Basic Health Planning &

Management Overview:
Concepts in Strategic
Management

AAAH Training Workshop on

Regional Guidelines for
Country Strategic Planning of
HR for Health

Mandaluyong, Philippines
5 May 2008
 Session Topics

1. Leadership and Management

2. Strategic Management,
Planning & Strategic Planning

3. Leadership as a HR Strategy
Session Objectives

1. Identify key leading & managing practices, & how they

improve delivery of health services & health outcomes
2. Define what health planning is & recognize the benefits
3. Define what strategic planning for health is & the
benefits
4. Identify the four stages of strategic planning for health,
& the resources and/or difficulties one may have when
beginning a strategic planning process.
5. Identify the six components in the HRH framework for
developing a national HR strategy
6. Understand the importance of professionalizing
leadership, one of the HRH framework components, in
national HR strategies.
Leadership and Management
Leading and Managing

“Leadership is different from management.....[They]

are two distinctive and complementary systems of
action. Each has its own functions and characteristic
activities. Both are necessary for success in an
increasingly complex and volatile...environment.”

John Kotter
Professor, Harvard University in “What Leaders Really Do”
Definitions of Leading and Managing

Leading means enabling others to face

challenges and achieve results under
complex conditions.

Managing means organizing the internal

parts of the organization to implement
systems and coordinate resources to
produce reliable performance.
Leading and Managing for Results
Strategic Management,
Planning
and
Strategic Planning
What is planning?
What is planning?

Planning is the process by which objectives

are established and the most appropriate
means to achieve them are selected, prior to
starting an action.

Planning means looking for the most

appropriate way to go from the current
situation to the desired situation.
What is planning?

All definitions of planning contain two

common elements:

1. establishment of objectives or goals

2. selection of the most appropriate means to

achieve them
What are the benefits of planning?

• Examines, analyzes, and allows for

discussion of different alternatives
• Facilitates decision-making
• Obtains greater benefits and reduce risks
• Optimizes the achievement of objectives
• Makes objectives coherent with available
resources and needs
Types of Planning

Three types of planning

• Strategic
• Tactical
• Operational

What makes them different?

• organizational scope
• execution period
Strategic Planning

• Long-term
• Involves all the organization’s management
areas
• Content is relatively general
• Focuses on broad and long-lasting issues
that ensure the organization’s long-term
effectiveness and survival
• Responsibility of the organization’s director
and executive levels
Tactical Planning

• Used by very large organizations

• Links strategic planning and operational
planning processes
• More specific than strategic planning
• Limited to a single direction, program, or
specific programmatic area with a medium-
term scope
• Responsibility of the organization’s mid-
level staff
Operational Planning

• Short-term
• Specific for the work teams of any
operational unit
• Focus is achieving objectives and carrying
out short-term activities
• Corresponds to the annual work plan
Types of Planning Compared

Type of Planning Duration Organizational Scope

Strategic Planning Long-term Upper management

(5-10 yrs.
or more)

Tactical Planning Mid-term Specific Program or

Management Unit

Operational Planning Short-term Operational units

(1 yr.)
Note on Planning in Small Organizations

Small organizations typically need only a

strategic plan and annual operation plans
What is Strategic Management?

Strategic management is the process of

• formulating, implementing and evaluating
cross-functional decisions that will enable
an organization to achieve its objectives
• specifying the organization's objectives,
developing policies and plans to achieve
these objectives, and allocating resources
to implement the policies and plans to
achieve the organization's objectives
Elements of Strategic Management

1. Strategy Formulation

2. Strategy Implementation

3. Strategy Evaluation
Strategic Management & Strategic Thinking

Strategic management applies strategic thinking

Strategic thinkers ask the question

• Is my organization (or program) doing the right things?

And then ask:

• Is my organization (or program) doing things right?

And not just:

• Is my organization (or program) doing things right?

Anecdote Reflection: The Three Generations
Anecdote Reflection: The Three Generations

Acting under the premise That’s how we have always

done it indicates the absence of analysis and
strategic thinking to define an institution’s course of
action.

We must ask ourselves:

• Why do we do what we do? Is it the right thing
to do?
• Is there another way of doing it?
• How could those we serve feel more satisfied?
Strategic Thinking ≠ Strategic Planning

Strategic thinking
• implies the capacity to manage interrelated events, systems,
processes, and people that affect the organization’s actions.
• identifies the questions whose responses will help anticipate
the clients’ and the program’s future needs
Strategic planning
• structured process aimed at improving the organization’s
future performance
• entails making decisions today to obtain results in the future;

Strategic thought is an essential ingredient of strategic

planning.
Strategic Thinking and Strategic Planning

The richness of the results of an effective

strategic planning process is directly related
to the amount and quality of strategic thinking
employed!
What is Strategic Planning?

Strategic planning is a process that

• defines long-term goals

• identifies quantitative goals and objectives
• develops strategies to achieve objectives
• finds resources to implement the strategies
Objectives of Strategic Planning

• Understand the critical aspects of the

current situation in order to transform it in
the future
• Create a shared vision of what the
organization’s (or program’s) future should
be and how to achieve it
• Select the appropriate strategies to achieve
the stated goals
Commitment to Strategic Planning – Key to Success

The strategic planning process must

secure the commitment of the majority
of the organization’s members, given
that its legitimacy will depend to a large
extent on the level of participation and
commitment.
Strategic Planning: Four Stages

Each stage responds to a question:

• Where are we?

• Where do we want to go?

• How can we get there?

• How do we ensure we get there?

 Strategic Planning Stages & Elements

Situation Analysis
1. Where are we? • External environment
• Internal environment
• SWOT Analysis
2. Where do we want to go? • Mission
• Vision
• Strategic Objectives
3. How can we get there? • Designing strategies

• Identification of expected results

4. How do we ensure we get • Monitoring indicators
there? • Means of verification
• Harmonization of strategic plan
with operational plans
Stage 1: Strategic Planning - Where are we?

3 steps

1. Analysis of the external environment

• Identification of key trends in the environment (macro & micro)
• Selection of indicators

2. Analysis of the internal environment

• Identification of strengths and weaknesses of organizational
systems, and their critical factors
• Selection of indicators

3. SWOT Analysis (Strengths, Weaknesses, Opportunities and

Threats)
 Strategic Planning Stages & Elements

Situation Analysis
1. Where are we? • External environment
• Internal environment
• SWOT Analysis
2. Where do we want to go? • Mission
• Vision
• Strategic Objectives
3. How can we get there? • Designing strategies

• Identification of expected results

4. How do we ensure we get • Monitoring indicators
there? • Means of verification
• Harmonization of strategic plan
with operational plans
Analysis of the External Evnvironment - Macro

Factors to be analyzed in the external

environment
• economic
• socio-cultural
• technological
• political-legal
 Analysis of the External Environment/Macro – Examples
Demographic Trends, Indicators and Data Sources

Demographic Trend Indicators Sources

Sustained high level of fertility, Total fertility rate = 5.7 • National Statistics
possibly indicating a significant level (1995) Institute
of unprotected sex and thus • Demographic and
increased exposure to HIV Total fertility rate = 5.6 Health Survey (DHS)
(2005)
Increasing urbanization which Population 60% • Census
brings more people from the village rural/40% urban (1995)
to the city, increasing their
vulnerability to HIV Population 30%
rural/70% urban (2005)
Analysis of External Environment/Micro – Examples
Health Sector Trends, Indicators and Data Sources

Health Sector Trends Indicators Sources

Increasingly more people have
geographical access to primary
health care
Reduced, but slowly growing,
number of health posts in rural
villages provide laboratory services.
The amount of money spent by the
government on health is increasing
80% of the population • Health sector situation
lives within 5 km. of a analysis
health center in 2006
compared to 63% in
1996
3% of health posts in • Health sector census
rural villages offered
laboratory services in
2002 compared to 10%
in 2006.
6.2% of GDP spent on • Reports from the
health (1998) Ministry of Planning
and Finance
12% of GPD spent on
health (2006)
 Strategic Planning Stages & Elements

Situation Analysis
1. Where are we? • External environment
• Internal environment
• SWOT Analysis
2. Where do we want to go? • Mission
• Vision
• Strategic Objectives
3. How can we get there? • Designing strategies

• Identification of expected results

4. How do we ensure we get • Harmonization of strategic plan
there? with operational plans
• Monitoring indicators
• Means of verification
Stage 1: Strategic Planning - Where are we?

3 steps

1. Analysis of the external environment

• Identification of key trends in the environment (macro & micro)
• Selection of indicators

2. Analysis of the internal environment

• Identification of strengths and weaknesses of organizational
systems, and their critical factors
• Selection of indicators

3. SWOT Analysis (Strengths, Weaknesses, Opportunities and

Threats)
Analysis of Internal Environment - Organizational Systems

Organizational systems operate like the systems in

the human body:

Each system has a fundamental, specific, unique, and

complementary purpose; therefore if one fails, it will
affect the performance of the others.
Analysis of the Internal Environment
Organizational Systems

• Management & leadership

• Planning
• Information/monitoring and evaluation
• Finance
• Human resources
• Communications
• Procurement and supply
• Health services delivery
• Control
Organizational Systems – Critical Factors

For the internal environmental analysis the critical factors of

each system must be identified and evaluated, given that these
determine the current performance of the organization’s
processes.

Examples of Critical Factors:

– a quick and timely response
– an effective response
– efficiency level and cost
– service provision reliability or security
– treatment granted to users
– infrastructure of facilities where health care services are
provided
Analysis of the Internal Environment - Example
Supply System – Identification of Critical Factors, Indicators &
Data Sources
Indicators and sources of data for critical factors in the supply system
Critical factor Indicator Source
Availability of ARVs in all 40% of provincial hospitals Central Medical Store
provincial hospitals and and district hospitals and pharmaceutical distribution
district hospitals and health health centers have ARVs in reports
centers stock
ARVs meet national All ARVs are tested and none Monitoring reports produced
standards for quality have not met quality by the National Agency for
1
standards. Health Quality Control
Price of ARVs The cost of ARVs is 2 times Central Medical Store
higher than the mean cost of procurement report and WHO
the same drugs purchased in monitoring reports on the cost
Luan (neighboring country). of ARVs
Staff technical competence 75% of staff working in MOH training report
in dispensing ARVs provincial hospitals and
district hospitals and health
centers have been trained in
dispensing ARVs
 Strategic Planning Stages & Elements

Situation Analysis
1. Where are we? • External environment
• Internal environment
• SWOT Analysis
2. Where do we want to go? • Mission
• Vision
• Strategic Objectives
3. How can we get there? • Designing strategies

• Identification of expected results

• Harmonization of strategic plan
4. How do we ensure we get with operational plans
there? • Monitoring indicators
• Means of verification
SWOT Analysis

The SWOT Analysis is

• a tool that depicts the organization’s current situation in a
chart
• contributes to a precise diagnosis that enables you to make
decisions about the future you wish to create for your
organization and the strategies to achieve it.

A SWOT analysis will help you analyze where you are within the
organization, provided that the organization’s external or
internal environmental factors are:
• well-classified
• relevant
• clearly positive or negative for the organization
SWOT Analysis & Strategic Thinking

We cannot analyze everything; we must focus on the most

important trends in the external environment and the most
important critical factors in the internal environment.

Remember that a strategic thinker focuses on whatever is

essential, critical, and relevant.

In the SWOT analysis, this filter reduces the universe to be

analyzed and facilitates focusing on what is strategic and
important.
 SWOT Analysis Chart - Example

External environment Internal environment

Opportunities

Strengths
Global Fund available for Pharmaceutical distribution chain in
TB, AIDS, and malaria 80% of population centers with
projects over 3,000 inhabitants

Weaknesses
Threats

4-week average to deliver

Zero GDP growth
pharmaceutical orders
 SWOT Analysis – Classification Example

External environment Impact Internal environment Impact

Opportunities

Global Fund available for
TB, AIDS, and malaria
projects
Strengths
Pharmaceutical distribution
chain in 80% of population
3 5
centers with over 3,000
inhabitants

Weaknesses
Threats

4-week average to deliver

Zero GDP growth 4 5
pharmaceutical orders
 Strategic Planning Stages & Elements

1. Where are we? Situation Analysis

• External environment
• Internal environment
• SWOT Analysis

2. Where do we want to go? • Mission

• Vision
• Strategic Objectives

3. How can we get there? • Designing strategies

• Identification of expected results
• Harmonization of strategic plan
with operational plans

4. How do we ensure we get • Monitoring indicators

there?
• Means of verification
Stage 2: Where do we want to go?

If you don't know where you're going, you'll probably wind

up no where!
—Clark Crouch
Products
• Mission

• Vision

• Strategic objectives
Mission

The mission describes

• the purpose for which the organization exists
• the target population to which its services are
aimed
• the organization’s services and/or products
• the scope of the organization’s activities

“The mission should be like a mini-skirt: long

enough to cover everything, but short enough to
be attractive.”
Sample Program Mission

The mission of the Provincial HIV & AIDS Program is to prevent

new HIV infections among populations at risk and provide care,
treatment and support to PLWH and those affected by HIV and
AIDS, by
– strengthening the multi-sectoral response &
collaboration,
– improving accessibility to prevention, care, treatment and
support services,
– promoting behavior change,
– building the capacity of personnel, and
– conducting research, while
involving PLWH in all aspects of the provincial response, in
order to improve the quality of life of PLWH and those affected
by HIV and AIDS, reduce death caused by AIDS, reduce stigma
and discrimination and mitigate the impact of HIV and AIDS on
those who are infected and affected.
 Strategic Planning Stages & Elements

1. Where are we? Situation Analysis

• External environment
• Internal environment
• SWOT Analysis

2. Where do we want to go? • Mission

• Vision
• Strategic objectives

3. How can we get there? • Designing strategies

• Identification of expected results
• Harmonization of strategic plan
with operational plans

4. How do we ensure we get • Monitoring indicators

there?
• Means of verification
Vision

The vision is
• the image of the future we wish to create,
speaking in the present tense
• it describes where we want to go and who
we will be once we get there
Sample Vision

We seek a world of hope,

tolerance, and social justice,
where poverty has been
overcome and people live in
dignity and security. CARE will
be a global force and a partner
of choice within a worldwide
movement dedicated to
ending poverty. We will be
known everywhere for our
unshakable commitment to the
dignity of people.
 Strategic Planning Stages & Elements

Situation Analysis
1. Where are we? • External environment
• Internal environment
• SWOT Analysis

2. Where do we want to go? • Mission

• Vision
• Strategic Objectives

3. How can we get there? • Designing strategies

4. How do we ensure we get • Harmonization of strategic plan with

operational plans
there? • Identification of expected results
• Monitoring indicators
• Means of verification
Strategic Objectives

Strategic objectives
• Synthesize the vision in terms of specific, observable, and
measurable results.

Strategic objectives must contain the following elements:

• Action: What must be done
• Object: What or who they refer to
• Description/Characteristic or quantity
• Where: Where the action will take place
• When: By what date
• Limits/conditions: The scope or the conditions under which
the action will be implemented
Sample vision – Identifying the main topics

Be positioned in the minds of our target population as their best

option to care for their health problems because we have the
most comfortable facilities, the most modern technology
available, and the friendliest and best qualified staff in the
market, where our constant concern is to exceed their
expectations.
Main Topics
Topic 1: Become positioned in the minds of our target
population as their best option to care for their health problems.
Topic 2: Have the most comfortable facilities and the most
modern technology available.
Topic 3: Have the friendliest and best qualified staff in the
market.
Topic 4: Meet and exceed the expectations of the target
population.
Strategic Objective Development – Based on Vision
Matrix to develop strategic objectives
Description
Action Object Where When Limits/Conditions
/Quantity
1 Position Our As their best In the entire By the Through excellence in
organization option to country end of the quality of care and
in the minds care for their 2008 innovative strategies to
of our target health enhance the
population problems organization’s image

2 Have Facilities The most Throughout By the Prioritizing the units

available comfortable the entire end of with the highest
and the organization 2008 demand
most
modern
technology

3 Strengthen Staff Permanently At the By the Offering the best

development institutional end of working conditions and
and an level 2008 incentives in
adequate accordance to
work performance results
environment and quality of care

4 Maintain Satisfaction Above 95% In all By the Special attention given

of external institutional end of to departments and
client facilities 2008 staff that come in
contact with the client
Sample Strategic Objectives (based on the vision)

By the end of 2008 the institution must:

• Position its institutional image in the minds of the country’s
population as the best option to care for their health
problems, through its excellent quality of care and the
implementation of innovate market strategies;
• Have the most comfortable facilities available, equipped with
state-of-the-art technology, prioritizing the areas with the
highest demand;
• Strengthen the staff’s development and foster a harmonious
working environment, offering the best working conditions
and incentives in accordance with staff performance and the
delivery of quality services;
• Maintain client satisfaction levels above 95% at all
institutional facilities, especially those that come in direct
contact with clients.
 Strategic Planning Stages & Elements

Situation Analysis
1. Where are we? • External environment
• Internal environment
• SWOT Analysis
Where do we want to • Mission
go? • Vision
• Strategic Objectives

3. How can we get • Designing strategies

there?
• Identification of expected results
4. How do we ensure we • Harmonization of strategic plan with
operational plans
get there? • Monitoring indicators
• Means of verification
Stage 3: How Can We Get There?

Products:
• WOST matrix
• Organizational strategies
What is a strategy?

Strategies are the means

to achieve a specific objective.

Current Strategies Desired

situation situation
(Objectives)
Types of Strategies

• Growth strategies

• Reinforcement strategies

• Response strategies

• Withdrawal strategies
Types of Strategies

Growth strategies take advantage of the organization’s internal

strengths and the environment’s opportunities to grow (S, O).

Reinforcement strategies force the organization to overcome

its internal weaknesses in order to take advantage of the
opportunities the environment offers (W, O).

Response strategies use the organization’s internal strengths

to respond to and address the environment’s threats (S, T).

Withdrawal strategies ensure survival when faced with internal

weaknesses and the environment’s threats, the organization
withdraws to seek the most favorable conditions (W, T).
Types of Strategies

Strengths Weaknesses

GROWTH STRATEGIES REINFORCEMENT STRATEGIES

• Expansion • Reorientation
Opportunities

• Maintenance • Approach
• Development and Innovation • Specialization
• Diversification

RESPONSE STRATEGIES WITHDRAWAL STRATEGIES

• Market segmentation • Reorientation
• Differentiation • Approach
• Diversification • Specialization
Threats

• Leadership development • Segmentation

• Strategic alliances • Differentiation
• Political actions • Leadership
• Alliances
• Political actions
WOST Matrix tool for strategy formulation

The WOST matrix is a tool that

• fosters strategic thinking
• facilitates an in-depth analysis of the existing
relationships among the various environmental factors
and the organization’s internal capacities
• helps users to analyze the relationships between:
– Strengths and Opportunities (SO)
– Weaknesses and Opportunities (WO)
– Strengths and Threats (ST)
– Weaknesses and Threats (WT)
WOST Matrix tool for strategy formulation (cont.)

• SO relationships - use internal strengths

to take advantage of external opportunities
• WO relationships - diminish internal
weaknesses in order to take advantage of
external opportunities
• ST relationships - utilize the organization’s
strengths to avoid or reduce the impact of
external threats
• WT relationships - minimize weaknesses
and threats through defensive strategies
Strategy formulation using the WOST Matrix

Internal Environment
Strengths Weaknesses
The best distribution system for
contraceptive methods and
supplies in the health sector

Possible interventions Possible interventions

External Environment

(SO) (WO)

Opportunities

Possible interventions Possible interventions

(ST) (WT)

Threats Strategic alliance

Provision, by the Offer to undertake for JICA,
Ministry of Health, of at a low cost, the distribution of
contraceptives donated methods to the Ministry of
by JICA to low-income Health and NGOs that serve
populations vulnerable populations
throughout the country

Increased competition
from NGOs that provide
contraceptives donated
by JICA to the same
target population we
serve
 Strategy formulation using the WOST Matrix

Internal Environment
Strengths Weaknesses
Strong distribution system Lack of funds to support
and with excess capacity social programs
External Environment

Possible interventions Possible interventions

(SO) (WO)

Opportunities Extend community Attract donations to rural

distribution of indigenous areas
Low coverage of contra-
contraceptives to rural
ceptive use in rural areas
areas

Possible interventions Possible interventions

(ST) (WT)

Threats Offer to undertake for Establish an alliance with

JICA, at a low cost, the other NGOs to serve
Distribution of JICA-
distribution of remote rural areas
donated methods by the
contraceptives to the
Ministry of Health and
Ministry of Health and
NGOs to low-income
NGOs that serve
populations
vulnerable populations
throughout the country
 Strategy Selection – NGO Example

Strategic Objective
Develop by 2008 an effective service delivery model that guarantees access to integrated sexual
and reproductive health services for the most unprotected population, through distribution,
specialized and integrated training, and technical assistance to the country’s Ministry of Health
and NGOs.

Possible intervention(s) Quadrant Selected strategy

Offer to the local JICA office, at ST Strategic Alliance

a low cost, distribution services
Establish a strategic alliance with JICA for the
for contraceptive methods at the
distribution of contraceptive methods, at the
national level both to the Ministry
national level, both to the Ministry of Health and
of Health and the NGOs that
NGOs
provide sexual and reproductive
health services to the country’s
most vulnerable populations
 Strategic Planning Stages & Elements

Situation Analysis
1. Where are we? • External environment
• Internal environment
• SWOT Analysis
2. Where do we want to go? • Mission
• Vision
• Strategic Objectives
3. How can we get there? • Designing strategies

• Identification of expected results

4. How do we ensure we get • Monitoring indicators
there? • Means of verification
• Harmonization of strategic plan
with operational plans
Stage 4: How do we ensure we get there?

• Strategic plans often fail because they are

not linked to operational plans.

• How can we link the strategic plan to the

operational plan?

• Answer: the Results Matrix

 Results Matrix - Example
Results Matrix

Strategic Objective 1: Develop an effective service delivery model by 2007 that guarantees access to integrated
sexual and reproductive health services for the most unprotected populations, through the distribution, training, and
provision of specialized integrated technical assistance to the country’s Ministry of Health and NGOs.
Strategy 1: Establish a strategic alliance with JICA for the distribution of methods to the country’s Ministry of Health and
NGOs.
Final
Expected final result: An operationalized distribution, completion date
Person
training, and specialized and integrated technical assistance
responsible
model through a strategic alliance with the country’s Ministry Jun-07
of Health and NGOs
Portfolio of training and technical assistance methods
Social
and services to be offered to the Ministry and identified
Jun-05 Marketing Manager
NGOs
Intermediate results

Income and expenditures budget for the completed

Jul-05 Financial Manager
distribution model

Agreement signed with JICA for the distribution,

training, and specialized and integrated technical
Sep-05 Executive Director
assistance on contraceptive methods and sexual and
reproductive health

The distribution, training, and specialized and

Executive Director
integrated technical assistance model operates
Jan-06 and Administrative
through a strategic alliance with the country’s Ministry
Manager
of Health and NGOs
 Results Monitoring Chart - Example
Results Monitoring Chart

Strategic Objective 1: Develop an effective model by 2007 that guarantees access to integrated sexual and
reproductive health services for the most unprotected populations, through the distribution, training, and provision of
specialized integrated technical assistance to the country’s Ministry of Health and NGOs.
Expected final result: An operational Final
distribution, training, and specialized completion
and integrated technical assistance date Person Means to verify
Indicator
model through the strategic alliance responsible compliance
with the country’s Ministry of Health and Jun-07
NGOs
Note from
Portfolio of training and technical Portfolio of
Social Directorate
assistance methods and services methods and
Jun-05 Marketing approving the
to be offered to the Ministry and services to be
Manager portfolio, with
identified NGOs offered completed
attached document
Income and expenditures budget Income and
Financial Final document of
completed for the distribution Jul-05 expenditures
Manager approved budget
model budget completed
Agreement signed with JICA for
the distribution, training, and
Agreement signed
specialized and integrated Executive Agreement
Sep-05 by the participating
technical assistance on Director finalized
parties
ediateresults

contraceptive methods and

sexual and reproductive health
Monthly distribution
% of products
reports and monthly
distributed with
report of inventory
new model
dispatches
Interm

Training reports with

% of NGOs with
results of the
sufficient staff of
The distribution, training and evaluation of training
Executive service providers
specialized integrated technical activities
Director
assistance model is operating
Jan-06 and % of service Training reports with
through a strategic alliance with
Administrative provision units of the results of the
the country’s Ministry of Health
Manager the Ministry that evaluation of training
and NGOs
were duly trained activities

% of service
provider from
Technical assistance
NGOs and the
reports and survey
Ministry that
reports
received technical
assistance
Linking the Strategic Plan to the Operational Plan

Using the Results Matrix and the Results

Monitoring Chart….

Each management unit, department,

program, project, or unit within the
organization prepares an annual operational
plan focusing on the intermediate results for
which it is responsible.
Content of the final strategic plan

Introduction
• Explains when and how the planning was done, to which concerns
or circumstance it responds, who participated, and how it will be
used.
Analysis of the current situation
• Summarize the organization’s macro- and micro- environments, the
threats and opportunities these represent, and the institution’s
strengths and weaknesses to address said threats. Includes tables
and graphs
Mission, Vision and Strategic objectives
Strategies
• Explains how each strategy takes advantage of the organization’s
strengths and the environment’s opportunities or compensates for
weaknesses or addresses the threats to achieve the organization’s
objectives.
Monitoring the results
• Present the results monitoring chart and explain how it illustrates the
connection between the strategic plan and the operational plans and
helps monitor progress towards achieving results.
Successful Strategic Planning: Lessons Learned

• Ensure the leaders’ commitment

• Involve a broad and representative group
of people
• Acknowledge and manage the impact of
organizational culture
• Collect, understand, and use valid
information
• Establish a clear global direction
• Ensure a link with operational plans
Leadership as a HR Strategy
 7

Human Resources for Health Framework to Achieve a

Sustainable Health Workforce

Preparation country
& Planning specific context
including
labour market

Policy
BETTER HEALTH
Leadership Finance Improved SERVICES
BETTER
Situation HRM Implemen Health Equity
tation Workforce Effectiveness HEALTH
analysis Systems
Outcomes Efficiency OUTCOMES
Accessibility
Partnership Education

other health
M&E system
components
The Need for Professionalizing Leadership in Health

Health care in developing countries is a multi-billion dollar

endeavor.

Yet, the people charged with leading and managing this

work have little, or no, preparation to succeed in these
roles.
– Role doctors & nurses play has changed but medical
& nursing education has not
– Role of health manager is not as valued as that of
surgeon, specialist or clinical nurse
The Dilemma

• Technically and medically, we know what to do to

in PHC to save millions of lives and reduce illness.

• A key limiting factor, in applying what is known, is

effective leadership and efficient management.

WHO Working Paper # 8: lack of effective management

is a key limiting factor in achieving the MDGs in Health
Cost of Poor Management

• Unnecessary death and illness

• Not tapping the creativity and energy of staff at

all levels (discretionary effort)

• Waste or loss of precious resources

 Cost of Poor Management

• Blood products in open

containers in a hospital yard
• No one is in charge of safe
disposal
• High grasses surround the
clinic, hiding insects and
vermin.

Source: MSH/LMS survey

…and staff morale

“Sorry, we’re out of the drug

you want/need.”

“I never hear anything about

the reports I submit.”

“She comes, she reprimands,

she leaves.”

“I am going to apply for a job

in the UK”
Voices from HC Managers - Interviews

“I remember I was appointed a District Medical

Officer in 1993, straight from a surgery ward as a
medical officer, and within a week I had to manage
an entire district. . . . It was a totally different
world.”
—a physician
Director of a National Malaria Control Program
Voices continued

• “The curriculum (in nursing school) focused on

managing the patient and safe delivery of
medication. Now I coordinate with institutions,
NGOs, and government departments to manage
HR.

A Director of Nursing – MOPH

 What is missing to scale up?

Proven treatments for

Child Health

• Oral Rehydration Therapy

• ITNs & LLNs

• Breastfeeding

• Antibiotics

• Immunization
WHO Assessments in Ghana and Uganda

• No specific management-related requirements for

positions that require m & l skills

• Almost all are doctors at district level and above

• Some have an MPH (but most MPH programs

don’t specifically address m & l capabilities)
Root Causes for Poor Leadership & Management

• Role of Health Care Managers is not valued

• Consequences of poor leadership/management are not clear

– little accountability

• Magical thinking: Roles have changed – Preparation has not

• Doctors & nurses are assumed to be good leaders

• Vertical programs – (individual disease focus)

• Pathways to improving l & m skills not previously clear

Source: MSH/LMS survey

Challenges for Health Managers

• Pressure for rapid scale up

• Constant resource constraints
• Gaps in quality and access
• Management of funding streams
• Dealing with the ambiguity of health sector reform
• Shifting from input-focus to results-focus
• Reducing corruption and misuse of funds
• Working in unstable conditions

Source: MSH/LMS survey

Skills Health Managers say they need

• Time management
• Team work and decision
making
• Motivating staff
• Resource management
(human & financial)
• Monitoring and evaluation
(owning the data)
• Forming partnerships
• Results focus - quality &
client satisfaction

Source: MSH/LMS survey

Response to the growing crisis

• Hire more doctors & nurses

• Hurry to train them as we’ve been training them for
years
• Buy more drugs at better prices

All are important … But…

Are we really addressing the challenges they face?

Or, are we primarily addressing the symptoms?

Quote from Performance Improvement

“ Humans have an incredible ability to

overcome challenges…

When we fail --- it’s often because we are

trying to solve the wrong problem.”
Professionalizing Leadership and Management

The Goal:
All current and future health care managers,
are well prepared to lead teams to achieve
results.
Paradigm Shift Required

• Raise the quality of health care leadership

and management to the level assumed by
industry & business
• Put bright young doctors and nurses early
in their careers in positions where they can
learn management and leadership roles
under seasoned professionals
• Open health management positions to non-
medical and non-nursing staff
Strategy for Professionalizing Leadership & Management
– Focus Areas

1. Make the case of the importance of leadership and

management by improving the perception of value of working
as a health leader/manager
Example: Ceará, Brazil

2. Prepare current leaders/managers

Example: Aswan, Egypt

3. Prepare future leaders/managers

Example: Makerere Fac. of Medicine, Uganda

4. Require preparation for positions needing leading &

managing capabilities
Example: Mexico
Strategy for Professionalizing Leadership & Management -
Examples to Address Focus Areas & Results

1. Improve the perception of value of a health care

manager/leader - Ceará State, Brazil (pop. 7
million)

What they did: Leadership Development Program for 800

managers & non-managers
Shifts from:
 Accidentally trained to intentionally developed
 Patronage to merit
 Activity driven to results-focused
 Passive and unmotivated to active and committed staff

Examples of Results: 2001 – 05:

 Prenatal enrollment increased from 50% to 80%
 IMR decreased from 26/1000 to 11/1000
Strategy for Professionalizing Leadership & Management -
Examples to Address Focus Areas & Results

2. Prepare current leaders/managers - Aswan, Egypt

What they did: a Leadership Development Program for
health care teams
 A new way of working together
 Inspired by results, confident in making a difference

Results: 2001 – 05:

 12% IMR decrease, 35% MMR decrease, 17% CPR
increase
 10 teams working with external support in 2001 to175
teams now working on their own w/o support
Pre-Service and Certification

3. Prepare future leaders/managers - Makerere

Medical School, Uganda
What they did: Pre-service training in management and
leadership
 Problem based learning – integrate leading teams to
achieve results.

4. Require preparation for positions needing leading &

managing capabilities - México
What they did: : Civil service reform
 Competencies required for new civil service hires include
management and leadership
And finally ---Professionalizing HR Leadership

Context of the HR Crisis

• New donor commitment (GHWA, WHO,
USAID etc.) has led to mechanisms to
provide leadership at the global level

However....

• Strategic HR leadership (managing people

as a strategic resource) poses a signficiant
challenge for most MOHs
HR Leadership Crisis

Why are MOHs not able to respond to the HR

crisis?

• HR management policies and practices are

not in professional hands
• Govts. lack ability to adapt to rapid changes
(labor migration, impact of HIV and AIDS,
structural adjustments and hiring freezes)
HR Leadership Crisis

To make significant improvements in human

resources for health and in the health of
populations—improvements that will last
What is missing?
• Critical mass of proactive and respected HR
managers and specialists who are professionally
qualified and have the authority and clout to attract
attention and deal with the HR challenges and
champion a comprehensive response
• HR managers who know how to lead and how to
influence HR changes within & outside their
organizations
 10

The Virtual Leadership Development Program

(VLDP)

• Blended learning program, on-site,

results-oriented,
• 20 programs have reached nearly 200 teams in
over 40 countries
• Every program has a story of people
successfully meeting a challenge.
 10

VLDP Worldwide Reach

Urgent Call to Action

Countries need to professionalize leadership and

management in health care, including human
resources leadership and management, by

 Improving the perception of value of leading

& managing
 Preparing current leaders/managers
 Preparing future leaders/managers
 Requiring preparation for positions needing
leading & managing capabilities
A Final Word

“The many projects generated by new funding

opportunities, e.g., the Global Fund, are exposing
weaknesses in existing systems, from monitoring
and evaluation to internal controls. We need
leadership and management development if the full
benefits of these initiatives are to be achieved.”
—Dr. Samuel Luboga,
Deputy Dean of Makerere University in Uganda
Closing the gap between

what is known about public health problems

and what is done

to solve them