By: Friehiwot Molla (BSC, MPH) E-Mail: May 2021 Debremarkos, Ethiopia

Debre Markos University
College of Health Sciences

Department of public Health
Health policy and Health Delivery System for
Third Year Nursing students
By: Friehiwot Molla (BSC, MPH)

E-mail: mollafrehiwot@gmail.com
May 2021
Debremarkos, Ethiopia
05/28/2021 BY:Friehiwot.M 1
Session objective
After completion of this session we will be able to:
 Discuss the health delivery system and health policy in
Ethiopia
 Analyze the health system building blocks and their
interactions
 Understand the basic steps of health policy development
 Comply with national and organizational health policies,
strategies and initiatives
 Develop, Implement and evaluate health policy, plan and
program documents in Ethiopia
Health Policy
Introduction
 Policy is often thought of as decisions taken by those
with responsibility for a given policy area – it may be
in health or the environment, in education or in trade.
 The people who make policies are referred to as
policymakers.
 Policy may be made at many levels – in central or
local government, in a multinational company or
local business, in a school or hospital
Introduction….
 Specific groups of decision makers who hold senior
positions in an organization are referred to as policy elites.
 A good policy gives a broad agenda and framework for
action; it provides direction without unduly limiting
implementers.
 It includes actions or intended actions by public, private
and voluntary organizations that have an impact on
health.
Public vs. Private Policymaking
Policies are made in the private and in the public sector
Public Policy
 Public policy refers to government policy.
 For example, Dye (2001) says that public policy is whatever
governments choose to do or not to do
Private Policy
 Policy that is established by private organizations
 In the private sector, multinational companies may establish

policies for all their companies around the world
 However, private sector corporations have to ensure that their
policies are made within the confines of public law made by
governments.
Health Policy
 Health policy is an organized set of values, principles
and objectives for improving health and reducing the
burden of disorders in a population
 It is a set of clear statements and decisions defining
priorities and main directions of improving health and
health care in a country
 Health policies have to be dynamic and should consider
national and international agreements and policies.
 Health policy embraces courses of action and inaction
that affect the set of institutions, organizations, services
and funding arrangements of the health system.
Health policy…
 It includes policy made in the public sector as well as
policies in the private sector
 As health is influenced by many determinants outside
the health system, health policy analysts are also
interested in the actions and intended actions of
organizations external to the health system that have an
impact on health
– for example, the food, education, agriculture or
pharmaceutical industries..
 It defines a vision for the future and helps to establish a
model for action.
Why Health Policy is Important
 Globally, the health sector is an important part of the

economy.
 It absorbs large amounts of national resources to pay
for the many health workers employed, and is a driver
of the economy, through innovation and investment
in the health sector, or through ensuring a healthy
population which is economically productive.
Why Health Policy is Important….
 Because the nature of decision making in health

involves matters of life and death,
 Health is also affected by many decisions that have
nothing to do with health care:
 Poverty affects people’s health, as do pollution,
contaminated water or poor sanitation.
 Economic policies, such as taxes on cigarettes or
alcohol, may also influence people’s behavior.
Policy versus strategy
 Policy is a blueprint of the organizational activities
which are repetitive / routine in nature.
 Policy formulation is responsibility of top level
management. While strategy formulation is basically
done by middle level management.
 Policy is concerned with both thought and actions.
While strategy is concerned mostly with actions.
 A strategy is a plan to do things a certain way to
achieve a desired outcomes
Policy versus strategy…..
 A policy is a rule designed to ensure consistency in
governance and to avoid undesirable outcomes.
 It is what is, or what is not done. While a strategy is
the methodology used to achieve a target as
prescribed by a policy
 Policy is concerned with what is to be done (content);
strategy refers to how to do it.
National Health Policy of Ethiopia
 Historically, the Ethiopian healthcare delivery System
has not been effective in responding to health needs of
the people.
 Since 1993, FMOH of Ethiopia has formulated a 20
years National Health Sector Development Program
(NHSDP)
 In 2015, the sector successfully concluded the NHSDP
(HSDP I to HSDP IV) and launched the Health Sector
Transformation Plan (HSTP).
National Health Policy of Ethiopia….
 The health policy (HSDP) principally focuses on
 Fiscal and political decentralization,
 Expanding the PHC services to all segments of the
population and
 Encouraging partnerships and the participation of
nongovernmental actors.
 Health Extension Program (HEP) was the country’s
flagship program through HSDP I to HSDP IV
- Which aimed to provide cost-effective basic services to

all Ethiopian mainly to women and children.
 It underpinned by the core principle of community

ownership that empower communities to manage
health problems specific to their community.
General Theme of the 1993 Health Policy
1. Democratization and decentralization of the health
service system.
2. Development of the preventive and promotive

components of health care.
3. Development of an equitable and acceptable standard of
health service system
4. Promoting and strengthening of inter-sectoral activities.
5. Promotion of attitudes and practices conducive to the

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BY:Friehiwot.M
strengthening of national self-reliance 16
General Theme of …
6. Assurance of accessibility of health care for all
segment of the population.
7. Working closely with neighboring countries, regional
and international organizations
8. Development of appropriate capacity building based on
assessed needs.
9. Provision of health care for the population on a scheme
of payment
10. Promotion of the participation of the private sector
and governmental organizations
05/28/2021 BY:Friehiwot.M
in health care. 17
The Ethiopian Health Policy (1993) places the
following interventions as top priorities
 Information, Education and Communication
 Control of communicable diseases and epidemics
 Promotion of occupational health and safety
 Development of environmental health
 Rehabilitation of health infrastructure

 Development of an appropriate health service
management system.
 Supporting curative and rehabilitative services,
 Developing the beneficial aspects of traditional
medicine and
 Provision of essential medicines, medical supplies
and equipment.
 In addition, the policy gives special attention to the
 Development of human resources for health (HRH),
 Applied health research, addressing the major health

problems, and
 The needs of women and children and those hitherto
most neglected.
The Health Sector Development Program
(HSDP)
 Launched in 1998
 Has three main goals:
‐ Building basic infrastructure
‐ Provide standard facilities and supplies
‐ Develop and deploy appropriate health personnel
The Health Sector Development Program
(HSDP ) …
HSDP I (1997/98–2001/02)
 Prioritized disease prevention
 Introduced a four-tier system for health service
delivery
 Characterized by a primary health care unit (PHCU)
The HSDP …
HSDP II (2002/03–2004/05)
 Introduced the Health Service Extension Program
(HSEP).
 Innovative health service delivery system
 It is a community based health care delivery
system provided at kebele and household levels
The HSDP …
HSDP III (2005/6-2009/10)
 Directly aligned with the health-related MDGs
 Focuses on high-impact health system
strengthening interventions needed to accelerate
scale-up and increase coverage
HSDP IV (2010 –2015)
 Developed as part of the National Growth and
Transformation Plan (GTP)
 The expression of the renewed commitment to the
achievement of MDGs.
 Gives priority to maternal and child health, nutrition,
prevention and control of major communicable
diseases
The (HSDP ) …
HSDP IV (2010 –2015) …

 Emphasizes the strengthening of health system
strengthening to improve the quality of PHC,
human resource development and health
infrastructure.
 Developed the three tier health delivery system
 Community empowerment / ownership
The (HSDP ) …
The priorities and targets of the HSDP IV

 Maternal and newborn health
 Child health
 TB and HIV/AIDS
 Malaria and nutrition
Health Policy Development and
Implementation
Health policy, plans and programs
Introduction
 Health policy is now becoming a central issue in
many developing countries.
 It should be based on the needs of the population
and should have the support of all actors.
 Health policy is a complex issue as health is by itself
unpredictable and uncertain.
 Government should develop a feasible health policy
document and devise health plans and programs to
implement it.
Policy, Plan, Program
 Sometimes policy is called a plan or a program,

 e.g. the government’s HSTP or the HEP, stating
what should be done to increase public access to
primary health services and to improve health.
Policy, Plan, Program….
 The program is thus the embodiment of policy.
 Policies may not arise from a single decision but
could consist of bundles of decisions that lead to
a broad course of action over time.
 And these decisions or actions may or may not
be intended, defined or even recognized as policy.
Health Policy
 Health policy is an organized set of values, principles and
objectives for improving health and reducing the burden
of disorders in a population.
 It defines a vision for the future and helps to establish a
model for action.
 Policy also states the level of priority that a government
assigns to health in relation to other social policies.
 Policy is generally formulated to cover a long period,
typically 5 to 10 years.
 Often the terms ‘plans’ and ‘programmers' are used
interchangeably.
 They are considered complementary to policies and
provide
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the means for implementing
BY:Friehiwot.M
actions. 32
Health Plan
 A health plan is a detailed pre-formulated scheme / system for
implementing strategic actions that favor the promotion of health,
the prevention of disorders, and treatment and rehabilitation.
 Such a plan allows the implementation of the vision, values,

principles and objectives defined in the policy.
 A plan usually includes strategies, time frames, resources required,

targets to be achieved, indicators and activities.
 A plan can correspond to the same administrative division and
period of time as the health policy.
 However, this does not always have to be so: a plan can be
developed for a smaller administrative division or a shorter period
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than the policy BY:Friehiwot.M
Health Program
 A health program is an intervention or series of
interventions with a highly focused objective for the
promotion of health, the prevention of disorders, and
treatment and rehabilitation.
 A program usually focuses on a specific health priority
and, like health plans, programs must be adequately
designed, budgeted for, monitored and evaluated.
 In contrast to the policy and plan, the program is
frequently implemented in a smaller administrative
division or for a shorterBY:Friehiwot.M
05/28/2021
period. 34
Health policy, plan and program
development
3.1. Health policy development
 Examining the experiences of various countries is possible to
identify several essential steps for the development of a
successful health policy.
 In developing a health policy, obtaining official approval and
implementing the policy through plans and programmes are
essential steps.
 It is important to have a timescale in mind when approaching a
health policy.
 For development one to two years and five to ten years for
implementing and achieving changes are probably realistic
periods.
 A shorter timescale is likely to be impossible, while a time
horizon that is too long may not satisfy many of the
stakeholders and the general
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population.
BY:Friehiwot.M 36
Steps in Health policy development
Step 1: Assess the population’s needs
Step 2: Gather evidence for effective strategies
Step 3: Consultation and negotiation
Step 4: Exchange with other countries

Step 5: Set out the objectives, vision, values and principles
of the policy
Step 6: Determine areas for action
Step 7: Identify the major roles and responsibilities of

different sectors
3.2 Health plan development
Health plan development
 Once the health policy has been written (and, preferably,
officially approved)
 it is necessary to formulate a plan for implementing the
identified objectives by
 building on the process already established for policy
development.
 The information about
 The population’s needs,
 Gathering evidence,
 Consultation, negotiation, and exchange with other
countries, which were required for the development of
the policy, must be utilized and expanded upon in the
formulation of a plan.
HEALTHCARE DELIVERY SYSTEM
HEALTHCARE SYSTEM
Definition of Key Terms
 System: A system is a set of interacting or interdependent
components forming an integrated whole.
 Health System: is defined as the sum of the organizations,
institutions, and resources whose shared primary purpose is to
improve health. (WHO).
 Fully Functional Health System: is a point at which the
various management systems and subsystems are connected
and integrated so as to provide the best possible health
services to all the intended beneficiaries of those services.
H/CARE SYSTEM…
Health systems: The broad health system
 Includes everyone responsible for good health, from the family
in a rural village to the surgeon in a hospital in the capital city.
 It encompasses sanitation and nutrition,
 All branches of government and operates within the public
sector, civil society and for-profit entities.
 Its goals are improving health and health equity in ways that are
responsive, financially fair, and make the best, or most efficient,
use of available resources.
 A health system needs staff, funds, information, supplies,
transport, communicationsBY:Friehiwot.M
05/28/2021
and overall guidance and direction.42
H/CARE SYSTEM…
When do we say a health system has fulfilled its role?

 A health system is said to be fully functional when the
various management systems and subsystems are connected
and integrated so as to provide the best possible health
services to all the intended beneficiaries of those services.
 An effective health system begins with parents who have
learned the best ways to keep their children healthy.
H/CARE SYSTEM…
 The following nine characteristics are means by which one
can check whether a health system is functional.
Access to services
Quality of care and service delivery
Safety, Coverage, Equity
Efficiency
Effectiveness of health care delivery
Ethics, and right based approach in delivery of services
Sustainability of services
ETH. H/CARE SYSTEM…
How is the delivery system organized in Ethiopia?

 The health service system in Ethiopia is federally decentralized
among the nine regions and two city administrations.
 Offices at different levels of the health sector in Ethiopia, from
the Federal Ministry of Health to Regional Health Bureaus and
Woreda health offices, share decision-making processes, powers,
and duties.
 The FMOH and the RHBs focus more on policy matters and
technical support,
 Woreda health offices focus on managing and coordinating the
operation of a district health system that includes a primary
hospital, health centers, and health posts under the Woreda’s
jurisdiction
ETH. H/CARE SYSTEM …
 The devolution of power to regional governments
has resulted in a shift of public service delivery,
including health care which is now largely under the
authority of the regions.
 Regional health bureaus are also responsible for
owning, financing and supervising the service
delivery of regional hospitals.
 The Ethiopian health service delivery is reorganized
into a three-tier structure of specialized hospitals,
general hospitals and primary healthcare units
The three tier healthcare delivery system of Ethiopia (since
2010)
ETH. H/CARE SYSTEM…
 The structure of primary healthcare units in rural and

urban areas is quite different: only health centers are
considered as a primary healthcare unit in urban areas
unlike in rural areas.
 Health service provision to the community in Ethiopia is
largely publicly provided particularly in rural areas.
 However the private sector also plays a significant role in
healthcare service provision in Ethiopia though mostly in
towns and mainly in providing
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BY:Friehiwot.M 48
Building blocks of health systems
 Governance
 Financing
 Human resources
 Information
 Medical products, vaccines and technologies

 Service delivery
Health system building blocks
Thank You
Health Care Financing
Session objectives
 Describe the basic function of HCF

 Describe the rational of HCF in Ethiopia
 List Health Care Financing Reform Components
 Identify services which can be outsourced to hospitals
 Describe the role of government in health care
What is Health Care financing / (HCF)?
 Healthcare financing is a mechanism that deals with

mobilization, allocation and utilization of health
resources to meet the health service needs of the
people
 Basic function of a health care financing:
 collecting revenue,
 pooling risks and
 Purchasing servicesBY:Friehiwot.M
05/28/2021 54
Basic function ----
 revenue collection is the means by which a health
system collects money from individuals, households or
external sources
 Risk pooling is the process of creating a common pool of
money so that the financial risks entailed by certain high-
risk individuals are mitigated by money from lower-risk
individuals.
 Resource allocation is a process of distributing the
revenues collected for the purpose of health care to
competing
05/28/2021 interests. BY:Friehiwot.M 55
What does HCF address?
 Health Care Financing addresses:
 How much resource is needed?
 Where does the money come from?
 How it is collected?
 How risks are pooled ?
 Who manages it?
 How is it re-distributed to the third-party payers and
 How is it used to pay the providers for their services
Sources of National HCF
1. Public sources:
a) Direct government budgeting
• General tax revenues
• Deficit financing
• Earmarked Taxes
b)Social health insurances sponsored or mandated by

the government
c) Community financing
Sources of National HCF…
2. Private sources
 Direct payment by households
 Private voluntary health insurance
 Employers finance scheme
 Payments by community and other local organizations
3. External financing
 Foreign aid for development loans
 International NGOs
Factors influencing health Care Financing
 Demographic changes
 Economic recession
 Rising expectation
 Concerns about equity
 Disease-pattern changes
 Efficiency
 Displacement effects
 Wider effects of the health

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sector
BY:Friehiwot.M 59
Criteria for choosing a Financing system
A. Viability and ease of using the system

B. Revenue generating ability
C. Effects on service – provision
D. Effects on equity
E. Participation in decision-making
Key Health Financing Issues
 The World Health Report of 2010 identified three

interrelated problems that limit universal coverage:
1. Limited availability of health resources,
2. Overreliance on direct payments at the time people
need care, and
3. Inefficient and inequitable use of resources.
 The limited availability of resources for health in
Ethiopia is very clear.
Key Health Financing Issues…
 The total health spending in Ethiopia increased from
time to time.
 However, overall health is under-financed, both in
absolute terms and when compared to the sub-
Saharan Africa average, as evidenced by per capita
health spending.
 On the demand side, cultural norms, distance to
functioning health centers, and financial barriers
were found to be the major causes for not seeking
health services in health facilities (FMoH 2011).
Health Care Financing in Ethiopia
 Aims to address health systems to the changing needs
of the population and achieve maximum impact from
the investment.
 A sustained process, guided by government,
 Developed in 1998 E.C
 It was endorsed by the council of Ministers and became
a very important policy document for introduction of
health financing reforms.
 The government recognized that health cannot be
financed only by government and emphasized the
importance of promoting cost sharing in provision of
health services.
Sources of Health Financing in Ethiopia
 According to the data from the Seventh National Health
Accounts (NHA),
The government and other public enterprises provide
32.1%,
 Donors and NGOs 35.2%,
 Households 30.6%, and
 Other private employers and funds about 2.1%.
What is health Care Financing Reform?
 Health Care Financing Reform is an alternative

arrangement for mobilizing, collecting, paying and
managing health resources in order to increase
efficiency, promote equity and improve access and
quality of health services in a sustainable manner
Why Health Financing Reform in Ethiopia
 In the early 1990s, the health infrastructure had
seriously deteriorated, and the health service system
was dysfunctional.
 Physical access to health service providers was
beyond the reach of the majority of the Ethiopian
population, and even more difficult for the poorest
segments of the population.
 The overall country budget was limited, resulting in
inadequate financing of health care.
 In addition, health service delivery was inefficient
and inequitable, and quality of health care was
generally poor.
Why Health Financing Reform in…
 In those areas where limited human resources were
available, diagnostic equipment was not functioning and
essential drugs were not available, compromising quality of
health care
 A willingness-and-ability-to-pay study conducted in 2001
revealed that
 respondents found the services provided by public health
centers and hospitals unsatisfactory and below average
(30 percent and 47 percent,
05/28/2021 respectively).
BY:Friehiwot.M 67
Highlights of HCF Reform Components
 In 1998, the Ethiopian government developed and
endorsed a health financing strategy that
 directs resources for the health sector to be mobilized
from different sources and
 permits government to provide health services through
its health facilities by means of a cost-sharing
arrangement with users.
 In order to operationalize the strategy, FMoH drafted a
prototype legal framework and operational manuals that
were adopted by regional governments.BY:Friehiwot.M
05/28/2021
68
HCF Reform Goals
 Identify and obtain resources that can be dedicated to
preventive, promotive, curative, and rehabilitative health
services
 Increase absolute resources to the health sector
 Increase efficiency in the use of available resources
 Promote sustainability of health care financing and
improve the quality and coverage of health services
 Monitoring and coordination of health care financing
system in their offices.
Key Activities of HCF Reform
 Strengthen management boards at the health facilities and
the community level to oversee the proper
implementation.
 Encourage the establishment of CBHI schemes in their
subordinate
 Implement the revenue retention and utilization at health
facilities and exemption policy in collaboration with the
relevant sectors at their subordinate.
 Implement the fee waiver system.

 Work in collaboration with the NGOs and the private
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HCF Reform Components
1. Revenue retention and utilization
2. Systematizing fee waiver system
3. Standardizing exemption services
4. Outsourcing of nonclinical services in public hospitals
5. User fee setting and revision
6. Initiation of health insurance
7. Establishment of a private wing in public hospitals
8. Health facility autonomy through establishment of
governing bodies
1. Revenue Retention and Utilization
 Ethiopia has a tradition of paying for health services,
that dates back to the introduction of the modern
health service delivery system.
 Ethiopia follows a reven+ue collection and budgeting
system in which all public institutions that are
collecting revenue are supposed to channel their
revenue to the central treasury
 And receive their operational funding in the form of a
05/28/2021 government budget. BY:Friehiwot.M 72
1. Revenue Retention and Utilization…
 Similarly, in the health sector, health facilities were
channelling all revenue that they had been generating
internally to the treasury.
 This caused a lack of sense of ownership by health
facility staff and health facilities,
 And the amount of money health facilities had been
collecting and channelling to the treasury was rather
insignificant.
1. Revenue Retention and Utilization…
 On the other hand, health facilities faced a serious shortage of
resources to cover their operational costs,
 In most cases, their non-salary operational budget was being
depleted by the end of the first quarter causing inefficient use of
scarce resources and poor quality of health care.
 In response to this problem, the health care financing strategy,
followed by the respective regional and federal laws, allowed
health facilities to retain and use their revenue for health service
quality improvements.
 Hospitals and health centres are now started to retain their
revenue.
2. Systematizing Fee Waiver System
 Ethiopia institutionalized mechanisms for providing
services to the poor free of charge
 through a fee-waiver system, as well as
 through free provision of selected public health
services through exemption
 through services targeting selected groups e.g. EPI
 However, a strong need existed to systematize and
standardize these services.
2. Systematizing Fee Waiver System…
 For instance, local authorities had been issuing (and is
still issuing in some regions) fee waiver certificates to the
poor as verified through local social justice systems at
the time of sickness.
 This resulted in cumbersome procedures that caused
delays in the poor’s ability to access care.
 This was not the case for individuals in higher income
categories, and the system therefore created health care
inequities.
3. Standardizing Exemption Services
 In the Ethiopian health system, some public health
services have been provided to all citizens free of
charge regardless of level of income.
 This has occurred because of the nature of these
activities and because of the need to promote use of
certain health care services.
 Although exemption services were more standardized
across regions, some services needed standardization
by government.
3. Standardizing Exemption Services….
 Services that were provided free of charge in some public health
facilities were not free in others.
 In addition, there was no clear distinction between the financing
and service provision.
 Health facilities were providing free services without
budgetary/funding support for these activities.
 In general to the above services current exempted services in our
country include;
 ART services, HIV testing, FP services, epidemic controls . . .
4. Outsourcing of Nonclinical Services in Public
Hospitals
 Hospital management was spending considerable time

and resources on
 routine administration and management of human
and material resources that are meant for provision
of supportive services for these health facilities.
 When managed by hospitals, these services tend to be
inefficient and expensive.
4. Outsourcing of Nonclinical Services in…
 This includes services such as:
 catering,
 laundry,
 cleaning,
 gardening,
 security, and
 maintenance.
 In view of this, the health care financing strategy
considered outsourcing nonclinical services to improve
efficiency, reduce spending, and reduce the burden on
hospital management.
5. User Fee Setting and Revision
 In the Ethiopian public health system, health facilities
have been collecting revenue in the form of user fees for
more than half a century.
 However, these fees have never been systematically
revised and no longer reflect the cost of providing
services, nor have the fees been adjusted based on the
user’s ability to pay for them.
5. User Fee Setting and Revision…
 The health care financing strategy clearly stipulated that
user fees needed to be revised to reflect the costs of
delivering health care services,
 But also underscored that individuals should be charged
according to their ability to pay.
 Cost sharing between the government and users was one
of the principles of the health care financing strategy.
6. Initiation of Health Insurance
 Direct payment at the time of sickness is considered inequitable
as they are regressive, allowing the rich to pay the same amount
as the poor for services.
 It could inhibit access, especially for the poor, and because of
“the risk of impoverishment or hardship,”.
 The WHO report, households spending more than 40 percent of
their disposable income, they could become impoverished.
 Given the poverty level of nearly one-half of the population in
Ethiopia, it is likely that households who decide to use health
services could easily slip into
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BY:Friehiwot.M 83
6. Initiation of Health Insurance…
 Health spending also accounts for a significant proportion of
household disposable income,
 And this level of spending could be prohibitive for accessing
health care services.
 Thus, the government is in the process of initiating health
insurance schemes,
 Social health insurance for the formal sector,
 Community-based health insurance for citizens in the
informal and agriculture sectors.
 Private health insurance for
05/28/2021
private sectors
BY:Friehiwot.M 84
7. Establishment of A Private Wing in Public
Hospitals
 In most regions and at the federal level, public hospitals

are allowed to open and operationalize a private wing with
the primary objective of
 Improving health workers’ retention,
 Providing alternatives choices to private health service
users, and
 Generating additional income for health facilities.
8. Health Facility Autonomy through
Establishment of Governing Bodies
 Before the introduction of health financing reform,
Ethiopian health facilities experienced cumbersome
and ill-timed communications regarding major
executive decisions from RHBs and woreda health
offices.
 These decision makers were also physically detached
from the health facilities and were not responsive to
day-to-day client health service needs.
8. Health Facility Autonomy…
 So the need for health facility autonomy through

establishment of a health facility governing body was
critical, as was involving appropriate representatives
from the local administration, the health facility, and
the local community.
Role of government in health care
 For every country to establish the best and fairest

health system possible , the health of the people must
always be a national priority
 Financing
 Delivery
 Regulation
 Guideline setting
Why do government set involved in
health care?
 Market failure
 Stewardship
 Needs healthy workforce
 Increasing commitment to equity
 Reduce social unrest
 Dogma/ideology
Thank you
Decision making
Session objectives
At the end of the session students be able
 Define decision making
 Describe the relationship b/n decision making

and other functions of mgt
 Describe types of decisions
 Determine decision making steps

 Identify factors influencing problem solving &
decision making
Decision making and problem solving
 Decision-making: the process of identifying and
selecting a course of action to solve a specific
problem.
 It is a major part of management since in all
management function managers make decisions
on a daily basis.
 It requires choosing among alternative courses
of action.
 Decisions must be made at many levels in an
organization from executive decisions on the
goals to the day to day repetitive operations
performed by lower level managers
Interrelations of the mgt process functions
Planning
Controlling Organizing
Decision
making
05/28/2021
Leading BY:Friehiwot.M
Staffing 94
Steps in decision making
In decision making process there are 7 steps:
1. Identifying and defining the problem
2. Identifying limiting factors
3. Developing potential alternatives
4. Analyzing the alternatives
5. Selecting the best alternatives
6. Implementing the decision
7. Establishing monitoring and evaluation system
Types of decision
There are deferent types of decision
1. Ends-means
 Ends: decision making based on our objectives
 Means: decision making based on our Strategies and
activities
2. Administrative-operational
 Administrative decisions: made by senior managers
 Policy decisions, resource allocation and utilizations
 Operational decisions: made by mid-level and first-
line managers
 Day-to-day activities, e.g. personnel deployment,
purchases, specific work assignments etc.
Types of decision….
3. programmed – non-programmed
 Programmed decisions are decisions which are similar and made so
often repetitive and routine.
 Mostly made by mid and low level managers
– E.g. patient admission, scheduling , inventory and supply ordering
 Non-programmed decisions are unique and non-routine and may

have unclear implications for the organization, requiring creative
problem solving because they are unfamiliar.
 Mostly made by top level managers
E.g. Decision to expand, add BY:Friehiwot.M

05/28/2021 or closes services 97
Ways of decision making
1. Individual decision making solving problems individually it
depends on :
 Style of the leader
 Ability to set priorities
 Timing of decision
 Creativity of the manager
2. Group decision making: is a process of solving problems

jointly
 It plays a key role in health care management
 very important in non-programmed
05/28/2021 BY:Friehiwot.M
decision making 98
Techniques of group decision making
1. Brain storming:- group effort are generating ideas and
alternatives that can help to solve a problem.
 Generates more information for decision.
 Dominant groups can be a problem.
2. Nominal group technique:- tries to solve the problem of

brain storming as the problems are identified individually.
 Group members are presented with a problem; each
member independently writes down his or her ideas on the
problem, and then each member presents one idea to the
group
05/28/2021 until all ideas have BY:Friehiwot.M
been presented. 99
Techniques of group decision …
 No discussion takes place until all ideas have been
presented
3. Delphi technique:- A group decision making
conducted by a group leader through the use of
written questionnaires.
 It provides equal opportunity to participants.

Out comes of group decision making
 Indecision: failure to decide (disagreement)
 Authority rule: Decision by the team leader
 Minority rule: Decision dominated by few influential

individuals.
 Majority rule: decision dominated by the majority
 Consensus: Immediate agreement without thorough
discussion
 Unanimity: agree after through discussion and
argument
Thank you

By: Friehiwot Molla (BSC, MPH) E-Mail: May 2021 Debremarkos, Ethiopia

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Debre Markos University

College of Health Sciences

By: Friehiwot Molla (BSC, MPH)

 In the private sector, multinational companies may establish

 Globally, the health sector is an important part of the

 Because the nature of decision making in health

- Which aimed to provide cost-effective basic services to

 It underpinned by the core principle of community

2. Development of the preventive and promotive

5. Promotion of attitudes and practices conducive to the

 Information, Education and Communication

 Control of communicable diseases and epidemics

 Promotion of occupational health and safety

 Development of environmental health

 Rehabilitation of health infrastructure

 In addition, the policy gives special attention to the

 Development of human resources for health (HRH),

 Applied health research, addressing the major health

‐ Develop and deploy appropriate health personnel

HSDP IV (2010 –2015) …

The priorities and targets of the HSDP IV

 Sometimes policy is called a plan or a program,

 Such a plan allows the implementation of the vision, values,

 A plan usually includes strategies, time frames, resources required,

Step 4: Exchange with other countries

Step 6: Determine areas for action

Step 7: Identify the major roles and responsibilities of

When do we say a health system has fulfilled its role?

How is the delivery system organized in Ethiopia?

 The structure of primary healthcare units in rural and

 Medical products, vaccines and technologies

 Describe the basic function of HCF

 Healthcare financing is a mechanism that deals with

b)Social health insurances sponsored or mandated by

 Wider effects of the health

A. Viability and ease of using the system

 The World Health Report of 2010 identified three

 Health Care Financing Reform is an alternative

 Implement the fee waiver system.

 Hospital management was spending considerable time

 In most regions and at the federal level, public hospitals

 So the need for health facility autonomy through

 For every country to establish the best and fairest

 Describe the relationship b/n decision making

 Determine decision making steps

 Non-programmed decisions are unique and non-routine and may

E.g. Decision to expand, add BY:Friehiwot.M

2. Group decision making: is a process of solving problems

2. Nominal group technique:- tries to solve the problem of

05/28/2021 BY:Friehiwot.M 100

 Authority rule: Decision by the team leader

 Minority rule: Decision dominated by few influential

05/28/2021 BY:Friehiwot.M 102

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