too much out of the available resources. Managers also may conduct fiscal
flow analysis to identify resources that are being either wasted or not fully utilized
and make subsequent outsourcing. In many programs, managers are medical doctors
without management and health finance training, and thus, managers with clinical
background should pay special attention to financial aspects of management and
obtain skills in budgeting, financial planning and financial management. Financial
needs are determined based on the scope of activities listed in the approved workplan.
Moreover, estimates for planned activities in the workplan are based on the spending
pattern and potential scaling up opportunities.
Budgeting and costing
Managers should take the following factors into account for budget preparation and
rational costing:
1. Comparative analysis between current level of ongoing activities with
anticipated level of new activities
2. Estimated changes in costs for salaries, drugs etc.
3. Projected changes in new services, etc.
4. Potential partnerships with new international organizations or supplemental
funding from donors
5. Contingency funds set aside for unexpected additional expenses
Managers have to specify all the resources that are required to implement the planned
activities listed in the workplan and to assign the cost to these resources. To do that,
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managers need to look at each activity in the workplan and quantify the time,
supplies, equipment, and other costs required to carry it out.
Understanding variable versus fixed costs
Most activities in the workplan are usually variable costs. These are costs that vary
with the volume of service or scope of activities that are provided. Example of
variable cost could be TB drugs, which will vary, based on number of TB patients
served. Some costs however will be fixed, which are incurred by the program no
matter what the level of activity or volume of service is. Examples of fixed costs are
1. Rent and utilities
2. Equipment leases or payments
3. Most salaries
Both variable and cost costs must be included in the budget.
Managers should have the skills to keep transparent financial statements on expenses,
which is crucial for securing new funding and maintain current support.
Module 5 Leadership Check your leadership profile:
FMOH-WHO Partnership
Health Sector Capacity Building Training
Leadership Questioner: Testing your leadership skills
June 5, 2004
Instructions
Objective: To determine the degree that a person likes
working with tasks and other people.
Instructions:
1. Have the managers (potential leaders) complete the 18
items in the questioner section.
2. Next, have them transfer their answers to the two
respective columns provided in the scoring section. Total
the score in each column and multiply each total by 0.2.
For example, in the first column (People), if he/she
answered 5, 3, 4, 4, 3, 2, 5, 4, 3 then his or her final score
is = 33 X 0.2 = 6.6.
3. The total score for the fist column (People) is plotted on
vertical axis in the matrix section, while the total score for
the second column (Task) is plotted on the horizontal
axis. For a sample, see Example. Finally, have the
participants intersect the lines to see in what leadership
dimension they normally operate out of:
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
Authoritarian
 Impoverished
 Team Leader
 Country Club
Questioner
Below is a list of statements about leadership behavior.
Read each one carefully, then, using the following scale,
decide the extent to which it actually applies to you. For
best results, answer as truthfully as possible.
Never Sometimes Always
0 1 2 3 4 5
1. _______ I encourage my team to participate when it comes
decision-making time and I try to implement their ideas and
suggestions.
2. _______ Nothing is more important than accomplishing a
goal or task.
3. _______ I closely monitor the schedule to ensure a task or
project will be completed in time.
4. _______ I enjoy coaching people on new tasks and
procedures.
5. _______ The more challenging a task is, the more I enjoy it.
6. _______ I encourage my employees to be creative about
their job.
7. _______ When seeing a complex task through to
completion, I ensure that every detail is accounted for.
8. _______ I find it easy to carry out several complicated tasks
at the same time.
9. _______ I enjoy reading articles, books, and journals about
training, leadership, and psychology; and then putting what I
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have read into action.
10. _______ When correcting mistakes, I do not worry about
jeopardizing relationships.
11. _______ I manage my time very efficiently.
12. _______ I enjoy explaining the intricacies and details of a
complex task or project to my employees.
13. _______ Breaking large projects into small manageable
tasks is second nature to me.
14. _______ Nothing is more important than building a great
team.
15. _______ I enjoy analyzing problems.
16. _______ I honor other people's boundaries.
17. _______ Counseling my employees to improve their
performance or behavior is second nature to me.
18. _______ I enjoy reading articles, books, and professional
journals about my profession; and then implementing the new
procedures I have learned.
Scoring Section
After completing the questioner, transfer your answers to the spaces below:
People
Question
1.______
4.______
6.______
9.______
10.______
12.______
14.______
16.______
17.______
TOTAL ________
X 0.2 = ________
(multiple the Total by 0.2 to
get your final score)
Task
Question
2.______
3.______
5.______
7.______
8.______
11.______
13.______
15.______
18.______
TOTAL ________
X 0.2 ________
(multiple the Total by 0.2 to
get your final score)
Matrix Section
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Plot your final scores on the graph below by drawing a horizontal line from the
approximate people score (vertical axis) to the right of the matrix, and drawing a
vertical line from the approximate task score on the horizontal axis to the top of the
matrix. Then, draw two lines from each dot until they intersect. The area of
intersection is the leadership dimension that you operate out of.
(See example below)
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The above sample shows score of 4 in the people section and a score of 6 in the
task section. The quad where the two lines intersect is the leadership style, in this
case -- Authoritarian section.
The Results
This chart will give you an idea of your leadership style. But, like any other
instrument that attempts to profile a person, you have to take in other factors, such
as, how does your manager and employees rate you as a leader, do you get your job
done, do you take care of your employees, are your GROWING your organization,
etc.
You should review the statements in the survey and reflect on the low scores by
asking yourself, "If I scored higher in that area, would I be a more effective
leader?" And if the answer is yes, then it should become a personal action item.
Notes:
People and Mission
Some may ask, "In order to get a perfect score I would
have to max out statements 2 (Nothing is more important
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than accomplishing a goal or task) and 14 (Nothing is more
important than building a great team), but this would be a
paradox."
One of the know leaders noted "People and mission first."
That is, nothing is more important than accomplishing the
mission and nothing is more important than looking out for
the welfare of the people. A good leader can do both!
Relationships With
Others
For statement 10 - "When correcting mistakes, I do not
worry about jeopardizing relationships," some people might
believe that a "people-person" would put a low score to this
question. They might believe that a "people-oriented"
person would not want to jeopardize a relationship.
But, if a leader really cared about the person, would the
relationship (being friends) be more important or would
guiding the person on to the correct behavior be more
important? Let's put it in a "leader-teacher" relationship - If
you did not correct your learner's mistakes, would that
make you a more "people" teacher? Probably not. Good
leaders do what it takes to build and develop the people
around them. The "relationship" is not what makes them
tick...guiding others onto greatness is what a "people"
leader is all about.
This question helps to separate the "country club leaders"
who want to be friends with everyone; the "impoverish
leaders" who are afraid they might make waves; and the
real "people leaders" who are more concerned with
coaching others so that they benefit the team. That is, if
the leader lets one of her peers continue with the incorrect
behavior, does this help or hinder the other members of
the team? It is best not to picture a "people" leader as a
friend, but as a person who concerned with the growth and
welfare of others.
Instead of presenting a manager with a dilemma of
choosing one or the other alternative, it shows how a
leader can simultaneously maximize both production
oriented methods and those that are people orientated.
Self Assessment
Can people assess themselves? For studies, see Learner
and Self Ratings
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A perfect score is a nine in both categories of People and
Tasks. If you gave yourself a perfect score or close to it,
you are being too easy on yourself -- you cannot learn if
you to not take a Critical Reflection of yourself.
Leaders:
Basic scope of activities:
 Policy and decision-making responsibilities
 Clinical service responsibilities
 Other managerial, organizational and non-clinical responsibilities
 Information, statistics and data analysis and reporting
Visionary Outlook and strategic thinking
Goal Clarity and Commonality
Clarity of roles
Explicitly talk about, define and clarify roles up front and periodically - in the group
and with individuals – as needed.
Provide insight to enhance team members’ abilities to be effective in those roles.
Leadership and Participation
Plan the overall strategy and process for addressing departmental mission. Prepare a
well-defined agenda with timetable (Leader and facilitator).
Keep team discussion on track. Clarify purpose of discussion if wandering. Keep
track of side issues (parking lot) on flip chart for future discussion.
Encourage equal, balanced participation from all members of the team
Share responsibility for work among team members.
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Managing conflicts
Establish explicit group norms (ground rules) for how conflict will be addressed when
it arises.
Anticipate areas of disagreement; bring those to the surface earlier rather than later.
Elicit objective discussion of differing perspectives.
Ensure that all parties have opportunity to voice their views.
See conflict situations as a positive opportunity for the team to move ahead.
Communication
Establish team norms around expectations for communication.
Listen, listen, and listen.
Structure discussions for balanced participation. Use team tools.
Encourage feedback to be given openly – both positive and critical.
Decision – Making
Discuss up-front how decisions will be made within the team.
Identify decision points prior to discussions on a topic.
When consensus is not possible, acknowledge minority viewpoints, but then move
ahead.
Summarize decisions for clarification.
Organizational Support
Clarify at the outset of the team what support the team can expect and what
constraints exist.
Stay in touch with the organizing facilitator or management group to which the team
is accountable to keep them apprised of the
team’s progress and difficulties.
Recognition
Celebrate achievements along the way and tell staff what a superb job he/she has
done.
Infuse the team’s work with stimulating activities for energy and fun.
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Thank team members and those outside the team who help its work.
Exercise: In preparation for the OPF, each team member is required to meet and use
the following steps:
Define one and only one major issue or problem which is considered by the
department/program as an obstacle against planned implementation
Develop subsequent problem statement or “opportunity statement for improvement”
according to the analytical tools used in the management training
Identify key issues related to the problem statement
Analyze root causes of the problem based on facts and data if available
Explore potential solving options for the identified problem or obstacle (3 to 4
options, one of which should be “do nothing option”
Define advantages and disadvantages for each option
Use one of the management tools provided in the training to select the most realistic
and cost-effective option. Defend chosen option with rationale
Develop action plan to be used at workplace for at least three months
Leadership:
Leadership is the process of the directing and influencing the task-related
activities of group members. This means that:
1. Leadership involves other people-employee or followers. By their
willingness to accept directions from the leader, group members help to
define the leader’
s status and make the leadership process possible.
2. Leadership involves an unequal distribution of power between leaders and
group members. Group members are not powerless; they can and do
shape group activities in a number of ways. Still the leader will usually
have more power. Power is the ability to exert influence-that is to change
the attitudes or behavior of individuals or groups.
The manager’s power comes from different five bases of sources:
a. Reward power : this is a power derived from the fact that one person
known as an influencer has the ability to reward another person known as
an influence for carrying out orders which may be expressed or implied.
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b. Corrective power: is the negative side of reward power based on the
influencer’
s ability to punish the influence for not meeting requirements.
Punishment may range from reprimand to loss of a job.
c. Legitimate power: power that exist when a sub-ordinate or influence
acknowledges that the influencer has a right or is lawfully entitled to exert
influence within certain bounds; this is also called formal authority.
d. Expert power: power based on the belief or understanding that the
influencer has specific knowledge or relevant expertise that the influence
does not have.
e. Referent power: power based on the desire of the influence to be like or
identify with or imitate the influencer
The situational leadership model of Hersy and Blanchard describes how leaders
should adjust their leadership style in response to their subordinates’ evolving
desire for achievement, experience, ability and willingness to accept
responsibility.
The model is based on a believe that the relationship between the manager and
follower moves through four phases as employees develop, and manager need to
vary their leadership style accordingly. The recommended style in each phase is as
follows:
1) High task and low relationship:
In the initial phase of readiness high amounts of task behavior by the manager is
most appropriate. Employee must be instructed in their tasks and familiarized with
the organizations rules and procedures. A non directive manager would cause
anxiety and confusion in new followers
2) High task and high relationship:
As followers begin to learn their tasks, task behavior remains essential because
they are not yet able to function without the structure. However the leaders trust in
and support of employees increases as the leader becomes familiar with them and
wishes to encourage further efforts on their part. Thus the leader needs to increase
relationship behavior.
3) High relationship and low task:
In the third phase employees have more ability and achievement motivation
begins to surface and they actively begin to seek greater responsibility. The leader
will no longer need to be directive. However the leader will still have to be
supportive and considerate in order to strengthen the followers’resolve for great
responsibility.
4) Low relationship and low task:
As the followers gradually become more confident, self- directing and
experienced, the leader can reduce the amount of support and encouragement.
They no longer need or expect direction from their manager.
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Setting and sharing objectives
An important issue in leadership is the involvement of the team members in
setting and sharing objectives. People work well together when they agree with
one another. People do not give of their best when they are dictated to. One of the
best ways to ensure that people are agreed on objectives and that their motivation
is applied to achieving them is to see that they take part in setting the objectives.
Motivation:
It is important for a team leader to understand what encourages people to apply
their ability and energy to work and what are those things that make people
dissatisfied at work. The six main motivators in work are:
1) Achievement; the good leader helps the team to achieve by
training them, by clear instructions, by suitable training and by
availing the facilities and supplies they need for their work.
2) Recognition: man, at any level, likes to be praised on his
achievements. Lack of recognition can be very discouraging.
3) The importance of work: A good leader is the one who manage
to assure every member of the importance of his work. This sense
of being important conducting an important part of the
organization work is very encouraging.
4) Responsibility : good leader helps his subordinate to be
responsible by giving room for decision making. Making
decisions for the staff can destroy their sense of responsibility.
5) Advancement: Advancement is an important expression of
recognition. Recognition without reward is not very convincing
6) Self- improvement: good leader is the one who helps his team
members to improve their knowledge and skills by providing
suitable learning material and by challenging them with questions
at work.
The six common causes of dissatisfaction are:
1) Inefficient administration.
2) Incompetent supervision.
3) Poor interpersonal relations.
4) Personal qualities of the leader.
5) Inadequate payment.
6) Bad working condition.
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Organizing manpower:
The leader is responsible for organizing the team activities. To do this, there is
high need for the team members to sit together at times to discuss what has been
achieved and what is to be next. Conducting useful meetings is a very important
management tool.
For a meeting to be fruitful:
1. Prepare for the meeting by:
 Deicide on the purpose of the meeting and the agenda.
 Nominate the members to attend and inform them early and decide
on time
 Prepare the place
2. Chair the meeting to :
 Give each employee a chance to express himself.
 Prevent any rudeness or personal remarks.
 Control the discussion, rule out irrelevant remarks and bring the
proceedings to a step if necessary.
 Enrich discussion by raising new questions or topics.
 Control the time.
 Put motions (i.e. formal proposals) to the members to be voted on
and declare them passed or rejected.
Supervision:
Another tool is supervision. Supervision is a term used in different meanings. It
may refer to management. In this context supervision refers to a process of
selection of certain indicators and preparation of check-lists and schedules for
announced or surprised visits to sub-ordinate at work to make sure that the staff
perform their duties effectively. It means that the supervisor helps and guides the
staff for whom he is responsible and trains them as necessary in such a way that
they become more competent in their work and takes the right measures when
there is negligence and misconduct.
A supervisor to perform these activities should be:
• More knowledgeable than the supervisee.
• More skillful than the supervisee.
• More powerful than the supervisee
The important purposes of super vision are:
1. To assess the effectiveness; the degree to which the intended sub targets
are achieved.
2. To assess the efficiency ;the degree to which resources are economized
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3. To assess the quality; the degree to which technical guidelines are
followed.
4. To detect discrepancies in all these aspects.
5. To correct the situation for better achievement.
To prepare for supervision you need to:
1. Review the work plan to detect what should have been achieved by the
time of your visit.
2. Review the job-description to determine who is responsible for each
activity.
3. Review the technical guidelines to refresh your knowledge about the
methods to be followed.
4. Select certain indicators for assessment.
5. Design a check list including the selected indicators
6. Review all the schedules of the management.
7. Prepare a schedule for visits
What should be done during the visit?
1. Ask.
2. Listen.
3. Observe.
4. Detect the achievements and the failures
5. Praise on achievements.
6. Advise on how to do things better.
7. Punish for negligence and misconduct.
8. Correct unintended wrong practices.
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Organizational Performance Framework (OPF):
OPF is a structured management tool used to encourage individual accountability and
team accomplishments. For managers, the anticipated product of the OPF can used to
define or diagnose present management capacity and develop action plan for
management capacity strengthening and improvement to achieve results.
When to use OPF:
Revisit original mission and actual goals of your program. For example, if a FMOH
department conducts OPF, the department would clarify the original departmental
objectives. Why they were established? What were the anticipated results? Why a
decision was made to create new unit or branch in the state. What are the staffing
needed, and what is the management capability required to undertake assigned
responsibilities. What is the management capability required for the newly created
unit and other affiliates to achieve goals of the national program.
Make reasonable assessment about the resources and systems required for the new
unit(s).
Estimate the time needed to improve current skills and develop needed management
capabilities
Provide objective information for all parties involved about investing resources,
including FMOH/SMOH, donors among other stakeholders.
Identify best venues to take advantage of technical assistance and training facilitated
by international partners.
Develop base-line data that will allow determining how successful planned
implementation has been overtime with impact evaluation
Decide when and how the program has the management capability to add or expand
existing activities based on rational criteria accepted by all parties interested in the
program.
Teams representing a given FMOH department or program and possible local health
authorities and any other management body responsible for policy, planning and
decision-making can use this management tool.
There are two primary goals for conducting an OPF:
1. To define operationally present level of management capabilities in your
FMOH, including department or program
2. To identify major deficiencies against planned implementation and explore
new levels of attainable management capabilities
As a leader, you and your multi-disciplinary team need to particularly identify those
management capabilities that are lacking in your effort to implement outcome-based
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targets, areas you and your team are determined to strengthen and develop
management skills and systems so that your department or program can become
mature and sustainable.
How to conduct OPF:
Step one: Inventory or environmental scan to select priority management
development areas. Each department shall start with the selection of key management
areas, which are most critical to focus on, and directly linked to the national strategic
objectives for health sector-wide capacity building. These areas usually cover the
know-how management skills and systems required for the program activities to
function well. Amongst the most common of such management areas are:
Mission statement, goals, objectives and rational plans to prepare strategic as well as
operational plans to assist in a successful implementing of FMOH department and
program;
Organizational design, leadership and lines of authority to review existing operating
bylaws, policies and procedures that impact communication, supervision, delegation
as well as decision making. Type of leadership to keep all parties involved in the
program implementation focused on achieving pre-established mission and goals;
MIS, data analysis and reporting to assess current state of information system,
including data gathering, analysis, reporting of results and feedback
Human resources management to review existing job descriptions, individual
workplans. Or to develop modern skills to recruit, supervise and train all staff
involved in the program implementation with ongoing performance appraisal and
objective assessment of anticipated outcomes;
Financial management to develop skills on rational using of existing resources
according to the designed budget, and transparent reporting. Source of funding and
how funding has been utilized as intended.
Please use the following tracer condition matrixes as samples for the selection of key
management areas:
Management Flow Analysis
Condition Internal &
external
communica
tion and
decision
making,
including
meetings,
Organizational
planning (use of
workplans,
accountability
matrix etc)
Performance
evaluation, how
often, individual
versus program
workplans
Budgeting and
financial
analysis,
including
efficient use of
resources and
outsourcing
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Ranking
priority
flow of
information
and
feedback
High-risk
conditions
High-volume
conditions
High-cost
conditions
You may use the same tool for patient and clinical flow analyses
Step Two: Compose a matrix (see below) containing key management priority areas
selected and reasons for importance of each area. Select explicit measurable indicators
for each selected priority management area needing improvement. Measurable
indicators should be selected in advance for each management area needing
development. For example, if the indicator were about formulation of a national
program-wide objectives and plans for implementation, the criteria to measure would
assess whether or not the operational plans with attached tasks are being executed
with the expected results. If not, an assessment will be required to determine why and
what is needed to overcome obstacles. Specifically, what is the management capacity
that has been lacking? And how to plan such skills-based training and whom to
contact for assistance. Subsequently, the assessment might show that the existing
workplan is insufficient and needs modification and improvement.
Use the following Management Mapping Framework (MMT):
Management Mapping Tool
Key management
area
Importance Indicators Yes No
Mission, goals,
objectives and
rational plans
- Sense of purpose,
strategic direction and
shared values
- Drive/motivation for
determination to
achieve results
- Take advantage of
present and future
opportunities to
stabilize and improve
- Create legitimate
demand to expand and
institutional roll out
sustainability
- Secure funding
- Mission/vision
statements developed
- Availability and use
of goals and objectives
- Short and long-term
plans
- Record of
achievements/results
Organizational
design, leadership
-Keeping all staff
focused on the
- Organogram/writtten
and approved
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and lines of
authority
goals/objectives
- Effective coordination
– Foster sharing/
communication and
clear lines of authority,
accountability for
decision making
organizational chart
- Mechanisms for
making decisions
- Internal and external
communication
- Accountability
matrix/workplans
MIS, data
analysis and
reporting
- Data Collection
Instruments (DCI) -
checklists
- Collection methods
- Analysis
- Results reporting
- Two-way
communication and
feedback
- MIS system in place
- Number of DCI
- Mechanism of data
analysis/interpretation
- Link between data
and decision making
- System for follow-up
monitoring - System
for data communication
and feedback
Human resources
management/dev
- Staffing needs
- Job descriptions
- Supervision system
- Performance appraisal
- Plans for staff training
and development
- Personnel manual
- System for matching
actual needs to
recruitment
- System for using job
descriptions
- Functioning
supervision - System
for performance
appraisal
- Personnel manual
exist and used
Financial
management
- Budgeting
- Financial planning
- Link finances to
objectives and planned
activities
- Resource allocation,
distribution and cash
flow
- Fundraising
- Financial records
- Budget exist and used
- Plans for future
finance
- System for tracking
spending per
objectives/activities in
the workplan
- Plan and system for
fundraising,
sustainability and
scaling up
- Financial records are
available and used
Step Three: Develop departmental capacity building plan based on the results of
MMT and its analysis. Each department/program will know by now where their
program stands. This MMT allows managers to assess status of their program in terms
of management capability in relation to the status of implementation, and what
management areas needing further improvement. This final step will also assist in
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determining what management capacity needed for further competency-based
training.
Review and evaluation of present departmental situation with regard to management
capabilities will allow drew or redesign a more cost-effective organizational
framework that can meet FMOH guidelines, needs and expectations. This will provide
the rational basis of the management capacity building strengthening plan, which is
the anticipated product of this exercise by each participating department in the
capacity building program. This management action plan should contain such
elements as strengths, weaknesses, recommendations, action, timeline and person
responsible. Each department is expected to walk out of the first round of
management training with such skills and tools. Once they return to work, the team
will use the new approaches and improved systems for capacity building
improvement. Moreover, each department will be required to communicate with other
participating departments, and report progress or setback. The following is a generic
sample of MMT.
MMT (Sample)
Management Area: MIS, Data Analysis and Reporting (please use results of step two)
Strengths Weaknesses
(Areas
needing
capacity
building
improvement
Recommendations Action Timetable Staff
responsible
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The logical frame approach
The logical framework is a tool for:
• Problem analysis.
• Planning.
• Appraisal.
• Implementation.
• Monitoring.
• Evaluation
The main concept underlying the logical framework is means and end. The better the
means and end linkages between each level of aims, the better the program design (5).
The frame combines both vertical logic and horizontal logic as shown in figure (4).
The logical framework (logframe) matrix is a planning tool that facilitates common
understanding of the expectations of the program by delineating a hierarchy of aims
and by highlighting external factors which may have an impact on the implementation
process. The matrix also establishes criteria for monitoring and evaluation. However
the matrix is not the only tool that is used in the programming process. It is used in
addition to other tools such as problem analysis and stakeholder analysis. In fact the
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matrix draws on the findings of these other tools, which are used at the initial stages
of the programming process.
The logframe matrix takes the form of a table with four vertical columns and four
vertical horizontal rows. In the first column, four types of aims-goal, purpose, outputs
and activities-are listed in hierarchical manner. The goal is mapped out in the top-left
cell of the matrix. Purpose, outputs and activities are then listed in successive cells
down the column. The second, third and fourth columns are then used to set out the
objectively verifiable indicators (OVIs), means of verification (MOVs) and
assumptions (5).
Figure (4): Vertical and horizontal logic frames
GOAL
PURPOSE
OUTPUTS
ACTIVITIES
AIMS MEASURED BY INDICATORS, THROUGH INFORMATION
COLLECTED AND PRESENTED IN SPECIFIED MEANS OF VRIFICATION
Table (2): The logical frame matrix
HIERARCHY
OF AIMS
OBJECTIVELY
VERIFIABLE
INDICATORS
MEANS OF
VERIFICATION
ASSUMPTIONS/RISKS
GOAL
PURPOSE
OUTPUTS
ACTIVITIES
The logframe matrix is a participatory planning tool whose power depends on the
degree to which it incorporates the full range of views of integrated beneficiaries and
HORIZONTAL
LOGIC
VERTICAL
LOGIC
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others who have a stake in the program design. It is a tool for summarizing the key
features of aprogram and is best used to help program designers and stakeholders:
• Set proper aims.
• Define indicators of success.
• Identify key activity clusters.
• Define critical assumptions on which the program is based.
• Identify means of verifying program accomplishments.
The logframe makes use of a number of terms which may have other usages and
meanings in different contexts. In order to avoid confusion, it is important to
understand and adhere to the definitions given below.
The goal: is usually described in terms of quality of the life improvement. It has as its
basis the goals of the government.
The purpose: is usually determined by asking question like “how will this goal be
achieved” and is described in terms of use, attitudinal changes and political
commitment.
The outputs: are the deliverables through which the purpose will be achieved. They
are time-bound and can be achieved through one component project or several
component projects.
The activities: are the means through which the outputs are achieved. However, the
matrix should not include each and every activity that is to be undertaken in the
component projects. The emphasis is on clusters of key activities rather than on
individual activities.
Objectively verifiable indicators: these are the quantitative, qualitative and time-
bound measures that constitute evidence of the extent to which aims have been met at
the four levels of the hierarchy. The basic principle of the OVIs column is: if you can
measure it, you can manage it. The OVIs demonstrates results and indicate not only
the level of accomplishment to be reached but also what will be sufficient
performance to reach the next level of aim (5).
SWOT analysis:
Strengths, Weaknesses, Opportunities and Threats (SWOT Analysis) is a useful
analytical tool to qualitatively and quantitatively examine and assess a system such as
district health system with respect to all of its individual system components. The
strengths, weaknesses, opportunities and threats of the state health care delivery
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system are identified and the information generated are used for planning. The results
from SWOT analysis are usually presented in a logical framework matrix featuring
the aspects of examination i.e. strengths, weaknesses in the vertical column and the
system components in the horizontal column (Table 3).
Table (3): SWOT logical frame matrix
SWOT COMPONENTS FINDINGS
STRENGTHS Service inputs
Service distribution
M&O
Service outputs
Service outcomes
WEAKNESSES Service inputs
Service distribution
M&O
Service outputs
Service outcomes
OPPURTUNITIES Service inputs
Service distribution
M&O
Service outputs
Service outcomes
THREATS Service inputs
Service distribution
M&O
Service outputs
Service outcomes
Unit (4) Health Manpower Management of
“Management is a specialty in dealing with matters of time and human
relationships as they arise in organization.”
Learning Objectives:
By the end of this module participant should be able to:
1. Estimate the number of workers (by qualification) needed to perform the
activities in the time stated.
2. Announce for jobs and select the suitable employee among the applicatants.
3. Deploy the manpower to the different activities on scientific basis.
4. Prepare:
o Personal job description
o Duty roster
o Schedule
5. Perfectly supervise the employee, lead and control their performance.
6. Motivate workers and improve their performance.
7. Evaluate the performance of manpower.
Contents
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o Planning
o Employment
o Deployment
o Job description
o The hierarchy
o Leadership
Exercise
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Introduction
Of all the problems which they have to face, health managers often find those
relating to the management of people to be the most difficult;. Things are
generally easier to manage than people; It is possible to define Health Manpower
Management (HMM) as the mobilization, motivation, development and
deployment of human beings in and through work for the achievement of health
goals; which is based on the essential value assumption that people are not a mere
factor of production but living, feeling, thinking being who seek certain
satisfactions from their work.
It follows that HMM is directly relevant to the main problems of most managers,
because management is focused on getting things done through people so any
failure in managing people will be reflected in failure of getting things done i.e.
overall management failure.
Issues in management of manpower all involve human behavior and inter-
personal relationships, which are often unpredictable, emotional and illogical,
leading to extra problems of the kind that would not arise in the management of
material things such as stores or records or money.
Moreover, the management of manpower in health systems is not immune from
influences in society as a whole. Amongst current pressures and trends affecting
the management of human resources in many countries are:
 The continuing growth of specialization in professional and managerial
life , involving the wider use of technical and sub-professional support
staff and also requiring a stronger “general management” function to co-
ordinate the work of specialists pursuing their own distinctive interests
 The impact of high technology and automated date processing in an
increasing variety of work situations, accelerating the pace of change and
eliminating many routine jobs performed by humans; and also making it
easier to hold, process and retrieve information about staff and their work.
 An increasing proportion of well educated staff whose basic material needs
are already satisfied and who are no longer motivated solely by traditional
rewards and sanctions
 A steady growth in membership of trade unions or professional staff
Viewing all these issues and realizing that man is the (blood) of the organization
and that if the organization has a problem with its blood organization performance
will be affected it will be easily understood that management of manpower is the
soul of management. It reflects the quality of managerial performance. If the
managerial performance is poor the organization performance will definitely be
poor.
Planning:
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The first step in management of manpower is planning i.e. estimation of the
number of manpower by qualification and experience needed to perform the
activities.
So planning of manpower is next to planning of activities. The quantities and
techniques for work needed will determine the number, qualifications and
experience of worker needed
Avery simple equation is used to estimate the number of manpower for each
category of activities. That is
N=P K t F
T
Where N is the number of workers needed
P is the population size
K is the fraction of population in need of that particular activity (service)
t is the time need to perform a unit of activity
F is the frequency of offering that service (activity) to the individual in a year.
T is the total time of work (in minutes) for a worker in a year
If we refer to “Kharsta” where the population size is 5,352,000 and the (%)of
under one year is 3.3%. The number of workers needed to (vaccinate) these
infants will be calculated as follows:
T the time needed to prepare the vaccine, give the dose, close the vaccine
carrier, report on the child’
s vaccination card, report on the facility record is
roughly 10 minute
F the frequency of vaccination per year for the infant is 5 times one for BCG and
polio0.three for DPT/Polio 1-3 and one for measles.
T the total time allowed for work per year is 268 days × 6 hours ×60 minutes.
Each worker will not be available on (Fridays) (52daysper year) and Eed holidays
(10 days per year) and his annual vacation (30 days per year) and national and
religious days (5 days per year) .This will account for 97 days, so out of 365 day
only 268 are left for work.
The total number of vaccinators needed for (Kharsta) is
P5352000 × K0.033 ×t 10× F 5
T (268× 6× 60)
This is equal to: 91.52 = 92 vaccinators.
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46.
Employment:
Next step is selection of the right candidate for the job. It is not necessarily to
chose the one with the longest experience and the highest qualification. The type
of activities and the job limits (Responsibilities and authorities) dictate the level of
the suitable candidate for the job. For time saving and perfection the
requirements should be clearly stated in the job announce. The qualifications, the
range of experience, the duties, relations and salary should all be stated in the
announce before interviewing all the applicants you have to short list them. The
short list is prepared by reading the application forms and certificates against the
announced requirements. Only those satisfying your requirements are going to be
included in your short list. The interview is for selection among the suitable ones
of those who will satisfy the interviewer by appearance and quality of reaction to
interview questions.
Deployment:
Once the candidate has been selected he has to know in details what are his duties
and responsibilities. The job description is the right way to inform the employee
Job description:
The job description explains to the worker his authority (the right to make
decisions) and his responsibility (the activities he has to achieve).It also states
clearly his relations (to who he is responsible and whose work he supervises) It is
an important tool for the organization of work so as to avoid gab or overlap. Each
activity is assigned to particular person and all activities are divided among the
workers (division of labor).
The main contents of job description are:
1) Job-title: this is the standard title for the person doing particular work e.g.
Doctor grade 9.
2) Date: The date of job is important because a job description is not final.
People and roles change and job description should be reviewed and if
necessary revised at least every year.
3) Job summary: Includes brief summary of the main responsibilities of the job
4) Duties: this is the most important part; it should clearly state the activities to
be performed by the worker. Each duty should be an identifiable entity and
should be a recognizable part of the job-holder’
s work.
5) Authority: Here the right to take decisions whether managerial or financial
should be clearly stated.
6) Relations: Under this sub-heading two important relation are stated:
o The title of the job for which he is responsible
o The title of jobs whose work he has to supervise.
7) Qualifications: This states the basic training and the level of experience required
for the job holder
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47.
8) Training and development:
Every job description should be accompanied by a program for the further
training and development of the person holding the job.
9) Review and appraisal:
This is a statement describing the process for review and appraisal of the
performance of the job-holder. The statement should clearly state who has this
responsibility and which form the appraisal takes. e.g. Annual confidential report
written by the supervisor
How the duties are decided:
The duties of a job are determined by
1. The work needs
2. The level of training of the worker
3. The Traditions.
The traditions refer to the agreed upon tasks that performed by certain cadres e.g.
Nurse in different institutes. These are related to his training background e.g.
dressing, injections etc.
The work needs dictate what of the tasks that a worker could perform are needed
in this particular job. A nurse working in the pharmacy could not have in this job
description among the duties “dressing of wounds “ or “taking temperature and
recording on temp chart”
If there is need for anesthetizing patients for operation this could not be in the job
description of a nurse or assistant pharmacist because they are not trained on that
particular task
Herewith is an example of a personal job-description of a medical assistant
working in a health facility of Sudanese Community Health Promotion
Organization (SCHPO) in Mayo area :
Name of employee: Abdel Motalib
Date of employment: 14.5.2000
Job-title: Medical manager
Job summary: “The employee is responsible for management of the health
facility and provision of curative care”
Duties:
 Manage the out patient clinic, examine patients, order necessary investigation
prescribe medicines according to A level of the national list of essential drugs
 Supervise the activities in the dressing unit and review the records and issue
supplies.
 Supervise the activities in the vaccination unit and review the records and
inspect discarding of disposable syringes and invalid vaccine vials.
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48.
 Supervise the activities in the pharmacy and review the records and orders for
drug supply
 Supervise the activities in the laboratory, review the records and orders for
supplies and ensure the quality control measures and lab safety.
 Supervise the activities in the short stay room and write the discharge notes for
patients after check up.
 Supervise the activities in the ORT corner and review the records and orders
for supplies.
 Order for supplies for different sections in the appropriate time
 Prepare a monthly report on the activities and performance.
 Attend the monthly meeting in the directorate of service
 Issue medical reports and sign on sick-reports for work-absentees not
exceeding 48 hours.
 Write annual confidential report on the performance of the staff.
 Any other relevant activities assigned by his supervisor.
Managerial Authorities: the employ has the right to:
 Conduct internal transfer of the nurses in the unit when needed
 Offer local leaves not exceeding 72 hours
Financial authorities:
The employ has the right to :
 Collect the daily income from the different departments after reviewing
the records and signing on the instatement documents
 Spend on the budget item of running costs and operation keeping the
invoice for expenditure.
Relations:
 The employee is under the supervision of the “health facilities
supervisor”.
 All the members of the clinic staff are under his supervision.
Qualifications:
The employees have “the medical Assistant certificate” plus 7 years of
experience .
Training and development:
The employee has to attend within a year of employment
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49.
1. A 6-days training workshop on syndromic approach for management of
sexually transmitted disease.
2. A 3-days workshop on case management of diarrhea.
Review and appraisal:
 Based on the managerial performance, the regular perfect conduct
of activities assigned, the monthly reports, and the reports on staff
performance the supervisor has to submit an annual confidential
report on the employee.
 Monthly incentive equal to 10% of the income of the clinic is
going to be offered.
“This has been explained to Mr. Abdel Motalib on the 14th
of May 2000
and agreed upon and signed by the employee in witness of Dr. Abel
Rahim and Dr. Amira; their signatures are herewith’
The hierarchy (structure):
The structure of the organization is another important tool for (deployment) of
manpower.
It tells about the vertical and the horizontal relations and it gives basis for flow of
decisions. Here with is the structure of Sudanese community health promotion
organization:
Management Audit
 Do you have clear written job-description?
 Have you prepared job-description for your sub-
ordinate
 Are you sure that every employee in your organization
knows exactly what to do and how to do it?
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Secretary general
Leadership:
Leadership is the process of the directing and influencing the task-related
activities of group members. This means that:
3. Leadership involves other people-employee or followers. By their
willingness to accept directions from the leader, group members help to
define the leader’
s status and make the leadership process possible.
4. Leadership involves an unequal distribution of power between leaders and
group members. Group members are not powerless; they can and do
shape group activities in a number of ways. Still the leader will usually
have more power. Power is the ability to exert influence-that is to change
the attitudes or behavior of individuals or groups.
The manager’s power comes from different five bases of sources:
f. Reward power : this is a power derived from the fact that one person
known as an influencer has the ability to reward another person known as
an influence for carrying out orders which may be expressed or implied.
g. Corrective power: is the negative side of reward power based on the
influencer’
s ability to punish the influence for not meeting requirements.
Punishment may range from reprimand to loss of a job.
h. Legitimate power: power that exist when a sub-ordinate or influence
acknowledges that the influencer has a right or is lawfully entitled to exert
influence within certain bounds; this is also called formal authority.
Executive manager
Office Secretary
Finance
secretary
member
Membership
affairs secretary
member
Project affairs
secretary
Research sec.
branch’s
affairs sec.
Communication
sec.
Training sec.
President of executive
committee
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51.
i. Expert power: power based on the belief or understanding that the
influencer has specific knowledge or relevant expertise that the influence
does not have.
j. Referent power: power based on the desire of the influence to be like or
identify with or imitate the influencer
The situational leadership model of Hersy and Blanchard describes how leaders
should adjust their leadership style in response to their subordinates’ evolving
desire for achievement, experience, ability and willingness to accept
responsibility.
The model is based on a believe that the relationship between the manager and
follower moves through four phases as employees develop, and manager need to
vary their leadership style accordingly. The recommended style in each phase is as
follows:
5) High task and low relationship:
In the initial phase of readiness high amounts of task behavior by the manager is
most appropriate. Employee must be instructed in their tasks and familiarized with
the organizations rules and procedures. A non directive manager would cause
anxiety and confusion in new followers
6) High task and high relationship:
As followers begin to learn their tasks, task behavior remains essential because
they are not yet able to function without the structure. However the leaders trust in
and support of employees increases as the leader becomes familiar with them and
wishes to encourage further efforts on their part. Thus the leader needs to increase
relationship behavior.
7) High relationship and low task:
In the third phase employees have more ability and achievement motivation
begins to surface and they actively begin to seek greater responsibility. The leader
will no longer need to be directive. However the leader will still have to be
supportive and considerate in order to strengthen the followers’resolve for great
responsibility.
8) Low relationship and low task:
As the followers gradually become more confident, self- directing and
experienced, the leader can reduce the amount of support and encouragement.
They no longer need or expect direction from their manager.
Setting and sharing objectives
An important issue in leadership is the involvement of the team members in
setting and sharing objectives. People work well together when they agree with
one another. People do not give of their best when they are dictated to. One of the
best ways to ensure that people are agreed on objectives and that their motivation
is applied to achieving them is to see that they take part in setting the objectives.
Motivation:
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52.
It is important for a team leader to understand what encourages people to apply
their ability and energy to work and what are those things that make people
dissatisfied at work. The six main motivators in work are:
7) Achievement; the good leader helps the team to achieve by
training them, by clear instructions, by suitable training and by
availing the facilities and supplies they need for their work.
8) Recognition: man, at any level, likes to be praised on his
achievements. Lack of recognition can be very discouraging.
9) The importance of work: A good leader is the one who manage
to assure every member of the importance of his work. This sense
of being important conducting an important part of the
organization work is very encouraging.
10) Responsibility : good leader helps his subordinate to be
responsible by giving room for decision making. Making
decisions for the staff can destroy their sense of responsibility.
11) Advancement: Advancement is an important expression of
recognition. Recognition without reward is not very convincing
12) Self- improvement: good leader is the one who helps his team
members to improve their knowledge and skills by providing
suitable learning material and by challenging them with questions
at work.
The six common causes of dissatisfaction are:
7) Inefficient administration.
8) Incompetent supervision.
9) Poor interpersonal relations.
10) Personal qualities of the leader.
11) Inadequate payment.
12) Bad working condition.
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53.
Organizing manpower:
The leader is responsible for organizing the team activities. To do this, there is
high need for the team members to sit together at times to discuss what has been
achieved and what is to be next. Conducting useful meetings is a very important
management tool.
For a meeting to be fruitful:
3. Prepare for the meeting by:
 Deicide on the purpose of the meeting and the agenda.
 Nominate the members to attend and inform them early and decide
on time
 Prepare the place
4. Chair the meeting to :
 Give each employee a chance to express himself.
 Prevent any rudeness or personal remarks.
 Control the discussion, rule out irrelevant remarks and bring the
proceedings to a step if necessary.
 Enrich discussion by raising new questions or topics.
 Control the time.
 Put motions (i.e. formal proposals) to the members to be voted on
and declare them passed or rejected.
Supervision:
Another tool is supervision. Supervision is a term used in different meanings. It
may refer to management. In this context supervision refers to a process of
selection of certain indicators and preparation of check-lists and schedules for
announced or surprised visits to sub-ordinate at work to make sure that the staff
perform their duties effectively. It means that the supervisor helps and guides the
staff for whom he is responsible and trains them as necessary in such a way that
they become more competent in their work and takes the right measures when
there is negligence and misconduct.
A supervisor to perform these activities should be:
• More knowledgeable than the supervisee.
• More skillful than the supervisee.
• More powerful than the supervisee
The important purposes of super vision are:
6. To assess the effectiveness; the degree to which the intended sub targets
are achieved.
7. To assess the efficiency ;the degree to which resources are economized
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54.
8. To assess the quality; the degree to which technical guidelines are
followed.
9. To detect discrepancies in all these aspects.
10. To correct the situation for better achievement.
To prepare for supervision you need to:
8. Review the work plan to detect what should have been achieved by the
time of your visit.
9. Review the job-description to determine who is responsible for each
activity.
10. Review the technical guidelines to refresh your knowledge about the
methods to be followed.
11. Select certain indicators for assessment.
12. Design a check list including the selected indicators
13. Review all the schedules of the management.
14. Prepare a schedule for visits
What should be done during the visit?
9. Ask.
10. Listen.
11. Observe.
12. Detect the achievements and the failures
13. Praise on achievements.
14. Advise on how to do things better.
15. Punish for negligence and misconduct.
16. Correct unintended wrong practices.
Unit (6) Management of equipment
Learning objectives:
By the end of able to:
1. Define equipment and classify as consumable and capital
2. Plan equipment; estimate the requirements by items and quantities.
3. Order the required equipment, store and issue according to need.
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4. Control equipment and maintain the non-expendable equipment.
Contents
Planning equipment
Ordering equipment
Storing equipment
Issuing equipment
Controlling and maintaining equipment
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Introduction
Equipment is a term used for any type of materials needed for implementation.
These material in any management are classified in to two main types:
1. Expendable or consumable or recurrent equipment. And these are generally
called supplies because they are continuously availed for maintenance of
service. Examples of these are vaccines, syringes and regents.
2. Non- expendable or capital or non- recurrent equipment. These lasts for
several years and need to be maintained and repaired to function perfectly.
Examples of these are microscopes, vehicles and furniture.
Planning equipment:
Is a term refers to estimation of the overall equipment equipments for
implementation of the project (or program) activities during the period of plan.
The quantity and the items to be estimated depend totally on the number of tasks
that need be performed. If among the introversions of your project is vaccination
of children you need to estimate the number of children targeted by this service,
the frequency by which this service is recommended and the type and amount of
equipment needed.
Referring to the equation for estimation manpower , and with minimal
modification the quantity of equipment for service could be estimated as
Q=KPfq
Where Q is the total number of equipment needed.
K is the fraction of population in need of the service.
P is the population size
F is the frequency by which the service is needed each year.
Q is the quantity of equipment needed.
If for karsta the pop size is 5352000 and the children in need of DPT vaccine are
3.3% of the population and the vaccine is gives 3 times (DPT1/2/3) and the
required dose is 0.5ml . Each time a syringe is needed.
The amount of DPT vaccine for Karasta is 0.33 ×5352000 ×3×0.5 =264924 ml
If the vial contains 10 ml so
264924 (26492) vials are needed.
10
The total number of syringes =0.033×5352000×3×1 =529848 syringes.
Ordering equipment:
Usually in the organization only the managers are authority to order equipment.
For ordering equipment certain skills are needed:
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1. Capability of appropriate estimation of the actual need (based on present and
past experiences)
2. Capability of balancing between the cost and quality pf available options.
3. Ability to use an order form or requisition form.
Manager should first make several list of his need for different places where he
can purchase. These lists include the item, the exact type required, the quantity,
price per unit and the total prize.
Item Type Quantity
Price
per unit
Total
price
Disposable syringes
5cc luer
fitting
10000
Disposable syringes
2cc luer
fitting
4000
Disposable syringes
1cc luer
fitting
6000
Needles Size 10 1000
Sphynogmanometers
Mercurial,
Japan
10
The prices given by gifferent sailers will help to decide from where are you going
to purchase your equipment.
The frequency of orders and amount per order depends on the following factors:
1. The utilization rates.
2. The storing requirement for each equipment.
3. The storage facilities.
4. The transport facilities.
5. The available budget.
6. The geographical and administrative conditions.
It is clear that if you can purchase all your requirements for the whole year you are
going to reduce the cost/unit and the transport fees.
But you are going to lose more expresses on storage if the item needs special
storage requirements e.g. freezing.
Again you are going to run the risk of expiry, destruction or loss of some of the
equipment.
If your area is going to be off transportation during the rainy season you need to
order the supplies (equipment) for the whole season before rain fall
Briefly discuss the factors that govern the frequency
of order and amount ordered in relation to your
organization. 57

58.
Storing Equipment:
Equipment is stored in two places:
1. A main store or reserve store where stocks are kept but used.
2. The place of use after issue.
A (store) of equipment should be arranged as follows:
1. Every item received into the store should be recorded by type , quantity, date
of reception date of expiration.
2. items should be arranged for issue according to their expiry date and not the
date of reception e.g. if you received catgut that is going to expire by march
2006 on 18th
of January 2004 and another batch is received on 20th
of April
2004 but its expiry date is may 2005 you issue for use the 2nd
and the first.
3. A stock-book or stock-ledger should be kept in balance.
An example of a ledger-balance for 5cc disposable is here with
Date Amount
in store
Received
form
Issue to Invoice No
Rece
ived
No
issue
d
Balan
in sto
10.1.200
4
17.1.200
4
100
11000
Medical
stores
-
-
Medical
words
145
-
1000
-
None
200
1100
900
Issuing Equipment:
To issue equipment from the store to any section of the organization, certain paper
work is mandatory.
 First of all the ledger record should be filled and state of balance refered to as
in the table above when issuing 20050c disposable syringes for the medical
wards.
 Secondly an issue voucher must be filled and kept in the store.
Duplicate copies are gives to the department that receives the equipment.. The
issue voucher is the going to be signed by the person who take the item and he is
going to take the responsibility for the care of the equipment received.
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59.
A simple example of issue voucher is here with
Item type Amount
Thermometers Glass mercurial 3
Possible syringe 5 ml plastic 200
Date of issue: 1.1.2004
Recipient: Name: Ali Hassan Ahmed
Signature:
Storekeeper: Osman Omer
 Thirdly the equipment received by a section should appear in
An inventory (or ledger record) at that section. An inventory is a list of items that
are kept at a certain place.
Each section of a health unit keeps an inventory of its non- consumable equipment
and a ledger for consumable equipment.
An example of an inventory of the vaccination unit is here with
Item Type Quantity Status
Date of
reception
Chairs Plastic 3 New 10.1.2003
Table Melatic 1 New 10.1.2003
Vaccine
carriers
UNICEF 3 New 10.1.2003
Scale Salter 2 New 2.2.2003
Refrigerator Solar 1 New 4.3.2003
Ice packs Plastic 10 New 10.5.2003
Controlling and maintaining equipment:
Consumable equipment needs to be controlled to avoid wastage, extravagance and
theft
Non –consumable equipment needs to be maintained i.e. kept in good working
condition by securing the requirements for working hours, operation , repairing
time and keeping in optimum condition.
Manager needs to:
1) Convince the workers of the importance of:
 Cleaning, inspecting and keeping equipment in order
 returning equipment to its correct place after use.
2) Use an inspection check-list and inspection schedule.
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60.
3) Conduct frequent inspections to detect any discrepancies.
4) Find an explanation for any discrepancy.
5) Take appropriate action when there is discrepancy.
Why it is important to keep accurate equipment records? Why take the trouble to
keep requisition books, stock ledgers, issue vouchers and inventories? Is all this
paperwork a waste of time and energy?
There are several good reasons for doing this paperwork.
1. Previous order- records make subsequent orders, next month or next year.,
much quicker and easier. The supplier’s addresses, item numbers, normal
quantities required, etc, are identified.
2. The balance in the stock ledger gives warning of when to order more supplies.
This prevents long periods without necessary equipment. Being “out of stock”
of equipment reduces the usefulness of the health service.
3. Issue vouchers encourage workers to take responsibility for equipment and
help to identify who is accountable for loss or breakage.
4. Inventories assist in the rapid checking of equipment in and help to detect
discrepancies, wastage, extravagance and theft.
Group work
Now estimate the equipment needed for health services that
you planned for Karsta. Discuss briefly the basis for
estimation of each item?
Management Audit
 Do you have an inventory for the equipment in your office and the other
offices in your organization?
 Do you have a ledger record for consumables in your office and the
organization?
 Do you have issue voucher or modified issue voucher for consumables
issue for secretarial services?
 D you have (maintenance plan) for the non-consumables in your
organization?
IF NO:
Would you prepare some now?
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