NT w e a k n e s s e s in health

AND MANAGEM!
HEALTU PLANNING of the major
some is to solve
934 for fulfilling a
pre-determined
fact, these
are

ministries. One of
the tasks of
health management
establishing suitable
and finances problems by channels.
-

basic
materials consists of four communication
management the
objective". In theory, horizontal
communication
vertical and
activities
what is to be done. INFORMATION SYSTEMS
(i) planning: determining
the framework or apparatus management of the
(ii) organizing: setting up work. is needed for day-to-day
for groups to do the Information both -

and making it possible

sources
Information c o m e s from many
to do thé work. health system. should be
communicating: motivating people The information system
(ii) to make sure the formal and informal. of the
(controlling): checking needs
(iv) monitoring to the management
tailored according information
work is progressing satisfactorily. The functions of an
business, individual health services.
techniques are familiar in
of collection, classification, transmission,
Management consist
fields. The current emphasis by system transformation and display
of information.
industry, defence and other storage, retrieval, and
on improving the efficiency for monitoring
WHO and many governments is provides data
the application A good information system the requisite
of the health care delivery systems through evaluation of health programmes
and gives
methods and techniques. administrators and planners at all
levels.
of modern management feed-back to health
the health
can play a great role in improving
MANAGEMENT METHODS AND Computers
information system.
TECHNIQUES (1, 8, 9)
5. MANAGEMENT BY OBJECTIVES (MB0)
many. They are based
on
Management techniques are
of behavioural sciences as well as quantitative Objectives set forth for different units and subunits,
are
principles of action usually on a
methods. These techniques have been developed by experts each of which prepares its own plan
in achieving the results more
of management science to help the managers of any short-term basis. This helps
organization goals more efficiently.
to achieve the stated effectively and smoothly.
Efforts are being made by the WHO for making these
field. Quantitative methods
techniques more popular for application in the health
A brief account of these techniques is given below: field of
Quantitative methods are derived from the
research and budgeting. Some of
Methods based on behavioural sciences economics, operation
these techniques have a great role in the management of
1. ORGANIZATIONAL DESIGN health services:
Poor organization results in waste of resources. It is a 1. COST-BENEFIT ANALYSISS
theory of management that organization must be suited to This is a management technique which has attracted the
its current situation and the needs to be serviced. The
organization of health services should, therefore, be widest attention for application in the health field. The
designed so as to meèt the health needs and demands of the economic benefits of any programme are compared with the
people. Further, the organizational design should be cost of that programme. The benefits are expressed in
reviewed every few years because of changing concepts or monetary terms to determine whether a given programme is
purpose, changing problems and changing technology. economically sound, and to select the best out of several
Efficient delivery of health services depends upon the alternate programmes. The main drawback with this
existence of an effective organization. technique is that the benefits in the health field, as a result of
a particular programme, cannot always be expressed in
2. PERSONNEL MANAGEMENT monetary terms. We generally express the benefit in terms of
births or deaths prevented, or illness avoided or overcome.
This is skilful use of human resources. Proper methods of
selection, training and motivation; division of responsibility; Hence the scope of applying this method is rather vague.
distribution of roles; el nination of "squar pegs in round
2. COST-EFFECTIVE ANALYSIS
holes" (i.e., professional staff not suited to administration,
either through training, selection or natural inclination, This is a more promising tool for application in the health
should not be entrusted with administrative and field than cost-benefit analysis. It is similar to cost-benefit
management burdens); incentive for better work; analysis except that benefit, instead of being expressed in
opportunities for promotion and professional advancement; monetary terms is expressed in terms of results achieved,
effective design of "health teams" are all fundamental e.g, number of lives saved or the number of days free from
techniques of personnel management which could dlisease. However, even cost-effective analysis is not possible
contribute to the efficiency of health service delivery. in many cases.

3. COMMUNICATION 3. COST-ACCOUNTING (10)

Better communication contributes to effective functioning It provides basic data on cost structure of any
of an organization. Communication roadblocks exist at programme. Financlal records are kept in
manner a
various levels: between the doctor and the patient; doctor permitting costs to be associated with the purpose for which
and nurse; between the senior officials and juniors; between they are incurred. Cost-accounting has three important
the directorate and the health ministry; between the health purposes in health services: (a) cost control; (b) planning
and allocatlon of people and financial resources; and
ministry and other ministries and rest of the government. (c) pricing of cost reimbursement.
Communication barriers are responsible for delays in regular
of
reporting and notification; delays in the compilation
statistics; delays in the release of supplies and salaries;
salaries; 4. INPUT-OUTPUT ANALYSIS
delays in the institution of prompt remedial measures. In Input-output analysis is an economic technique. In the

health field, "inpuf" refers to all health service activities
which consume resources (manpower, money, materials and
time); and "output" refers to such useful outcomes as cases
treated, lives saved or inoculations performed. An input
output table shows how much of each "input" is needed to
produce a unit amount of each "output". It enables
calculations to be made of the effects of changing the inputs.
5. MODEL
The model is a basic concept of management science. It is
an aid to un nd how the factors in a situation affect one
It is
another. abstraction of the reality, not the
an
reality
itself. The decision process includes the use ofa model.
6.SYSTEMSANALYSIS
The purpose of systems analysis is to
help the decision
maker to choose an appropriate course of action by
investigating his problem, searching out objectives, finding
out alternative solutions, evaluation of the alternatives in
terms of cost-effectiveness, re-examination of the
objectives
if necessary and finding the most cost-effective alternative.
Systems analysis is essentially finding the cost-effectiveness
of the available alternatives. The
system can be a hospital
supply system, an information system, a total community
health service system, an outpatient clinic or
any other
system with problems of management. A system may be
made of independent subsystems.
7. NETWORK ANALYSIS
A network is
a graphic plan of all events and activities to
be completed in order to reach an end objective (Fig. 2). It
brings greater discipline in planning. The two common types
of network technique are (a) PERT and (b) CPM.
(a) PERT (Programme Evaluation and Review
Technique) is a management technique which. makes
possible detailed
more
planning and more
supervision. Every housewife who plans a meal so that each
part of the menu is completed at the same time is using the
basic technique of PERT.
The essence of PERT is to construct an
(Fig. 2). The diagram represents the logical sequence in
which events must take place. It is possible with such aa
diagram to calculate the time by which each activity must bee
Completed, and to identify those activities that are critical.
his simple technique provides a basic discipline by which
all concerned in a project can know what is expected of
tnem and to minimise any delays or crises in the
implementation of the plan.
MANAGEMENT 935
PERT is a useful management technique which can be
applied to a great variety of projects. It aids in planning,
scheduling and monitoring the project; it allows better
communication between the various levels of management;
it identifies potential problems; it furnishes continuous,
timely progress reports; it forms a solid foundation upoon
which to build an evaluation and checking system.
(b) CRITICAL PATH METHOD (CPM) The longest path
of the network (Fig. 2) is called "critical path". If any activity
along the critical path is delayed, the entire project will be
delayed (11).
8. PLANNING-PROGRAMMING
BUDGETING SYSTEM (PPBS)
ThePlanning-Programming-Budgeting System (PPBS) is
primarily a system to help decision makers to allocate
resources so that the available resources of an organization
are used in the most effective way in achieving its objectives.
The PPBS does not call for changes in the existing
organization. It calls for grouping of activities into
programmes related to each objective. Another approach is
known as the Zero Budget Approach", i.e., all budgets start
at zero and no one gets any budget that he cannot
specifically justify on a year-to-year basis.
9. WORK SAMPLING
It is systematic observation and recording of activities of
one or more individuals, carried out at
predetermined or
random intervals. It provides quantitative measurement of
the various activities. The major
parameters that are
analysed are the type of activities performed and the time
needed to do specified jobs. Work sampling studies have
been done on doctors, nurses, pharmacists and
technicians. Work sampling permits judgments to the
laboratory
appropriateness of current staff, job description and training.
comprehensive It helps in standardising the methods of
performing jobs and
determining the manpower needs in any organization.
10. DECISION MAKING
Arrow Diagram Decision
making is just like the basic
discipline of
differential diagnosis in medical practice. It is an
should be made at the level whereadage
decisions that
the best
decisions can be made; it does not
follow that the best
decision is always made at the
top of an
organization.
Decisions should not be made with
incomplete data. In the
health sector, decisions have to be made
of resources, optimum work about development
load for medical and
paramedical workers, strategies for providing health care. etc.

4 months staff staff

recruited 2 months trained

START plan 1 month

service

start
Z monthsequipment
ordered
equipmen providing
10 months installed 1 month service

TERMINAL
FIG. 2 EVENT
Network analysis