THE PRIMARY HEALTH CARE PACKAGE

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THE MANAGEMENT PROCESS

According to Kroon’s model (Uys 2005:6) and basic management functions include planning, organisation, leading and control. Smit & Cronjè (2002:8) maintain that the management process basically comprises planning, organisation, leading and control. In addition, the four management functions of decision-making, communication, motivation and disciplining are the means by which the organisational goals can be achieved. Without proper planning, organising, leading and control, the goals will not be achieved. A well-planned, organised, managed and controlled service could nevertheless still fail due to factors like poor communication and lack of staff motivation.

Planning as a concept

Planning is the first of the four basic management functions. The management level determines the types of goals, objectives and plans that should be developed (Kroon & van Zyl 1995:111; Huber 2000:82). Middle and first-line managers are responsible for tactical and operational planning, while top management is mainly concerned with strategic planning and the strategic plan (Kroon & van Zyl 1995:112). Strategic planning is costly and the commitment of top management is essential to achieve success (du Preez 1998:4; Uys 2005:39). It entails consideration of the organisation’s vision and mission as well as strategies, policies, goals and objectives (Uys 2005:39; Steven 1995:70). The clinic manager has to plan the activities that should take place in a clinic. When planning, the clinic manager should consider the DOH’s goals and objectives. These goals and objectives should guide all the activities that should take place in the clinic.

The role of the past, present and future in the planning process

Planning cannot ignore change and by means of planning, management tries to be proactive. Planning should be a feasible process and regular revision of plans is necessary to prevent planning from becoming static (Kroon & van Zyl 1995:114). In the health sector changes are constantly taking place. To keep track of all the changes, planning has to take place as the need arises (du Preez 1998:4). Prior to the implementation of the antiretroviral treatment (ART) programme, planning had to be done on a strategic as well as implementation level to estimate the sustainability of the programme.

The process of organising

Organising deals with the grouping of activities to maintain functional divisions and subdivisions in order to achieve the organisational goals (Smit & Cronjè 2002:193). Examples of this are the creation of posts within these divisions as well as determination of duties, authority and responsibility. An organisational structure is established which provides a structural framework (organogram) of the organisation’s activities, its main and subdivisions, lines of authority, channels of responsibility as well as communication and different management levels (Kroon 1995b:10; Smit & Cronjè 2002:190).

Definition of leading

Kroon (1995b:10) describes leading as “the process of influencing people to such an extent that they will excitedly contribute to work activities in order to achieve the goals of the institution”. D’Aunno, Fottler and O’Connor (2000:65) maintain that it is the primary task of management to motivate people to perform at high levels to achieve organisational objectives. Leadership is crucial to the nursing profession because of tumultuous changes in health care and the demand on nurses to improve care delivery (Donnelly 2003:22).

Table of contents :

• CHAPTER 1 – Orientation to the study
  • 1.1 INTRODUCTION
  • 1.2 BACKGROUND TO THE PROBLEM
  • 1.3 STATEMENT OF THE PROBLEM
  • 1.4 RESEARCH QUESTIONS
  • 1.5 OBJECTIVES OF THE STUDY
  • 1.6 ASSUMPTIONS
  • 1.7 SIGNIFICANCE OF THE STUDY
  • 1.8 DEMARCATION OF THE STUDY FIELD
  • 1.9 CONCEPTUAL FRAMEWORK
    • 1.9.1 Primary health care
    • 1.9.2 Primary health care package
    • 1.9.3 Kroon’s management model
    • 1.9.4 Systems approach
    • 1.9.5 The four basic management functions
  • 1.10 RESEARCH METHODOLOGY
  • 1.11 POPULATION AND SAMPLE
  • 1.12 DATA COLLECTION
  • 1.13 DATA ANALYSIS
  • 1.14 PRE-TESTING THE INSTRUMENT
  • 1.15 ETHICAL CONSIDERATIONS
  • 1.16 LIMITATIONS OF THE STUDY
  • 1.17 DEFINITION OF TERMS
  • 1.18 OUTLINE OF THE STUDY
  • 1.19 CONCLUSION
• CHAPTER 2 – Conceptual framework
  • 2.1 INTRODUCTION
  • 2.2 KROON’S MANAGEMENT MODEL AS ADAPTED BY UYS
  • 2.3 THE MANAGEMENT ENVIRONMENT IN PERSPECTIVE
    • 2.3.1 The macro-environment
    • 2.3.2 The market or task environment
    • 2.3.3 Job description of a clinic manager
      • 2.3.3.1 Definition of a job description
      • 2.3.3.2 Role clarification of a clinic manager
• 2.3.4 The micro-environment
  • 2.3.4.1 Business functions
  • 2.3.4.2 Business economics management
• 2.4 THE MANAGEMENT PROCESS
  • 2.4.1 Planning
• 2.5 THE ADDITIONAL MANAGEMENT FUNCTIONS
• 2.6 INTEREST GROUPS
• 2.7 BUSINESS CAPABILITIES
• 2.8 THE SYSTEMS APPROACH
• 2.8.1 Significance of the systems approach to the nurse manager
• 2.9 INTERDEPENDENCY BETWEEN KROON’S MANAGEMENT MODEL AND THE SYSTEMS APPROACH
  • 2.9.1 Business capabilities as structural input
  • 2.9.2 Interest groups
  • 2.9.3 Business functions
  • 2.9.4 Interdependency of processes, business functions, the management process and additional management functions
• 2.10 OUTPUT
• 2.11 CONCLUSION
• CHAPTER 3 – Literature review
  • 3.1 INTRODUCTION
  • 3.2 HISTORICAL OVERVIEW
  • 3.3 DISTRICT HEALTH SYSTEM
    • 3.3.1 Definition and clarification of the District Health System
    • 3.3.2 Characteristics of the District Health System
    • 3.3.3 Reasons for developing a District Health System
    • 3.3.4 Aims of restructuring the health sector
    • 3.3.5 Principles of the District Health System
    • 3.3.6 Effects of implementing the District Health System
      • 3.3.6.1 Positive effects
      • 3.3.6.2 Negative effects
      • 3.3.6.3 Evaluation of the District Health System
• 3.4 PRIMARY HEALTH CARE
  • 3.4.1 Definition of primary health care
  • 3.4.2 Basic components of primary health care
  • 3.4.3 Primary health care as a concept
  • 3.4.4 The functioning of a clinic manager
  • 3.4.5 Clinic managers’ workload
  • 3.4.6 Inadequate management training
  • 3.4.7 Lack of resources
• 3.4.8 Lack of autonomy
• 3.4.9 Stress and human resources
• 3.4.10 Attitudes of colleagues
• 3.4.11 Obtaining optimal clinic management
• 3.4.12 Line management support
• 3.4.13 Community involvement and support
• 3.4.14 Availability of clear job descriptions
• 3.4.15 Clear selection criteria
• 3.4.16 Implementation of an orientation programme
• 3.4.17 Delegation of responsibility and authority
• 3.4.18 Preparation for a management role
• 3.4.19 Review of training needs of clinic managers
• 3.5 THE PRIMARY HEALTH CARE PACKAGE
• 3.5.1 Distinction between The Primary Health Care Package for South Africa – a set of norms and standards and A Comprehensive Primary Health Care Service Package for South Africa
• 3.5.1.1 The Primary Health Care Package for South Africa – a set of norms and standards
• 3.5.1.2 A Comprehensive Primary Health Care Service Package for South Africa
• 3.5.2 Value of The Primary Health Care Package for South Africa – a set of norms and standards and A comprehensive PHC service package for South Africa for the clinic manager
• 3.6 CONCLUSION
• CHAPTER 4 – Research design and methodology
  • 4.1 INTRODUCTION
  • 4.2 RESEARCH DESIGN
    • 4.2.1 Quantitative
    • 4.2.2 Exploratory
    • 4.2.3 Descriptive
    • 4.2.4 Contextual
  • 4.3 POPULATION
    • 4.3.1 Sampling
    • 4.3.2 Sampling method
    • 4.3.3 Inclusion criteria
  • 4.4 DATA-COLLECTION INSTRUMENT
• CHAPTER 5 – Data analysis and interpretation
• CHAPTER 6 – Findings and recommendations

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THE ROLE OF A CLINIC MANAGER IN A PRIMARY HEALTH CARE SETTING