Country examples from Afghanistan, Brazil and Tanzania 1:3 Improved governance in action in the context of decentralization. Young people in action – Country examples from Haiti and Mozambique 9:18 Building on experience, data and enthusiasm to scale –.
What People Are Saying about Health Systems in Action
Preface
Each chapter includes links to online resources so you can learn more about these topics. In many cases you will find detailed instructions on the steps you can take in your organization.
Joseph Dwyer, Director of the LMS Program at MOH, provided inspired leadership, strong guidance, and unwavering support in trying to make the best of our experience for this manual. Finally, we thank Marguerite Farrell, USAID Technical Officer for the LMS Program for her dedication to this manual and her continued encouragement and support.
Acronyms
Achieving Results by
Strengthening Health Systems
Introduction
A third response is at the root of all major societal change: a sense of purpose born of indignation at the status quo that makes one say, "I'm not going to settle for this anymore, and I'm going to do something about it ." This attitude creates a wave of energy that turns indignant managers and providers into agents of change. This handbook is designed to help you become effective change agents and enlist others for the benefit of the whole.
Building functional health systems
Strengthening health systems is an empty exercise if we forget the people at the center of it all. Therefore, this handbook focuses on the human element that defines "people-centred" health systems.
A framework for people-centered health systems strengthening
You might think that strong health systems require a large staff and sophisticated equipment – especially computers. Regardless of the role you play, you both contribute to and benefit from your organization's and society's role in your country's health systems.
Designing management systems with people in mind
The result will be prevention, treatment and care leading to a reduction of disease and malnutrition, and improved maternal and reproductive health. Answers to these questions will be invaluable to you in the design and implementation of management systems - reinforcement work.
Interventions to build stronger health systems
This interdependence of higher and lower level systems has real consequences for the achievement of the purpose of the overall health system. But in the long run, such uneven development will benefit some management systems to the detriment of others and create imbalances and inequalities that can disrupt the functioning of the entire health system.
Proven practices
This is the risk of working on one component of the health system without awareness or concern for the wider context in which services are provided.
Glossary of health systems terms
Critical Competencies for
Health Systems Strengthening
However, you don't have to be like Mother Teresa, Mohandas Gandhi, Nelson Mandela, or Guatemalan Nobel Peace Prize winner Rigoberta Menchú to make a difference in the lives of others. Unlike any of these heroes, you don't have to make huge personal sacrifices.
Scaling up is also essential to get on track to achieve the Millennium Development Goals for health. You can be like the many health care managers and providers who have quietly and without great personal sacrifice made critical changes in their organizations that have brought good services and good health to their clients.
When managers lead: A path to results
We also hope that you will gain strategies to develop your leadership and management skills so that you can be proud of the results you and your team produce. Above all, we hope that you will gain confidence that you are making a positive contribution to improving the working climate and ultimately the health of the people you serve.
From better leadership and management to improved health outcomes
How can I support – rather than control – my staff to help them "own" and face challenges, and learn their way through them. And once you start, one change will lead to another; you will see improvements in team spirit, customer service, quality and even the physical environment in which people work.
You can learn how to better supervise, communicate with stakeholder groups, or lead a productive meeting. Unfortunately, leadership and management skills are rarely included in the education of healthcare professionals.
Developing managers who lead
The intensity of many academic programs leaves little time for topics not considered of immediate interest to aspiring physicians and nurses. It appears that the majority of healthcare professionals enter the workplace unprepared for what awaits them.
Strong leadership skills will reduce the amount of energy you and your team waste when procedures and processes are overly complex, not clearly linked to desired outcomes, and unfair. Your ability to lead will enable you and your team to effectively move towards your desired future.
The organization's work is guided by a well-defined mission and strategy, and its priorities are clear. Internal and external stakeholders understand and support the organization's objectives and have mobilized resources to achieve these objectives.
Putting management and leadership into action
You may also need to reach out to people who do not fully share your goals, but whose support is so important that you cannot progress without it. We can be inspired by people who believe in what they are doing, care about the cause and know that others care too.
By using a common language, you can build on what you and your team members already know and remind each other to keep doing it. For a full discussion of monitoring and evaluation in the context of information management, see Chapter 8 of this handbook.
Monitoring and evaluation are necessary to ensure that activities proceed as planned and that the intended results are achieved. The lessons learned about effectiveness and performance are fed back into new plans through monitoring and evaluation.
Managers who lead have the talent to communicate in many different ways where their organization and staff are going and why—the organization's vision. By communicating the vision and getting others in key positions to reinforce it, you help everyone feel like they're on the same team and that you're all moving forward together.
As a manager or supervisor of someone who feels betrayed, you can make good use of leadership practices. As stated by Dennis and Michelle Reina (2006), you can scan for facts and recognize what happened that made people feel their trust was betrayed.
Box 6 shows what you can do to move from disjointed activity and busyness to coordinated and purposeful action. See Box 7 to find out what you can do to move from a preoccupation with yourself to a concern for the common good.
A proven methodology for learning in action
This may be the first time you and your team collect data or interview people you've never spoken to before. So far you have used the leadership practices in answering the Challenge Model questions.
Glossary of management and leadership terms
As a manager who leads, you can use the Challenge Model to create a road map for your team and yourself, no matter what your clinical or management specialty may be. Managers who lead effectively: internal report on the management and leadership project's leadership investigation.” Cambridge, MA: Management Sciences for Health, 2000.
Promoting Good Governance in Public and Private Health organizations
The concept of good governance has gained prominence as interest in improved economic performance and poverty reduction in developing countries has increased. Both governments and national and international non-governmental organizations (NGOs) feel the pressure to be accountable and transparent in the use of development funds and to work in the public interest.
The column on the left lists the leading and managing practices that, if used systematically and consistently, will result in better governance and, ultimately, better performance of the health care system. The right side defines longer-term outcomes for improved healthcare system performance, as measured by greater equity, access, quality, efficiency and sustainability.
The middle column identifies intermediate outcomes for good governance, as measured by the four dimensions mentioned. Leaders who lead effectively repeatedly use the four essential leadership practices shown in the left column of Figure 1: They scan, focus, adjust, and mobilize and inspire.
Governance in three health-sector contexts
Multisectoral bodies such as CCMs and AIDS committees can also undertake action-oriented leadership development to improve members' skills in team working, focus and planning. Manuals explaining standard operating procedures for the partnership can clarify roles and describe for multi-sector agencies what is expected of them.
Within the context of the decentralization of healthcare services, this system is a valuable tool for local governments, as it provides a better picture of health status at the municipal level and helps in making policy decisions and drawing up community development plans. After this evaluation, the policy's viability had to be verified by other federal government agencies.
Afghanistan records some of the worst statistics in the world for women's and children's health. An important feature of the program was that all NGOs were brought together as planning and information sharing partners.
Good governance in civil society organizations
Good governance in civil society organizations is not only practiced at the top of the organizational structure; However, the higher the level in the organization, the more responsibility people have for maintaining good governance throughout the organization.
The statutes specify the purpose of the organization and the way it is set up, as demonstrated in Box 2. The statutes are supplemented by bylaws, the rules under which the governing body of the CSO operates.
Governance roles and responsibilities of the board of directors and management team
In addition to providing the legal basis for the organization, the articles of association describe the roles of the membership meeting (if applicable) and the board of directors, as well as the key rights and responsibilities of each. The most effective CSOs clearly separate board and management: generally, the board of directors governs and the management team manages day-to-day operations, as described below.
Provides administrative and logistical support for the Board's public relations activities. Maintaining Board Effectiveness. The board must provide guidance and input to the management team throughout the strategic planning process.
The board can ensure financial sustainability and organizational growth through three activities: (1) promoting the rational use of the organization's resources, (2) developing projects and programs to increase its income, and (3) collecting additional funds. In these circumstances it is important to distinguish the role of the board from that of the management team.
The management team can assist board members in this task by keeping them and staff informed about public policy developments affecting the organization, by working with the media, and by coordinating volunteer activities dealing with public affairs. Click here to find a tool you can use to analyze and manage the political dimensions of decision-making and public policy.
Each year, depending on their tenure, the board should formally evaluate its performance. The objective of the evaluation is to assess the Board's fulfillment of its roles and responsibilities and to define ways in which its performance can be improved.
A Handbook of NGO Governance by Marilyn Wyatt includes a useful self-assessment checklist on pages 66–69.
It is also the responsibility of the treasurer to suggest ideas to improve the organization's financial status. The management team is responsible for providing accurate and timely information to board members so they can carry out this duty.
Full board meetings are used to review the work of the committees and make final decisions about this work. Depending on the size of the board, other committees may be formed when there is a specific need, for example, a recruitment committee when the organization is looking for a new CEO, a strategic planning committee when the organization is updating the strategic plan, or a program committee. to help management assess the organization's programs and services.
Manager provides more information on selecting board members and a sample table that can be used to analyze the characteristics, skills and experience of current and prospective board members.
What key partnerships does the CSO have with other organizations, government agencies, communities and donors? The quality of board decisions will depend on the planning, preparation and efficient conduct of the meetings.
Plan the agenda for the regular monthly meeting, taking into account the suggestions of the CEO and board members. With two more members of the board as allies, she started an investigation to clarify the purchase of contraceptives.
Good governance policies for boards
Board members may not disclose the organization's confidential information or decisions made at board meetings, unless the board agrees to release specific information on a case-by-case basis. At the beginning of their term, all board members must sign a confidentiality agreement covering all information handled by the board.
The remuneration policy must ensure that board members are reimbursed for expenses incurred during their work for CSO, including travel expenses. This will help ensure that board members come from a variety of geographic locations, not just the city where the CSO is headquartered.
Common board challenges and how to deal with them
Dedicated and well-intentioned board members misrepresent their roles and try to interfere with decisions made by the CEO and other senior managers. During orientation, clearly define the roles of board members and their relationship with professional staff, especially the executive director and management team.
Glossary of governance terms
A Handbook for Effective CSO Management.” Cambridge, MA: Management Sciences for Health, supported by the US Agency for International Development, 2010, http://erc.msh.org/toolkit/Tool.cfm?lang=1&TID=136&CID=9. Strengthening Global Fund Grant Management and Oversight: Lessons Learned from Pilot Experiences with Executive Dashboards in Nicaragua, Zanzibar, Tanzania and Nigeria.” Cambridge, MA: Management Sciences for Health, 2007b, http://www.theglobalfund.org /documents/ccm/LessonsLearnedReport.
Planning the Work and Working with the Plan
As a health program or health services leader, you must help your organization develop or reevaluate its mission and vision and renew its commitment to that mission and vision. These actions will help your organization fulfill its mission and turn its vision into reality.
To meet these challenges and shape the future of your organization, you and your team must do more than think about internal and external realities and manage and lead on a daily basis. The most important thing is that we plan because planning is the foundation of managing and leading teams to achieve results.
The atmosphere in the organization is one of constant learning and the staff shows commitment even when there are setbacks. The organization has functional structures, systems and processes for efficient operation; the staff is organized and aware of work obligations and expectations.
If they are not aligned, the plan is usually relegated to the back burner, and implementation is rarely successful. Nevertheless, it is not unusual to find plans in which inputs (resources used, such as personnel and equipment) are insufficient or inappropriate to achieve the desired results.
As Stephen Covey (2004) asserts, it is important to "begin with the end in mind." By understanding what results you want to produce and what future you want to create, you can plot the steps and actions required to get to that destination.
You can rely on this person to solve problems, generate breakthrough ideas and test the feasibility of these ideas. You can rely on this person to gather intelligence and relay important news to others.
Analyzing the external and internal environments
In addition to identifying the current situation of your organization, the SWOT analysis helps you prepare for the next planning steps, formulate the mission and generate a vision of the future. They help you formulate or revise your organization's mission and create a vision of the future.
Articulating the mission
The results of the SWOT analysis allow you and your organization to gauge where you are relative to where you intend to be.
Our mission is to help reduce the number of unwanted pregnancies by providing uninterrupted access to modern, high-quality contraceptive methods [how] so that men and women of childbearing age can control the number and spacing of pregnancies. Our mission is to help reduce the number of unwanted pregnancies by providing uninterrupted access to modern, high-quality contraceptive methods so that men and women of childbearing age can control the number and spacing of pregnancies [why].
Creating the vision
Once you've completed steps 1-4 and come up with a vision, invite a larger group of colleagues in addition to the planning team members to a visioning meeting. The next step in the planning process is to think about how you will fulfill this destiny.
Some are broad and long-term, the results of organizational strategies involving the highest levels of management. The shortest goals are the desired results of a particular activity or task that falls within the scope of a small group or individual.
We are widely recognized as the leading provider of convenient and uninterrupted access to high-quality, modern contraceptive methods. 3 have a supply chain that functions optimally to ensure an uninterrupted supply of modern contraceptive methods.
Measuring the implementation of the plan
Although you may want to include some other types of indicators, you can focus on impact and outcome indicators to monitor the progress and results of your planned interventions. You and your planning team will want to agree on how often you will monitor the results and milestones in the strategic plan; many organizations find it useful to do this once or twice a year.
Converting the strategic plan into an operational plan
At this point, you and your team have completed the strategic planning process and are ready to produce the plan itself. The written document must be accompanied by a summary visual presentation in a table (see sample template in Appendix B).
Determine potential family planning (fP) clients' unmet needs, desires, and barriers to access. Conditions and criteria Rating (scale of 1–3) Weight (scale of 1–3) Total score (rating × weight) Evidence of external circumstances Activity is socially acceptable 326 The use of modern family planning methods is a widely accepted practice in our country.
To prepare the budget for your operating plan, it is important to seek the help of someone with solid experience in financial management and budgeting.
Above all, operational or annual plans should be based on the content and strategic priorities outlined in the strategic plan. You can check the integrity of your strategic goals by conducting a modified SWOT analysis and then formulating strategies that align with those goals.
Glossary of planning terms
You and your planning team can use your organization's mission to create a future vision that guides the selection of the organization's strategic goals. It focuses on broad and long-standing issues that will promote the organization's long-term effectiveness and survival.
Appendixes
APPenDIX A. SWot Matrixes
Comments: Instructions: Assessment: for the proposed activity described at the top of the form, there are a number of conditions and criteria in the first column that must be met. Weight: For each of the conditions and criteria, assign a "weight" indicating the relative importance of the specific condition or criterion to the performance of the activity as follows: 1 = not relevant to success 2 = important to success 3 = essential to evidence of success: In the column titled "evidence," please describe the circumstances that support the rating you assigned to each specific condition or criterion.
Managing Human Resources
Human resource management is a critical management area responsible for any organization's most important asset: its people. When organizations manage their investment in people wisely, the result is a satisfied and motivated workforce that delivers high-quality health services and an organization that fulfills its mission, achieves its health goals and contributes to its community by providing excellent services.
Click here for more information on how to use the hRh Action Framework to develop a strategic approach to hRh and what actions to take in relation to each of the six components of the framework.
HRM as a leadership issue
HRM practices that improve employee satisfaction
Incentive programs build employee satisfaction and motivation
Managing volunteer staff
Just as you would develop job descriptions for paid staff, you should develop clear areas of work for volunteers so that everyone understands his or her role. Furthermore, non-financial incentives – a positive working environment, personal respect and support for development – are especially relevant for unpaid staff.
Using a survey to improve HRM policies and practices
Volunteers should be vetted, just as paid staff are, to ensure that they have the skills or potential to perform their duties and that the work will be mutually beneficial to both the volunteer and the organization. Having a system to screen and assign volunteer staff also sends a signal that their work is considered valuable to the organization and that it is worth your time to carefully plan it.
By definition, volunteers do not receive a salary, but must receive money for day-to-day expenses or expenses related to their work. You can reward and recognize them by receiving items such as t-shirts or bags with your organization's logo printed on them.
Despite the lack of operating budget for most of the program, 10 of the 11 health units achieved most of their goals and improved the quality of health services. Explain the purpose of the questionnaire and assure staff that their responses are completely confidential.
Assessing the HRM capacity of your organization
The results can give you insight into the areas of the work environment that are the biggest source of dissatisfaction, and you can start working to change these negative aspects. You will also learn the areas that provide the greatest satisfaction, and you can be sure to maintain them.
Each component is followed by a description of four possible stages of development ranging from the least developed to the most fully developed. The characteristics of the four phases provide useful information for developing a plan of action for your organization to improve those HRM areas that need strengthening.
Job Classification System ■■ Enables the organization to standardize the jobs and types of skills it requires. Compensation and benefits system ■■ Allows for equity in employee wages and benefits linked to local economy.
Revitalizing HRM with your actions and example
You can find the HRM Rapid Assessment Tool and guidelines for its use on the Internet. You can best support HR changes by embedding solutions in your organization's daily management systems.
Glossary of human resource management terms
To achieve measurable results, developing a comprehensive HR management strategy aligned with your organization's mission is more effective than working on one HR issue at a time. Improving Retention and Performance in Civil Society in Uganda.” Human Resources for Health vol.
The numbered levels at the top of the table refer to the development phases. For each HRM component, the tool provides an explanation that describes the common characteristics of organizations in four stages of development.
Most organizations are at different stages of development for different HRM components at any given time because the components received different levels of attention as the organizations grew. In the fourth stage, the characteristics describe an organization that functions extremely effectively in relation to that component and can perhaps direct its energies towards components that are in lower stages of development.
Each person at all levels of the organization possesses a piece of the truth, and an accurate picture is best achieved by combining these individual perceptions. Performance management and supervision systems define how people will formally interact with each other and how the work they do will support the goals of the institution or organization.
They must be in place before effective performance management and supervision can be implemented. Training is essential to an effective HRM capability, but it is most effective when integrated into human resource planning, HRM policy and performance management.
Conclusion
Managing Finances and Related Systems
As a manager, you should focus financial management actions so that they reflect the organization's mission. The organization's activity, financial and administrative managers engage in the four management practices with respect to financial management.
Finance and Operations employees, with all their rules and regulations, cause too many delays and bottlenecks. Finance and operations staff do not understand the needs or challenges of the service delivery teams.
Assessing your organization’s financial and operations systems
This chapter is intended to inform you as a manager of a health care program or health care services and to enhance your ability to manage program activities by understanding the role of finance and operations. Not only will improvements in financial and operational systems strengthen the health of the organization, sound management practices will also make a good impression on potential contributors.
Accounting and financial management basics
Such improvements generally include strengthening internal control systems, documenting and communicating financial policies and procedures to staff, and instilling in all staff members an understanding of how they contribute to maintaining the financial health of the organization. They will be more inclined to award projects or grants because they believe that the funds will be used correctly, that the desired results will be achieved, and that the results will be accurately documented and shared.
The art of accounting is manifested when financial reports are created in a way that tells a story and provides enough information for administrators and managers of technical operations to make good operational decisions. Too often, financial reports serve only to please governments or donors, at the expense of meeting the needs of the organization.
This is the concept of balanced books - the two schedules must offset each other to show the overall value of the organization. The income statement (also known as the profit and loss statement) reports on the income and expenses resulting from the organization's operations. (See Appendix B for an example.) The format lists all sources of income first, followed by expenses.
Is the discrepancy related to the timing of income or expenses, which will correct itself in the next accounting period. However, it is essential that managers in an organization are clear about the types of information and reports they need so that a useful chart of accounts can be created and maintained.
For example, it is difficult to provide monthly gasoline cost data if the costs of water, oil, electricity, and gasoline are all summarized under Utilities. However, it is important to understand this principle because some entries, such as general journal entries or adjusting entries, will normally require the accountant to manually indicate the debit and credit sides of the entry.
You can account for the use of assets, such as buildings, vehicles or equipment, by recording depreciation, which spreads the cost of the asset over its useful life. For example, only one-fifth of the cost of a truck, which is expected to be in service for five years, will be charged as an expense each year.
They are essential to the performance of technical work, but cannot be directly assigned to a specific project or activity. An activity with more employees would bear a larger share of the costs of Internet services.
These may include salaries, supplies, equipment, or other expenses that are spent solely for the benefit of specific program activities. All staff, not just accounting, must use these processes because only the cost driver can know what activity the cost supports.
Therefore, it is important to be able to recognize a financial obligation, which can be defined as an agreement to transfer an organization's assets, generally cash, in exchange for goods, services or other assets. Donors often specify how donated funds can be used and require reporting as a condition of their donation.
Managing risk
As a manager, you must keep the ultimate goal in mind: providing quality services at a price that customers can afford or support through other funding sources. Donated funds may also include cost principles that specify what types of costs are or are not allowed, such as a prohibition on using funds for entertainment or alcohol.
The purpose is to put policies and procedures in place to monitor any events or circumstances that may cause risk events and to prevent them, control them or reduce their severity. This involves having plans in place that can be quickly mobilized if the unfortunate event occurs.
In addition to documentation related to specific financial transactions, it is essential to have well-documented financial and operational policies and procedures. These policies and procedures also provide the background against which your organization will be audited and held accountable by management, owners and funders.
Conflicts of interest and unethical conduct
Funders often require clear, documented policies and procedures to demonstrate a controlled environment and to ensure that assets will be treated in accordance with sound management practices and in a manner that supports the mission. The importance of policies and procedures and guidelines for establishing and documenting standard operating procedures (SOPs) is discussed in the "Using Policies and Procedures to Improve Internal Control" section.
A conflict of interest may exist even if it does not result in any misconduct. If the public may consider a relationship or action to be improper, even this potential appearance of a conflict of interest should be avoided.
Procurement management
Your organization's purchasing policies and procedures should be documented in writing and shared with all personnel who have the ability to purchase goods or services for the organization. Policies and procedures should also reflect the philosophy and values of the organization and its funders.
Procurement policies and practices should be consistent with local law, generally accepted accounting practices and donor requirements, where applicable. Finally, procurement policies and procedures should be in the best interest of the organization, but flexible enough to deal with additional requests if you have multiple donors.
