Health System Management: Part-1

Health System Management: Part-1

Proloy Barua*, Dr Phudit Tejativaddhana**, Reggie Dalman Hinoguin***

* PhD student, College of Health Systems Management (CHSM)
** Assistant Professor, CHSM
*** Lecturer, CHSM

In the previous post, we talked about health system (Health System). In this post post, we briefly discuss health system management and its basic components. To understand health system management, we have to know first the definition of health system and management because these two key terms will lead us to understand health system management. In Part-1, we briefly discuss the classical approach of management.

Health System: According to Dr Prawase Wasi “Health means perfect happiness in physical, mental and social aspects, which is the ultimate goal of life and development, and the linkage of all factors affecting health is called health system.” A health system of a country or a region is dependent on its specific cultural, governmental, social, economic and political factors. So it is impractical to use the knowledge of health system from one country or region to other country or region.

According to WHO, “A health system consists of all organisations, people and actions whose primary intent is to promote, restore or maintain health”. The goal of the health system is to improve health and health equity in ways that are responsive, financially fair and make the best, or most efficient, use of available resources.

 Classical approach of management: Management means directing and controlling a group of one or more people or an organisation to reach a goal. According to Harold Koontz, “Management is the art of getting things done through and with people in formally organised groups.” According to Mary Parker Follet, “Management is the art of getting things done through people.” According to Henri Fayol, “To manage is to forecast and to plan, to organise, to command, to coordinate and to control.” Fayol’s six primary functions of management are: forecasting, planning, organising, commanding, coordinating, and controlling. These management functions are based on Henri Fayol’s 14 management principles as stated below:

(i) Division of work: Work should be divided among individuals and groups to ensure that effort and attention are focused on special portions of the task. Fayol presented work specialisation as the best way to use the human resources of the organisation.

(ii) Authority: The concepts of authority and responsibility are closely related. Authority was defined by Fayol as the right to give orders and the power to exact obedience. Responsibility involves being accountable, and is therefore, naturally associated with authority. Whoever assumes authority also assumes responsibility.

(iii) Discipline: A successful organisation requires the common effort of workers. Penalties should be applied judiciously to encourage this common effort. Workers must obey, but this is two-sided:  Workers will only obey orders if management play their part by providing good leadership.

(iv) Unity of command: Workers should receive orders from only one manager with no other conflicting line command

(v) Unity of direction: The entire organisation should be moving towards a common objective in a common direction.

(vi) Subordination of individual interest (to the general interests): The interests of one person should not take priority over the interests of the organisation as a whole. So, goals of organisation are always paramount.

(vii) Remuneration: Many variables, such as cost of living, supply of qualified personnel, general business conditions, and success of the business, should be considered in determining a worker’s rate of pay. However, Fayol pointed out that there is no such thing as a perfect system.

(viii) Centralization (or Decentralization): Fayol defined centralization as lowering the importance of the subordinate role. Decentralization is increasing the importance. The degree to which centralization or decentralization should be adopted depends on the specific organization in which the manager is working. So, it depends on condition or situation of organisation and quality of its personnel.

(ix) Scalar chain (Line of authority): Scalar chain refers to the number of levels in the hierarchy. Managers in hierarchies are part of a chain like authority scale. Each manager, from the first line supervisor to the president, possess certain amounts of authority. The President possesses the most authority; the first line supervisor the least. Lower level managers should always keep upper level managers informed of their work activities. The existence of a scalar chain and adherence to it are necessary if the organisation is to be successful.

(x) Order: Both material order and social order are necessary. The former minimises the lost time and useless handling of materials. The latter can be achieved through organisation and selection. For the sake of efficiency and coordination, all materials and people related to a specific kind of work should be treated as equally as possible.

(xi) Equity: In running an organisation a ‘combination of kindness and justice’ is needed. Treating all employees well is important to achieve equity.

(xii) Stability of tenure of personnel: Retaining productive employees should always be a high priority of management. Employees work better if job security and career progress are assured to them, an unsecured tenure and a high rate of employee turnover will affect organisation adversely. Recruitment and selection costs, as well as increased product-reject rates are usually associated with hiring new workers.

(xiii) Initiative: Management should take steps to encourage worker initiative, which is defined as new or additional work activity undertaken through self-direction.  It is source of strength of the organisation.

(xv) Team spirit (Esprit de corps): Management must foster the morals of its employees. Fayol further suggests that ‘real talent is needed to coordinate effort, encourage keenness, use each person’s abilities, and reward each one’s merit without arousing possible jealousies and disturbing harmonious relations’.

Given the complexity and dynamism of health system, classical approach of management is inefficient to some extent.  So, the neoclassical approach has emerged in health system management, which is briefly discussed in Part-2 of the article.



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–  WHO (2000) World health report 2000 – Health systems: Improving performance. Geneva: World Health Organization.
–  WHO (2007) Everybody’s business: Strengthening health systems to improve health outcomes: WHO’s Framework for Action. Geneva: World Health Organization.
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