MEDTABLE COMRADES

HEALTH SYSTEM MANAGEMENT I

TRIAL Q/A
1.
A.
i. In not more than ten (10) sentences, explain what is meant by a broad as
opposed to a narrow definition of a health system.
ii. List four (4) essential public health functions.
B. Define the following
i. Effectiveness
ii. Efficiency
C. According to the WHO Framework for Health Systems, what are the overall
goals/outcomes if the building blocks function effectively?
D. As the officer in charge (PA, CMH) at Tano North district, why should you be
concerned with the activities at the Health systems pyramid according to WHO?

ANSWER

A.
i. The broad definition of a health system comprises of all the
organizations/institutions, their resources, activities or duties, combined to
produce or create an intervention whose primary aim is to promote, restore,
improve and maintain health in order to reach the achievement of a health
needs of the target population. The broad definition focus on a wider view. It
includes all initiative that can help to improve health performance and can lead
to greater access coverage of health. This includes all public sectors, socio-
economic, cultures, religions and politics that have influence on health.
On the other hand, the narrow definition only focuses directly on health sectors
that provide health care services to patients. This does not include any factor
that can contribute to health.

ii. Essential Public Health Functions

 Health promotion and prevention
 Health education
 Health screening in the community
 Follow ups on patients and attending outreaches
  Reducing the impact of emergencies and disasters in health
 Social participation in health
 Public Health surveillance and research to public health
 Monitoring, evaluation and analysis of the health situation of the
population
 Human resources development and training in public health
 Quality assurance in personal and population-based health services

B.
i. Effectiveness refers to the achievement of a goal or being able to achieve a goal.
ii. Efficiency refers to using minimum resources to achieve desired results but not
compromising on quality.

C.
 Improved health
 Responsiveness
 Social and financial risk protection
 Improved efficiency

D. I would be concerned with the activities at the base of the pyramid because it is the
point where most cases are managed first, and also with large population.
Hence, effective primary health care and promotion at the base of the pyramid will tend
to reduce morbidity and mortality rate within the district.

2.
A. COMPLETE THE TABLE BELOW WITH THE ACTIVITIES THAT FOLLOW
SR. NO MANAGER LEADER

Does things right Innovates

Accept the staus quo Is an original
Relies on trust Maintains
 How & when What & why
Focus on people Short range view
B.
i. Differentiate between Public and Private health systems
ii. Formal and Informal Health systems
C.
i. Explain the following in not more than three (3) sentences
1. Great man theory of leadership
2. Trait – based theory of leadership
3. Situational theory of leadership
ii. How will you become an effective manager who leads?
D. Give three (3) qualities each of
i. Good leadership
ii. Bad leadership
E. List the components each of managing and leading according to the
Management Sciences for Health Framework

ANSWER

A.
SR. NO MANAGER LEADER
1. Does things right Innovates
2. Accepts status quo Is an original
3. Maintains Relies on trust
4. How & when Focus on people
5. Short range view What & why

B.
i. Public health system is the form of health system which is owned by the
government, with strict standards or protocols followed universally and not for
profit whiles private health system is owned by an individual or group of people
and are in for profit making.
ii. Formal health system is the form of health systems where there are standards
and strictly followed protocols for health care and well-structured or organized
whiles informal health system is the health system where there are no
universally followed standards and protocols for health care and thus assumes
any structure of interest.

C. i.
 1. Great man theory of leadership: This theory talks about the elite being born
leaders. That is the rich, clever students, etc. are those seen to be leaders.
2. Trait-based theory of leadership: With this theory, it is believed that people are
being born with certain traits of leadership. This theory emphasis on the fact that
leaders are born.
3. Situational theories of leadership: This theory talks about not having a single
style of leadership. Every situation a leader finds him/herself in determines the
kind of leadership style to adopt or use.
ii. An effective manager who leads is the one who combines the components of
leader (that is, scanning, focusing, aligning and implementing) and a manager
(that is, planning, organizing, implementing and monitoring & evaluating) to
achieve an improved management system, improved health delivery and
improved capacity to respond to health.

D.
i. Qualities of a good leader includes;
 Gives structure when needed
 Gives freedom when possible
 Stimulates creativity
ii. Qualities of a bad leader include;
 Imposes ideas on followers
 Too sluggish
 Too directive, that is kills creativity

E. Components of Management
1. Planning
2. Organizing
3. Implementing
4. Monitoring & evaluation

Components of Leadership
1. Scanning
2. Focusing
3. Aligning
4. Mobilizing
3.
A. What is an Emotional Bank Account?
B. What is P/PC balance?
C. Tabulate four (4) differences in the languages of a proactive and reactive
persons
D.
i. What three (3) main considerations must be taken into account before
you try to manage a conflict in your organization?
ii. Indicate four (4) sources of conflict in an organization

ANSWER

A. An emotional bank account refers to the behavioural accounts which consist of

deposits (that is, doing things that pleases an individual such as showing
kindness) and withdrawals (that is, doing things that displeases an individual
such as being unfaithful).

B. P/PC balance refers to the balance between production (activity outcomes) and
production capabilities (assets needed to produce) such as human, financial and
physical resources.

C.
PROACTIVE PERSON REACTIVE PERSON
I will I must
Let’s look at other alternatives There is nothing we do about it
I control my feelings He makes me so sad
I can choose a different approach I can’t choose any other approach
I will choose an appropriate response They won’t allow that
I prefer If only

D.
i. In managing a conflict, the following must be taken into consideration;
1. What type of conflict is involved?
2. How your biases and instincts will influence the conflict management,
and device ways to curb that.
3. What process you will use to resolve the conflict.
ii. Sources of conflict in an Organization
 1. Role ambiguities
2. Scarcity of resources
3. Poor objective setting
4. Task interdependent

4.
A. Mention three (3) importance of an organizational structure
B.
i. Outline four (4) responsibilities of DHMT.
ii. Mention four (4) members of DHMT.
C. Describe the team building process.
D.
i. Briefly explain four (4) each the benefits and drawbacks of a team
ii. Mention five (5) dysfunctions of a team

ANSWER

A.
i. It is the basis of grouping work into departments
ii. It provides hierarchy of roles so that members in it get to know who is
superior and subordinate
iii. It provides a framework in which the people interact as a group to achieve
organizational objective
iv. It also directs the flow of authority and responsibility and also effective
communication
v. It helps to delegate duties, to assign responsibilities, and provides a means
for determining who is accountable to who.

B.
i. Responsibilities of DHMT
1. Management of the district health services, district hospital and all
health facilities and staffs.
2. Supervise sub-district health staff.
3. Conduct in-service training for district and sub-district staff.
 4. Financial administration and management.
5. Provide technical expertise from MOH at the district level.
6. Applied research on health priorities in the district.
7. They conduct in-service training for the district and sub-district staffs.

ii. Members of DHMT

1. District Director of Health Service
2. Senior Medical officer of the district hospital
3. The District public health officer
4. The District environmental health officer
5. The District disease control officer

C. Team Building Process

i. Forming: This is when the team first comes together. It can also be when
there has been a big change in membership of the team. Members introduce
themselves to one another at this stage. There is both excitement and
anxiety. People having high expectations and others are uncertain about how
things will go on in the group & even how they can fit into the group.
ii. Storming: conflict is the key feature at this stage as members finds it difficult
to figure out who is subordinate & who is in-charge. They find it difficult to
define their own roles. There may be frustrations, disappointments, curiosity,
& anxiety which can lead to arguing, competition, questioning & unrealistic
goal setting.
iii. Norming: Here the team begins to become more cohesive because norms &
expectations are set for how the team and its members should operate at
this stage. Members accept one another and interact playfully. Conflicts
occurring at storming stage are controlled. They all focus on the team’s goals
& objectives.
iv. Performing: The team is fully functional at this stage. Members are satisfied,
trust one another, anticipate problems and so devise mechanisms to prevent
them. They have high commitment to work and take risk for the success of
the team.
v. Transforming: This is the final stage where teams will either change or
dissolve. This might happen because the group’s task is done, or because the
organization itself is changing or because members of the team changes.
D.
i. Benefits of a Team
1. Motivation
 2. Delegation
3. Self-worth
4. Skill development
5. Ownership
6. Shared responsibility
7. Proactivity
8. Flexibility
(Briefly explain)

Drawbacks of a Team
1. Time consuming
2. Differing work styles
3. Confusion over roles
4. Requires change
(Briefly explain)

ii. Dysfunctions of Team

1. Absence of trust
2. Fear of conflict
3. Lack of commitment
4. Avoidance of accountability
5. Inattention to results

5.
A.
i. What is Quality in Health care?
ii. State four (4) each the visible and invisible costs associated with poor
quality.
B.
i. Mention six (6) dimensions of quality.
 ii. Briefly explain the Donabedian approach to Quality of Health Care.
iii. Discuss quality by Donabedian; “The Secret of Quality is Love.”
C.
i. Define the following terms
1. Monitoring
2. Supervision
3. Evaluation
ii. Briefly describe the two (2) types of supervision
iii. List the five (5) key words of supervision
D.
i. Mention four (4) responsibility of a supervisor.
ii. State five (5) challenges mitigating against effective supervision
E.
i. What are the five (5) traits of a Great Boss?
ii. Outline four (4) importances of monitoring and evaluation to program

ANSWER

A.
i. Quality in health care refers to the proper performance of standard health
interventions that are known to be safe, affordable to the society in question
and have the ability to have impact on mortality, morbidity and disability.
ii. Visible costs associated with Poor Quality
 Poor utilization
 Prolonged illness
 Wrong diagnosis
 Wrong treatment
 Repeated OPD visits
 Death
Non-visible costs associated with Poor Quality
 Frustrated patients
 Wasted health worker time
 Wasted laboratory tests
 Low health worker morale
 Loss of community trust
 Unnecessary illness
 Late presentation
 Wasted patient time
 Wasted medication
  Unnecessary treatment
 Loss of patient trust
 Poor patient compliance
 Poor cost recovery

B.
i. Dimensions of Quality
 Accessibility
 Amenities
 Effectiveness
 Efficiency
 Continuity
 Safety
 Interpersonal communication
 Technical competence

ii. Donabedian approach to Quality of Health Care.

 Structure
 Process
 Health outcomes
(Briefly explain)

iii. The Secret of Quality is Love by Donabedian

 Systems awareness and systems design are important for health
professionals, but they are not enough. It is the ethical dimensions of
individuals that are essential to a system’s success.
 Thus, according to Donabedian, ultimately, “the secret of quality is love.”
He explains that, to have a quality care, you have to love your patient,
love your profession and love your God. If one has love, then he/she can
then work backward to monitor and improve the health system.
 If you love somebody, you don’t hurt the person. You treat with care &
respect; you understand them and put yourself in their shoes. You also
improve & monitor the health system.
 As an officer you may not directly deal the people, you will put up
measures to ensure that the people are safe & protected. Ensure that
what need to be done is done at every level in the health system and
further ensure that protocols are observed in relation to how things are
done at the health facility.
 C.
i.
1. Monitoring is a step-by-step follow up of activities and
performance with the view of ensuring that they are performed
according to pre-determined standards.
2. Supervision is a process of guiding, helping, training and
encouraging staff to improve their performance in order to provide
higher quality health care services.
3. Evaluation is a systematic and objective assessment of an ongoing
or completed project, program or policy, its design, implementation and
results.

ii. The two types of supervision are the facilitative and conductive supervision.
1. Facilitative supervision: this type of supervision offers the
supervisee to discuss an inherent problem in job performance with the
supervisor. It looks at the knowledge and skills of the worker as against
what the worker requires to perform a given task. This helps the
supervisor to identify the needs of the supervisee.
2. Conductive supervision: this type of supervision entails the
planning of the activity schedule, date(s) for the supervision by the
supervisor and communicates to the supervisee. Arrange for adequate
resources such as funds for accommodation, feeding & allowances for
the supervisory team. Also arrange for transport.
Show courtesies, fairness, and affection on arrival and during supervision.
Acknowledge hard work and point out any observed gap, and then
conduct job training, coaching & mentoring for the supervisee if gap can
be filled within the time frame.

iii. 5 Keywords of Supervision

1. Clarity
2. Empathy
3. Courage
4. Attention
5. Persistence
D.
i. Responsibility of a Supervisor
1. A supervisor facilitates community outreaches
 2. He/she motivates staff
3. A supervisor is a problem solver
4. He/she creates conducive environment for team work
5. They provide feedback to staff about their performance

ii. Challenges Mitigating against Effective Supervision

1. Time constraints
2. Poor feedback system
3. Absence of performance
4. Nepotism/favouritism
5. Inadequate resources to support supervisory activities
6. Lack of knowledge on the part of supervisors
7. Lack of appreciation of the relevance of supervision on the part of the
managers

E.

i. Traits of Great Boss

1. He values what the employees say
2. He solicits for diverse opinions
3. He offers constructive feedback
4. He is honest
5. He keeps every one informed

ii. Importance of Monitoring & Evaluation

It helps program implementers to:
1. Make informed decisions regarding program operations & service delivery
based on objective evidence
2. Ensure the most effective & efficient use of resources
3. Objectively assess the extent to which the program is having or has had the
desired impact, in what areas it is effective, and where corrections need to
be active.
4. Meet organizational reporting and other requirements, and convince donors
that their investments have been worthwhile or that alternative approaches
should be considered.
6. Indicate whether the following statements are part of the health systems or not with
“T” for true and “F” for false.
A. The Minister for Food & Agriculture set a vision to train all farmers on how to use
fertilizers and other farm chemicals so that they can have bumper harvest for
the coming farming season. _____
B. The Minister of Food & Agriculture met his counterpart from the Ministry of
Health to have a discussion regarding the use of chemicals on fruits and
vegetables to make them wholesome for human consumption. _____
C. The Motor Traffic & Transport Unit (MTTU) of Ghana Police Department is
embarking on an exercise in the coming weeks to arrest and prosecute all drivers
who drive without putting on their seatbelts. _____
D. The Motor Traffic & Transport Unit (MTTU) of Ghana Police Department has
decided to use the next two weeks to embark on a public/education for all
drivers to ensure use of seatbelts as this can save their lives in times of
accidents. _____
E. The Parliament of Ghana has passed a bill that seeks to ensure the provision of
separate tracks for pedestrians, bicycles, and motor riders to ease traffic on our
roads. _____
F. The Parliament of Ghana is proposing a bill to be passed that ensures provision
of tracks for bicycles as they argue that the use of bicycles is a form of exercise
that helps the heart. _____

ANSWER

A. F
B. T
C. F
D. T
E. F
F. T

-MEDTABLECOMRADES-

…WhenKnowledgeSpeaks; WeHear…