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Topic 11

HEALTH CARE MANAGEMENT AND ADMINISTRATION COURSE

Course DescriptionThis course is designed to prepare the student to work as a member of the

health care team in a Primary Health Care setting and to implement the basic

principles of Quality care. It also orients the student to basic principles of

planning, implementation and evaluation of health care activities, and the

management of resources including application of basic principles of health

economics and approaches for cost containment.

Goal of the topic:

Orient the future PHC physician to his role in acting as a team leader

efficiently managing the health facility, and adopting the principles of cost-

effective high quality care and adopting the concepts of cost containment

Objectives of the Course

By the end of this course, the student will be able to:

Identify management functions: planning, implementation,

and evaluation

Describe the planning function and its components

Define steps for community needs assessment

Use data/information for situation analysis and

identification and prioritization of health and health-

related problems

List the basic implementation functions

Define the principles of leadership and team building

Define the evaluation function and demonstrate the ability

to evaluate inputs, process, and outputs by the use of

appropriate indicators

Egyptian Community Medicine Association 63


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Define quality and identify the dimensions of quality in

health care

Define the three major aspects of health economics:

financing, cost analysis, and cost-effectiveness

Identify the principles of cost analysis and define some

measures for cost containment

These objectives can be rearranged as/ Intended learning

outcomes (ILOs)and classified as :

1. Knowledge and understanding

2. Professional and intellectual skills

General skills and attitudes

Course Prerequisites

This course supports other courses of Community Medicine. It can be given at

any time of the course after the introduction, and statistics modules. It

precedes the Health Systems and Health Services in Egypt

Course Logistics

This course is covered in 8 theoretical and 6 practical hours. It is mainly a

classroom setting.

Course Contents

Definition of management; and identifying its function as planning,

implementation, and evaluation functions. Principles of management including: Management by objectives;

learning from experience; division of labor; convergence of work,

substitution of resources, function determine structure; delegation; shortest

decision path.

The planning function

o Definition of planning. The planning functions (Situation

analysis, problem identification and priority setting, objective setting,



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selection of alternative solutions, planning for resources, planning

for monitoring and evaluation, planning for sustainability)

o Types of planning as population / community based;

organization-based (institution-based) planning; planning periods

starting from long range planning, yearly plans, three monthly

implementation plans, down to weekly do it list; levels of planning

and the importance of the middle level planning (District), and first

level planning in the health facility.

o Population-based / community based planning and its

application in planning for identifying health problems in the

community; and prioritizing these problems.

o Situation analysis: population-based and community-based.

o Assessment of community needs: Definition of needs;

identification of needs (sources of information, techniques for

identifying needs).

o Problem identification and priority setting in the community.

o Goals and objectives: Definition, setting SMART objectives

(Specific, Measurable, Attainable, Relevant, Time-bound)

o Selection of interventions to solve community health problems:

Criteria for selection

Organization-based management (Applied to a PHC setting):

o Situation analysis: Strengths, Weaknesses, Opportunities, and

Threats (SWOT analysis).

o Organization vision, mission, and objectives (apply to PHC)

o Problem solving: Problem identification and definition, Analysis

of the root causes, identification of solutions and selecting the best

solution, develop an action plan, implement monitor and evaluate.

The implementation function:

o Implementation functions include: Organizing, staffing and

human resource management, directing and leadership,

coordination of work and team building, recording and reporting,

monitoring and supervision)



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o Leadership: Definition of leadership, characteristics of effective

leader, leadership skills, comparison between a leader and a

manager

o

Team work: Definition, Characteristics of effective teams, Teamprocess (Forming, storming, norming, performing), The PHC team.

o Monitoring: definition, purpose, and methods

o Supervision: traditional supervision versus supportive

supervision

The evaluation function:

o Definition of evaluation, components (evaluation of inputs,

process, outputs, and outcome)o Conducting evaluation ( describe the program / organization

activities, describe goals and objectives, identify indicators, develop

evaluation design, collect data, analyze and interpret, utilize results

for decision making for corrective actions).

Quality management:

o Definitions: Quality, quality assurance, quality control, total

quality management, continuous quality improvement CQI)o Dimensions of quality in health care ( accessibility,

appropriateness, effectiveness, equity, efficiency, support for health

care providers).

o Quality improvement tools (Statistical and qualitative methods)

o Steps for CQI

o Auditing

o Accreditation (The present system for accrediting Family HealthUnits)

Health economics:

o Definition and major components (Financing, cost analysis and

cost effectiveness)

o Financing health care (governmental financing, user fees, health

insurance, etc.)



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o Present systems of financing health care in Egypt with emphasis

on the family health fund, and the evolving national health

insurance system and implementation in the Family Health Model.

o

Cost analysis: Cost categories (Fixed costs category I, Directcost category II, and capital cost category III); calculation of unit

cost.

o Cost-effectiveness analysis: Indicators used to measure the

effectiveness of health improvement (Adjusted life years: Concepts

of Disability Adjusted Life years DALYs, and Health Adjusted Life

Years HALYs); steps for cost effectiveness analysis.

o Cost containment: The rising cost of health care; measures for

cost containment on the demand side and the supply side; cost-

effective public health measures; essential clinical services. Egypt

basic benefit package and basic promotion/preventive package.

Teaching Methods

Theoretical: Lectures including large group discussions

Practical:

Case studies

Exercises on problem solving, priority setting, use of quality

improvement tools, decision making for selecting best solutions, cost-

effectiveness analysis

Practicing brain storming and decision making technique

Learning Materials

Reference Department Book

Case studies

Relevant publications

Course Assignment

At the start of the course students are asked to prepare a plan to address a

certain community health problem or an organizational problem. They can



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work in teams and present the assignment at the end of the module during the

practical sessions.

Assessment Methods

Follows the assessment methods described in the guide's

introduction for the whole course. As part of formative or summative

assessment.

The practical will be assessed by the tutors in a formative approach. A

proportion of the midterm grade will be allocated to the class performance.

Attendance

Fourth year medical students

Course Schedule

8 hours classroom teaching and 6 hours practical training

These lectures are entry to health system, health care and administration.

Teaching session plan

The course is 8 theoretical hours and 6 practical hours.

The theoretical is presented as session plans for each one hour. It can be

modified according to the time table of each faculty and the time allocated for

each lecture. Teachers could arrange the teaching slides according to the

following tables:

Introduction, Definitions and Principles of Management, and the

Planning Function (First hour)

Learning Activity Time

Introduction

- Introduce yourself,

- Present slide 1: Description of the topic and its

importance for the physician as a member of the PHC

team;

- Present slide 2: Goal of the topic,

5 m



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- Slide 3: Objectives of the topic

- Slide 4: Objectives of the lecture

Definition of management

- Ask 2 students to express their concept of what

management means to them.

- Comment and present slide 4 & 5: Definitions of

management and explain effectiveness and efficiency.

10 m

Principles of management

- Explain the principles of management: slides 7 14

giving examples for each of the principles

15 m

Management cycle / Planning function

- Present slide 15 for management functions cycle:

planning, implementation and evaluation for re-planning.

- Ask 2 other students to give their concept of

planning.

- Present slide 16: Definition of planning,

- Present slide 17: the planning functions

10 m

- Present slide 18: Types of planning as

population/community-based planning and organizational

planning.

- Present slide19: Planning periods.

- Present slide 20 on the planning periods and its

relation to the management level: top, middle and first level

- Comment that every individual in his work have to do

some sort of planning.

6 m



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Situation Analysis

- Present slide 21(same as 17) and tell the students

you are going to discuss the first planning function which is

situation analysis.

- Present slide 22: Information needed for population-

based situation analysis as: socioeconomic and

development policies, socioeconomic, demographic,

epidemiologic, and health and other resources situation

analysis.

- Present slides 23 27 explaining each of the above

components

- Present slide 28: Items included in community-based

situation analysis

14 m



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The Planning Function (Cont.); Assessment of Community Needs and

Resources (Second hour)


- Present lecture objectives: slide 1

- Tell the students that as a PHC physician s/he is

responsible for planning to improve the health of the

community and address their health problems through

mobilizing community involvement and their full

participation.

Community needs assessment

- Tell the students that assessment of community

needs and resources is a form of situation analysis at the

community level.

- Ask 2 students what is meant by needs

- Present slide 2: Definition of needs

- Present slide 3: definition of resources

5 m

- Re-emphasize that needs assessment conducted

with the participation of the target population strengthencommunity commitment to their participation in solving

their problems.

- Slide 4: Why assessment of community needs

- Slide 5: How would services intended to help

people be most effective, and the importance that

communities identify their own problems, become

interested in solving them and have confidence in their

capabilities in solving them

5 m

- Slide 6: Information required for identification of

needs and resources

- Slide 7: Techniques for identifying needs, and

obtaining information.

- Slide 8: Needs assessment ends up by identifying

Who needs what as defined by whom

10 m

Problem identification on community basis:- Slide 9: Problem definition

15 m



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- Slide 10: Causes, underlying and contributing

factors, Problem tree

- Select a public health problem and ask students to

think about the causes, underlying and contributing

factors (e.g. diarrhea, protein energy malnutrition, etc).

Draw the problem tree on the board

Priority setting

- Slide 11 & 12: criteria for selecting priority

problems on community basis

5 m

Goals and objectives:

- Slide 13: Types of objectives

- Slide 14:Definition of goals. Select a problem e.g.malnutrition and a program e.g. MCH and ask two

students to mention the goal

- Slide 15: Give examples of good objectives

- Mention that at this stage we have to think about

indicators to measure achievements of objectives,

mention examples, present in slide 16

10 m

Selection of solutions / interventions

- Slide 17: Criteria for selection of the solution /

interventions

- Slide 18: Decision matrix for selection of solutions /

interventions

- Give examples of appropriate solutions for a

selected priority problem

10 m



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Organization based management (Applied to a PHC setting) (Third hour)

- Learning Activity Time


- Slide 1: Concept & definition of an organization

- Slide 2: Organizational principles

- Slide 3: Management functions of an organization;

organizing, coordinating, directing, motivating controlling.

- Slide 4: Job descriptions. Give examples of Job

description for different members of the PHC team

15 m

Organization Vision and Mission- Slide 5: Organization Vision. Ask 2 students to give

a vision statement for PHC.

- Slide 6: Present an example of vision statement

- Slide 7: Organization Mission. Ask 2 students to

give a mission statement for PHC / Family practice

- Slide 8: Present an example of mission statement.

10 m

Strategic planning in an organization

- Explain that strategic planning considers where are

we and where we want to be (Slide 9); the difference

represent the gap, reflecting the needs, or the problems.

- Where we are is the situation analysis. It is done

through SWOT analysis which stands for Strengths,

weaknesses, opportunities and threats. (Slide 10)

- Ask students to give from their own point of view

points of strengths, weaknesses, opportunities and threats

of a PHC center.

- Present slide 11 giving examples of SWOT

20

Problem solving

- Slide 12: Steps for problem solving include: Identify

and define the problem (the gap between what is and

what should be), discover and analyze causes of the

problem, identify possible solutions, select the bestsolution, make an action plan, implement the solution,

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monitor and evaluate.

- For the identified gaps / problems we are going to

look for the root causes (mention that this is going to be

discussed with quality tools)

The implementation function, leadership and team building (Fourth )



- Slide 2: Components of the implementation

function, and comment on each of the components

10 m

Leadership

- Slide 3: Definition of leadership

- Slide 4: Continuum of leader decision-making

authority

- Slide 5: Characteristics of an effective leader

- Slide 6: Difference between leaders and managers

25 m

Team building

- Slide 7: Definition of team work

- Define team members in different health care

settings, PHC, clinics, etc.

- Slide 8: Characteristics of effective teams

- Slide 9: Team process (forming, storming, norming,

performing)

- Slide 10: Team problems

- Slide 11, 12: Solving team problems

25 m

Monitoring, supervision and evaluation (Fifth hour)



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Monitoring

- Slide 2: definition of monitoring

- Slide 3-5: Purpose of monitoring inputs, process,

outputs

- Slide 6: Methods of monitoring

10 m

Supervision

- Tell students that while monitoring is for all

resources, supervision is intended for human resources

- Slide 7: Definition of supervision- Slide 8: Objectives of supervision

- Slide 9: Basic functions of a supervisor

- Slide 10: Methods of supervision

- Slide 11: Definition of supportive / facilitative

supervision

- Slide 12: Differences between supportive

supervision and traditional supervision- Slide 13: Role of the supervisor as facilitator,

trainer, coach

- Slide 14: Definition and role of a coach

20 m

Evaluation

- Slide 15: Definition

- Slide 16: Components (evaluation of inputs,

process, outputs and outcomes)

- Slide 17 : Conducting evaluation

- Tell the students that evaluation needs indicators.

And give examples for indicators used to evaluate

different programs

30 m

Quality Management (Six hour)



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- Slides 2 - 5: Definition of quality terms: Quality

assurance, quality control, total quality management (TQM),

continuous quality improvement (CQI)

5 m

Dimensions of quality in health care

Explain each of the following (slides 6 11)

- Accessibility

- Appropriateness

- Effectiveness

- Equity- Efficiency

- Support for health care providers

5 m

Perception of quality by the health care service triad (slides 12 15)

- Community

- Health team

- MOHP

5 m

TQM model slide 16:

- Well designed systems of work

- Effective functioning teams

- Use of quality tools

Elements of TQM slide 17: The customer (external and internal,

teamwork, scientific approach)

10 m

Quality improvement tools slide 18: Statistical and qualitative

methods

- Rapidly mention few words on each

- Display in slides 19 21 the control chart, run chart,

and Pareto chart, and mention that these will be part of the

practical

- Explain the process of brain storming for decision

making in eliciting qualitative information (slides 22 24)

- Display slides 25 27 for some qualitative methods:

flow chart, fish bone, force field analysis. And mention that it

will be demonstrated in the practical

20 m



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The ten steps for quality assurance process: slides 28 - 30 5 m

Auditing and accreditation

- Slide 31: Definition of auditing

- Slide 32: Auditing as a problem solving process

- Slide 33: Definition of accreditation

- Slide 34-35: the present system of accreditation of the

family health units

10 m

Health Economics (Seventh hour)



- Slide 1: Definition

- Slide 2: The three major aspects of health

economics

5 m

Financing health care

- Slide 3: Major methods for financing

- Slide 4 & 5 : Government financing : sources and

allocation

- Slides 6: User fees (user charges) potential

advantages

- Slides 7: User fees (user charges) potential

disadvantages

- Slide 8: Suitability of services to users fees

- Slide 9: Types of health Insurance

- Slide 10: Social insurance / government insurance

- Slide 11: Private health insurance

- Slide 12: Health maintenance organizations

- Slide 13: Other financing mechanisms: Community

financing, employer financed systems, charity and voluntary

contributions

20 m

Present systems for financing health services in Egypt

- Slide 14: The multiplicity of systems

- Slide 15 & 16: The family health fund

20 m



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Cost analysis

- Slide 17 -19: Classification of cost by inputs:

Category I, II, & III

- Slide 20: Simple classification by Capital cost and

recurrent cost

5 m

Cost-effectiveness analysis (Snap shot)

- Slide 21: Its use in selection of alternative solutions

- Slide 22: Indicators used to measure the

effectiveness of health care in health improvement

- Slide 23 & 24: Disability adjusted life years (DALYs)

- Slide 25: Health adjusted life years (HALYs)

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Health Economics (cont.) Cost Containment (Eighth hour)



- Definition and concepts of cost containment (slide

2 & 3)

5 m

Causes of the rise in health care spending

- Ask 4-5 students about their concept of the causes

of rising costs

- Present slides 4 & 5 on causes of rising health care

spending

Allow for addition from the students

15 m

Actions / measures for cost containment:

- Slide 6: Measures on the demand side: user fees,

education to rationalize use

- Slide 7 & 8: Health insurance and rationalized use

of service

- Slide 9: measures of cost containment on the

supply side: Identify most effective actions, training at all

levels, appropriate technology, rationalized use of drugs,

reform health insurance

15 m

- Slide 10 & 11: Rational use of drugs 5 m



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- Slide 12: Essential drug list as a method for

rationalizing drug use

Cost effective services

- Slide 13 & 14: International concepts of public

health services that are highly cost effective

- Slide 15 & 16: International concepts of essential

clinical services

- Slide 17 19 Egypt promotive / preventive

package

- Slide 20 23: Egypt basic benefits package

20 m

Practical training

(Six hours)

Practical Setting

The practical sessions are given in groups of 20 per tutor. This topic is

covered in three practical sessions each of 2 hours. Students receive the

material at the start of the theoretical course. They are asked to go throughthe material before coming to the class. Students work in groups of five to

reach answers for the questions posed by the case study and exercises.

The expected learning outcomes from this practical that, student should be

able to:

1. Do a situation analysis

2. Identify and prioritize health problems

3. Define the causes and contributing factors of a communityhealth problem

4. Describe root causes a performance-related problem

5. Write SMART objectives

6. Practice brain storming to select appropriate solutions

7. Identify indicators for evaluation

8. Each group will present a report with the final product of the

class work to be graded.



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Case Study:Allow students to construct their own data sheets from the

following information

-The village xyz has a population of nnnnnnnnnn. The families in the area are

nn. The services available in the village include:

A family health unit belonging to the MOHP is keeping family folders for n

families.

-Other developmental resources include: A community development

association with limited activity. Two private practicing physicians. An NGO

working in the field of development. A primary and a preparatory school are

present.

-Illiteracy rate among males 10Years of age and older is 25%, and among

females is 65% and Consanguineous marriage is very high.

-The village has potable water, but no sewage disposal system, nor a safe

way for solid waste disposal.

Give some health related data are as follows:

The population is = nnnnnnnnnn

Number of births =

Number of deaths =

Infant deaths =

Women in the child bearing period =

Contraceptives prevalence rate (CPR) =

Vaccination coverage by all vaccines =

The main causes of death are: Cardiovascular diseases, and respiratory

problems

The main causes of infant deaths are:

Births attended by the center are only half of the total births

Number of mothers attending ANC represent 60% of the expected

pregnancies

The outpatient clinic is attended by 15 -20 persons per day. Most of them are

females.

The main chronic diseases diagnosed among males are: Hypertension, Type

II Diabetes. Females suffer in addition, obesity and genital tract infections.

** From the available data students are asked to:

- Profile the present situation



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- Identify the main health problems

- Select two problems and draw a problem tree to identify the

causes and contributing factors

- Formulate objectives

- Select interventions

- Determine the methods and indicators for evaluation

Exercise 1:

The family health unit has lately experienced a drop in the number of health

care consumers of the family planning services.

** Draw a fishbone diagram to elicit the possible root causes for this problem.

What are possible interventions needed to solve this problem?

Exercise 2:

An exit questionnaire for 150 clients revealed the following causes for not

being satisfied:

Cause Number of times mentioned

Unit not clean 20

Drugs not available 50

Deficiency in giving information 75

Providers not nice 45Long waiting time 15

Unavailability of doctors 15

Cost of service 30

**Draw a Pareto chart, Identify the vital few causes you are going to work on

Practical Training Sessions' Plan

Practical 1: Community based planning and evaluation (Two hours)




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- Introduce the objectives of the practical training

- Describe the process of conducting the training and

divide the students in small groups

10 m

- Describe the principles for group work

- Describe the steps for brain storming

10 m

-Ask the students in each group to read the case study (5 m)

- Each group will perform a situation analysis (15 m)

- Group presentations with no comments (10 m)

- Invite comments to complete the picture of situation

analysis (10m)

40 m

- Each group will write a list of problems identified from

the situation analysis (5 m)

- Present the group list and come up with a

comprehensive list (15m)

20 m

- Ask each group to develop a priority list

- Present the priorities for each group

10 m

- Each group will select a problem different from the

others to work on

- Define the causes and contributing factors of a

community health problem

- Group presentations and discussions

20 m

- Summarize the work of the session 10 m

Practical 2: Community based planning and evaluation (cont) (Two h)



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- Introduce the work of the day (2 m)

- Each group revises the problem they selected in

the last session, their causes and contributing factors

- Develop SMART objectives

- Present and discuss

15 m

- Each group uses brain storming technique to select

best solutions using decision making criteria / matrix (to

be provided as a handout)

- Present and discuss

25 m

- Group work: From the sum of all the groups, what

will be the interventions recommended to be implemented

by the family health unit

- Group presentation and discussion

20 m

- Present the principles of evaluation, and the

evaluation grid (to be provided as a handout)

5 m

- Each group develops the indicators for evaluation

and completes an evaluation grid

25 m

- Presentation of group work and discussion 20 m

- Summarize the work of the session and give a date

to collect the assignment on the community plan finalized

in the two sessions

10 m

Practical 3: Organization based management (Two hours)


- Introduce session objectives 5 m

- Group work: Do a SWOT analysis to a PHC unit 15 m

- Group presentation and discussions 20 m- Present exercise 1:

- Group work for root causes

- Presentation and discussion for root causes

20 m

- Group work for interventions

- Presentation and discussion for interventions

25 m

- Present exercise 2

- Individual work to draw a Pareto

- Presentation of a sample

- Large group discussion

25 m



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- Summarize the practical work and ask for verbal /

written evaluation

10 m

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5Com. Med.mang.Modified11