Administration of Health Facilities and Resource Management PDF

ADMINISTRATION OF HEALTH FACILITIES AND RESOURCE MANAGEMENT. PUT 727: Principles of Teaching and Administration Applied to Nursing BY MAGNUS CHINEDU APUANU PhD(in view), DPA(in view), MSc.(Midwifery), MSc.(OH&S), MSc.(Medical...

ADMINISTRATION OF HEALTH FACILITIES AND RESOURCE MANAGEMENT. PUT 727: Principles of Teaching and Administration Applied to Nursing BY MAGNUS CHINEDU APUANU PhD(in view), DPA(in view), MSc.(Midwifery), MSc.(OH&S), MSc.(Medical Education), MPA(Executive), MPH, PGDE, PGCert(Nuclear Science), AdvDip(Critical Care Nursing), BNSc, RN, RM, RPHN, RCCN, RNE, AEP, CMC, MNIM, MISPN, FIMC, FCP.  CLASS INTRODUCTION NAME BACKGROUND LOCATION 2  TOPICS COVERED  Concept of Resource Management— Human resources, Material resources, Financial resources, Time, Space.  Functions of Human Resource Management for Health care services—Personnel functions, Managerial functions  Key problems/Constraints in health resource management 3  TOPICS COVERED  Health facilities—Primary health facilities, Secondary health facilities, Tertiary health facilities.  Primary health care levels (personnel)  Problem solving and Decision making  Contemporary issues in Nursing Administration 4  SCHEDULE Days Topics Day 1  Concept of Resource Management— Human resources, Material resources, Financial resources, Time, Space.  Functions of Human Resource Management for Health care services—Personnel functions, Managerial functions Day 2  Key problems/Constraints in health resource management.  Health facilities—Primary health facilities, Secondary health facilities, Tertiary health facilities. Day 3  Primary health care levels (personnel).  Problem solving and Decision making. Day 4  Contemporary issues in Nursing Administration 5  DAY 1 CONCEPT OF RESOURCE MANAGEMENT 6  Lecture Outline Definition of resource Classifications of resource Characteristics of resource Health resource Management of resources Human resource management Non-human resource management 7  Learning Objectives Discuss the concept of a resource Identify the various resources in healthcare Explain the need for managing resources Analyze the management process. Apply the various human resource management functions in the administration of healthcare services Develop a positive leadership trait in managing human and material resources in healthcare 8  Definition of Resource  A resource is anything that is needed to execute a task or project. Fig.1: Executing a task 9  Definition of Resource  It means anything that can give help or support when needed in order to achieve a goal or objective by an individual, group of individuals or an organization. Money A worker A computer Fig 2. Examples of a Resource 10  Classifications of Resource Resources can be classified in different ways. Human/non-human or material resources Individual/shared resources Natural/community resources 11 Classifications of Resource 12 Classifications of Resource 13 Classifications of Resource 14  CLASS ACTIVITY Think of your own self and make a list of the human resources you have. 15 Characteristics of Resources 16  Characteristics of Resources Utility: Utility means the importance or usefulness of a resource in helping one to achieve a goal. All resources have utility, which means they have the want-satisfying power. Accessibility: Resources are accessible For use. Interchangeability: One resource can be exchanged for another. E.g, a human resource (skill) can be exchanged for a non-human resource (money). 17  Characteristics of Resources Limitedness: All resources are limited. They are scarce, and some are more scarce. Manageable: Resources can be managed, meaning management process can be applied to all resources. Interrelatedness: All resources are interrelated. The use of one resource depends on the use of other another resource. 18  Health resource A health resource is the resource needed to perform healthcare activities. It includes the materials, facilities, health supplies, and equipment required to diagnose, mitigate or prevent the impairment of, improve, treat, cure, or restore the physical or mental health conditions of the population It can be human or non-human 19 Health resource Examples of health resource 20  Resource Management All resources are scarce. None of the resources is unlimited. Thus, effective management of resources is extremely essential. Resource management is the efficient and effective deployment of an organization’s resources when they are needed. It is about getting the most from the resources which are available to us. 21 Resource Management Process Planning Organizing Implementating Controlling Evaluation 22 Resource Management Techniques Resource Planning Resource Forecasting Resource Allocation Resource Scheduling Resource Leveling Resource Smoothing 23  Human Resource Management Human resource is the set of people who make up the workforce of an organization - the personnel. The human resource is the most valuable or strategic out of all the resources in organizations, because it is the personnel that put other resources in the organizations to use.  All organizations have their objectives or purpose, but it is people/personnel that will perform the tasks that will make these objectives attainable. 24  Human Resource Management  Human resource management (HRM) means managing people in any organization.  According to Wendell L French, “human resource management refers to the philosophy, policies, procedures, & practice related to the management of people within an organization. 25  Human Resource Management Human resource management is concerned with the most effective use of people to achieve organizational and individual goals. It addresses the need to ensure that qualified and motivated personnel are available to staff the organization. It entails creating a sustainable workforce and involves keeping the jobs filled with people who have the right knowledge, skill and attitude. 26  Human Resource Management Human resource management is concerned with the most effective use of people to achieve organizational and individual goals. It addresses the need to ensure that qualified and motivated personnel are available to staff the organization. It entails creating a sustainable workforce and involves keeping the jobs filled with people who have the right knowledge, skill and attitude. 27  HRM  HRM operates through human resource systems that bring together in a coherent way:  HR philosophies describing the overarching values and guiding principles adopted in managing people.  HR strategies defining the direction in which HRM intends to go  HR policies, which are the guidelines defining how these values, principles and the strategies should be applied and implemented in specific areas of HRM.  HRM  HR processes consisting of the formal procedures and methods used to put HR strategic plans and policies into effect.  HR practices comprising the informal approaches used in managing people.  HR programmes, which enable HR strategies, policies and practices to be implemented according to plan  Features of HRM People Oriented Continuous HR Individuality M Oriented Pervasive 30  IMPORTANCE OF HRM HRM is important for the organization, for the employee, and for the society. For the Organization - Attracting and retaining the best people - Developing right attitudes among the employees - Securing willing cooperation of employees - Effective utilization of available human resources - Ensuring that organization will have in future a team of competent and dedicated employees.  IMPORTANCE OF HRM For the Employee - Maintains the dignity of the employees as human beings - Provides a healthy working environment for employees - Provides maximum opportunities for personal development - Improves the employees’ skills and capacities - Promotes team wok & team spirit among employees  IMPORTANCE OF HRM For the Society - Provides suitable employment, which in turn provides social and psychological satisfaction to people. - Helps to speed up the process of economic growth which, in turn, leads to higher standards of living  FUNCTIONS OF HUMAN RESOURCE MANAGEMENT FOR HEALTH CARE SERVICES 34  HRM Functions Managerial Functions HRM Functions Personnel Functions 35  HRM Functions Planning Organizing Directing Controlling Managerial Functions 36  The Managerial Functions 1.Planning – workforce planning, personnel programs, etc. 2.Organizing – allocating task as per their skills, grouping of personnel activity into functions or positions, coordinating activities of different employees. 3.Directing – guide and motivate the employees to accomplish organizational goal. 4.Controlling – Regulation of activities in accordance with the plans  Personnel Functions Job analysis Job description and job specification Recruitment Selection/Interview Personnel Placement Functions Induction and orientation Training Managerialand development Functions Compensation, promotion, and benefits Appraisal Employee relations and engagement Exits and separation 38  Job analysis This is the process of determining the duties and skill requirements of a job, and the kind of person who should be recruited for it. It involves identifying those unique responsibilities, duties, and activities specific to every position in the organization. The main purpose of job analysis is to prepare job description and job specification, which will in turn help to hire the right quality of workforce into the organization. 39  Job description & job specification A job description is what the job entails, i.e. what one will be doing if employed or appointed to a position. A job specification on the other hand is what is required of one to qualify to get the job, such as educational qualifications, professional qualifications, individual characteristics, etc. 40 Job description & job specification 41  Recruitment This involves all set of activities in identifying, searching and attracting candidates to fill current and future positions in an organization. There are basically two sources for recruitment, the internal and external sources. 42 Recruitment  Selection and Interview Selection is the process of choosing the most suitable candidate out of many interested ones to occupy identified job positions. Interviews are conversations whereby a candidate interacts with one or more people who assess the candidate and decide on whether this person should be offered a job. Interviewing helps to determine if an applicant's skills, experience and personality meet the job's requirements. 44  Placement  Placement is the process of assigning a specific job to each one of the selected candidates.  It implies assigning a specific rank and responsibility to an individual.  It follows after successful candidates have been selected and interviewed.  Proper placement makes the employee happy and reduces absenteeism and labour turnover.  Principles of Placement  1. Job requirement: An employee should be placed on the job according to the requirements of the job. The job shouldn’t be adjusted according to the qualification and abilities of the employees.  2. Suitable Qualifications: The job should be offered to only that person who is suitably qualified. The placement should neither be higher nor lower than the qualifications.  3. Adequate Information: All the information and facts relating to the job should be given to the employees along with the prevailing working conditions in the organization.  Principles of Placement  4. Loyalty & Co-operation: While introducing the job to the new employee, an effort should be made to develop a sense of loyalty and cooperation cooperation in him so that he may realize his responsibilities better towards the job, the organization and his associates.  5. Flexibility: There should be some elements of flexibility. The placement in the initial period may be temporary as changes are likely after the completion of training. The employee may be later transferred to the job where he can do better justice.  Induction and Orientation  Induction and orientation are the sum total of activities undertaken by employer (management) to introduce a new employee to the organization, the co-workers and the job.  It is the welcoming process to make the new employee feel at home and generate in him a feeling of belongingness to the organization.  The process communicates the basic organizational philosophy, policy, rules, and procedures.  Contents of an Induction Programme  1. Organization’s history, mission, vision and philosophy.  2. Products and services of the organization.  3. Organization’s structure (organogram).  4. Location of departments, units and employee services  5. Employees activities like clubs, credit society.  6. Personnel policies and procedures.  Contents of an Induction Programme  7. Rules and Regulations.  8. Terms and conditions of services.  9. Grievance procedures.  10. Safety measures.  11. Benefits and services for employees.  12. Training, promotions and transfer facility  13. Career advancement schemes.  14. Counseling facility  Training and Development  This is a learning process that involves the acquisition of knowledge, sharpening of skills, concepts, rules, or changing of attitudes and behaviours to enhance the performance of employees in the workplace or to enable the learner attain a required level of knowledge or skill.  It is defined as the process of instilling candidates with the necessary skills to allow them to perform a specific role.  This function allows employees to acquire new skills and knowledge to perform their job effectively.  Training and Development  There are two types of training:  1. On-the-job training  2. Off-the-job training  Compensation, Promotion, and Benefits  This is concerned with adequate and equitable remuneration of the employees in the organization of their contribution to the organizational goals.  Compensation is a systematic approach to providing monetary value to employees in exchange for work performed. It refers to any payment given by an employer to an employee during their period of employment. E.g, salary, wages, bonuses, paid leave, etc.  Compensation, Promotion, and Benefits  Promotion means the advancement of an employee to a higher job involving more work, greater responsibility and higher status.  It is one of the best forms of incentives and it provides higher responsibilities, better salary, high morale and job satisfaction to the employees.  Promotion may be classified into the following types: Compensation, Promotion, and Benefits Types of Promotion Horizotal Promotion Vertical Promotion Dry Promotion  Compensation, Promotion, and Benefits Horizontal Promotion: This kind of promotion rewards an employee with a pay increase but little to no change in responsibilities. E.g, the move from lecturer to senior lecturer, Nursing Officer II to Nursing Officer I, etc. There is no clear increase in responsibilities  Compensation, Promotion, and Benefits Vertical Promotion: This is the traditional promotion that everyone has gotten used to. When an employee is shifted from a lower category to higher category with increase in pay, status and responsibility, it is called vertical promotion. E.g, from a Ward Manager (In-charge) to Assistant Director of Nursing Services (ADNS).  Compensation, Promotion, and Benefits Dry Promotion: This is the type of promotion that is made without increase in salary or remuneration. There is an increase in duties and responsibilities without benefits having been positively affected. E.g, a Professor promoted as Head of the Department (HOD).  Important Principles of Promotion  1. Uniformity: There must be a uniform distribution of promotional opportunities throughout the organization.  2. Consistency: Promotion should have consistency, that is, it must be applied to all personnel concerned, not a sudden spurt and ad hoc to benefit a few individuals.  3. Fair and Impartial: Promotion should be fair and impartial. Fairness and impartiality in promotion ensure that only right personnel are promoted, and other factors such as family connection, ethnic or religious considerations, etc. do not play their role.  Important Principles of Promotion  4. Planned Activity: Promotion should be undertaken as a planned activity and as a regular process, rather than ad hoc process.  5. Sound Basis of Promotion: There should be sound basis of promotion and it must be made known to the employees.  6. Sanction: All promotions should be officially sanctioned (officially approved) by the concerned authority.  7. Follow-Up: There should be a suitable system of follow-up to assess the how the promoted employee is working in his new position.  Performance Appraisal  This is also called performance review, performance evaluation, development discussion, or employee appraisal.  It is the periodic assessment of an employee’s job performance as measured by the competency expectations set out by the organization.  It evaluates an employee’s skills, achievements, and growth, or lack thereof. Types of Performance Appraisal Self- assessment Types of Negotiated appraisal Performanc Peer assessment e Appraisal 360-degree feedback assessment  Types of Performance Appraisal  Self-assessment: Here the employee themselves rate their job performance and work behavior  Peer assessment: Under this assessment, the team members, co-workers, and workgroup are responsible for the performance rating of the employee.  360-degree performance appraisal: In this type of appraisal the performance rating is collected from the employee, their immediate supervisor, and peers. It includes input from an individual, supervisor, and peers.  Types of Performance Appraisal  Negotiated appraisal: This involves the use of a mediator during the employee evaluation.  The mediator evaluates the performance of the employee and puts focus on the good side of performance rather than the criticism  The negotiated appraisal is a new trend of appraisal is utilized in situations of conflict between employees and their supervisors.  Methods of Performance Appraisal  The methods of performance appraisal are broadly classified as traditional and modern methods of performance appraisal.  The traditional methods lay more emphasis on rating of individuals' personality traits, such as initiative, dependability, drive, creativity, integrity, intelligence, leadership potential, etc.  The modern methods have a broader scope than the traditional methods, and provide a more accurate and comprehensive evaluation of an individual.  1. Rating Scale  Rating scale rates employees on a fixed scale based on the qualities they are required to possess.  The required qualities (e.g. attitude, initiative, dependability, etc) are quantified on a Scale, in range of “Excellent” to “Poor”  The performance of the employee is then calculated.  The final score obtained classifies employees into various tiers and helps in their performance evaluation. Rating Scale  2. Checklist  This is a list of employee traits in the form of statements, consisting of a column of ‘Yes’ and ‘No’ for the different employee traits.  The rater has to put a tick mark in “Yes” or “No” column against the trait checked for each employee, based on if the traits exist or do not exist in the employee. Checklist  3. Forced Choice Method  This method was contributed by J.P. Guilford.  In this method, different ready-made statements about the performance of the employee are provided, and the rater is forced to answer the statements as true or false.  These statements are a combination of positive and negative statements and are arranged in blocks of two or more. Forced Choice Method  4. Forced Distribution Method  This technique was contributed by Joseph Tiffi.  This method of performance appraisal is based on the assumption that employee’s job performance conforms to the normal distribution curve, and can be plotted in a bell-shaped curve.  Here 10% of the employees are given excellent grade, 20% are given good grade, 40% are given the average grade, next 20% are given the below average grade and last 10% are given unsatisfactory grade. Forced Distribution Method  5. Critical Incidents Method  This method evaluates an employee on the basis of certain `events' or `episodes' known as critical incident.  Here, the critical behavior of the employee is considered while evaluating the performance. Traditional Methods 6. Behaviorally Anchored Rating Scale (BARS)  BARS combines the benefits of Essay Method, Critical Incident and Rating scales.  Here, different descriptive statements about the behaviour of the employee, both effective and ineffective, are prepared.  These behaviour are put on the scale points and the rater has to indicate the points which explain the employee behavior the best. BARS  7. Field Review Method  Under this method, the performance evaluation of an employee is done by someone who does not belong to his department.  The outsider reviews the performance of an employee through his (employee’s) records and interviews.  For example, the performance of a Nurse in the Accident and Emergency Ward could be evaluated by someone from the SERVICOM unit.  8. Performance Tests and Observations  This is a kind of written or oral test that is conducted to test the skills and knowledge of the employees in their respective fields.  The employees sometimes receive a situation and are asked to demonstrate their skills and then their performance is evaluated based on that presentation.  For example, the performance of a Nurse in the Labour Ward can be evaluated by asking her questions on “Stages of Labour” or asked to demonstrate the Pinard maneuver or McRoberts maneuver.  9. Confidential Reports  Here, the evaluation is done by the immediate boss or supervisor.  The employees are evaluated based on the parameters such as leadership quality, teamwork, integrity, technical ability, attendance, etc.  The reviewer sends the confidential review to the concerned authority about the performance of the employee.  10. Essay Method  In this method, the rater writes a narrative description of an employee’s strengths, weaknesses, past performance, potential and suggestions for improvement.  11. Cost Accounting Method  This is also known as Human Resource accounting method.  In this method, the employee’s performance is evaluated in monetary terms, i.e. how much cost an organization is incurring on keeping the employee and how much the employee is contributing to the organization in terms of output.  12. Comparative Evaluation Approaches  Under this method, the performance of one employee is compared with that of another Co-worker, and the rating is determined accordingly.  There are basically two ways to conduct comparative evaluation; they are Ranking Method and Paired Comparison Method.  In Ranking method, employees are ranked from the best to the worst according to their performance level. 12. Comparative Evaluation Approaches  Under the paired comparison method, the pairs of employees of same job post or level are formed, following which they are evaluated on the basis of performance of each other.  Modern Methods  1. Management by Objectives (MBO) – This concept was given by Peter F. Drucker. In this method, the performance of an employee is assessed on the basis of the targets achieved by him as set by the management of an organization.  The performance of an employee is compared against the set goals of the organization. 1. Management by Objectives (MBO)  2. Psychological Appraisals  In this method, a psychologist assesses the employee’s potential for future performance rather than the past one.  This is done through in-depth interviews, psychological tests, discussions with the supervisors and the reviews of other evaluations.  This assessment is done to determine the intellectual, emotional, motivational and other related characteristics of an employee that is necessary to predict his potential for the future performance  3. Assessment Centres  In this method, employees are taken to a place away from work (the Assessment Centre) and a series of tests and exercises are administered to actually evaluate the performance of the employees.  The exercises include discussions, role-playing, computer simulations, and many more.  The employees are evaluated in terms of communication skills, mental alertness, emotional intelligence, confidence, and administrative abilities.  3. Assessment Centres  This entire exercise is done under a trainer who observes the employee behavior and then discusses it with the rater who finally evaluates the employee’s performance.  This method is mainly used to evaluate executive and supervisory potential.  4. 360-Degree Feedback  Under this method, an employee’s job performance is appraised by the help of the factors that are present around him at the workplace, such as the immediate supervisors, superiors, team members, peers and self. Supervisors Peers 360 Superiors degree Appraisal Team Self members  5. 720-Degree Feedback  Here, the assessment is done not only by the help of the factors that are present at the workplace but also from the outside of the workplace, such as customers, investors, outside experts, suppliers, regulators, etc. Employee Relations and Engagement  Employee relations consist of all those areas of human resource management that involve relationships with employees – directly and/or through collective agreements where trade unions are recognized.  They consist of the approaches and methods adopted by employers to deal with employees either collectively (through their trade unions) or individually. The Elements of Employee Relations  The formal and informal employment policies and practices of the organization.  The development, negotiation and application of formal systems, rules and procedures for collective bargaining, handling disputes and regulating employment.  Policies and practices for employee voice and communications. The Elements of Employee Relations  The informal as well as the formal processes that take place in the shape of continuous interactions between managers and team leaders or supervisors on the one hand and employee representatives and individuals on the other.  The philosophies and policies of the major players in the industrial relations scene: the government of the day, management and the trade unions.  The legal framework – Labour Act, Trade Union Act, the National Industrial Court of Nigeria Act, the Nigerian Constitution (Section 254C), Trade Disputes Act, etc.  The Elements of Employee Relations  A number of institutions such as the employment tribunals, Industrial courts, Federal Ministry of Labour, etc.  Employee Engagement  Employee engagement is how much an employee is committed to helping their organization achieve its goals.  Gallup defines employee engagement as the involvement and enthusiasm of employees in their work and workplace.  It is demonstrated by how employees think, feel, and act, as well as the strength of the mental and emotional connection employees feel towards their organization, their work, and their team. Employee Engagement  Employee Engagement  Based on their perceptions of their workplace, employees are categorized into four main groups/levels:  The VOICE framework  John Storey et al. (2009) outlined the ‘VOICE framework’ as a useful model for for achieving employee engagement. V VISION O OPPORTUNITY I INCENTIVE C COMMUNITY E EXPERIMEN TATION COMMUNI IMPACT CATION  The VOICE framework  a. Vision: The Vision identifies the objectives of an organization and helps define what they hope to accomplish. It serves to unite the people by pointing toward a destination.  It involves the use of good leadership techniques which give the organizational unit a clear sense of the future that engages hearts and minds and creates pride among employees.  The VOICE framework  b. Opportunity: The work on offer provides a chance for the employee to grow both personally and professionally, through participation in the organization’s activities.  c. Incentive: The compensation package is fair and equitable, including base salary, bonus, and other financial incentives.  d. Impact: The work itself makes a difference or creates meaning for the employee  The VOICE framework  e. Community: The social environment includes being part of a team when appropriate, and working with co-workers who care.  f. Communication: The flow of information is two-way, so employees are in the know about what is going on.  g. Experimentation: Work practices i.e., the hours of work, dress code, and other policies are flexible and designed to adapt to the needs of both the organization and the employee.  Exits and Separation  Employee separation refers to the circumstances, timing and method by which an employee leaves his/her job.  Separation and exit can happen when an employment contract or an at-will agreement between an employer and an employee ends.  An employee might quit, might get fired, or might retire after years of service. An employee may be separated as consequence of resignation, death, permanent incapacity, retrenchment or lay-off.  Exits and Separation  Employee separation can be divided into two broad categories: voluntary separation and involuntary separation.  Voluntary separation is initiated by the employee. It is when the employee quits the organization on his or her own accord.  Whereas, involuntary separation is initiated by the employer, where an employee is asked by the organization/management to quit. Exits and Separation MATERIAL RESOURCE MANAGEMENT 108  Material Resources Non-Human (material) Resources are time, money, properties, goods, facilities, etc. Material resources can be classified as consumable resources and non- consumable resources. Non- consumable resources are the resources which could be repeatedly used (but may eventually have to be replaced or updated). 109  Non-Consumable Resources Non-consumable resources may include thermometer, sterilizer, scale, surgical instruments, furniture (including beds), computers, printers, scanners, books, electrical goods, etc. 110  Consumable Resources Consumable resources are resources that get consumed or get exhausted in the process of their usage. They include all the medicines, drugs, vitamin supplements and infusion fluids, gloves, cotton wool, tape/adhesive, gauze, paper, cartridge ink, chemicals, etc. 111  Consumable Resources It is important to maintain demand and supply cycle of these resources for smooth functioning of an organization. Healthcare organizations need to actively manage what is bought, when it is bought, how much, as well as for what price, including discounts and rebates. 112 Material Resource Management Material resources management (MRM) is the process of mobilizing and deploying material resources to support the efficient provision of effective health services. It is concerned with the integrated approach to planning, organizing, controlling of the flow of materials as per the demands, purchase and distribution to the consumers. 113 Material Resource Management MRM aims to ensure the availability of the right materials (in terms of quantity and quality) at the right time, in the right place, and at a minimum cost. Material resource management is as important as the human resource management. It is basic, because no organization can operate or survive without it. 114  MRM Process Planning Material Utilization Resource Procurement & Control Management Storage & Distribution 115  Planning Planning for the material resources is a scientific way of determining the material needs an organization. This would involve determining the consumption patterns of the institution, material resource requirements of the institution, quantity needed, taking account of the available material stock, and listing the sources of supply available. 116  Purchase/Procurement Procurement includes sourcing, obtaining and paying for the material resources. It also include selecting the vendors from where the material can be procured, negotiating price for quality, receiving and inspection and inventory control. Procurement is the activity responsible for placing the right quantity of material to the right place at the right time for right price. 117  Storage and Distribution Storage is an important function to ensure that materials are maintained in proper shape and condition and that there is no wastage. It also helps in proper identification and retrieval of items at the right time without any wastage of time and effort. Storage management deals with keeping the materials safely without deterioration, pilferage or theft and in a cost effective manner. 118  Storage and Distribution Distribution of material resources involves the careful movement of the materials from where they are stored to the point of consumption or utilization. Storage and distribution of materials are essential aspects of material resource management. When materials are supplied or purchased for use, there is the need for proper storage. 119  Utilization and Control Utilization implies making the best use of the available material resources effectively to achieve the desired goal. It means putting the material resources into use. Control means ensuring that the material resources are utilized according to how they were planned. 120  Utilization and Control Controlling involves seeing that the utilization is according to specification and taking remedial actions when needed to prevent unsatisfactory results. Also, movement of materials (distribution) should be controlled to avoid loss of materials. Effective supervision is one of the strategies adopted to control the use of materials resources. 121  DAY 2 KEY PROBLEMS/CONSTRAINTS IN HEALTH RESOURCE MANAGEMENT 122 Problems Health in Health 1. Politicization Resource Mgt. Resource Management Problems 2. Ineffective health policy 3. Interprofessional rivalry and conflict 4. Industrial actions 5. Underfunding of the health sector 6. Corruption 7. Poor motivation of workers 8. Weak health facilities and infrastructure 9. Insecurity 123 HEALTH FACILITIES 124  HEALTH FACILITIES A health facility is a place where healthcare service is provided. It refer to the physical structure and supporting equipment established for provision of healthcare services. In Nigeria, health facilities are broadly classified into primary, secondary, and tertiary health facilities. Each level has a specific set of healthcare services that are expected to be provided. 125  HEALTH FACILITIES There are 34, 141 primary health facilities, 5,275 secondary health facilities and 155 tertiary health facilities. Primary health facilities = 88% Secondary health facilities = 12% Tertiary health facilities = 0.25% Health facilities in Nigeria can be privately owned (individuals, NGOs, religious organizations, etc.), publicly owned (local govt., state govt., federal govt.) or jointly owned (public-private partnership). 126 TYPES OF HEALTH FACILITIES Hospitals Hospice Clinics Homes Nursing Birth Centres Types Homes of Health Facility Radiology Community Centres Pharmacies Patent Diagnostic Medical Laboratories Stores 127  Hospitals Hospitals are facilities that typically have at least one doctor and offer a variety of inpatient services. Hospitals typically have a wide range of units, and their services can vary greatly depending on their size and location. 128  Clinics Clinics typically offer outpatient and more limited inpatient services. It is often for patients who need short-term care and can recover at home. 129  Nursing Homes Nursing homes are residential facilities that provide 24-hour care for the elderly or disabled. They are facilities owned and operated by a Nurse or Midwife with at least five years of experience. According to Nigerian federal law, nursing homes should have access to a doctor at all times so that they will know when to refer patients whose conditions are beyond their capacity to treat. 130 Nursing Homes 131  Community Pharmacies Community pharmacies are stand-alone retail pharmacies that employ a trained pharmacist and that are licensed by the Pharmacy Council of Nigeria to sell prescription pharmaceuticals. 132  Patent Medicine Stores Patent medicine stores are stand-alone medicine shops licensed by the Pharmacy Council of Nigeria that are only allowed to sell certain basic (over-the-counter) medications. Patent medical vendors are not required to employ any formally trained health workers, though many do. 133  Diagnostic Laboratories Diagnostic Laboratories are health facilities that completes diagnostic tests ordered by physicians and primary care providers. Using biological specimens, such as blood, urine, or saliva, medical laboratory scientists/technicians run tests to help diagnose, treat, and monitor a patient’s health 134  Radiology Centres Radiology or imaging centers are health facilities that offer diagnostic imaging services to patients. Diagnostic imaging includes CT scans, ultrasounds, X-rays, MRIs and more. 135  Birth Centres A birth center is a healthcare facility for childbirth that focuses on the midwifery model. Birth centers typically aim to offer the mother and family a comfortable birth environment, and allows for a cost-effective, family-inclusive birth. Unlike hospitals, birthing centers do not typically employ specialized staff for difficult births, such as surgeons that are prepared to perform C-section surgeries. 136  Birth Centres For this reason, birth centers are typically only an option for scheduled pregnancies that do not have any known complications or risks. 137  Hospice Homes Hospice homes are health facilities which aim to improve the quality of life for people with advanced and end-stage illnesses, as well as their families and caregivers. Unlike most health care institutions, which only provide medical care services to patients, hospice care facilities often employ a diverse group of health care providers that also take care of the patients' emotional, spiritual and social needs. 138  Hospice Homes A patient with hospice care has a team of care providers made up of the patient's personal physician, a hospice physician, nurses, home health aides, social workers, clergy or other counselors and physical or occupational therapists, if needed. 139 LEVELS OF HEALTH FACILITIES 140  LEVELS OF HEALTH FACILITIES The World Health Organization (WHO) categorized healthcare facilities into three levels: Level 1: Small hospital/health centre (Primary health facilities) Level 2: District/provincial hospital (Secondary health facilities) Level 3: Referral hospital (Tertiary health facilities) 141  Primary Health Facilities These are the facilities that normally provides primary health care services—maternity services, accident and emergency services, treatment of minor ailments, etc. These facilities are usually comprised of a small number of beds and a sparsely equipped procedure room (but not operating theatre). Patients with advanced or complicated ailments are referred to a higher level facility. 142  Primary Health Facilities Examples of primary health facilities include Primary Health Centres, Community Health Centres, Maternity Homes, Nursing Homes, outpatient clinics, clinics operated by industrial firms, Health posts, community pharmacy, Dispensary, etc. 143  Secondary Health Facilities These are health facilities that provides secondary health care services. They are the smaller, non-departmentalized hospitals. Services offered to patients with symptomatic stages of disease, which require moderately specialized knowledge and technical resources for adequate treatment. The different secondary health care facilities are general hospitals, comprehensive health center, district hospital, specialist and general hospitals. 144  Tertiary Health Facilities These are health facilities that provides tertiary health care services—the highly technological and sophisticated services offered by medical centers and large hospitals. Services rendered at this level are for clients afflicted with diseases which seriously threaten their health and which require highly technical and specialized knowledge, facilities and personnel to treat effectively. 145  Tertiary Health Facilities Tertiary health facilities are the specialized national hospitals (National Orthopedic Hospital, National Ear Care Centre, etc.), Teaching Hospitals, Federal Medical Centres (FMCs), national laboratories. 146 PRIMARY HEALTH CARE LEVELS (PERSONNEL) 147  Primary Health Care Levels The health workforce is composed of a wide range of health professionals, including medical doctors, nurses, midwives, clinical officers or physician assistants, laboratory technicians, pharmacists, community health workers (CHWs), etc., plus management and support staff. The three levels of primary health care personnel are: Village health workers Intermediate health workers First line hospital personnel 148  Village Health Workers These are the first contacts of the community and initial links of health care. They consist of lay people who comes from the local community and is trained in basic medical care. They provide simple curative and preventive health care measures promoting healthy environment. They include Community health workers, volunteer village health workers, traditional birth attendants, etc. 149  Intermediate Health Workers These are the professional group that represent the first source of professional health care. They attend to health problems beyond the competence of village health workers They include Medical officers, Public Health Nurses, Midwives, community health officers. 150  First Line Hospital Personnel These provide backup health services for cases that require hospitalization, and establish close contact with intermediate level health workers or village health workers. They include Physicians with specialty, Specialist Nurses, Dentist, Pharmacists, other health professionals 151