Contents

CHAPTER ONE...........................................................................................................................................................1
INTRODUCTION TO COMMUNITY HEALTH NURSING AND ADMINISTRATION...................................1
FUNCTIONS/COMPONENTS OF MANAGEMENT........................................................................................2
OVERVIEW OF GHANA’S HEALTHCARE SYSTEM....................................................................................4
CHAPTER TWO..........................................................................................................................................................6
ORGANIZATIONAL STRUCTURE OF THE MINISTRY OF HEALTH............................................................6
FUNCTIONS OF MOH........................................................................................................................................6
DIRECTORATES OF THE MOH.......................................................................................................................7
AGENCIES THAT IMPLEMENTS MINISTRY OF HEALTH POLICIES......................................................8
CHAPTER THREE....................................................................................................................................................11
ORGANIZATIONAL STRUCTURE OF THE GHANA HEALTH SERVICE...................................................11
ADMINISTRATIVE LEVELS OF GHS...........................................................................................................11
FUNCTIONAL LEVELS OF GHS....................................................................................................................12
GOVERNANCE OF GHANA HEALTH SERVICE.........................................................................................12
DIRECTORATES OF THE GHANA HEALTH SERVICE.............................................................................12
CHAPTER FOUR.......................................................................................................................................................15
THE ROLES AND FUNCTIONS OF THE RHMT, DHMT AND SDHMT........................................................15
HEALTH AGENCIES AND THEIR ROLES IN HEALTH DELIVERY SYSTEM........................................17
HEALTH PROFESSIONALS’ REGULATORY BODIES IN GHANA..............................................................21
CHAPTER FIVE........................................................................................................................................................26
THE HEALTH TEAM...........................................................................................................................................26
THE CURATIVE HEALTH TEAM..................................................................................................................26
THE PREVENTIVE HEALTH TEAM..............................................................................................................27
THE ROLE OF THE NURSE AS A MEMBER OF THE HEALTH TEAM....................................................28
CHAPTER SIX...........................................................................................................................................................30
BUDGET AND IMPREST ACCOUNT................................................................................................................30
CHAPTER SEVEN....................................................................................................................................................34
GOVERNMENT POLICIES ON VARIOUS HEALTH PROGRAMS................................................................34
THE SUSTAINABLE DEVELOPMENT GOALS (SDGS).............................................................................35
HEALTH PARTNERS IN GHANA......................................................................................................................37
ROLES OF HEALTH PARTNERS...................................................................................................................38
GOVERNMENT HEALTH RELATED AGENCIES...........................................................................................38
CHAPTER EIGHT.....................................................................................................................................................40
VARIOUS HEALTH INSURANCE SCHEMES..................................................................................................40
CHAPTER NINE........................................................................................................................................................41
HEALTH INDICES................................................................................................................................................41
CHAPTER TEN.........................................................................................................................................................46
i|Page
 REGISTRATIONS OF BIRTHS AND DEATHS.................................................................................................46
CHAPTER ELEVEN..................................................................................................................................................49
MANAGEMENT FUNCTIONS (review)..............................................................................................................49
PLANNING:.......................................................................................................................................................49
ORGANISING:..................................................................................................................................................54
STAFFING.........................................................................................................................................................56
DIRECTING/LEADING....................................................................................................................................57
CONTROLLING................................................................................................................................................63
CHAPTER TWELVE.................................................................................................................................................67
RECORD KEEPING..............................................................................................................................................67
CHAPTER THIRTEEN..............................................................................................................................................68
REPORT WRITING...............................................................................................................................................68
CHAPTER FOURTEEN............................................................................................................................................71
QUALITY ASSURANCE AND IMPROVEMENT..............................................................................................71
CHAPTER FIFTEEN.................................................................................................................................................81
DATA MANAGEMENT, SOP, USE OF DHIMS II, WEB-BASED....................................................................81
STANDARD OPERATING PRECEDURES (SOPs)........................................................................................82
DISTRICT HEALTH INFORMATION MANAGEMENT SYSTEM (DHIMS 2)..........................................82
WED-BASE INFORMATION SYSTEM..........................................................................................................83
CHAPTER SIXTEEN.................................................................................................................................................84
HEALTH BILL DECENTRALIZATION..............................................................................................................84
REFERENCES...........................................................................................................................................................85

ii | P a g e
 CHAPTER ONE
INTRODUCTION TO COMMUNITY HEALTH NURSING AND ADMINISTRATION
Community nursing is an art that combines primary healthcare and nursing practice in a community
setting. Community health (CH) nurses provide health services, preventive care, and intervention and
health education to communities or populations.

The Concise Oxford dictionary definition of ‘administration’ is ‘management’ one word being substituted
for another therefore in looking at the concepts of Administration one cannot ignore the concept of
management. This is because the two concepts are often used interchangeably. They are interrelated and
interdependent.
Managing is one of the most important activities of human life. Managing has become essential to ensure
the coordination of individual efforts. Management applies to all kinds of organizations and to managers
at all organizational levels. Principles of management are now used not only for managing business but in
all walks of life namely; government, military, educational and health institutions. Essentially,
management is same process in all forms of organization. But it may vary widely in its complexity with
size and level of organization. Management is the life giving element of any organization.
According to (Allende and Sprawled, 2005), Community health nurses like all other nurses engage in
the role of managing health services. They carry out administrator activities by assessing client’s needs,
directing and leading, controlling and evaluating the progress to ensure that goals are met. Overseeing
clients care, supervising auxiliary staff, running clinics, as well as conducting community needs
assessment are all ways in which a nurse serves as a manager. It is therefore important to understand
why administration and management should be applied in community health nursing.
Mary Parker Folett also defined management as the “art of getting things done through people.” That is
to say it is a process by which human efforts are co-ordinated and combined with other resources to
accomplished organizational goals and objectives.
Management also refers to the process of meeting organisation goals with limited resources. Thus, to
succeed in achieving the organization’s goal in the event of various problems in the environment by
ensuring that objectives are specific and marking sure they are implemented to achieve goals (Afful
Broni, 2004).
According to George R. Terry, management is a process “consisting of planning, organizing, actuating
and controlling, performed to determine and accomplish the objectives by the use of people and
resources”.
All these definitions suggest that management is a process, that is, a sequence of coordinated event –
planning, organizing, coordinating and controlling or leading – in order to use available resources to
achieve a desired outcome in the fastest and most efficient way.
1|Page
FUNCTIONS/COMPONENTS OF MANAGEMENT
o Planning

o Organizing

o Staffing

o Leading/Directing

o Controlling/monitoring

PLANNING
In organization such as the GHS/MOH, Planning is a management process, concerned with defining
goals for an organization's future direction and determining the missions and resources to achieve those
targets. Planning may involve setting objectives and establishing the principles, strategies and
procedures/methods for implementation that will help to realize the goals.
Planning as a function/component of management simply involves setting objectives and determining a
course of action for achieving those objectives

ORGANISING
Organizing is the function of management that involves developing an organizational structure and
allocating human resources to ensure the accomplishment of objectives. The structure of the organization
is the framework within which effort is coordinated.

Organizing also involves the design of individual jobs within the organization. Decisions must be made
about the duties and responsibilities of individual jobs, as well as the manner in which the duties should
be carried out. Organizing is a part of management function that involves in establishing an intentional
structure of roles for people to fill in an organization.

STAFFING
This is considered as an important function which makes provision for man power to fill different
positions. It involves in building the human organization by filling, and keep filling the staff. This is done
by identifying work-force requirements, taking inventory of people available, recruiting new staff,
selecting, placing, promoting, apprising, planning their career, training the staff to accomplish their tasks
effectively and efficiently.
DIRECTING/LEADING
After planning, organizing and staffing, the next important function of management is directing or
leading the people towards the defined objectives. Directing may be defined as a function of management
consisting of various activities such as instructing, guiding and inspiring the personnel to achieve the
organizational objectives.

2|Page
Leading on the other involves the social and informal sources of influence that you use to inspire action
taken by others. If managers are effective leaders, their subordinates will be enthusiastic about exerting
effort to attain organizational objectives.
The behavioral sciences have made many contributions to understanding this function of management.
Personality research and studies of job attitudes provide important information as to how managers can
most effectively lead subordinates. For example, this research tells us that to become effective at leading,
managers must first understand their subordinates’ personalities, values, attitudes, and emotions. Studies
of motivation and motivation theory provide important information about the ways in which workers can
be energized to put forth productive effort. Studies of communication provide direction as to how
managers can effectively and persuasively communicate. Studies of leadership and leadership style
provide information regarding questions, such as, “What makes a manager a good leader?” and “In what
situations are certain leadership styles most appropriate and effective?”
CONTROLLING/MONITORING
Controlling is measuring and correcting of activities of subordinates to make sure that the work is going
on as per the plans. It involves ensuring that performance does not deviate from standards. Controlling/
monitoring measures performance against goals and plans, shows where short falls or deviations exist and
takes necessary corrective actions to achieve the goals. Controlling generally relates to the measurement
of achievement. Controlling consists of three steps, which include establishing performance standards,
comparing actual performance against standards, and taking corrective action when necessary.
Performance standards are often stated in monetary terms such as revenue, costs, or profits but may also
be stated in other terms, such as units produced, number of defective products, or levels of quality or
customer service.
The measurement of performance can be done in several ways, depending on the performance standards,
including financial statements, sales reports, production results, customer satisfaction, and formal
performance appraisals. Managers at all levels engage in the managerial function of controlling to some
degree. Effective controlling requires the existence of plans, since planning provides the necessary
performance standards or objectives. Controlling also requires a clear understanding of where
responsibility for deviations from standards lies.

Although controlling is often thought of in terms of financial criteria, managers must also control
production and operations processes, procedures for delivery of services, compliance with company
policies, and many other activities within the organization.

NB. The management functions of planning, organizing, staffing, leading, and controlling are widely
considered to be the best means of describing the manager’s job, as well as the best way to classify
accumulated knowledge about the study of management. Although there have been tremendous changes

3|Page
in the environment faced by managers and the tools used by managers to perform their roles, managers
still perform these essential functions.

OVERVIEW OF GHANA’S HEALTHCARE SYSTEM

The health care system in Ghana is confronted with the formidable task of improving and guaranteeing
the health and well-being of the Ghanaian people.
The health sector has seen many changes during the past decades. Initially, the MoH assumed the role of
the sole provider of services with collaboration from the missions and the para government institutions
such as the military, the police, and the mines. Its services were oriented more toward curative care than
preventive care and involved programmes that were to a large extent donor driven.
It has evolved from a purely traditional system to an allopathic system. The healthcare system has
increasingly become pluralistic involving public and private healthcare providers in service delivery
unlike before.
Within the public sector, formal health service delivery is organized in three tiers;
o National (tertiary care)
o Regional (secondary care)
o District and sub-district (primary care)
Regional (secondary) and national (tertiary)
Health services deliveries are more specialized at theses level coupled with the responsibility of training
health professionals and medical research.
District and sub-district (primary care)
This is the lowest level of healthcare championed by community-based service providers; CHPS
compounds, health centres; clinics and district hospitals. The focus of service delivery at the community
level is preventive health, health education and community participation in health services planning and
implementation.
Health providers at this level are;
o Community Health Nurses ( RCNs/NAP)
o Community midwives
o Community Health Volunteers (CHVS),
o Community-Based Distribution Agents (CBDAS) And
o Traditional Birth Attendants (TBAS).
Note that at district hospitals, health centers, etc. there are more sophiscated staff in addition to the
community level (CHPS compound staff as stated above).
Complicated medical conditions at the sub-district level are referred to district hospitals for expert
attention.
Private sector service providers
4|Page
The private sector also renders health services at the primary, secondary and tertiary levels. Majority of
private-for-profit health facilities render services in urban areas while faith-based facilities are
predominantly located in rural areas.

5|Page
 CHAPTER TWO
ORGANIZATIONAL STRUCTURE OF THE MINISTRY OF HEALTH
An organization is an entity, such as an institution or an association that has a collective goal and is
linked to an external environment. Every organization has a management structure that determines
relationships between activities and members.
The ministry of health is one of the ministries of the central government of Ghana which is responsible
for health policy formulation. In Ghana it is responsible for sector-wide policy formulation, resource
mobilization and monitoring and evaluation of progress in achieving sector targets. (Health sector targets)
Vision of the MOH
The vision of the health sector is to have a healthy population for national development. That is to ensure
improved health status and reduced inequalities in health outcomes of all people living in Ghana.
Mission statement of the MOH
The mission is to contribute to socio-economic development and the development of a local health
industry by promoting health and vitality through access to quality health for all people living in Ghana
using motivated personnel. It’s to work in collaboration with all partners to ensure that every individual
household and community in Ghana is adequately informed about health and has access to high quality
health and health services.
The Goal of the MOH
To improve the health status of all people living in Ghana through effective and efficient policy
formulation, resource mobilization, monitoring and regulation of delivery of health care by different
health agencies. Working together for equality and good health for all people living in Ghana.
Policy Objectives
The health policy objectives within the Sector Medium Term Development Plan 2014-2017 were to:
o Bridge equity gaps in geographical access to health services
o Ensure sustainable financing for health care delivery and financial protection for the poor
o Improve efficiency in governance and management of the health system
o Improve quality of health services delivery including mental health services
o Enhance national capacity for the attainment of the health related MDGs and sustain the gains
o Intensify prevention and control of communicable and non-communicable diseases and promote
healthy lifestyles

FUNCTIONS OF MOH
The functions of MOH include the following:
o Formulate health policy and institutional development.
o Set standards for the delivery of health care in the country.
6|Page
 o Provide strategic direction for health delivery services.
o Monitor and evaluate the health service delivery by the Ghana Health Service (GHS) and the
Teaching Hospitals, as well as other Agencies, Development Partners and the Private sector.
o Develop policies for the practice of Traditional and Alternate Medicine in the country.
o Source funding for service delivery through GoG, Health Insurance and the international
community.
o Resource mobilization and allocation of resources to all health care delivery agencies under the
Ministry.
o Provide framework for the development and management of the human resources for health.
o Provide a framework for the effective and efficient procurement, distribution, management and
use of health sector goods, works and services.
o Make proposals for the review and enactment of health legislation.
o Provide framework for the regulation of food, drugs and health service delivery and practice.
o co-ordination of all agencies and partners involving health development
o Co-ordinate investments in the service. Capital investment.
o Management of training institutions.

DIRECTORATES OF THE MOH

The ministry of health consists of directorates namely;
o Policy planning monitoring and evaluation (PPME)
o Research development/information management
o Human resources
o Procurement and supply chain
o Traditional medicine and alternate medicine
o Finance
o General administration
NB. The Chief Director is the highest officer within the Ministry. The minister of health is his immediate
supervisor.
The Chief Director is the Coordinator within the Ministry and acts as the Chief Advisor to the political
head. He/She guides, co-ordinates, monitors and supervises the work of the Directors within the Ministry
and other matters related to the health sector.
The theme of the Ghana National Health Policy (2007) is Creating wealth through health.
ROLE OF THE MOH HEADQUARTERS
o Provision of overall policy direction for all stakeholders (players) in the health delivery.
o Provision of a strong and effective advocacy role in inter-sectorial action in the health delivery.
7|Page
 o Mobilization and allocation of resources to all providers in the health delivery services.
o Provision of relevant and adequate information for co-ordination and management of health
services.
o Provision of regulatory framework for all providers of health services.
o Monitoring and evaluation of health services in Ghana.
o Coordination of activities of the agencies, providers and partners in the health sector.

AGENCIES THAT IMPLEMENTS MINISTRY OF HEALTH POLICIES

o Ghana Health Services (GHS)
o Christian Health Association of Ghana (CHAG)
o Korle-Bu Teaching Hospital
o Komfo Anokye Teaching Hospital
o Tamale Teaching Hospital
o Cape Coast Teaching Hospital

8|Page
 STRUCTURE OF THE HEALTH SECTOR IN GHANA

Ministry of Health Development partners

MDAs
(MoH)

Public Sector Traditional sector

Private Sector

T-HOSPs GHS Q-GIHs P-HOSPs PHMHB DTAM

TMPs
PC MBPs PMDPs
G-HOSPs HC
AM
Source: Organized by author based on available literature
FH

9|Page
MDAs: Ministries Departments and Agencies
G-HOSPs: Government Hospitals
GHS: Ghana Health Service
T-HOSPs: Teaching Hospitals;
Q-GIHs: Quasi-Government Institution Hospitals
P-HOSPs: Psychiatric hospitals
PC: Poly-Clinics
HC: Health Centers
PHMHB: Private Hospitals and Maternity Homes Board
MBPs: Mission-Based Providers
PMDPs: Private Medical and Dental Practitioners
DTAM: Department of Traditional and Alternate Medicine
TMPs: Traditional Medical Providers
AM: Alternative Medicine
FH: Faith Healer

10 | P a g e
 CHAPTER THREE
ORGANIZATIONAL STRUCTURE OF THE GHANA HEALTH SERVICE
The Ghana Health Service (GHS) was created in 1996 by parliamentary Act (525) and was given the
responsibility to manage the provision of primary, secondary and some specialist care.
The GHS headquarters operates under a council appointed by the president of Ghana on the advice of a
presidential advisory body called Council of State.
It is a Public Service body established as required by the 1992 constitution. It is an autonomous
Executive Agency responsible for implementation of national policies under the control of the Minister
for Health through its governing Council (the Ghana Health Service Council). The GHS continue to
receive public funds and thus remain within the public sector.
MANDATE AND OBJECTIVES OF GHS
To implement approved national policies for health delivery in the country.
To Increase access to good quality health services, and
To manage prudently resources available for the provision of the health services
LEVELS OF GHS
The Ghana health service is organized under three (3) administrative levels and five (5) functional levels
which as seen below;

ADMINISTRATIVE LEVELS OF GHS

National level
o Ghana Health Service Council
o Office of the Director General and Deputy Director General
o Eight National Divisional Directors
Regional level
o Regions are headed by 10 Regional Directors of Health Services (note. With the recent creation
of the additional regions in the country making a total of 16, the directors of health services will
also increase to 16.)
o Supported by Regional Health Management Teams
o Regional Health Committees
District Level
o All 260 MMDAs (metropolitan, municipal , district assemblies)as at June,2018 formerly 110 are
headed by District Directors of Health Services.
o Supported by the District Health Management Teams
o District Health Committees
o Sub District Health Management Teams
11 | P a g e
FUNCTIONAL LEVELS OF GHS
o National Level
o Regional Level
o District Level
o Sub-district Level
o Community Level

GOVERNANCE OF GHANA HEALTH SERVICE

GHS is governed by a 12-member Council known as Ghana Health Service Council.
Its functions include the following:
o Ensure the implementation of the functions of the Service
o Submit to the Minister recommendations for health care delivery policies and programmes
o Promote collaboration between the Ministry of Health, Teaching Hospitals and the Service
o Advise the Minister on posts in the Service and other matters that the Minister

DIRECTORATES OF THE GHANA HEALTH SERVICE

12 | P a g e
 GHANA HEALTH SERVICE – HEADQUARTERS LEVEL STRUCTURE

Ghana Health
Service Council

Office of the
Director General
And His Deputy

Health Supplies,
Policy
Human Administration Internal
Planning Institutional Public
Resources and Stores and Finance Audit
Monitoring Care Health
Development Support Drug Directorate Directorat
and Directorate Directorate
Directorate Services Management e
Evaluation
Directorate Directorate Directorate

13 | P a g e
 REGIONAL LEVEL STRUCTURE

Office of the Regional

Directors

Regional Health Committees

Public Clinical Regional Regional Training DHMTs

Health Unit Care Unit Hospital HSSU Institutions & SDHT

14 | P a g e
 CHAPTER FOUR
THE ROLES AND FUNCTIONS OF THE RHMT, DHMT AND SDHMT.
At all the three levels, there are two types of teams namely:
1. Service providing team
2. Service management team
Regional level (service provision)
At the regional level, there are specialized hospitals with several units and departments, providing diverse
health services such as medical care, surgical care, obstetrics and gynecology, physiotherapy, psychiatric,
laboratory services, laundry services and mortuary services.
The health team therefore consists of medical officers, surgeons, physicians, pediatricians,
ophthalmologist, dental surgeons, physiotherapists, psychiatrists, nurses of all categories, technicians,
laborers, cleaners, orderlies, cooks, secretarial staff, account officers, dieticians.
Regional level (management team)
There are two management teams at the regional level:
o The regional hospital management team
o The regional health management team
Regional Hospital Management Team
The team is a tripartite team made up of the medical director, the nurse manager (DDNS) and the
administrator / business manager.
Functions:
o Ensuring access to quality of care
o Mobilizing and distributing resources
o Training of personnel
o Collection and management of health information
o Supervising, monitoring and evaluating information
o Carrying out research

REGIONAL HEALTH MANAGEMENT TEAM (RHMT)

The RHMT is led by the Regional Director of Health Services and comprises the following:
1. District Director of Health Services (DDHS)
2. Senior Medical Officer of Health (Public Health). - S.M.O. (PH)
3. Deputy Director of Nursing Services (Public Health). - DDNS (PH)
4. Deputy Director of Nursing Services (General). DDNS (General)
5. Regional Health Services Administrator - RHSA

15 | P a g e
Functions
1. Conducting need assessment and trend analysis
2. Mobilization and allocation of resources
3. Development and dissemination of regional protocol and guidelines based on national guidelines.
4. Organizing in-service training
5. Providing technical support
6. Supervising, monitoring and evaluating service provision
7. Conducting research

DISTRICT LEVEL HEALTH TEAM

a. (Service Provision Team)
There is usually a district hospital that serves as a referral point from the health Centres, community
clinics.
The hospital provides clinical, surgical, obstetric and gynecological services. Additionally, preventive
and promotive services are also rendered.
The team comprises; medical doctors, nurses, midwives, technicians, accountant, drivers, laborers, and
domestic staff.
b. Service Management Team
There are two teams namely:
i. The hospital management team
ii. The district / municipal/metropolitan health management team

HOSPITAL MANAGEMENT TEAM (HMT)

It is a multilateral team made up of the medical superintendent, the Principal Nursing Officer and hospital
administrator.
FUNCTIONS OF THE HOSPITAL MANAGEMENT TEAM (HMT)
o Ensuring the rendering of the quality service
o Mobilizing and allocating resources
o Training of staff
o Supervising, monitoring and evaluating service
o Conducting research

DISTRICT HEALTH MANAGEMENT TEAM (DHMT)

The team consists of the DDHS, SSMO, in-charges of the district hospital, PHN, disease control officer,
nutrition officer, health promotion officer, administrator and accountant.

16 | P a g e
FUNCTIONS OF DISTRICT HEALTH MANAGEMENT TEAM (DHMT)
o Conducting training needs assessment and carrying out training
o Providing technical and administrative support to the sub-district level
o Collaborating with health related sectors
o Seeing to the overall responsibility of planning, organizing, supervising, monitoring and
evaluation
o Carrying out data collection and managing information.
SUB-DISTRICT LEVEL
a. Service Provision Team
The team provides integrated services in clinical public health and maternity services at the health centre.
The team is headed by a medical assistant, with the other members as midwives, community health nurse,
field technicians, medical record assistant and cahier.
THE SUB-DISTRICT MANAGEMENT TEAM (SDHT)
The team is made up of the members of the health centre and other health related agencies such as the
environmental health and other health care providers such as TBA, community based surveillance agents,
teachers, religious leaders and other opinion leaders.
FUNCTIONS OF THE SUB-DISTRICT MANAGEMENT TEAM (SDHT)
o Ensuring the provision of quality primary health care services.
o Ensuring the availability and efficient use of resources
o Forge and foster close partnership with community and other health related agencies
o Empowering household members to take increasing responsibility for their own health
o Playing advocacy role in ensuring the provision of health related services such as portable water,
sanitation facilities, improved agricultural and farming practices enrollment of schools especially
girl child.

HEALTH AGENCIES AND THEIR ROLES IN HEALTH DELIVERY SYSTEM

CHRISTIAN HEALTH ASSOCIATION OF GHANA (CHAG)

The Christian Health Association of Ghana (CHAG) is a faith-based network organization of 21 (now
25 ) Christian church denominations, involved in the provision of health care and training of health
professionals.
Established in 1967, the Association currently comprises 59 hospitals, 114 health centres and clinics, and
12 health training health-training institutions; Membership has gone up from 25 in 1967 to 183 in 2011.

17 | P a g e
The Ghana Pentecostal Council was later admitted into membership as an Associate Member. The
uniqueness of CHAG as an organisation is the independence and autonomy of its members. This is
recognized as the strength of the organization where the diversity of its members is respected and
harnessed for human centred, affordable and high quality patient care.
Vision of CHAG
“A healthy nation, Christ’s Healing Ministry Fulfilled”
Mission of CHAG
To promote the healing ministry of Christ and be a reliable partner in the Health Sector in providing the
health needs of the people in Ghana in fulfilment of Christ’s mandate to go and heal the sick.
Core Values of CHAG
o Christian identity and witness
o Unity in Diversity
o Respect for the dignity of the person
o Holistic health care
o Creativity and Excellence
o Accountability and Transparency
o Co-operation and partnership
o Option for the poor and the marginalized

Goal of CHAG
The goal of CHAG is to improve the health status of people living in Ghana, especially the marginalized
and the poorest of the poor, in fulfilment of Christ healing ministry

Objectives of CHAG
o To foster a closer partnership between Churches related health services and the Ministry of Health
to promote health care in Ghana.
o To assist in planning and coordinating the training programmes and other medical work or
services of the members of the Association.
o To assist the members of the Association with respect to the employment of staff, provision of
supplies to the hospitals or other medical services maintained or supported or controlled or
supervised by any member of the Association.
o To encourage and assist the members to promote the healing ministry for the benefit and the
welfare of the people of Ghana.

18 | P a g e
 o To implement policies set by the members and do such other things in cooperation with the
members of the Association as are conducive to the attainment of the above aims and objectives
of the Association or any of them and generally to act for the benefit and welfare of the people
living in Ghana.

RELATIONSHIP OF THE MINISTRY OF HEALTH TO THE VARIOUS SECTORS AND

ORGANIZATIONS IN GHANA

NATIONAL AMBULANCE SERVICE

The National Ambulance service is an agency set up in 2004 with the aim of helping to manage victims
of accidents, disasters and other medical emergencies, thereby reducing casualty rates that may occur in
any part of the country after such events. The Ghana Ambulance Service aims at providing accessible 24-
hour ambulance service nationwide through its own ambulance service and by collaborating with other
service providers such as the Fire Service and other hospital-based ambulances.
The service also provides improved pre-hospital care in accidents, emergencies and disasters
KORLE BU TEACHING HOSPITAL (KBTH)
Korle-Bu Teaching Hospital was established in 1923 as a colonial hospital for what was then the Gold
Coast by Governor Guggisberg. KBTH was to become the standard by which all other hospitals in the
nation were to model themselves after. It was known as Gold Coast Hospital.

19 | P a g e
The KBTH is a teaching hospital affiliated with the medical school of the University of Ghana. Three
centres of excellence, the National Cardiothoracic Centre, the National Plastic and Reconstructive
Surgery and the Radiotherapy Centre are all in it.

TRAINING INSTITUTIONS
The hospital has a very large campus and has expanded to host a number of institutions. The list includes
the following:
o University of Ghana Medical School
o University of Ghana Dental School
o University of Ghana School of Allied Health Sciences
o Nurses Training College
o Midwifery Training School
o Ghana Medical Association
o Ghana Association of Biomedical Laboratory Scientists
o School of Hygiene
o School of Radiology
o school of Peri-operative and critical care nursing
o Ophthalmic Nursing school
CENTRES OF EXCELLENCE
National Cardiothoracic Centre
National Plastic and Reconstructive Surgery
Radiotherapy Centre
KOMFO ANOKYE TEACHING HOSPITAL (KATH)
The Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, is the second-largest hospital in
Ghana and the only tertiary health institution in the Ashanti Region.
The KATH was built in 1954 as the Kumasi Central Hospital. It was later named Komfo Anokye
Hospital after Okomfo Anokye, a legendary fetish priest of the Ashanti kingdom.The hospital is also
accredited for postgraduate training by the West African College of Surgeons in surgery, obstetrics and
gynaecology, otorhinolaryngology, ophthalmology and radiology. The KATH currently has over 1000
beds, up from the initial 500 when first built.
DIRECTORATES OF KOMFO ANOKYE TEACHING HOSPITAL (KATH)
The hospital has clinical and non-clinical directorates
Clinical Directorates
20 | P a g e
 o Anesthesia and Intensive Care Unit (ICU)
o Child Health
o Dental, Eye, Ear, Nose and Throat (DEENT)
o Diagnostics
o Medicine
o Obstetrics & Gynaecology
o Oncology
o Polyclinic
o Surgery
o Accident and Emergency department
o Pharmacy
Non-Clinical Directorates
1. Domestic Services
2. Security
3. Supply Chain Management
4. Technical Services
TAMALE TEACHING HOSPITAL (TTH)
The TTH is the third teaching hospital in Ghana after the Korle Bu and the Komfo Anokye Teaching
Hospitals. The hospital was established in 1974 and was formerly called the Tamale Regional Hospital.
The TTH was to provide various healthcare services to the people of the then three Northern regions of
Ghana namely, the Northern, Upper East and Upper west regions. However, these include the current
north east and savanna regions respectively.
MANDATE OF TTH
The mandate of the TTH is set by Act 525 of the Ghana Health Service and Teaching Hospitals Act of
1996.
HEALTH PROFESSIONALS’ REGULATORY BODIES IN GHANA
NURSING AND MIDWIFERY COUNCIL OF GHANA
The Nursing and Midwifery Council is the statutory body whose mandate is derive from part III of the
Health Professions Regulatory Bodies Act 2013 (Act 857). Until the passage of this Act, the council
operated under NRCD117 of 1972 and the LI683 of 1971 respectively. It is responsible for the Nursing
and Midwifery professions and in particular, with the organization of the training and education of
Nurses and Midwives and the maintenance and promotion of standards of professional conduct and
efficiency. It promotes the highest standards of training and practice.

21 | P a g e
The purpose of this code is to: Inform Nurses and Midwives of the standard of professional conduct
required of them in the exercise of their professional accountability and practice. Inform the public, other
professionals and employers of the standard of professional conduct that they can expect of a registered
Nurse or Midwife.
Note. The name of the Council changed from Nurses and Midwives Council of Ghana as provided for in
the NRCD 117 of 1972 and LI 683 of 1971. During the year 2013 to Nursing and Midwifery Council
following the enactment of the Health Professions Regulatory Bodies Act, 2013 (Act 857).

VISION OF NMC
To secure in the public interest the highest standard of training and practice of nursing and midwifery.
MISSION OF NMC
Ensure the availability of trained nursing and midwifery professionals who would give competent, safe,
prompt and efficient service for client delight.
NURSES AND MIDWIVES ACT: 1972 (NRCD 117)
This act established the Nurses and Midwives Council of Ghana. Members of the council consist of:
(a) Eleven registered nurses (including at least one registered nurse or midwife and also a military nurse)
elected by the registered nurses;
(b) Five registered midwives elected by the registered midwives;
(c) Three registered medical practitioners appointed by the Ghana Medical Association;
(d) One person experienced in the administration of hospital and health services, and appointed by the
Commissioner;
(e) One person appointed by the Commissioner responsible for Education.
Chairman of Council
Per the NMC act, the chairman of the council shall be a registered nurse or midwife elected by the
members of the Council from among their number.
FUNCTIONS OF THE COUNCIL.
The NMC should perform the following functions:
(1) The Council shall be concerned with the nursing and midwifery profession and, in particular, with the
organization of the training and education of nurses and midwives, and the maintenance and promotion of
standards of professional conduct and efficiency.
(2) The Council shall be responsible for—
Prescribing the conditions of registration of nurses and midwives and of the granting of certificates and
badges to nurses and midwives;
The establishment of a system of training of nurses and midwives;

22 | P a g e
The selection of the subjects in which persons seeking to qualify as nurses or midwives may be
examined;
The establishment of courses of instruction for student nurses and midwives;
The admission, subject to such conditions as the Council may prescribe, of students to pursue courses of
instruction leading to qualification as nurses or midwives;
The examination of student nurses and midwives.

THE PHARMACY COUNCIL

The Ghana Pharmacy Council is a statutory regulatory body established by an Act of Parliament, The
Pharmacy Act, 1994 (Act 489).
Members of the council shall be appointed by the President in consultation with the Council of State;
i. A chairman who shall be a registered pharmacist of not less than fifteen years standing as a pharmacist.
ii. The Director of Pharmaceutical Services of the Ministry of Health.
iii. The Dean of the Faculty of Pharmacy, University of Science and Technology, Kumasi.
iv. The President of the Pharmaceutical Society of Ghana.
v. Two registered pharmacists including at least one fellow, elected by the Pharmaceutical Society of
Ghana.
THE COMMITTEES
To facilitate effective operations of the Council, the Act grants the Council the power to appoint such
committees as it may be deemed necessary. There are currently six committees of the Council, which
include the following:
Disciplinary committee – statutorily set up (Section 23), responsible for enquiries into such matters
“relating to professional conduct and standards of pharmacists as may be referred to it by Council”. Its
procedures and penalties are prescribed by L.I.1645 (1998).
General Purpose committee – responsible for dealing with complaints that come against corporate
bodies and licensed chemical sellers. Also responsible for making proposals for legislation and law
reform.
Registration committee – considers applications for registration of premises and makes
recommendations to the Council.
Education committee – responsible for professional training of Pharmacists and auxiliary
pharmaceutical service providers
Finance committee – advises the Council on financial matters
Management/executive committee – comprises the Registrar, deputy registrar and the heads of
department and units. Its function includes assisting the Registrar in the day-to-day administration of the

23 | P a g e
Council. The committee also strategizes on the implementation of the Council’s decisions. It also advises
the Council on matters affecting the organization as a whole.
FUNCTIONS OF THE PHARMACY COUNCIL:
A. The Council shall be responsible for securing in the public interest the highest standards in the
practice of pharmacy.
B. Without prejudice to subsection (1) of this section the Council shall—
1. Ensure that courses of study and training in pharmacy at any institution in Ghana guarantee the
necessary knowledge and skills needed for the efficient practice of pharmacy.
2. Determine in consultation with the appropriate educational institutions courses of instruction and
practical training for pharmacy students.
3. Prescribe standards of professional conduct.
4. Exercise disciplinary power over pharmacists.
5. Uphold and enforce professional standards through the disciplinary powers conferred on it.
6. Keep a register of duly qualified and practicing pharmacists and
7. Regulate the distribution of pharmacies in the country.
VISION
The Vision of the Council is “To guarantee the highest levels of pharmaceutical care”.
MISSION
The Council’s Mission is “To secure the highest level of pharmaceutical care by ensuring competent
pharmaceutical care providers who practice within agreed standards and are accessible to the whole
population. In addition it collaborates with related local agencies and international pharmaceutical
organizations to enhance its effectiveness and its contribution to rational drug use in the nation. This
mission shall be carried out with dedication, integrity, and professionalism.”

ALLIED HEALTH PROFESSIONALS’ COUNCIL OF GHANA

The Allied Health Professions Council is the body established by an Act of Parliament (Act 857, 2013) to
regulate the training and practice of Allied Health Professions in Ghana. As part of its mandate, the
Council is responsible for granting Professional Accreditation for all Allied Health Programmes.
OBJECTIVE OF THE COUNCIL:
The Council is responsible for ensuring the highest standard in the practice of allied health profession in
Ghana.
FUNCTIONS OF THE COUNCIL:
o Regulate the standard of services for the practice of allied health professions.
o Ensure that the standard of study and training in recognized institution in maintained.
o Set practice standards of proficiency and conduct for allied health professionals.

24 | P a g e
 o Register practitioners
o regulatory agency.

MEDICAL AND DENTAL COUNCIL OF GHANA

The Medical and Dental Council is a statutory body responsible for securing in the public interest the
highest level of training and practice of medicine and dentistry in Ghana. A Practitioner (doctor) is a
person registered under the Medical and Dental Council Decree (1972) NRCD 91 to practice medicine or
dentistry in Ghana.

FUNCTIONS OF THE MEDICAL AND DENTAL COUNCIL

o Ensure that courses of study and training in medicine or dentistry at any medical school or
Universities in Ghana are such as can sufficiently guarantee possession of the knowledge and
skill needed for the efficient practice of medicine or dentistry.
o Prescribe standards of professional conduct.
o Uphold and enforce such standards by the disciplinary powers conferred upon it by this Decree.
o Be responsible for the keeping of registers of duly qualified practitioners
Mission the Medical and Dental Council
An internationally acclaimed competent regulatory authority for medical and dental practice in Ghana,
for the public good.
Vision the Medical and Dental Council
Ensuring the highest level of training of Medical and Dental Practitioners and determining the adequacy
and quality of service facilities.

25 | P a g e
 CHAPTER FIVE
THE HEALTH TEAM
Is “a group of persons who share common objectives determined by community needs and toward the
achievement of which each member of the team contributes in accordance with her/his competence and
skills, and respecting the functions of the other.”
The two main divisions are: curative health team and preventive health team. One cannot talk about the
role of the nurse without considering the other members of the health.

THE CURATIVE HEALTH TEAM

This health team operates mostly within hospital and clinic settings and aims at curing diseases. This
team usually consists of physicians, nurses, pharmacists, paramedical technologists (laboratory and X‘
ray technologists), social welfare officers (where necessary), dieticians, physiotherapists and other
supporting staff.
The physician
The physician in the hospital setting is one who has completed successfully a course in medical studies
and is authorized legally to do medical diagnoses and determine the therapy required for curing diseases.
Where there is no physician, the medical assistant diagnoses and treats minor ailments, and refers cases
above his competence to the physician.
The general nurse (curative)
The nurse is someone who has acquired special knowledge and skills in the care of the sick. In the
hospital setting she provides care and assists the patients and their families to satisfy their health needs,
and provides comfort till recovery or death. She is the first contact in the hospital as she receives the
patients, makes him comfortable before the physician arrives. She makes nursing diagnoses and prepares
a care plan for the patient according to his needs. The responsibilities of the nurse would be described in
detail towards the end of this discussion.
The pharmacist
The pharmacist is assisted by dispensary technicians and assistants. They are responsible for preparing
drugs, storing and dispensing drugs prescribed by the physician. They also monitor and evaluate the
actions and effects of drugs.
The laboratory scientist and technician

26 | P a g e
The laboratory technologist is assisted by technicians and assistants. They examine specimen of all kinds
from the patients in order to provide the physician with the exact information about the disease condition,
to facilitate medical diagnosis and for effective treatment.

The X’ ray technologist and technician (radiologist)

The X‘ ray technologists and technicians are responsible for taking x‘ rays of various parts of the body to
aid in diagnoses and treatment.
The dietician
The dietician and catering officers take care of the nutritional aspects of patients. They prescribe and
cook special diets for patients on admission, especially those whose condition require diet regulation.
They also give education on the importance of dieting to clients of certain disease conditions.
The physiotherapists
They and their assistants aid individuals in gaining the usefulness of an injured part of the body through
exercises, healthy manipulations and other related physical therapies.
The social welfare officers
They assist patients and their families with such problems as finances, family problems and other related
problems which may be linked with the illness.
The hospital chaplain
Some hospitals have chaplains who see to the spiritual needs of the patients. This provides the patients
with a feeling that despite hardships and suffering, there is a purpose for one‘s existence. This emotional
state helps in the speedy recovery of the patients.
The supporting staff
These are a group of health workers who play specific roles which are not directly on the patients but
contribute to their care. These include ward orderlies, porters, records officers, drivers, laundry staff,
mortuary staff, maintenance staff, accounts personnel and the like. The administrative staff is also
supportive.

THE PREVENTIVE HEALTH TEAM

Members of the preventive health team operate mostly in the communities as well as the public health
unit of the regional and district health directorates, hospitals and clinics. Their activities are geared
towards health promotion, disease prevention and prolongation of life.
The medical officer (public health)
The medical officer in the community setting is one who is a qualified medical officer who has
specialized in public health and serves as a consultant to the other preventive health workers.

27 | P a g e
The nurse (preventive)
The preventive nurses comprise public health and community health nurses who give reproductive and
child health services including family planning. They also educate the public on health related issues in
order to promote health, prevent diseases and prolong life as much as possible. They do this through
needs assessment of the community and nursing diagnoses of client problems.
The environmental health officers
They and their assistants are responsible for ensuring good environmental and food hygiene and the
enforcement of sanitary laws in the communities. They supervise slaughter houses and inspect premises
where foods and drinks are prepared for public use. Even though they are no longer under the authority of
the Ministry of Health, they are still considered to be part of the preventive health team.
The nutrition officers
They organize and give nutritional talks to the general public, especially pregnant and nursing mothers.
The talks may include proper storage of food items, the choice and preparation of diet, and also hold
demonstration clinics for mothers of malnourished children.
The disease control officers
They are also known as epidemiological officers. They see to the proper storage of vaccines at the
various storage points. They also give immunizations during outbreaks of diseases, treat infectious
diseases like leprosy, yaws and the like as well as report outbreak of resurgence of diseases through
surveillance for prompt action.
The health education officer
The health education officer is a specialist in educating the public on matters that relate to healthy living.
He also prepares health education materials for effective teaching and learning.
The health statisticians
They compile all data on health activities, reported cases within a period of time, mortality and other
relevant data on health. They interpret data to help health authorities do effective planning as well as
taking appropriate measures to forestall any circumstances that may be detrimental to health.
Supporting staff
The supporting staff of the preventive health team include: records officers, accounts officers, drivers,
orderlies, watchmen and the administrative staff.
Research and training staff
The research and training staff conduct research into health related issues, and train other staff in research
work where necessary. Even though their services are not directly on the health of individuals, the
important role they play in the health sector cannot be overemphasized.

28 | P a g e
THE ROLE OF THE NURSE AS A MEMBER OF THE HEALTH TEAM
In all the health teams, nurses form a greater majority. No health team can be effective without the nurse,
due to the uniqueness of the services she renders.
o The nurse is one member of the health team who usually has the first contact with the client and
the last, and continues to have contact with the client and his family even in the home. The nurse
has a primary responsibility of working closely with clients and their families as well as her
significant others to make health related experiences more personal and dignified.
o The nurse‘s major contribution is through her expertise in dealing with man and environment
interrelationships. She is the health professional who is concerned about the total wellbeing
(social, physical, psychological and spiritual) of the client both in hospital and at home. She
assists in attaining a degree of comfort which strengthens the self-image of clients.
o The nurse by her technical competence accepts the responsibility for many functions that were
formally for the physician, thereby supplementing the inadequate supply of doctors, especially in
the rural areas.
o She coordinates activities of other health team members, adopting continual effective measures to
help meet the changing demands of clients. The nurse collaborates with all health professionals,
as well as the client and his family in executing the nursing process which is essential for
effectiveness of care.
o The nurse takes leadership roles in communities in which she lives and teaches by precept as well
as by example. The nurse by virtue of the fact that she is always available for the client is able to
plan health care, interpret health status, identify health problems, give better care and coordinate
health care.
o She also participates in research and teaching for the improvement of health care as a result of
better innovations, made possible by the continuing education she goes through. In conclusion,
the responsibilities of the nurse as a member of the health team as described are personal
interaction in her therapeutic, caring and socializing roles which are unique to nurses in the health
care services. This she does with adoptive skills and methods which may vary according to the
needs of patient / client and his family as well as the whole community.

29 | P a g e
 CHAPTER SIX
BUDGET AND IMPREST ACCOUNT
Financial Management in Community Health Nursing
In every organization, effective planning and efficient use of money is required for its growth.
A budget is a plan quantified in monetary terms, prepared and approved prior to a defined period of time,
usually showing planned income to be generated and /or expenditure to be incurred during the period and
resources to be employed to achieve a given objective.
It is simply a set of plans focused on present and future revenues and expenses. The goal of a budget is to
plan spending and often to save money.
Budgeting is however refers to a number of activities performed in order to prepare a budget.

GUIDELINES FOR EFFECTIVE BUDGET FUNCTIONS

o Becoming fully knowledgeable about the past and present financial situations of the community
health nursing unit.
o Determining the methods and sources of income for the unit.
o Exploring the possibilities for future income potential resources.
o Ensuring that there is proper book keeping
o Projecting the potentials for future survival of the unit based on the past and present financial
situation
o Determining the modes of financial self-sustenance of the unit
o Putting in place viable structures to monitor the manner of spending
o Developing appropriate planning structures for the future of the unit
o Determining the competence of those who project, plan and control the financial matters of the
unit
o Examining the extent to which the leadership is involved in the detailed administration of the
financial affairs of the unit.
MOH, GHS, Planning and Budgeting
Budgeting has four key components as seen below;
o An awareness of how much money is coming in
o attention to how much money is going out
30 | P a g e
 o spending habits and
o Financial goals.

CHARACTERISTICS OF BUDGET
 It is resource based. It takes account of all expected sources of funding of the health activities.
There are three main sources of funding of the MOH and GHS.
 Government of Ghana (GOG): this is the contribution of government from consolidated fund to
the health fund that constitutes 60% of the total budget estimate of the MOH and GHS.
 Donor Pooled Fund (DPF): these are contributions from international donor agencies like
European Union, DANIDA, USAID, UNFPA, UNICEF, WHO, WORLD BANK. The DPF
constitute 30% of the budget estimate.
 Internally Generated Fund (IGF): these are user charges from the facilities. The IGF constitute
10% of the budget estimate.
 It is Net based: This is based on major health priorities identified by national health policies and
adopted at district levels according to local peculiarities.
NB. It consists of four items:
Item I – personal emolument e.g. payment of salaries, allowances
Item II – administration e.g. computers, furniture
Item III – services
Item IV – investment
IMPREST
The imprest system is an accounting system designed to track and document how cash is being spent. The
most common of which is the petty cash system.
Petty cash is small amount reserved for transactions and expenditures where it doesn’t make sense to
write a cheque. However due to the rise of electronic transactions, the imprest system is becoming less
common. Many organizations including MOH/GHS prefer to use credit cards for incidental purchases or
ask employees/officers to pay in cash then apply for reimbursement.

REASONS WHY THE RCN SHOULD STUDY THE IMPREST SYSTEM.

As a manager and administrator at the CHPS compound,
The community health nurse will be given physical money (cash) to meet the day-to-day running of the
unit by the authorities of the public health unit.
It is not safe to handle this money hence it is normally given in petty cash (smaller amounts).
This money is normally advanced to the in-charge to be used exclusively for a certain authorized services
in the unit.

31 | P a g e
These services vary from place to place but the common items this money can be used for include the
following:
o Transport – lorry fares, repairs of the unit‘s / facility’s motorbike
o Postage – stamps, telephone calls , data for sending reports via internet etc
o Office needs – pens, pins, envelops, glue
o Cleaning needs – soap, detergents , gloves etc

HOW THE PETTY CASH IS USED

It is an advance of cash given for a particular purpose and replenished as necessary.
The petty cash may be spent within a week or may last up to 2 months.
Whatever the period, this money will be replenished to its original level provided what has been spent has
been accounted for. Petty cash is only replenished against original receipts of money spent. This measure
is to prevent misuse of funds.
Accurate recording of account is significant to the petty cash because the community health nursing
manager is answerable to the authorities on all monies given to her. Apart from that, auditors sometimes
come unannounced every year to go through the accounts. Any financial irregularities detected may lead
the community health nurse manager to prosecution in the court for misappropriation of funds.
In view of this, the following two accounting records are kept by the community health nurse manager:
a. petty cash voucher
b. petty cash book
THE PETTY –CASH VOUCHER
A petty cash voucher is usually a small form that is used to document a disbursement (payment) from a
petty cash fund. Petty cash vouchers are also referred to as petty cash receipts and can be purchased from
office supply stores.
The petty cash voucher should provide space for the date, amount disbursed, name of person receiving
the money, reason for the disbursement, general ledger account to be charged, and the initials of the
person disbursing the money from the petty cash fund. Some petty cash vouchers are pre numbered and
sometimes a number is assigned for reference and control.
This means anything money is used from the petty cash coffers, it must be recorded on this form called
petty cash voucher.
Each of such vouchers is numbered and filed in order.
Each voucher must also have the receipt attached to it from the one who sold the items.
If this is not possible, then the voucher must be signed by the hospital authority in-charge of the petty
cash.
The vouchers are kept carefully for future auditing.

32 | P a g e
THE PETTY CASH BOOK
Petty cash book is a type of cash book that is used to record minor regular expenditures such as
stationery, fuel, etc.
This gives a record of the expenditure on the items and the balance left from the imprest.

33 | P a g e
 CHAPTER SEVEN
GOVERNMENT POLICIES ON VARIOUS HEALTH PROGRAMS
The Ministry of Health has over the years formulated a number of policies to guide health service
delivery and programme implementation even though a number of them have not yet been achieved.
Below are some of Ministry of Health policies:
o Human Resource policies
o Anti-malaria drug policy
o National Health Policy
o National nutrition policy
o Traditional medicine policy
o Health sector gender policy
o Health sector ICT policy and strategy
o Hospital accident and emergency services policy
o Occupational health and safety policy
EMERGING HEALTH ISSUES
This refers to trend of issues that have become of public health importance and a great concern the
ministry of health and the government as a whole.
The Sustainable Development Goals (2015-2030) and Millennium Development Goals (MDGs) (2000-
2015)
Facts about progress on health related MDGs (4,5,6)
MDG 4: Reduce child mortality
MDG 5: Improve maternal health
MDG 6: Combat HIV/AIDS, malaria and other diseases
Child health progress made since 1990
17,000 fewer children die each day than in 1990, but more than six million children still die before their
fifth birthday each year
Since 2000, measles vaccines have averted nearly 15.6 million deaths
Despite determined global progress, an increasing proportion of child deaths are in sub-Saharan Africa
and Southern Asia. Four out of every five deaths of children under age five occur in these regions.
Children born into poverty are almost twice as likely to die before the age of five as those from wealthier
families.
Children of educated mothers—even mothers with only primary schooling—are more likely to survive
than children of mothers with no education.

34 | P a g e
Maternal health progress made since 1990
Maternal mortality has fallen by almost 50 per cent since 1990
In Eastern Asia, Northern Africa and Southern Asia, maternal mortality has declined by around two-
thirds
But maternal mortality ratio – the proportion of mothers that do not survive childbirth compared to those
who do – in developing regions is still 14 times higher than in the developed regions
More women are receiving antenatal care. In developing regions, antenatal care increased from 65 per
cent in 1990 to 83 per cent in 2012
Only half of women in developing regions receive the recommended amount of health care they need
Fewer teens are having children in most developing regions, but progress has slowed. The large increase
in contraceptive use in the 1990s was not matched in the 2000s
The need for family planning is slowly being met for more women, but demand is increasing at a rapid
pace
HIV/AIDS, malaria and other diseases progress made since 1990
At the end of 2014, there were 13.6 million people accessing antiretroviral therapy
New HIV infections among children have declined by 58 per cent since 2001
Globally, adolescent girls and young women face gender-based inequalities, exclusion, discrimination
and violence, which put them at increased risk of acquiring HIV
TB-related deaths in people living with HIV have fallen by 36% since 2004
There were 250 000 new HIV infections among adolescents in 2013, two thirds of which were among
adolescent girls
AIDS is now the leading cause of death among adolescents (aged 10–19) in Africa and the second most
common cause of death among adolescents globally
As of 2013, 2.1 million adolescents were living with HIV
Over 6.2 million malaria deaths have been averted between 2000 and 2015, primarily of children under
five years of age in sub-Saharan Africa. The global malaria incidence rate has fallen by an estimated 37
per cent and the morality rates by 58 per cent
Between 2000 and 2013, tuberculosis prevention, diagnosis and treatment interventions saved an
estimated 37 million lives. The tuberculosis mortality rate fell by 45 per cent and the prevalence rate by
41 per cent between 1990 and 2013.

35 | P a g e
THE SUSTAINABLE DEVELOPMENT GOALS (SDGS)
There are a total of 17 SDGs and 169 sub targets to be pursued from 2015 to 2030. Among these SDGs,
goal 3 is directly related to health (i.e. SDG 3: Ensure healthy lives and promote well-being for all at all
ages)

The SDGs are:

o End poverty in all its forms everywhere
o End hunger, achieve food security and improved nutrition and promote sustainable agriculture
o Ensure healthy lives and promote well-being for all at all ages
o Ensure inclusive and equitable quality education and promote lifelong learning opportunities for
all
o Achieve gender equality and empower all women and girls
o Ensure availability and sustainable management of water and sanitation for all
o Ensure access to affordable, reliable, sustainable and modern energy for all
o Promote sustained, inclusive and sustainable economic growth, full and productive employment
and decent work for all
o Build resilient infrastructure, promote inclusive and sustainable industrialization and foster
innovation
o Reduce inequality within and among countries
o Make cities and human settlements inclusive, safe, resilient and sustainable
o Ensure sustainable consumption and production patterns
o Take urgent action to combat climate change and its impacts
o Conserve and sustainably use the oceans, seas and marine resources for sustainable development
o Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests,
combat desertification, and halt and reverse land degradation and halt biodiversity loss
o Promote peaceful and inclusive societies for sustainable development, provide access to justice
for all and build effective, accountable and inclusive institutions at all levels
o Strengthen the means of implementation and revitalize the global partnership for sustainable
development
SDG 3 and Specific Targets by 2030
3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries
aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to
at least as low as 25 per 1,000 live births
36 | P a g e
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat
hepatitis, water-borne diseases and other communicable diseases
By 2030, reduce by one third premature mortality from non-communicable diseases through prevention
and treatment and promote mental health and well-being
Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful
use of alcohol
By 2020, halve the number of global deaths and injuries from road traffic accidents
By 2030, ensure universal access to sexual and reproductive health-care services, including for family
planning, information and education, and the integration of reproductive health into national strategies
and programmes
Achieve universal health coverage, including financial risk protection, access to quality essential health-
care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water
and soil pollution and contamination
3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco
Control in all countries, as appropriate
3.b Support the research and development of vaccines and medicines for the communicable and non-
communicable diseases that primarily affect developing countries, provide access to affordable essential
medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public
Health, which affirms the right of developing countries to use to the full the provisions in the Agreement
on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health,
and, in particular, provide access to medicines for all.
3.c Substantially increase health financing and the recruitment, development, training and retention of the
health workforce in developing countries, especially in least developed countries and small island
developing States
3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk
reduction and management of national and global health risks.
HEALTH PARTNERS IN GHANA
Health partners are individuals and organizations working in various capacities with the ministry of
health towards attaining health sector goals and objectives. Health partners can be local or international
with varying interest and target

INTERNATIONAL PARTNERS
o Adventist Development Relief Agency (ADRA)
o Catholic Relief Services (CRS)

37 | P a g e
 o Department for International Development (DFID)
o Embassies and High commissions of countries
o European Union (EU)
o International Labor Organization (ILO)
o Japanese International Cooperation Agency (JICA)
o Quality Health Partners (QHP)
o The Blue Cross Society
o The Red Cross Society
o United Nation‘s Education, Science and Cultural Organization (UNESCO)
o United Nations Children Emergency Fund (UNICEF)
o United Nations Fund for Population (UNFPA)
o United States Agency for International Development (USAID)
o World Bank (WB)
o World Food Programme (WFP)
o World Health Organization (WHO)
o World Vision International

LOCAL PARTNERS
o Ghana AIDS Commission
o Industry and private companies
o Ministries Departments and Agencies (MDAs)
o Philanthropists (e.g. Kristo Asafo; The Lions Club, Rotary Club etc)
o Telecommunication companies (e.g VODAFON Health Line)
o Universities (University of Ghana Legon; KNUST; University of Cape Coast; UDS etc)

ROLES OF HEALTH PARTNERS

Depending on focus and interest, health partners play diverse and critical role in execution of health
programmes in the country. Health partners render support in a several dimensions such as:
 Funding support
 Technical support
 Logistical support
 Research development
 Capacity building
 Joint monitoring and assessment activities
 Information sharing
38 | P a g e
  Support in policy formulation and implementation
GOVERNMENT HEALTH RELATED AGENCIES
Ministry of Food and Agriculture:
This ministry is responsible for agricultural related policies and implementation in the country.
The direct and indirect effects of food and agriculture on health are not farfetched particularly on issues
of food security and malnutrition and overall health outcomes.
For instance, food shortage or inability to afford balanced diet could result in stunted growth and other
health conditions.
Ministry of Local Government and Rural Development
This is responsible for formulating rural development policies and setting strategies for attaining good
quality of life in rural areas.
Improve rural development is necessary for good health seeking behaviors
Also, improved quality of life promotes better access to healthcare facilities and also enhances financial
accessibility especially through community empowerment
Department of Social Welfare and Community Development
This department is responsible for social issues related to broken homes, child delinquency and
abandonment, child abuse.
The department is also responsible for rehabilitation of people with various impairments and orphans.
Activities of this department remain critical to community health because of the direct and remote effects
of social challenges on health and wellbeing.
Close collaboration between the community health and social worker is thus important towards
identifying and preferring solutions to both the social and health needs of the community
Ministry of Water Resources Works and Housing
This ministry is responsible for formulating policies related to housing and shelter needs of the country.
Poor housing has deleterious effects on public health outcomes. For instance housing units with poor
ventilation could result in contracting communicable diseases such as Tuberculosis.
Moreover poor housing could result in poor drainage, flooding and possibly loss of lives especially
during the raining seasons
Spread of cholera could also be precipitated by poor housing and drainage systems
Ministry of Transport and Community
The role of this ministry towards attaining desired health outcomes cannot be over emphasized. This is
because access to good roads networks and effect transportation systems promotes geographic
accessibility to healthcare facilities especially in remote areas.
This ministry therefore plays an important role in attainment of the health related millennium
development goals particularly those related to maternal and child health
39 | P a g e
 CHAPTER EIGHT
VARIOUS HEALTH INSURANCE SCHEMES
A full scale implementation of formal health insurance system started in 2003 through an Act of
parliament (Act 650; Amended Act 850, 2012) to ensure universal access to quality healthcare services
by every Ghanaian.

TYPES OF HEALTH INSURANCE SYSTEMS IN GHANA

The National Health Insurance Act (NHI Act) (Act 650) established three types of health insurance
schemes in the country:
o The District Wide Mutual Health Insurance Schemes (DWMHIS) (Now district health insurance
offices)
o Private Mutual Health Insurance Schemes (PMHIS) (E.g Glico; Medex etc)
o Private Commercial Health Insurance Schemes (PCHIS) (Private companies)

SOURCES OF FUNDING TO THE NHIS

The source of funding for the NHIS comes from:
o The National Health Insurance Levy (NHIL), 2.5% top up of the Value
Added Tax (VAT)
o A 2.5% from formal employees’ social security contributions (i.e. SSNIT)
o Premiums from informal workers (amount dependent on poverty levels) and government
subsidies.

OPERATIONAL AND FINANCIAL SUSTAINABILITY CHALLENGES OF THE NHIS

o Health providers indulging in massive fraudulent claims
o Delayed re-imbursements of healthcare providers
o Delayed issuance of cards to subscribers of the scheme.
o Stagnating enrolments and re-enrolment rates (8.2 million Ghanaians active (33% coverage))
o Polypharmacy and irrational drug prescription
o Informal fee charges (co-payments)

WAY FORWARD AND SUSTAINABILITY STRATEGIES

o Early reimbursement
o Correct claims filing and early submission
40 | P a g e
 o Regular monitoring
o Effective accreditation
o Efficient call center for complaints
o Education for clients and providers
CHAPTER NINE
HEALTH INDICES
Health Indicators or Health Indices are factors that reflect the state of health of persons in a defined
population. They are used in analysing the present situation and in comparing different geographical
areas and measuring how health status health status has improved.
The following are types of health indicators:
o Health policies indicators
o Socio-economic development indicators
o Population indicators
o Provision of health care
o Health status indicators
o Morbidity indicators
o Mortality indicators
o Life expectancy
o Population growth rate
o Disability rate
o Mental indicators etc

HEALTH POLICIES INDICATORS

Health policies that indicate the health level of any given population include:
 The level of political commitment to health services
 Availability of a health policy statement and written health plans such as ―the health sector 5
year programme of work, document of Ghana‖ which is a medium term health strategy document
towards vision 2020.
 Allocation of manpower and financial resources from the government of the health sector
 The equitable distribution of equipment, vehicles, staff accommodation and staff according to the
workload and the level of the health facility.
 Availability of decentralized organizations in the regions of health planning and management,
establishment of more district health teams with financial and logistic support and given the
capacity to manage both human and material resources efficiently.

41 | P a g e
  The degree of collaboration between the government and the non-governmental health agencies.
There should be strategies in place for advocacy and joint action support at the district and sub-
district levels with the active involvement of other sectors and district assemblies.

SOCIO-ECONOMIC INDICATORS
The socio-economic status of the community that can be used to assess its health status include:
 The level and distribution of economic wealth. It is not practicable for the economic wealth of
everyone in the community to be at the same level. However, it is possible for efforts to be made
to reduce the wide gap between the rich and the poor, and for even distribution of resources
irrespective of one’s geographical location.
 The per capita income- when the per capita income of a country is high, it gives an indication that
the majority of the people can have access to the factors that will improve and maintain their
health.
 The types and levels of employment- when employment levels of a community are high, the
income levels are high resulting in reduction in poverty levels.
 The availability of food all year round. This helps reduce starvation, malnutrition and deaths.
 The educational level- people who are educated have more capacity to assess health care needs to
promote their health.
POPULATION INDICATORS.
These include the total population of the country, its age and sex structure distribution. Other indicators
include birth rates and migration rates. Provision of health care. This is the availability of health services
and facilities. This includes the provision of health care institutions such as hospitals, health centres and
clinics. It also involves a health care system that is effectively re-directed towards public health services
and for that matter, community-based health care like community-based health planning and services
(CHPS). It also includes manpower or human resource development for quality care, as well as adequate
resources to work with.
NUTRITIONAL STATUS
The nutritional status indicator can be determined by:
 Monitoring the child‘s growth and development and accessing the weight and comparing it with
the age to get the percentile.
 Using other anthropometric measurement such as measurement of the mid-arm circumference to
determine level of malnutrition in a child.
HEALTH STATUS

42 | P a g e
To determine the health status of the community, the nutritional status, morbidity and mortality rates are
used. The higher the rates the less healthy the community is said to be.
LIFE EXPECTANCY
This is the average number of years members in a population are projected to live. The life expectancy
indices of developing countries like Ghana are said to be lower than that of developed countries. This is
attributed to the differences in the levels of nutrition, housing and medical services which are available to
these groups. Generally, life expectancies are said to be high in females than in males (as much as 8
years‘difference).
POPULATION GROWTH RATE
The rate of population growth in a country also determines the health status of the individuals in it. If it is
too high it overstretches the economic, basic and social resources
MORBIDITY INDICATORS
These are based on the incidence and prevalence rates of diseases in the community, as well as its attack
rate.
Morbidity has been defined as any departure, subjective or objective, from a state of physiological or
psychological wellbeing. However, in epidemiology it is refers to as the relative occurrence of disease in
a population. In practice, morbidity encompasses disease, injury, and disability .This occurs in incidence
and prevalence forms.
Incidence
Incidence refers to the occurrence of new cases of disease or injury in a population over a specified
period of time. In otherwise it is the number of new cases arising in a given period of time in the same
area.
A rate is a measure of the frequency with which an event occurs in a defined population over a specified
period of time.
Incidence rate (IR) –
describes a proportion in which the numerator is all new cases appearing during a given period of time,
and the denominator is the population at risk during the same period:
IR= Number of new cases × 1000 / year
Total population at risk
The incidence rate tells the number of people who get affected with a particular disease at a particular
time, and therefore tells how the infection is increasing.
Attack rate - describes the proportion of a group or population that develops a disease among all those
exposed to a particular risk. Changes in attack rates may indicate a change in the immune status of the
population, or an indication of a more virile strain of organism. It may also depend on the herd immunity
of the population.
43 | P a g e
 Prevalence - is the number of both new and old cases in a defined population at a specified time. The
prevalence rate describes a proportion in which the numerator is both new and old cases within a given
period of time and the denominator is the population at risk during the same period.
PR= Total number of cases (old and new) × 1000 / mid –year
Total population at risk
The Prevalence rate gives the number of both previously infected and newly infected individuals of a
particular disease at a given time. Period prevalence rate- refers to prevalence measured over an interval
of time. It is the proportion of persons with a particular disease or attribute at any time during the interval
or the prevalence rate over a defined period of time. Point prevalence rate - refers to the prevalence
measured at a particular point in time. It is the proportion of persons with a particular disease or attribute
on a particular date or the number of cases that are present in a particular point in time.
MORTALITY INDICATORS
These include the level of all the death rates of the community such as infant mortality rates and maternal
mortality rates.
Crude mortality rate - general mortality rates are called crude rates. The numerator of the crude rates
includes all relevant deaths in the entire population of the area of interest.
Crude mortality (death) rate = Number of death during a year × 100,000
Average (estimated) midyear population
When the numerator includes only deaths from a particular cause the rates are called: Cause specific
mortality.
Cause specific mortality rates
= Number of deaths from a stated cause during a year x 100,000
The estimated mid-year population
Such rates provide only an average rate and there may be a problem interpreting comparisons of such
rates.
ii. Age specific mortality rate = Number of persons in a specific age group during a year ×
100,000 the estimated mid-year of the population of the same age group
iii. Case fatality rate = number of deaths from a particular disease × 100
The total number of cases of the same disease
iv. Proportional mortality ratio
= number of deaths from a specific cause within a given time period × 100
Total deaths in the same time period
Maternal Mortality Rate (MMR) This is the rate that measures a woman‘s risk of dying from causes
associated with pregnancy and child birth. Maternal death is the death of a woman during pregnancy or
within forty two days of termination of pregnancy.
44 | P a g e
MMR = Number of deaths from puerperal causes in a year × 100,000
Number of live births during the same year
This rate is still high in developing countries mainly due to abortions, toxemia of pregnancy, infections,
hemorrhages and malnutrition.
Infant Mortality Rate (IMR) this is the number of children dying before 1 year of age out of every
thousand children born alive that year.
IMR = Number of deaths of children under 1 year for a given year × 1,000
Number of live births for the same year
Perinatal mortality rate
= Number of foetal deaths plus infant deaths under 1 year of age during 1 year × 1,000 The
number of live births plus foetal deaths during the same year
Specific Rates for Infant Populations
Crude Birth Rate = Number of live births during a year × 1,000
Estimated mid -year population

General Fertility Rate

= Number of live births during a year
Number of females aged 15 – 44 years

45 | P a g e
 CHAPTER TEN
REGISTRATIONS OF BIRTHS AND DEATHS

BACKGROUND TO BIRTHS AND DEATHS REGISTRATION IN GHANA

Vital registration in Ghana (the Gold Coast) began as far back as 1888. However, at its inception, it was
registration of deaths. It was not until 1912 that the registration of births was introduced. The registration
system has gone through a series of transformations just as the law establishing it has seen a number of
amendments. All this was aimed at improving upon the final delivery system.
Starting as the Cemetries Ordinance of 1888, it was first amended in 1891. In 1912, it became the Births
and Deaths and Burials Ordinance, which once again amended in 1926. This was finally replaced with
the Registration of Births and Deaths Act of 1965, (Act 301) which is the legislation currently in force.
The Births and Deaths Registry was therefore established by the Act 301 of 1965, within the Ministry of
Local Government and Rural Development, to handle and develop the births and deaths registration
system in Ghana. Its core business is to provide accurate and reliable information on all births and deaths
occurring within Ghana for Socio-economic development of the Country through their registration and
certification.
VISION OF THE BIRTHS AND DEATHS REGISTRY
The vision of the Registry is to attain universal births and deaths registration in Ghana
MISSION STATEMENT OF THE BIRTHS AND DEATHS REGISTRY
The Births and Deaths registry exists to provide accurate, reliable and timely information of all births and
deaths occurring within Ghana for the Socio-economic development of the country through their
registration and certification.

FUNCTIONS OF THE BIRTHS AND DEATHS REGISTRY

 Legalization of registered Births and Deaths

 Storage and management of births and deaths records/registers

 Issuance of Certified Copies of Entries in the Registers of Births and Deaths upon request.
 Effecting corrections and insertions in the Registers of Births and Deaths upon request
 Preparation of documents for exportation of remains of deceased persons
 Processing of documents for the exhumation and reburial of remains of persons already buried.
 Verification and authentication of births and deaths certificates for institutions, especially the
foreign missions in Ghana.

46 | P a g e
REGISTRATION OF BIRTHS AND DEATHS
Operations of the Births and Deaths Registry is co-ordinated from the Central Registry Office, which is
located in Accra, the capital of Ghana. The entire country has been divided first into 10 Registration
Regions, which coincide with the political and administrative regions of Ghana. The Registration Regions
have further been partitioned into 110 Registration Districts, which also coincide with the country’s
administrative local authority areas. There is at least one Registry Office in each registration district
manned by one District Registration Officer, who supervises the registration system through the registries
and reporting centres in the district. The Registration Officer submits monthly, all registration forms,
numbered serially to the Regional Office for further processing and onward transmission to the Central
Registry Office, where national data is compiled. Registration records are kept at all three levels to secure
the information for development activities at all three levels.
PROCEDURE

NB. The birth of every child is to be registered in the district where the birth occurred. There is no de jure
or defacto discrimination between mothers and fathers in the registration process. Fathers name is entered
even if the parents are not married.

TO REGISTER THE BIRTH OF THE CHILD;

 It is the duty of one parent (father or mother) to report the birth of a child for registration. In the
absence of the parents, one of the following persons is allowed by law to report the birth for
registration;

(a) The owner of the premises in which the child is born.

(b) A person present at the birth.

(c) A person having charge of the child to furnish the prescribed particulars for registration.

 The informant will be required to produce evidence of birth, such as a clinical weighing card.
 A Registration Assistant administers a questionnaire, (the birth report form A) to the informant.
 Information thereby collected is recorded in the register of births.
 A birth certificate is issued after the

CONDITIONS/CRITERION FOR REGISTRATION OF THE BIRTH IN GHANA

The birth should be registered, free of charge, within 21days of occurrence but registration outside this
condition period attracts a prescribed fee.
47 | P a g e
IMPORTANCE OF BIRTH REGISTRATION
Here are four important reasons why birth registration is important.
Creation of identity
Birth registration gives a legal identity to the child which opens up to a world of opportunities to the
child. Access to education is granted with proof of birth registration amongst other privileges.
Access to healthcare
Since a child without a birth certificate is denied the ability to partake in some of the simplest rights it is
duly entitled to, it is often the case that children die from easily preventable diseases due to their lack of a
birth certificate, possession of one makes them capable of receiving the medical treatments and
vaccinations needed.
Rights
Certain individual rights can be withheld without proof of birth certification. In line with the previous
point, without possession of a birth certificate, the individual right to health can be jeopardised. The right
to get an education, rightfully inherit property, prevent child exploitation is also guaranteed.. All these
rely on birth registration to prove identity and thus entitlement to basic rights.
Protection from abuse
Lack of birth documentation renders a child vulnerable to crimes and abuse, since the government has no
evidence of the child’s existence; it is incapable of protecting the child from forces of crime. Children in
this situation are more susceptible to being recruited as child soldiers or being trafficked.

CHALLENGES OF BIRTHS AND DEATHS REGISTRATION IN GHANA

The Key Issues & Challenges the births and deaths registry faces include;
o Low priority accorded to registration and general apathy
o Lack of inter-departmental co-ordination
o Inadequate budget allocation by the States for Civil Registration work
o Low levels of knowledge amongst registration functionaries about the processes and procedures
of registration, reporting and management of data
o Lack of regular monitoring and supervision of civil registration work in the states

48 | P a g e
 CHAPTER ELEVEN
MANAGEMENT FUNCTIONS (review)
Functions of both administrative and management depends largely on being effective and efficient by
carrying out functions of POSDCoCB.
o Planning,
o Organizing
o Staffing
o Directing
o Coordination
o Controlling/Monitoring
o Budgeting/financial management

PLANNING:
Planning is the first function of the management process. It involves decision-making about activities or
programs for the existence, survival, growth and progress of the organization for the present and the
future.
It means working out in broad outline the things that need to be done and the methods for doing them to
accomplish the purpose set for the organization.
In schools, planning may involve setting objectives and establishing school policies and procedures for
implementation that will help to realize the goals.
In the hospital situation, it may entail appointing directors/ DDNS, ward in charges/ unit heads etc: and
establishing the chain of command as well as assigning responsibilities such as that of students clinical
coordinators, welfare officers and providing the resources for carrying out such responsibilities.
The Community health nurse engages in planning as part of the manager’s role when supervising a group
of subordinates, or clients’ care in the home.
The plan of care must include setting short-term and long-term objectives, describing actions to carry out
the objectives, and designing a plan for evaluating the care given.
Planning in the context of community health nursing includes effective collection of data, identification
of problems from the data, setting of objectives, reviewing any objectives and making a plan for care.

TYPES OF PLANNING IN HEALTH SERVICES

o Corporate planning
o Strategic planning
o Management planning
o Operational planning

49 | P a g e
CORPORATE PLANNING
Dixon (1994) defined cooperate planning as planning for an organisation as a whole in order to ensure
that, long term objectives of each department are compatible and in line with the overall goal so as not to
conflict with the overall goal . The main reason for this planning is to define and make clear the goals of
an organisation.
STRATEGIC PLANNING
This is the process of determining what the health sector should be achieving in the future and how it will
carry out the actions necessary to bring about those achievements. Top-level managers develop strategic
plans in order to achieve their strategic goals. Usually strategic planning covers the long term and the
specific actions to be taken in the next five to ten years. It is about the ‘bigger picture’ and it shows a
‘map’ of where the health sector is aiming to be in the future. It is through strategic planning that the
health sector determines its priorities and the strategies that are likely to help the nation to achieve its
overall health.
It also involves matching the clients’ needs successfully with the organisations’ strength, competencies
and resources.
MANAGEMENT PLANNING
Management planning refers to lower intermediate level of planning. It involves determining the
organisational structure, establishing functional and departmental objectives in line with the strategic
plans and aims, planning staff requirements and setting budget.
OPERATIONAL PLANNING
Operational planning refers to the action plans that guide your day-to-day work. It is an instrument for
implementing the strategic plan so without an operational plan, it is likely that the strategic plan will
remain a distant dream and you will not get there anyway. As the lowest level of planning which covers
monthly, weekly and daily planning, include scheduled action plan, nursing care plans and time tables etc

IMPORTANCE OF PLANNING
o Good planning has lots of benefits to the community health nurse. These benefits include:
o Planning makes objectives clearer for members to focus on
o It provides a sense of direction and prevent frustration and conflicts
o It counteracts future uncertainties.
o It helps increase participation in decision making
o It supports the opportunity to evaluate actions
o It allows the opportunity to be effective and efficient thereby making operations more
economical.
50 | P a g e
 o Planning promotes team building and a spirit of co-operation
o Planning provides direction
Planning community nursing activities or program
Examples of specific programmes in community health nursing include: immunization programmes,
family planning programmes, school health programmes, health promotion programmes, occupational
health programmes etc.
A programme according to Standhope and Lancaster (1992) is an organised response designed to meet
the assessed needs of individual, families, groups or communities. In every community, there are
population groups at risk of certain health problems .It is therefore necessary for the community health
nurse to plan health programs in line with that. The nurse is in direct contact with the community
members so he/she is able to identify their needs and the available resources and use appropriate
strategies to meet the overall goals. It can be stated therefore that, health planning for population at risk is
one of the major functions of a community health nurse.
NB. There are guidelines when planning for a programme.
They include:
o Needs, desires and interest of the people should be identified used in planning
o Those will be involved in carrying out the plan should be identified and involved in the initial
stage
o Ensure that, planning includes those who have major stake
o The planning should be realistic in terms of money, people and other resources.
Stages Involve In Planning a Health Programme
o Situational analysis
o Problem identification and prioritization
o Setting objectives
o Strategy formulation
o Identify and sequence activities
o Identify resources
o Prepare action plans and schedules
o Monitoring and evaluate the implementation
 Situation analysis
Situational analysis is the first stage in the operational planning process. It is the stage where the
community health nurse need to:
o Gather reliable information about the causes of health problems in the community, including from
local people who will benefit from any interventions.
51 | P a g e
 o Identify the health situation of the community and identify where affected population groups are
located geographically.
o Discover what is currently being done to resolve the identified needs and who is doing it.
o Investigate how well identified needs have been addressed in the past and consider how you could
collaborate with others in the community in order to address current needs.
 Problem identification and Prioritization
A problem is a perceived gap between what something is and what that thing should ideally be. Gathering
information about the root causes of health problems is necessary to identify the health problems that
exist in the community. When analyzing a problem, the intention is to find out the root cause (etiologic)
of that problem. It is essential for a community health nurse to do a thorough situational analysis in order
to identify critical health problems. The “but why” technique is used here. It involves asking questions at
each stage to identify the causal factors. When assessing the needs of a clients, the age group mostly
affected, the number of people affected (prevalence rate), the location of the problem, extend of the
problem, and the existing solutions to the problem.
As a public health worker, the RCN is expected to prioritize and make strategic choices in order to
implement the health plan. When she set priorities, she decides what is most important to tackle first.
One way to determine priority problems is to apply a set of selection criteria that establish a standard by
which something can be measured. Example pair wise ranking.
 Setting / formulation of objectives
In order to plan effectively, the community health nurse needs to be clear about what she and her work
group are trying to achieve. Objectives include the steps to be taken in pursuit of agreed goals, such as
those in the strategic plans set by the wider health service. However, you need to base your objectives on
the local context and the capacity of your community.
REASONS FOR SETTING OBJECTIVES
A clear objective is essential to create a definite plan. For example, the objective could be to increase the
number of nursing mothers attending child welfare clinic.
Setting objectives enables results to be evaluated. When a programme has no stated or known objectives
its outcome cannot be evaluated. For example, the objective could be to increase the number of nursing
mothers attending child welfare clinic by 60% in one year.
When setting objectives convert problems into positive statements and make them specific, measurable,
attainable, realistic, time (SMART).
It is important to look at all alternatives and choose the one that is most appropriate.
 Strategy formulation

52 | P a g e
This is to consider which ways to employ towards the project success.it includes the identification of
possible solutions. During this stage, the manager weighs the pros and cons and compares the objectives
with the anticipated results. A list of the logistics or resources needed to implement each activity is make
and the cost involve is also estimated. The use of the “problem tree” can be helpful.
 Identify and sequence activities
This is the stage where you already know what you are trying to achieve and need to list all the activities
and place them in the correct sequence according to their importance and timing. You should identify any
dependencies, i.e. which activities cannot start until others have been completed, since this is the factor
that will determine your overall sequencing. Identify if any activities could possibly be undertaken at the
same time.
 Identify the resources
This is the time when you have to consider what resources will be needed to complete your health project
activities. Once you have clarified the tasks to be done and the sequence in which the tasks must be
carried out, you should be able to calculate what resources you will need more accurately .The resources
you need to carry out an action plan include: staff, accommodation, power, equipment and materials.
Time, skill and information are also important to be considered in resource calculations. It involves the
presentation of the best plan for sponsorship. The reason for selecting the plan should be convincing to
the sponsors. It is beneficial to keep the sponsors informed al all level of planning or better still involve
them during to achieve aim. Objectives for implementation are set and actual activities are ensured.
Prepare action plans and schedules
 Preparing an action plan for funding and implementation
This stage involves the presentation of the best plan for sponsorship. The reason for the selecting the plan
should be convincing to the sponsors. It is beneficial to keep the sponsors informed al all level of
planning or better still involve them during to achieve aim. Objectives for implementation are set and
actual activities are ensured.
 Monitor and evaluate the implementation
Monitoring is a technique by which you can check that everything is continuing to go according to plan
and evaluation is to compare the outcome with the set objectives.
This stage is a “must be” for every programme designed. This is the stage where measures are put in
place to check whether objectives are met. This is where monitoring is done to obtain information about
the program is systematically for the purpose of improving practices, and to have both internal and
external accountability of resources used and the results obtained. Evaluation is also carried out based on
date collected during monitoring to draw conclusion on five main aspects: relevance, effectiveness,
efficiency, impact and sustainability.

53 | P a g e
ORGANISING:
Involves designing structures within which people and tasks function to achieve objectives. This
includes: deciding the task to be done, who to do it, how to do group the task, who reports to whom,
where decisions will be made (Cherry and Jacob 2002).
It also involves establishing an intentional structure of roles for people to fill in an organization. To
organize a business/an institution well, it is required to provide all the useful features for its proper
functioning.
This involves in:
o Determination of activities required to achieve goals.
o Grouping these activities into department.
o Assigning such groups of activities to managers.
o Forming delegation of authority.
o Making provisions for coordination of activities.

THE SIGNIFICANCE OF ORGANIZING

Ensuring specialization: the allocation of work amongst the workers on the basis of their experience,
talents and qualification ensures that the right people are on the right jobs. This makes them happy and
their efficiencies are increased at the work place
Ensuring maximum utilization of resources: the grouping of work ensures that there are no delays or
duplication of work
Realization of relative importance of various units in the set-up: through organizing, one gets to
know the relative importance each unit contributes towards the achievement of the objectives of the
organization unit
Personal identification: due to the compartmentalization of the jobs, the position and roles played by
each member can be easily defined
Conflict reduction: conflicts are reduced due to factors like well-defined lines of communication, job
descriptions, and the levels of responsibilities and authorities entrusted unto the workers
Ensuring management succession: the junior nurses are trained through delegation of the duties to
make up the work after the superior resigns or retires.

GENERAL PRINCIPLES OF GOOD ORGANIZING

Unity of objectives: every activities of the unit must aim at contributing to the attainment of the stated
objectives of the unit
Flexibility: the organizational structure of the unit should have provision for adjustments necessitated by
changing policies or circumstances without disruptions to the basic design.
54 | P a g e
Span of control: the number of persons an individual can supervise should be kept at minimal. This
varies with reasons but averagely one can effectively supervise only six subordinates.
Unity of command: each subordinate should have only one superior. This is because, instructions from
two or more supervisors, (dual subordination) creates conflicts.
Delegation of authority: authority should be delegated as far down the levels as much as possible for
each member to feel a part of the organization.
Scalar principles: the community health nurse manager must have ultimate authority, and a clear line of
authority should be in existence in all parts of the unit.
Discipline: this is needed in any human institution. It is normally achieved by the law of situation-that-is,
the community health nurse manager informs the subordinates of the facts of the situation and allows
them to partake in decisions.
Promotion of specialization: the activities should be grouped according to the similarities in the
activities and assigned to people who have the experience and technical knowledge.
DELEGATION OF AUTHORITY
It is important for a community health nurse manager to know how to delegate authority since he/she will
be responsible for actions of their subordinates. Authority refers to the right and power to act or the right
to give orders. Delegation of authority is a process of assigning responsibility and authority to a
subordinate and ensuring his/her accountability.
NB. For a community health nurse manager when delegating authority, the following should be done:
o Consult the various subordinates when assigning responsibilities appropriately
o Grant the due authority to the subordinate to fulfill their responsibilities and share decision
making power with them
o Ask for feedback and accountability regularly after delegating responsibilities
o The community health nurse manager should know when delegation is necessary.
NB. For instance, delegation can be done in the following circumstances;
When workload increases
To develop staff/ for staff development
When qualified staff are available to do the work
Existence of administrative bottlenecks
It is important to note that when a community health nurse manager delegates authority, it doesn’t mean
he/she is losing his/her authority but retains all power assign to his function
PRINCIPLES OF DELEGATION
o Make sure task to be perform are well specified and understood by the subordinates
o Task sure be assigned to subordinates who are willing to do them

55 | P a g e
 o Subordinates should understand the extend and limitation of the authority given to them
o Give a written authority to prevent ambiguity
o Give advice, a briefing or training necessary to the subordinate
o Encourage subordinates who have delegated
o Allocate resources to the subordinate
o Decide which task to delegate
o Decide who carries out the task taking into consideration competence, time etc.
o Authority and responsibility should be properly balanced
o Be prepared to run interferences if necessary
o Establish a feedback system
Advantages of delegation
1. Workload is distributed evenly and fairly
2. It offers the opportunity to develop staff abilities
3. It motivates staff since the take part in decision making
4. It reduces overburdened task on community health nurse managers and in charges
Limitations of delegation
1. The nature of the work can prevent delegation. For instance very confidential and highly
specialized duties
2. Permission to delegate
3. The ability of the subordinates
4. Controls available
5. Cost of decision

STAFFING
This is considered as an important function which makes provision for man power to fill different
positions. This is done by identifying work-force requirements, taking inventory of people available,
recruiting new staff, selecting, placing, promoting, apprising, planning their career, training the staff to
accomplish their tasks effectively and efficiently. It is the task of recruiting.
This involves in:
o Finding the right person for right job.
o Selecting the personnel.
o Placement, training and developing new skills required for present and future jobs.
o Creating new positions.
o Apprising the staff and planning their growth and promotions etc

56 | P a g e
The community health nurse (Nurse manager) should be guided by the following principle to
perform this role:
o Establishing the prepared procedures for requesting the needed personnel for the unit
o Establishing the modalities guiding the promotion of qualified personnel in the respective tasks
(staff performance appraisal)
o Ensure there are adequate provisions for in-service training for new as well as old staff to ensure
quality of service
o Put in place the necessary mechanisms that monitor the daily activities of the personnel in order to
notice deficiencies for appropriate solutions
o Make sure all staff have well spelled out job descriptions to avoid confusion
o Ensure there is fair distribution of personnel at the various sub-units for the needed output
o Establish measures which will ensure workers are reasonably satisfied to retain them for longer
periods.
o Put in place the necessary work conditions that would attract better qualified staff to accept
postings to the unit.
o Use staff training as a means of making the best use of the human resources of the health system
as a whole.
The quality of the community health nursing care and its equitable distribution in the catchment areas
depend greatly upon human resources.

DIRECTING/LEADING
It may be defined as the continuous duty of making decisions and making them work in the specific
instructions that are meant to guide the subordinates in the discharge of their duties.
Directing involves three sub-functions namely communication, leadership and motivation.
Communication is the process of passing information and understanding from one person to another.
Leadership is the process by which a manager guides and influences the work of his subordinates.
Motivation means arousing desire in the minds of employees of an organization to perform their best. If
properly motivated, the employees will put their best efforts with dedication, loyalty and carry out the
assigned task effectively.
There are two types of motivations namely; financial and non-financial. Financial motivations are in the
form of salary, bonus, profit-sharing, rewards etc. The common non-financial motivations are job
security, promotions, recognition, praise, felicitation etc.
An example of directing function in Community health nursing is having periodic meetings with
subordinates on issues regarding the work.
57 | P a g e
With an appropriate plan and clearly defined organizational goal, the Community health nurse directs
implementation of the plan. The Community health nurse plays leadership roles constantly as they
conduct activities and give nursing care.
Staff members also need to understand the leadership style of the Community health nurse manager and
their own behavior in order to promote effective function.
Guidelines to a successful directing as a leader
o Making sure that the daily routine of the organization, as well as its structure help with the smooth
conduct of affairs so that the organization can meet its desired objectives.
o Making sure there is a system in place that motivates personnel to continue meeting the needs of
clients.
o Making sure the processes of daily operations are clearly laid for workers and supervisors, and
that there are few or no ambiguities
o Ensuring the free flow of information as far as orders are given and received, between the
supervisors and subordinates, and among the subordinates
o Looking out for the existence of influential forces within the organization that tend to resist
important changes intended to promote progress.

LEADERSHIP STYLES
Leadership style is the manner in which managers exercise their authority in the workplace and ensure
that their objectives are achieved. It covers how managers plan and organise work in their area of
responsibility and, in particular, about how they relate to, and deal with their colleagues and team
members.
It is also a leader's style of providing direction, implementing plans, and motivating people. There are
many different leadership styles that can be exhibited by leaders in the political, business or other fields.
Authoritative
The authoritarian leadership style or autocratic leader keeps strict, close control over followers by
keeping close regulation of policies and procedures given to followers.
Direct supervision is what they believe to be key in maintaining a successful environment and follower
ship. In fear of followers being unproductive, authoritarian leaders keep close supervision and feel this is
necessary in order for anything to be done.
Authoritarian Traits:
o sets goals individually,
o engages primarily in one-way and downward communication,
o controls discussion with followers,
o dominates in interactions.
58 | P a g e
Paternalistic Leadership
In paternalistic style of working, the leaders decide what is best for the employees as well as the
organization.
The way a Paternalistic leader works is by acting as a father figure by taking care of their subordinates as
a parent would. In this style of leadership the leader supplies complete concern for his followers or
workers.
In return he receives the complete trust and loyalty of his people. Workers under this style of leader are
expected to become totally committed to what the leader believes and will not strive off and work
independently. The relationship between these co-workers and leader are extremely solid.
One of the downsides to a paternalistic leader is that the leader could start to play favorites in decisions.
This leader would include the workers more likely to follow and start to exclude the ones who were less
loyal.
Democratic
The democratic leadership style consists of the leader sharing the decision-making abilities with group
members by promoting the interests of the group members and by practicing social equality.
This style of leadership encompasses discussion, debate and sharing of ideas and encouragement of
people to feel good about their involvement. The boundaries of democratic participation tend to be
circumscribed by the organization or the group needs and the instrumental value of people's attributes
(skills, attitudes, etc.).
The democratic style encompasses the notion that everyone, by virtue of their human status, should play a
part in the group's decisions.
However, the democratic style of leadership still requires guidance and control by a specific leader. The
democratic style demands the leader to make decisions on who should be called upon within the group
and who is given the right to participate in, make and vote on decisions.
Research has found that this leadership style is one of the most effective and creates higher productivity,
better contributions from group members and increased group morale.
Democratic leadership can lead to better ideas and more creative solutions to problems because group
members are encouraged to share their thoughts and ideas. While democratic leadership is one of the
most effective leadership styles, it does have some potential downsides.
In situations where roles are unclear or time is of the essence, democratic leadership can lead to
communication failures and uncompleted projects.
Democratic leadership works best in situations where group members are skilled and eager to share their
knowledge. It is also important to have plenty of time to allow people to contribute, develop a plan and
then vote on the best course of action.

59 | P a g e
Laissez-faire leadership
The laissez-faire leadership style is where all the rights and power to make decisions is fully given to the
worker. The laissez-faire style is sometimes described as a "hands off" leadership style because the
leader delegates the tasks to their followers while providing little or no direction to the followers.
If the leader withdraws too much from their followers it can sometimes result in a lack of productivity,
cohesiveness, and satisfaction
Laissez-faire leaders allow followers to have complete freedom to make decisions concerning the
completion of their work
It allows followers a high degree of autonomy and self-rule, while at the same time offering guidance and
support when requested.
The laissez-faire leader using guided freedom provides the followers with all materials necessary to
accomplish their goals, but does not directly participate in decision making unless the followers request
their assistance
Laissez-faire: style of leadership is used when:
o Followers are highly skilled, experienced, and educated.
o Followers have pride in their work and the drive to do it successfully on their own.
o Outside experts, such as staff specialists or consultants are being used.
o Followers are trustworthy and experienced
Laissez-faire style of leadership is NOT to be used when:
Followers feel insecure at the unavailability of a leader. The leader cannot or will not provide regular
feedback to their followers.
Transactional leadership
Transactional leaders focus their leadership on motivating followers through a system of rewards and
punishments. There are two factors which form the basis for this system, Contingent Reward and
management-by-exception.
Contingent Reward: Provides rewards, materialistic or psychological, for effort and recognizes good
performance.
Management-by-Exception: allows the leader to maintain the status quo. The leader intervenes when
subordinates do not meet acceptable performance levels and initiates corrective action to improve
performance. Management by exception helps reduce the workload of managers being that they are only
called-in when workers deviate from course.
This type of leader identifies the needs of their followers and gives rewards to satisfy those needs in
exchange of certain level of performance

60 | P a g e
Transactional leaders focus on increasing the efficiency of established routines and procedures. They are
more concerned with following existing rules than with making changes to the organization.
Transformational leadership
Transformational leadership involves the engagement of followers and therefore transformational leaders
are often charismatic.
A transformational leader is a type of person in which the leader is not limited by his or her followers'
perception. The main objective is to work to change or transform his or her followers' needs and redirect
their thinking.
Leaders that follow the transformation style of leading, challenge and inspire their followers with a sense
of purpose and excitement.
They also create a vision of what they aspire to be, and communicate this idea to others (their followers).
Charismatic leadership has a broad knowledge of field, has a self-promoting personality, high/great
energy level, and willing to take risk and use irregular strategies in order to stimulate their followers to
think independently

TRAITS OF A GOOD LEADER

Honest: Display sincerity, integrity, and candor in all your actions. Deceptive behavior will not inspire
trust
Competent: Base your actions on reason and moral principles. Do not make decisions based on childlike
emotional desires or feelings.
Forward-looking: Set goals and have a vision of the future. The vision must be owned throughout the
organization. Effective leaders envision what they want and how to get it. They habitually pick priorities
stemming from their basic values.
Inspiring: Display confidence in all that you do. By showing endurance in mental, physical, and spiritual
stamina, you will inspire others to reach for new heights. Take charge when necessary.
Intelligent: Read, study, and seek challenging assignments.
Fair-minded: Show fair treatment to all people. Prejudice is the enemy of justice. Display empathy by
being sensitive to the feelings, values, interests, and well-being of others.
Broad-minded: Seek out diversity.
Courageous: Have the perseverance to accomplish a goal, regardless of the seemingly insurmountable
obstacles. Display a confident calmness when under stress.
Straightforward: Use sound judgment to make a good decision at the right time.
Imaginative: Make timely and appropriate changes in your thinking, plans, and methods. Show
creativity by thinking of new and better goals, ideas, and solutions to problems. Be innovative!
MOTIVATION

61 | P a g e
Motivation can be defined as the process of channeling a person’s inner drives so he can accomplish the
objective of an organization.
Motivation may be viewed as a causative factor, an incentive drive for a job performance.
It may also be explained as the process of moving oneself and others to work toward the attainment of
individual and organizational objectives.
Basic characteristics of motivation
There are three characteristics of motivation as follows:
Amount of Effort: refers to the strength of a person’s work-related behavior or the amount of exertion a
person exhibits on the job.
Persistence of Effort: refers to the endurance or perseverance that individual’s exhibit in applying effort
to their work task. Both effort and persistence determine the quantity of work done by an individual
worker.
Direction of Effort: refers to the trend of a person’s work-related behavior.
TYPES OF MOTIVATION
Worker motivation can be intrinsic or extrinsic
Intrinsic motivation: is derived from within the person. It refers to the direct relationship between a
worker and the task, and is usually self-applied. Examples of intrinsic motivation are achievement,
accomplishment, challenge and competence, which are derived from performing one‘s job well.
Extrinsic motivation: is derived from the work environment external to the person and his work. A
different person usually applies it. Good salary, fringe benefits, enabling policies and various form of
supervision are good examples of extrinsic motivators
Importance of motivation
o High performance level: motivated workers harness all resources to increase their level efficiency
at workplace. Among others, a highly motivated staff is always likely to be highly productive
o Low health worker turnover and absenteeism: motivated workers tend to stay in the unit for long
and their absenteeism level is reduced. This gives the unit a good performance level.
o Reputation and good economic conditions in the unit are enhanced
o Low disputes level: helps to prevent disputes and conflicts in the organization
o Acceptance of changes: motivated workers readily accept changes in technology or value systems
in a unit
CO-ORDINATING OR CONTROL FUNCTION
Co-ordination refers to harmonious integration of activities and processes of the various sections within
an organization towards the attainment of its goals.

62 | P a g e
In the co-ordination of activities, the community health nurse manager brings activities into proper
relation with each other so as to ensure that everything that needs to be done is done and that no two
people are doing the same job.
To make co-ordination effective in community health settings, the community health nurse manager
should recognize the following principles:
o The objectives of each group of task must contribute to the objectives of the unit as a whole.
o Each group of the task must be clearly defined so that everyone knows exactly what the tasks for
each activity are.
o Each group of tasks must have one person in-charge and all concerned must know who is.
o The person in charge of a team is responsible for the person of its members.
o Each person responsible for a group of tasks must have authority equal to the responsibility.
o No person in charge of a group of tasks should be expected to control more than ten other people.
o The person in charge of several groups must see that the groups of balance.
o Ensure that there are structures in place to make information flow effectively within the units and
between units.
o Activities of the various units must be evaluated on regular bases to ensure the avoidance of
unhealthy conflicts.

CONTROLLING/MONITORING
Controlling is measuring and correcting of activities of subordinates to make sure that the work is going
on as per the plans. It measures performance against goals and plans, shows where short falls or
deviations exist and takes necessary corrective actions to achieve the goals. Controlling generally relates
to the measurement of achievement. This involves three elements.
Establishing standards of performance.
Measuring performance and comparing with established standards.
Taking necessary corrective action to meet the set standards.
With accomplishment of this function, the “Management Cycle” is said to be complete.
There are three basic steps in control processes;
Setting standards of performance by deciding on the standard, carrying out a research, and or comparing
units of the same kind
Measuring and comparing actual results against standards. This can be done through:
Visits by superior
Job description
Using schedules for work
Sampling
63 | P a g e
 Checking vital statistics
Taking note of symptoms
Correcting any deviation which might occur

TYPES OF CONTROL
o steering controls and
o post action controls.
Steering control is where activities are monitored and corrections are made whiles post action control
reviews the activities after it has been completed.
Conditions/ Criteria for good controls
o It should be easy to understand
o It should be accepted by the one carrying them out
o It should be few as possible to avoid confusion and frustration
o It should be flexible enough to change and meet the needs of the unit
o It should be measureable
o Its benefits should outweigh the cost involve in setting up the system
o It should be timely

IMPORTANCE OF CONTROL
Good controls can be beneficial in the following ways;
It offers the opportunity to identify areas in the unit that have inadequate resources
Staff who put in their best are easy identified and rewarded
It ensure work is done properly and in line with standard require and this can lead to increase in
quality of work and output
Management of material equipment in Public Health unit
As a community health nurse manager, one of your duties is to manage the material equipment in your
unit. There are two types of material equipment; expendable which refers to items that are used up
within a short time e.g. Vaccines, gauze, cotton wool, vaccines etc. and non-expendable which are
either fixed or moveable and are used for a long period of time e.g. sterilizers, vaccine refrigerators, bed
pans, weighing scale etc.
Importance of management of material equipment in Public Health Unit
o It reduces cost if management is done because 40-50% of the total expenditure of health unit is
used on equipment
o It ensures equity in distribution of logistics
o It ensures the availability of the right materials for use.

64 | P a g e
 o It ease work and make patient care effective
Procedure in managing equipment
The main procedures include:
Ordering
Storing
Issuing
Controlling or monitoring
ORDERING
This is process of obtaining the equipment which is usually authorized by the senior staff or officer. To
order, we must;
o Make a list of all items needed
o Balance requirements with a cost estimate.
When making the list of equipment, it is important to note the following;
Write down the exact type required
The quantity of each item needed
Completing a requisition form
Order forms may vary from unit to unit. After listing the require items, an order form is filled. It have the
following columns item number, name of article or item, quantity requested, unit price ant total price.
An example of an order form
Item Name of Type of article unit quantit Price per unit Total price
no article y (cedis) (cedis)
1 Vaccine Four-size vaccine Large 2 40.00 80.00
carriers carrier size
2 Cotton wool Cotton roll Big roll 1 10.00 10.00
3 Syringes Intradermal Solo 1box 10.00 10.00
injection shot (50)
TOTAL 100.00

STORING
Storing is done either in a place for daily use or in a store to be kept for future use. When receiving new
items to be kept, one must check for any discrepancies in quantity, quality, product specification and
expiry date.
Items are usually delivered with invoice or receipt which should be put in a separate file. Items should be
grouped into similar, generic name or application and quantity entered into a ledger book or stock book

65 | P a g e
An example of a stock ledger
S/ Item Number Date Number Date Balance in
No. received received issued Issued stock
1 Weighing scale 55 21/01/21 10 05/02/21 45
2 Tally booklets 5 21/01/21 2 05/02/21 3
3 Cotton wool 25 21/01/21 15 05/02/21 10
4 Weighing pants 30 21/01/21 14 05/02/21 16
5 Syringes 100 21/01/21 60 05/02/21 40

ISSUING
Issuing is the process of supplying or distributing items/entity for use. NB. A voucher containing the
following should be kept anytime a store keeper issue out items
o Date of issuing the item
o Item issued
o Quantity issued
o Department receiving the item
o Signature of the one who receives the items
The original voucher should be kept in a file in the store and duplicate given to the department receiving
the item. When issuing the items the principle of FIFO must be applied to avoid first items from
expiring.
Example
Date Item Quantity Unit/ department Name/Signature
05/02/21 Vaccines 20 NHC David
05/02/21 Syringes and needles 60 Gongnia CHPS Priscilla
05/02/21 Cotton wool 15 Wuru H/C Beatrice
05/02/21 Weighing scale 10 NHC David

CONTROLLING/MONITORING

To control and maintain equipment the staff should be encouraged to do the following:

66 | P a g e
 o Keep items non expendables(non -consumable ) clean
o Inspect and keep equipment in good condition
o Report any fault immediately for repair
o Return equipment back to its rightful place after use
o It is important to control equipment especially expendables to avoid wastage
CHAPTER TWELVE
RECORD KEEPING
Records are written accounts of facts and events for references. Keeping records can be of tremendous
importance to a facility. Records can be kept in various forms depending on the purpose and how long it
should be kept. Records could be in writing, tape recordings, folders, computerized etc.
The types of record in health include the following:
o Reproductive and child health records
o Community health care records
o School health services records
o Disease surveillance records
o Clinical care records
o Nursing care plan

USES OF RECORDS
o Records help to assess the quality of health services rendered to clients.
o Records helps us to identify trends in care interactions and make changes if need be.
o Records can help to vindicate the nurse in case of legal issues
o Records makes nurses accountable for resources they have been given and speeds up the process
of acquiring the necessary equipment for their facility
o Records help the nurse to evaluate herself
o Records are useful documentation for treatment and care plan for services rendered and help
determine clients progress.

MANAGEMENT OF RECORDS/RECORD KEEPING

Records should therefore be kept well by ensuring:
o Those keeping them are well trained on how to keep them
o They should be protected from damage ( either by fire or water) and insects
o They are updated regularly
o They are made accessibly to authorized personnel
o Papers should be kept in well labeled files
67 | P a g e
 o They are kept confidential

CHAPTER THIRTEEN
REPORT WRITING
Report writing is creating an account or statement that describes in detail an event, situation or
occurrence, usually as the result of observation or inquiry.
According to Afful-Broni, 2004 reporting is about the sharing of information with those who matter the
most in an organisation. Reporting is important because it helps people to plan ahead and avoid present
mistakes and also prevent unnecessary suspicious which can cause unhealthy tensions in the organisation.
In community health nursing, reporting means communicating to all levels.

TYPES OF REPORTS
o Statistical reports
o Narrative reports

GUIDELINES TO EFFECTIVE REPORT WRITING

o Use words that are clear and use few words
o Do not jargons and avoid repetition
o Use words correctly
o Use correct grammar and spellings
o Make sure it contains facts and relevant information

USES OF REPORTS
1. Is used for references
2. It can also be used for research purposes
3. For continuity of care
4. Evaluation purposes
5. Resource allocation
6. For planning of work at the higher level
7. For budgeting
8. It’s a source of criteria for awarding a facility or hard working staff.

OUTLINE FOR NARRATIVE REPORT WRITING

NB. The procedure in writing a narrative report includes;
Introduction: This consist of a brief description of what is expected in the report, objectives, period and
service area
68 | P a g e
The main body of the report: This explains the main facts, ideas or information to be presented. Report
on each objective is written in a paragraph as well as achievements and the problem .
Summary and conclusion: bring out the main points and also summarize the achievements and the
problems
Recommendations: should be made the appropriate persons and agencies for improvement of services

69 | P a g e
70 | P a g e
 CHAPTER FOURTEEN
QUALITY ASSURANCE AND IMPROVEMENT
The term "quality assurance" means maintaining a high quality of health care by constantly measuring the
effectiveness of the organizations that provide it.
Quality Assurance (QA) is a management method that is defined as “all those planned and systematic
actions needed to provide adequate confidence that a product, service or result will satisfy given
requirements for quality and be fit for use”.
According to GHS/MOH (2002), quality assurance in health care is a planned, systematic approach for
continuously monitoring, measuring and improving quality of health services with available resources, to
meet the expectations of both providers and users.

CONCEPT OF QUALITY HEALTHCARE

In simple terms, healthcare quality entails activities that are performed to benefit patients without causing
harm to them. Quality of Care demands that adequate attention is paid to the needs of patients and clients.
It is also expected healthcare providers use methods that have been tested to be safe, affordable and
capable of reducing deaths, illness and disability. Furthermore, healthcare services are provided
according to set standard professional practices as laid down by clinical guidelines and protocols. It
involves activities such as;
o The setting of standards
Monitoring to see if there is a gap between what is being done now and what is expected
Addressing the gap on a regular basis (quality improvement)
Rational for Quality Assurance
It is professional and legal obligation to satisfy the expectations of users and service providers.
A lot of clients are not ignorant about their rights and hence quality must be ensured.
It reduces frustration on the part of users and providers.
There is high utilization which leads to high income and good health outcomes, among others. For quality
assurance to be implemented effectively there must be quality assurance teams to spear head all activities
to achieve quality care.

RELEVANCE OF QUALITY ASSURANCE (QA) TO THE HEALTH SERVICE PROVIDER

Quality is critical because health service users (also called clients) should be assured of quality in order to
ensure maximum utilization of health services and facilities.
COMPONENTS OF QUALITY HEALTH SERVICES
According to the Quality Assurance Manual of the Ghana Health Service for sub-districts (2004), quality
health service has several parts namely:
1. Accessibility

71 | P a g e
 2. Technical competence
3. Equity
4. Effectiveness
5. Efficiency
6. Continuity
7. Safety
8. Interpersonal relationship
9. Amenities
o Accessibilty/Access to Service
Healthcare services should be reachable to clients; thus, individuals should be capable to have easy reach
to services without any form of hindrance. Accessibility could be:
Physical/geographical. This may be due to long distance, physical abuse etc
Financial; with inadequate finances and no active NHIS card
Culture, beliefs and values: The services provided may not be in line with the culture, beliefs and values
of some people. For instance, some cultural beliefs attribute sickness to witchcraft as the main cause, that
person may not make any attempt to seek health services at a nearby health facility even if it is physically
accessible and the person can afford to pay for the services.
o Technical Competence
Technical competence as an indicator of quality means that healthcare providers should have adequate
knowledge and skills to carry out their functions in order to provide quality service.
There is also the need for continuous in-service training to update health workers knowledge of new
standard practices.
Health workers’ practice should also be guided by laid down standards and guidelines such as the
Standard Treatment Guidelines
o Equity
Quality services should be provided to all people who need them, be they poor, children, adults, old
people, pregnant women, disabled etc. Quality services should be available in all parts of the country, in
villages, towns and cities.
o Effectiveness
This component of quality care involves adopting care practices that produce positive change in the
patient's health or quality of life. In view of this, treatments that are known to be effective are used; for
example, giving Oral Rehydration Salt (ORS) therapy to a child with diarrhea
o Efficiency

72 | P a g e
Efficiency is the provision of high quality care at the lowest possible cost. Health care providers are
expected to make the best use of resources and avoid waste of the limited available resources.
Often, health workers waste resources by: prescribing unnecessary drugs stocking more drugs than is
required and making them expire buying supplies; sometimes, health equipment are not used and left to
go waste.
o Continuity
Continuity means that the client gets the full range of health services he/she needs, and that when the case
is beyond a level of the healthcare hierarchy, such a condition is referred to the right higher level for
further care.
Continuity may be achieved by the patient seeing the same primary health care worker or by keeping
accurate health records so that another staff can have adequate information to follow up on the patient.
o Safety
Safety means that when providing health services, we reduce to the barest minimum injuries, infections,
harmful side effects and other dangers to clients and to staff.
In providing quality care, we should not put the patient's life at risk. For example, we should not give
unsafe blood to patients and thereby infect them with HIV/AIDS.
o Interpersonal Relations
It refers to the relationship between health workers and our clients and communities, between health
mangers and their staff. Health workers should show respect to clients; feel for patients; not be rude or
shout at them; not disclose information gotten from patients to other people.
These professional practices will bring about good relations and trust between the clients/communities
and health workers.
Clients consider good interpersonal relationship as an important component of quality of care though
often overlooked by health workers.
o Amenities
These are features that can be provided by health facilities to make life comfortable and pleasant for
clients. These amenities contribute to clients' satisfaction and make clients willing to use services. For
example, comfortable seats, television set, music, educational materials, educative video films, etc. at the
OPD and wards.

COMPONENTS OF A QUALITY ASSURANCE PROGRAMME

These are often grouped into three levels, variously labeled:
o The strategic or organisational level (dealing with the quality policy objectives and management
and usually produced as the Quality Manual)

73 | P a g e
 o The tactical or functional level (dealing with general practices such as training, facilities,
operation of QA); and
o The operational level (dealing with the Standard Operating Procedures (SOPs) worksheets and
other aspects of day to day operations).

PERSPECTIVES OF QUALITY
Different stake holders have different perspectives about what constitutes quality. For the purposes of this
course, four dimensions are discussed namely:
THE PATIENT/CLIENT PERSPECTIVE
Patients/clients measure quality of services through;
o How services are delivered on time and by friendly and respectful staff;
o How safe, timeliness of positive result and affordable the services are
o How accessible and readily available adequate information about their condition and treatment;
o Provision of all the drugs they need
o Level of privacy
o Form of communication (language they can understand).
THE HEALTH STAFF PROVIDER / HEALTH PROFESSIONAL’S PERSPECTIVE
The health staff/professionals measure quality assurance based on;
o Adequate knowledge and skills.
o Enough resources- staff, drugs, supplies, equipment and transport etc
o Safe and clean workplace.
o Opportunity to regularly improve himself/herself
o How well they are paid and rewarded for good work.
HEALTH CARE MANAGER’S PERSPECTIVES
NB. The health care manager measures quality care based on:
1. How efficiently the resources are managed at the health facility.
2. How health staff achieving set targets.
3. How health staff are regularly supported and supervised.
4. Having adequate and competent staff to provide care.
5. How staff are discipline.
6. How available adequate resources are for staff to work with.
COMMUNITY’S PERSPECTIVE
The community expects to be treated well; the provider must identify and tailor services to meet
community‘s expectations.

74 | P a g e
QUALITY OF THE HEALTHCARE SYSTEM
Other classifications of quality care
Besides the various perspectives of quality care, the concept of quality can be understood from the entire
healthcare system perspective. Quality can thus be viewed as follows:
Inputs
These are materials needed to provide care. Examples include staff, drugs, buildings and equipment.
Process
This refers literally to “what is done and the way things are done”. An example is the activities for
outpatient care. The patient has to make a card, go to the screening table for his/her temperature and
blood pressure to be taken. He/she then goes to the consulting room after which he/she goes to the
dispensary for drugs.
Output/Outcome
It is the results gotten out of health service delivery. For example, is the client satisfied with the service
he/she gets after visiting a health facility? Has there been a decrease in outpatient attendance?
Cost of poor quality care
Poor quality care can be detrimental to clients, healthcare providers and the entire healthcare system. Cost
of poor quality care can be obvious or hidden.
NB. The obvious costs of poor quality care include:
o wrong diagnoses
o wrong treatment
o repeated visits to clients
o prolonged morbidity or oven death.
The hidden or indirect cost includes:
o Unproductivity
o increased poverty due to disability or morbidity
o reduced staff motivation.
The above hidden and obvious cost of poor quality care can also be classified as cost to client and cost to
healthcare provider.
Cost of poor quality care to clients
o Waste of productive hours
o Prolonged morbidity
o Result in poverty due to recurrent expenditure on health
o Non-adherence to treatment regimen
o Disabilities Compromised quality of life

75 | P a g e
 o Death
o Frustrated/dissatisfied patients

Cost of poor quality care to the healthcare provider

o Wrong diagnosis
o Wrong treatment
o Repeated visits to the OPD resulting in congestion
o Cost of healthcare delivery
o Undue pressure on health facilities due to increased OPD visits
o Wasted time to health worker
o Unnecessary treatment, wasted drugs
o Patients not complying to treatment
o Unnecessary laboratory tests, wasted reagents
o Low staff morale or low intrinsic motivation
o Reduced profit or revenue due to low patronage

PRINCIPLES OF QUALITY ASSURANCE

 Meeting the Needs of Clients
Quality assurance is primarily oriented towards meeting the needs and expectations of the patient and the
community. This means that quality assurance requires a commitment to finding out what individuals and
groups need and expect from the promotive, preventive and curative health services provided. Quality
assurance also requires that the needs and expectations of health workers be found out and met.
 Focusing On Systems
Quality assurance focuses on systems and processes. By focusing on the analyses of service delivery
processes, activities, and tasks as well as outcomes. Quality assurance allows health care providers and
managers to develop a deep understanding of a problem and to address its root causes. Quality assurance
focuses on improving or eliminating the factors in the systems and processes that make it possible for
problems to arise.
 Use of Data to Improve Quality
Quality assurance uses data to analyze service delivery processes Simple quantitative approaches to
analysis and monitoring are another important aspect of quality assurance. Data –oriented methods allow
the quality assurance team and providers to identify root causes so that problem solving is based on facts
and assumptions.
 Improving Quality through Team Work

76 | P a g e
Quality assurance encourages team approach to problem solving and quality improvement. Multi-
disciplinary participatory approaches offer two advantages; the technical product is likely to be of higher
quality because each team member brings unique perspective and insight to the quality improvement
effort. Collaboration facilitates a thorough problem analysis and makes development of a feasible
solution more likely. Secondly, staff members are more likely to accept and support changes that they
helped to develop.
 Effective Communication
Communication is indispensable to the success of quality assurance. Quality assurance must encourage
two-way communication mechanisms between providers and clients, between managers and other
workers, and between the QA team and other workers.
In health delivery there is communication between:
o Health worker and Patient
o Health worker and Community
o Health worker and Health worker
Effective communication helps to:
o Eliminate suspicion and promote understanding.
o Promote co-operation and teamwork.
o Gather diverse views and expectations.

BENEFITS OF QUALITY ASSURANCE (QA)

Quality assurance is beneficial to everybody - the client, community, health workers, health managers
and the health institution. Benefits of quality assurance are varied in nature. We have benefits to the
clients, to the health worker and to the health institution.
BENEFITS OF QUALITY ASSURANCE TO THE CLIENTS
The client stands to benefit in the flowing ways:
o Good health outcomes
o Client satisfaction
o Value for money.
o Less frustration
BENEFITS OF QUALITY ASSURANCE TO HEALTH PROVIDERS
o Health providers also benefit from quality assurance in the following ways:
o Health staff become more satisfied with their work (staff are intrinsically motivated)
o Health workers understand patients better and diagnose and treat health conditions better
o Information flow among staff is improved, thus promote better adherence to treatment protocols

77 | P a g e
 o Health staff who perform well are rewarded and further motivated to render good quality care
BENEFITS OF QUALITY ASSURANCE TO THE HEALTH INSTITUTION
Quality assurance brings some benefits to the health facility and they include:
o Patients become more satisfied with the services
o More patients may use our services
o The environment will become clean and beautiful
o The facility will have a good reputation

ORGANIZATIONAL LEVELS OF QUALITY ASSURANCE

To implement quality assurance successfully, there should be appropriate structures at all levels. The
roles, responsibilities and linkages of the structures within the organization must be clearly defined.
These help to identify the monitoring and supervisory systems that are required.
National Level
Quality Assurance structures at all levels should derive from existing structures for effective
implementation. Support from the national level is crucial to the success of the quality assurance
programme. The role of national level is to give direction and support to regions in the implementation of
quality assurance. Again, it is important to note that, effective leadership and management commitment at
all levels is key to the sustainability and success of Quality Assurance.
This can be achieved through a national QA team or the establishment of a quality assurance unit.
Functions of the national level quality assurance team include:
o Comparing and ranking performance of facilities
o Co-ordinating countrywide quality assurance program
o Developing clinical guidelines and protocols
o Developing policies and strategies
o Mobilizing resources for quality assurance.
o Monitoring quality of care
o Providing technical support to regional qa teams
o Setting national standards
Regional Level
The regions have an important role to play in supporting the districts through facilitation, coaching,
monitoring and supervision.
The specific functions of the regional level quality assurance team include;
o Co-ordination, guidance and coaching
o Organising quality assurance workshops and seminars

78 | P a g e
 o Training and facilitation during workshops
o Monitoring and supportive supervision to health facilities
o Encouraging high performance by comparing institutions and promoting best practice
o Developing region-specific standards and adapt national standards
o Giving feedback to districts
o Establishing reward/incentive systems.
District Level
This is also a very important level that serves to co-ordinate and support health facilities in the district.
Functions of district level quality assurance team include;
o Co-ordination and guidance to the facilities
o Encouraging high performance by comparing institutions and promoting best practice.
o Monitoring performance of facilities
o Organizing training for health workers to improve their knowledge and skills
o Promoting qa awareness
o Supporting the training of facilities in quality assurance
o The team should provide feedback to health facilities - hospitals, health centres and clinics.
Facility Level
At the facility level it is vital that a quality assurance team, made up of different categories of health
workers, is formed to be responsible for co-ordinating the implementation of quality assurance. The team
is likely to function better if management shows interest in the activities of quality assurance. At the
facility level, Quality Assurance team is responsible for:
o Co-ordinating and providing guidance and information to heads of department and facility
management teams
o Promoting qa awareness
o Conducting patient satisfaction surveys
o Using facility data to improve quality of care
o Identifying quality problems and drawing up action plans
o Monitoring the implementation of quality activities
o Producing/adapting/updating relevant local standards, guidelines and protocols
o Disseminating information on quality assurance to staff.
IMPLEMENTING QUALITY ASSURANCE IN A FACILITY
Steps in the Implementation of QA in A Facility

79 | P a g e
To effectively implement a QA system in a facility, there are certain basic steps to be considered. Some
of these steps can be carried out at the same time. It will be helpful to review each step periodically to
ensure that the implementation process is continuous. The steps involve the need to:
o Form a multidisciplinary quality action team
o Create awareness among staff
o Review present state quality
o Develop/adapt written guidelines
o Carry out QA training
o Apply skills to continuously improve your performance
o Share results periodically with other staff and clients
o Hold regular QA meetings to plan and review performance

BARRIERS TO QUALITY ASSURANCE

o Non commitment of top management to quality,
o Wrong attitude of staff,
o Lack of team work,
o Concept of quality poorly understood,
o Inadequate information about routine practice,
o Fear of change,
o Suspicion about comparisons,
o Patients/clients views are not given adequate attention,
o Low staff morale and motivation,
o Lack of facilitative supervision.

RESPONSIBILITIES OF QUALITY ASSURANCE TEAMS

Responsibilities of quality assurance teams include:
Coordinating and providing guidance and information to heads of departments and facility management
teams.
Promoting quality assurance awareness to all stake holders
Conducting quality assessment/inspections
Identifying problems and drawing up action plans
Monitoring the implementation of quality assurance activities
Producing, adapting, updating relevant local standards, guidelines and protocols Disseminating quality
assurance information to staff

80 | P a g e
 CHAPTER FIFTEEN
DATA MANAGEMENT, SOP, USE OF DHIMS II, WEB-BASED
Data are factual information (such as measurements or statistics) used as basis for reasoning, discussion,
or calculation.
Data management is the practice of collecting, keeping, and using data securely, efficiently and cost-
effectively. There are two main types of data: primary and secondary data

PRIMARY DATA
According to Bullough and Bullough 1990, primary data is the direct collection of useful facts from
individuals and the community regarding their health through observation, interviews and physical
examination. Data can take the following format; physical data, psychological, developmental, socio-
economic, spiritual and environmental. Primary data can be collected on a community to help the nurse
provide better services. Data will include: resources, needs, problems, strengths, weaknesses etc.
Physical data: refers to data that consist of personal facts of a person. These include demographic data
such as age, sex, address, educational background, marital status, etc. This data also give information on
the health status (past and present) and nutritional status
Developmental data: refers to data which gives information on how a child is growing and developing.
This data gives an idea on how a child is growing and developing. This is done through regular weighing
and comparing the weight to the age. It is also crucial to monitor the developmental milestone of the child
by observing the motor activity9 the rate at which the can do certain things) the cognitive activity (their
level of understanding things) and the affective activity ( the way they behave at a particular age).
Psychological data: refers to data collected on the emotional state, mental status, coping patterns and
any psychological problem of a person. It helps the nurse to know if the client is at risk of any future
psychological problems

81 | P a g e
Environmental data: refers to data that is collected on effects of the physical environment on client’s
health. This include source of drinking water, state of building, climate etc
Spiritual data: refers to the religious beliefs, how it impacts the health status of a person and how these
beliefs affect the way they access health.

SECONDARY DATA
Is data collected from documents sources such as:
o Reports on clinical care
o Annual reports of the DHMT, District Assembly, Environmental Health and Department of
Community Development.
o Disease surveillance reports
o Births and deaths registry reports
o Newspapers, health journals
o Relevant research

STANDARD OPERATING PRECEDURES (SOPs)

SOP is a set of step-by-step instructions compiled by an organization to help workers carry out routine
operations. It is usually a document with accurate and detailed instructions on how to perform a
procedure to ensure that the procedure is performed the same way each time by each person.
CHARACTERISTICS OF A GOOD SOP
o Is should be clear and brief
o It should be easy to read and understand
o It should emphasize on the critical stepps and warn abot safely issues
Steps in writing an SOP
o Define the procedure about which it will be written
o Define the critical and non-critical steps of your SOP and list steps in sequence to be executed
o Think about readers experiences and background whiles you write content
o Use tables and flowcharts
o Be accurate and consistent with terminologies/nomenclature
o After writing the SOP, it should be reviewed by QA managers, colleagues, lab manager, research
facilitators etc
o Submit for approval

DISTRICT HEALTH INFORMATION MANAGEMENT SYSTEM (DHIMS 2)

District Health Information Management System (DHIMS2) is a software develop by University of Oslo
in collaboration with GHS. District Health Information Management System is a system which enables
82 | P a g e
health facilities to enter their summary reports directly into an electronic database. It has the capacity to
generate reports, map data through geographic information systems (GIS). It aids managers to process
raw information at the facility level.
DHIMS2 is a comprehensive HMIS solution for reporting and analyzing the needs of district health
administrators and health facilities, at every level of the GHS.
DHIMS2 also is centralized, which enables easy, online deployment and updates of the application.
The dashboard can be customized to look for different indicators that are linked to specific health
outcomes.
All staff in district health directorates and health facilities with the required capacity for DHIMS2
management has been registered as secure users on the DHIMS2 server.
To access DHIMS2, you do not need any software to be installed on your computer; it works
independently from the operating system on your personal computer. Data is encrypted with a SSL
certificate authentication.

WED-BASE INFORMATION SYSTEM

Web information system, or web-based information system, is an information system that uses Internet
web technologies to deliver information and services, to users or other information systems/applications.
It is a software system whose main purpose is to publish and maintain data by using hypertext-based
principles.
A web information system usually consists of one or more web applications, specific functionality-
oriented components, together with information components and other non-web components. Web
browser is typically used as front-end whereas database as back-end.
Advantages include:
o It’s manageable
o Highly deployable
o Secure live data
o Reduce cost

83 | P a g e
 CHAPTER SIXTEEN
HEALTH BILL DECENTRALIZATION
“Decentralization is "the means to allow for the participation of people and local governments” (Morell)
Decentralization, or decentralizing governance, refers to the restructuring or reorganization of authority
so that there is a system of co-responsibility between institutions of governance at the central, regional
and local levels , thus increasing the overall quality and effectiveness of the system of governance, while
increasing the authority and capacities of sub-national levels
Decentralization is often linked to concepts of participation in decision-making, democracy, equality and
liberty from higher authority
Ghana has developed a comprehensive Mental Health Bill which protects the rights of people with mental
disorders and promotes mental health care in the community in accordance with international human
rights standards.
WHO is helping Ghana to prepare for the implementation of the new legislation, and has provided
guidance on the elaboration of a detailed action plan and regulations for putting the provisions of the law
into effect.
The Mental Health bill addresses decentralization of mental healthcare, and covers mental healthcare in
the community, spiritual and traditional settings. It as well allows supervision and revision of mental
health practices.
It would compel government and policy makers to include them in policy making. The bill, would give
the mentally retarded a better position in the society. More and better hospital facilities would be
provided for them, and sleeping on a wet floor and using a limited number of washrooms would be a
thing of the past. Their rights, as well, would not be trampled upon, since it clearly states that a person
with mental disorder has the right to enjoy a decent life as a normal person, and as full as possible, which
includes the right to education, vocational training, leisure, recreational activities, full employment, and
participation in civil, economic, social, cultural and political activities, and any specific limitation on
these rights shall be in accordance with the assessment of capacity.

84 | P a g e
 REFERENCES
1. Bannerman, C; Tweneboah, N.T; Offei, A; Nicholas,T.A; Acquah, S; (February 2002): Health
Care Quality Assurance Manual.
2. Cynthia Bannerman, A. K. (2004). Healthcare Quality Assrance. Healthcare Quality Assrance
Manual for sub-districts.
3. Ghana, M. O. (2017). The Health Sector. Medium -Term Development Plan.
4. Ofosu, A. ( 2012 ). Dhims2 demo using quality health information for decision making. Annual
general conference medical superintendents’ group. Kumasi.

85 | P a g e