بسم الله الرحمن الرحيم
Community Medicine
Lec -9-
Learning objectives
At the end of this lecture student will be able to :1-Define health administration .
2-Identify steps of health administration.
3-Enumerate essential factors of medical administration.
4-Categorize purposes of administration .
5-Describe relative factors of administration .
6-Outline elements of administration.
7-Arrange plan criteria.
8-Determin types and stages of health administration planning .
To a level accepted to the accreditation standard of the College .
Health Administration
Definition: It is a process by which the potential of manpower and or material are activated and synthesized together for the a achievement of a definite objective.
It is described as a process since it moves through a sequence of steps , each one depends on the other
These steps are:
1- Defining the objectives of the health program.
e.g. Eradication of polio.
Control of cancer of breast .
Control of tuberculosis.
2- Identification of necessary tasks to achieve the objectives or the main goal of the program.
e.g. Performing mass immunization against poliomyelitis.
3- To put and implement a plan( planning and carrying out the tasks).
4- Evaluation. It means a method of assessing the process and result or outcome.
5- Taking a corrective action (feed back).i.e. If the plan was not a proper one , re-planning again.
Some times , these tasks may overlap in time e.g. In malaria control , a team for insecticides spraying , there is another team performing collection of blood smears.
Thus , the process of administration is a problem solving process (the health problems identified ,plan of actions suggested and solution of the problem involve a group of people , certain situations and circumstances).
Accordingly it is a complex process which might create problems with time which again need understanding and solution.
That is why , administration considered a continuous activity in life.
Essential Factors in Medical Administration:
1- Balance between available means and end.
(means and ends can not be separated)
2- Attention focused on the objectives and also to the steps
(objectives without step means reach to nothing).
3-Inter-relation of service potentials .
Activation of different manpower potentials (medical staff personnel , nursing staff ,engineers , health educational system) all together in order to create:
dynamic unified efforts to achieve the over all program objectives and purposes.
Purposes of Administration:
The purposes of administration: are to get the required job done with the least possible expenditure of time , energy , and cost.This must be consistent with the agreement upon quality of work and the shorter time.
e.g. If the job done at a high unusual cost or un-hoppy with frustrations , then the medical administration can not be considered an effective one.
Relative Factors Of Administration:
1- Cost-benefit analysis.Careful cost-benefit analysis must be done to evaluate the effectiveness of any program.
Productivity = quality and quantity of work done at a unit of time.
Cost-saving is not always beneficial ,quality of work is more important.
2- Time-Saving.
It is essential , but should not be on the expense of result quality.
3- Energy-saving.
The energy of making a job may be influenced by the administrative procedures.
e.g. informal contact procedures such as telephone can save energy , time and cost , more better than the routine ways. Latter on these can be followed by and confirmed through written ways.
The purpose of administration is to balance and take into account the different aspects which affect the conduction of a program.
Thus the most efficient relationship is that which establish between the purposes and policies of the agency ,manpower and resources of services provided , with a stress on quality of output and its feasibility.
Elements of Health Administration
• Planning.• Organizing.
• Staffing.
• Directing.
• Coordinating.
• Reporting (including evaluation).
• Budgeting.
Planning:
It is a constant factor in medical & health work , at every level from the program of highest executive chief to the work of lowest health worker level .Planning is the organic function of management and also a functional responsibility of high level doctors.
Planning always involve futurity.
So it is forecasting or estimating future or must be a part of it.Planning should be done at several levels and each level has his own problems and particular methods.
Plan criteria: it should be;
1) Consistent with immediate and future human needs.2) Constant with the organization of health profession philosophy.
3) Based on accurate statistical budget researches.
4) Feasible and flexible enough for an expected changes within the available funds and acceptable by doctors and community.
5) Simple and not complicated to be interpreted easily by doctors and public.
6) Progressive and designed to improve the criteria.
Types of health planning:
• Directional planning .• Administrative planning .
• Operational planning .
• Network planning .
• All types .
‘’Stages of health planning’’
Stage 1: Policy - Broad goal setting.Stage 2: Diagnosis of the problem or situation.
Stage 3: Putting priorities.
Stage 4: Suggesting alternatives.
Stage 5: Putting plan details.
Stage 6: implementation planning.
Stage 7: Evaluation planning.
Stage1:Policy-Broad Goals.(politically determined).
Policy: considered the guide of the plan.
Goal:
It is a long range of specified states of accomplishment towards which planning programs are directed.
It doesn’t include a fixed time for achievement but usually stated in terms of complete overcoming for the health problem e.g. Malaria eradication ; Bilharzia control.
Objective: is stated in terms of achieving or measuring the amount of progress towards a goal.
Objectives include the following specifications:
• What i.e. the nature of the situation or condition to be attempted or dealt with.• Extent i.e. quantity ,amount or size of the situation or condition to be attained or be attempted.
• When i.e. the time , at / or by which , the desired situation is intended to exist.
• Who i.e. the target population.
• e.g. in Breast cancer control-females>40 years.
• Where i.e. the geographical region where activity will be encountered.
Target:
It is a measured amount of progress towards health objectives.e.g. The objective is to reduce mortality from measles by 50% of the present situation by the end of second year.
A target is to immunize 80-90% of high risk group individuals against measles during the next two years.
Stage2: Diagnosis of the situation or problem.(Facts finding-Information gathering)
It is essential for the assessment of the situation and its development. It include :-• Nature of health problems & its extent among population i.e. morbidity, mortality and disability data concerning that disease or health problem.
• Size of population to be served and its distribution.
• This include also the age, sex & occupation.
• 3) Forecasting i.e. expected changes in the nature, extent , size of the problem and population structure and distribution.
4) Medical care i.e. the availability of various forms of medical or health care services in addition to the available manpower and their efficiency in the utilization of different facilities e.g. CT scan , MRI, lab techniques.
5) Training Facilities essential for overcoming the problem.
6) Biophysical environment i.e. is it to carry out the program in mountains area , desert , a rainy season or a hot climate .All these things should be considered.
• Economic Resources i.e. the cost of program and the cost of its activities.
Stage3: Priorities.
Stating priority health problems need essential knowledge and experience to make a final decision.The priority choosing should respond to the actual health needs , health demand and health resources.
Needs are the most important but demands should also taken in consideration , otherwise cooperation of general public can not be gained which may result in the failure of the plan or the program.
Stage4: Alternatives
Each plan outline should have a stated alternatives in order to achieve an optimal solving of health problems.Basis of selection:
Decision is made to select the best alternative , taking in consideration funds available , cost-effectiveness & cost-benefit analysis.
Stage5: Plan Details
A- long-term goals and objectives should be specifically stated & the proposed step to carry them out should be designed in details.B- Target should be specified according to quantitative indices within a clear stated time framework.
Target should be realistic , measurable and with quality criteria.Cost and time should be decided.
Health Indicators or indices should be:
1) Associated with the health status of population (e.g. morbidity , mortality & disability data).2) Concern the health services activities including hospital beds availability , health personnel & health care facilities utilization .
3) Related to biophysical environment (e.g. air pollution , housing , population density & safe water supply).
*Health indices provide a measure for :
the health level of a community and the medical care facilities & manpower availability for the plan.
In addition it will provide a rational basis for evaluation
Stage6: Implementation.
It include the following activities:• Integration. It is an integral part of planning.
• Incorporation. Plan should incorporate details of planning for implementation.
• Clearness (to ensure successful implementation).
• Acceptance(to political leaders , health personnel and general publics).
• Tactical steps for successful implementation should be available.
• 6) Participation.
• Probability of plan acceptance increase proportionally with the extent of health personnel , political leaders & consumer publics participation in planning.• 7) Harmless. The more harmless a plan is the more chance for acceptance.
• 8) Pilot project. Making pilot study or a demonstrative project make plan more clear to doctors and health personnel.
• This simplified implementation of the plan is useful in overcoming rigidity of most administrative structures .
• Pilot project can be used as a training technique for manpower wider implementation later on.
Stage7: Evaluation.
It is to determine the extent to which the objectives and target of a plan been attained and the revision of plan in the light of results(out come).
Types of evaluation:
• Continuous evaluation to see the extent to which objectives and target have been achieved.
• Periodic evaluation. Usually centrally directed activity.
Its purposes are:
• Qualifying achievements in particular planning period
• Preliminary arrangements usually precedes the plan or a modification of an existing plan.
Such activity should concern:
• Whether the original working objective is appropriate?• Whether priority setting was justified?
• Whether data gathering system is producing useful information?