Roles between Leadership and Management Assignment.

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This article aims to focus on the differences and similarities at all organization’s levels and to by
reviewing requests of the most known Business Excellence Frameworks.
Leadership versus Management
Leadership
There are many diverse definitions of leadership. Stogdill concluded that “there are almost as
many definitions of leadership as there are persons who have attempted to define the concept”. Roles between Leadership and Management Assignment.
While Peter Drucker sums up that: “The only definition of a leader is someone who has followers.
To gain followers requires influence but doesn’t exclude the lack of integrity in achieving this”
(Yukl, 1989). Some theorists believe that leadership is no different from the social influence
processes occurring among all members of a group and others believe that leadership is everything
someone is doing in order to lead effective.
The classic question if leaders are made or born is still concerning many researchers. Is it a
charisma or something that can be taught? The answer to this question varies. Although it is
unexceptionable that leading isn’t easy, leaders should have some essential attributes such as
vision, integrity, trust, selflessness, commitment, creative ability, toughness, communication
ability, risk taking and visibility (Capowski, 1994).
Management
Some would define management as an art, while others would define it as a science. Whether
management is an art or a science isn’t what is most important. Management is a process that is
used to accomplish organizational goals. that is, a process that is used to achieve what an
organization wants to achieve.
But do leaders and managers have the same role? Can organizations have only leaders or only
managers?

A well balanced organization should have a mix of leaders and managers to succeed, and in fact
what they really need is a few great leaders and many first-class managers (Kotterman, 2006)
Managers and Leaders: Are they different?
Managers are the people to whom this management task is assigned, and it is generally thought
that they achieve the desired goals through the key functions of planning and budgeting,
organizing and staffing, problem solving and controlling. Leaders on the other hand set a
direction, align people, motivate and inspire (Kotter, 2001).
Other researchers consider that a leader has soul, the passion and the creativity while a manager
has the mind, the rational and the persistence. A leader is flexible, innovative, inspiring,
courageous and independent and at the same time a manager is consulting, analytical, deliberate,
authoritative and stabilizing (Capowski, 1994). Roles between Leadership and Management Essay.
The most important differences between leaders and managers concern the workplace and are
concluded in table I:
Process Management Leadership
Vision Establishment  Plans and budgets
 Develops process steps and
sets timelines
 Displays impersonal attitude
about the vision and goals
 Sets direction and develop
the vision

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 Develops strategic plans
and achieve the vision
 Displays very passionate
attitude about the vision
and goals
Human Development and
Networking
 Organizes and staffs
 Maintains structure
 Delegate responsibility
 Delegates authority
 Implements the vision
 Establishes policy and
procedures to implement
vision
 Displays low emotion
 Limits employee choices
 Align organization
 Communicates the vision,
mission and direction
 Influences creation of
coalitions, teams and
partnerships that
understand and accept the
vision
 Displays driven, high
emotion
 Increases choices
Vision Execution  Controls processes
 Identifies problems
 Solves problems
 Motivates and inspires
 Energizes employees to
overcome barriers to
 Monitor results
 Takes low risk approach to
problem solving
change

Roles between Leadership and Management Assignment.
 Satisfies basic human
needs
 Takes high risk approach
to problem solving
Vision Outcome  Managers vision order and
predictability
 Provides expected results
consistently to leadership and
other stakeholders
 Promotes useful and
dramatic changes, such as
new products or
approaches to improving
labor relations
Table I: Comparison of Management and Leadership Process Differences in the workplace
(Kotterman,2006).
Leadership and Management in TQM and Excellent Organizations
Total Quality Management is a philosophy based on a set of principles, as customer focus,
continuous improvement, everyone’s involvement and management by fact. TQM literature also
highlights management’s commitment and leadership as determining factor for the implementation
of this management philosophy and the basic precondition in order to succeed Business Excellence
(Gonzàlez, Guillèn, 2001). Roles between Leadership and Management Essay.
A research project started in 1996 by Jim Collins and his research team shows that companies that
had shifted from good performance to great performance and sustained it follow a particular
module of leadership and management hierarchy, known as Level 5.
Level 5 Hierarchy means that in a organization managers and leaders exist with different forms,
roles and responsibilities: Level 1: Highly Capable Individuals – Makes productive contributions
through talent, knowledge, skills, and good work habits, Level 2: Contributing Team Member
-Contributes to the achievement of group objectives, works effectively with others in a group
setting, Level 3: Competent Manager – Organizes people and resources toward the effective and
efficient pursuit of predetermined objectives, Level 4: Effective Leader – Catalyzes commitment to
and vigorous pursuit of a clear and compelling vision; stimulates the group to high performance
standards, and Level 5: Level 5 Executive – Builds enduring greatness through a paradoxical
combination of personal humility plus professional will (Collins, 2001).
Business/ Performance Excellence and Leadership-Management
In the early 80’s when everyone was talking about quality and business excellence many
frameworks and performance models derived. Leadership was a basic concept in all these
frameworks with a direct or indirect impact.
In the Australian Quality Award Leadership Criteria examine the role of management in creating
values and developing an appropriate management system to make them a reality. Malcolm
Baldridge Award and European Foundation for Quality Management (EFQM) Business
Excellence Model have an extend report to leadership criterion (Edgeman, Rodgers, 1999). Later
on some new Performance Management systems arrive (Performance Pyramid, Performance
Prism, a.o.) where management involvement and leadership commitment are still a basic aspect
behind the deployment of all their requests, but not with a clear and obvious way, as the
frameworks mentioned before.
It can be argued as to whether “management” and “leadership” in these models are the equivalent.
the framework, as well. Partnership and Resources the forth criterion indicates the above
conclusion, as all partnerships and resources need effective leaders and capable manager in order
to be administrated. Finally, processes is the criterion with the highest proportion in the
assessment system (14%). It refers to how organizations design, manage and improve the
processes intending to satisfy its stakeholders. TQM and Business Excellence philosophy
underlines the importance of everyone’s involvement in processes and procedures design, in order
to meet customers’ (internal and external) expectations.Roles between Leadership and Management Essay. Therefore, it is really important to identify
leadership contribution in the journey for succeeding Business Excellence but first line managers’,
team managers’, and individuals’ offer must not be ignored or underestimated.
 Balanced Scorecard
In early 90’s David Norton and Robert Kaplan came up with a comprehensive framework named
Balanced Scorecard. Aim of this framework is to give managers and leaders a comprehensive view
of the business and allow them to focus on critical areas, as customer perspective, financial
perspective, Internal Business perspective and Innovation and Learning (Wongrassamee, Gardiner
and Simmons, 2003). The balance Scorecard is shown in Figure 2.
Financial Perspective
Goals Measures
Customer Perspective
Goals Measures
Internal Business Perspective
Goals Measures
Innovation & Learning
Goals Measures
How do we look to
our stakeholders?
What must we excel at?
Can we continue to
improve and create value?
How do customers see us?
Figure 2: The Balanced Scorecard (Kaplan, Norton, 2005)
This framework does not have direct requests for leadership commitment and manager
involvement. But studying it in depth, different conclusions are emerging. Balanced Scorecard
demands that managers translate customer requests into specific measurements. Customers want
good time, quality, performance and service.

To put this frmework to work leaders should be
aware of these four requirements and determine relevant goals. Managers in all levels should also
focus on those critical internal business processes that enable them to satisfy customers. Leaders
on the other hand, have to identify their company’s core competencies and critical technologies
needed and give all the resources in order to succeed customer delight. But the targets for success
keep changing. Global market and strong competition command organizations to make continuous
improvements to their existing products/services and processes and have the ability to introduce
new products into the market. Roles between Leadership and Management Essay.Leaders have the responsibility to identify the need for change and
set the directions, when managers should participate in this procedure and suggest solutions. At
last financial performance is regarding to leaders and managers. Leaders need to know how the
organization is going and develop the policy and strategy, while managers should know the results
of the operational actions and their areas for improvement (Kaplan and Norton 1993, 2005). Roles between Leadership and Management Assignment.
 Performance Pyramid or “SMART” System
The Strategic Measurement Analysis and Reporting Technique (SMART) system was proposed by
Cross and Lynch in 1992, as a result of dissatisfaction with traditional performance measures such
as productivity and financial variances. The objective was to devise a management control system
with performance indicators designed to define and sustain success (Ghalayini, Noble, 1996).
The Performance Pyramid includes four levels of objectives that address the organization’s
effectiveness and its internal efficiency. As it is shown in figure 3, there isn’t a direct request for
leadership and management involvement. Nevertheless, leaders develop vision (first level of the
system) and they translate stakeholders’ needs into individual business and unit objectives. The
second level of the pyramid indicates that managers set short-term targets when leaders determine
long term goals of growth and market position. Middle managers bridge the gap between top-level
measures and day-to-day operational measures, as customer satisfaction, flexibility and
productivity. Finally, first line managers measure on a daily basis indicators that effect
performance, as quality, delivery, cycle time and waste (Tangen, 2004).
Operations
The
vision
Market
Measures
Financial
Measures
Customer
Satisfaction
Flexibility Productivity
Quality Delivery Process Time Cost
Business Unit
Business
Operating Units
Department
and work
centres
Objectives Measurements
Figure 3: The Performance Pyramid (Neely, Bourne, Kennerley, 2000)
 Performance Prism
The Performance Prism (Figure 4) is a performance measurement framework that addresses the
key business issues to which a wide variety of organizations, will be able to relate. It asks critical
questions and encourages managers and leaders to think through the links between measures in a
way that other frameworks do not intuitively suggest (Neely, Adams and Crowe, 2001).
Stakeholders Satisfaction
Stakeholders Contribution
Strategies
Capabilities
Processes
 Corporate
 Business Unit
 Brands/Products/Services
 Operating
 Develop Products & Services
 Generate Demand
 Fulfill Demand
 Plan & Manage Enterprise. Roles between Leadership and Management Assignment.
 People
 Practices
 Technology
 Infrastracture
Figure 4: The Performance Prism (Neely, Adams and Crowe, 2001)
This framework suggests that stakeholders’ wants and needs must be considered first. Then leaders
can formulate the strategies, identify capabilities and plan processes (Tangen, 2004). When on the
other hand managers of all levels participate in the procedures and follow instructions. Roles between Leadership and Management Essay.
Conclusion
Based on the above it is obvious that there is an underlying strong request for leadership, even in
the areas where the request is either verbally or actually of a managerial nature. Managers of all
levels play an important role in the development of a self assessment project through the known
Business Excellence/ Performance Evaluation Models and have a high impact on the
organizations’ journey to Excellence. Further research on how organizations comprehend this
strong request of leadership involvement and commitment and how do excellent organizations
manage to sustain the competitive advantage is important to be held out. Nevertheless, it cannot be
debatable that the contribution of leadership and management on the organizations’ success is high
and it is clearly shown by reviewing the wider known Business Excellence / Performance
Management/Assessment Frameworks and Models.

The main difference between leaders and managers is that leaders have people follow them while managers have people who work for them.

A successful business owner needs to be both a strong leader and manager to get their team on board to follow them towards their vision of success. Leadership is about getting people to understand and believe in your vision and to work with you to achieve your goals while managing is more about administering and making sure the day-to-day things are happening as they should. Roles between Leadership and Management Essay.

WHILE THERE ARE MANY TRAITS THAT MAKE UP A STRONG LEADER, SOME OF THE KEY CHARACTERISTICS ARE:

Honesty & Integrity: are crucial to get your people to believe you and buy in to the journey you are taking them on
Vision: know where you are, where you want to go and enroll your team in charting a path for the future
Inspiration: inspire your team to be all they can by making sure they understand their role in the bigger picture
Ability to Challenge: do not be afraid to challenge the status quo, do things differently and have the courage to think outside the box
Communication Skills: keep your team informed of the journey, where you are, where you are heading and share any roadblocks you may encounter along the way

SOME OF THE COMMON TRAITS SHARED BY STRONG MANAGERS ARE:

Being Able to Execute a Vision: take a strategic vision and break it down into a roadmap to be followed by the team
Ability to Direct: day-to-day work efforts, review resources needed and anticipate needs along the way
Process Management: establish work rules, processes, standards and operating procedures
People Focused: look after your people, their needs, listen to them and involve them

In order for you to engage your staff in providing the best service to your guests, clients or partners, you must enroll them in your vision and align their perceptions and behaviors. Roles between Leadership and Management Assignment.You need to get them excited about where you are taking them while making sure they know what’s in it for them. With smaller organizations, the challenge lies in making sure you are both leading your team as well as managing your day to day operation. Those who are able to do both, will create a competitive advantage. Are you both a leader and a manager; what would your staff say if you were to ask them?

Leadership and management are often considered practically overlapping concepts. But are they?
Is there a difference between the two concepts or leadership is a facet of management and
therefore cannot be separated? Virtually all organizations, including large corporations, academia,
leadership theorists, researchers and authors are concerned about the difference and believe it is
important. Roles between Leadership and Management Essay.
This article aims to focus on the differences and similarities at all organization’s levels and to by
reviewing requests of the most known Business Excellence Frameworks.
Leadership versus Management
Leadership
There are many diverse definitions of leadership. Stogdill concluded that “there are almost as
many definitions of leadership as there are persons who have attempted to define the concept”.
While Peter Drucker sums up that: “The only definition of a leader is someone who has followers.
To gain followers requires influence but doesn’t exclude the lack of integrity in achieving this”
(Yukl, 1989). Some theorists believe that leadership is no different from the social influence
processes occurring among all members of a group and others believe that leadership is everything
someone is doing in order to lead effective.
The classic question if leaders are made or born is still concerning many researchers. Is it a
charisma or something that can be taught? The answer to this question varies. Although it is
unexceptionable that leading isn’t easy, leaders should have some essential attributes such as
vision, integrity, trust, selflessness, commitment, creative ability, toughness, communication
ability, risk taking and visibility (Capowski, 1994).
Management
Some would define management as an art, while others would define it as a science. Whether
management is an art or a science isn’t what is most important. Management is a process that is
used to accomplish organizational goals. that is, a process that is used to achieve what an
organization wants to achieve.
But do leaders and managers have the same role? Can organizations have only leaders or only
managers?
A well balanced organization should have a mix of leaders and managers to succeed, and in fact
what they really need is a few great leaders and many first-class managers (Kotterman, 2006)
Managers and Leaders: Are they different?
Managers are the people to whom this management task is assigned, and it is generally thought
that they achieve the desired goals through the key functions of planning and budgeting,
organizing and staffing, problem solving and controlling. Leaders on the other hand set a
direction, align people, motivate and inspire (Kotter, 2001). Roles between Leadership and Management Assignment.
Other researchers consider that a leader has soul, the passion and the creativity while a manager
has the mind, the rational and the persistence. A leader is flexible, innovative, inspiring,
courageous and independent and at the same time a manager is consulting, analytical, deliberate,
authoritative and stabilizing (Capowski, 1994). Roles between Leadership and Management Essay.
The most important differences between leaders and managers concern the workplace and are
concluded in table I:
Process Management Leadership
Vision Establishment  Plans and budgets
 Develops process steps and
sets timelines
 Displays impersonal attitude
about the vision and goals
 Sets direction and develop
the vision
 Develops strategic plans
and achieve the vision
 Displays very passionate
attitude about the vision
and goals
Human Development and
Networking
 Organizes and staffs
 Maintains structure
 Delegate responsibility
 Delegates authority
 Implements the vision
 Establishes policy and
procedures to implement
vision
 Displays low emotion
 Limits employee choices
 Align organization
 Communicates the vision,
mission and direction
 Influences creation of
coalitions, teams and
partnerships that
understand and accept the
vision
 Displays driven, high
emotion
 Increases choices
Vision Execution  Controls processes
 Identifies problems
 Solves problems
 Motivates and inspires
 Energizes employees to
overcome barriers to
 Monitor results
 Takes low risk approach to
problem solving
change
 Satisfies basic human
needs
 Takes high risk approach
to problem solving
Vision Outcome  Managers vision order and
predictability. Roles between Leadership and Management Assignment.
 Provides expected results
consistently to leadership and
other stakeholders
 Promotes useful and
dramatic changes, such as
new products or
approaches to improving
labor relations
Table I: Comparison of Management and Leadership Process Differences in the workplace
(Kotterman,2006).
Leadership and Management in TQM and Excellent Organizations
Total Quality Management is a philosophy based on a set of principles, as customer focus,
continuous improvement, everyone’s involvement and management by fact. TQM literature also
highlights management’s commitment and leadership as determining factor for the implementation
of this management philosophy and the basic precondition in order to succeed Business Excellence
(Gonzàlez, Guillèn, 2001).
A research project started in 1996 by Jim Collins and his research team shows that companies that
had shifted from good performance to great performance and sustained it follow a particular
module of leadership and management hierarchy, known as Level 5.
Level 5 Hierarchy means that in a organization managers and leaders exist with different forms,
roles and responsibilities: Level 1: Highly Capable Individuals – Makes productive contributions
through talent, knowledge, skills, and good work habits, Level 2: Contributing Team Member
-Contributes to the achievement of group objectives, works effectively with others in a group
setting, Level 3: Competent Manager – Organizes people and resources toward the effective and
efficient pursuit of predetermined objectives, Level 4: Effective Leader – Catalyzes commitment to
and vigorous pursuit of a clear and compelling vision; stimulates the group to high performance
standards, and Level 5: Level 5 Executive – Builds enduring greatness through a paradoxical
combination of personal humility plus professional will (Collins, 2001).
Business/ Performance Excellence and Leadership-Management
In the early 80’s when everyone was talking about quality and business excellence many
frameworks and performance models derived. Leadership was a basic concept in all these
frameworks with a direct or indirect impact.
In the Australian Quality Award Leadership Criteria examine the role of management in creating
values and developing an appropriate management system to make them a reality. Malcolm
Baldridge Award and European Foundation for Quality Management (EFQM) Business
Excellence Model have an extend report to leadership criterion (Edgeman, Rodgers, 1999). Later
on some new Performance Management systems arrive (Performance Pyramid, Performance
Prism, a.o.) where management involvement and leadership commitment are still a basic aspect
behind the deployment of all their requests, but not with a clear and obvious way, as the
frameworks mentioned before. Roles between Leadership and Management Assignment.
It can be argued as to whether “management” and “leadership” in these models are the equivalent.
the framework, as well. Partnership and Resources the forth criterion indicates the above
conclusion, as all partnerships and resources need effective leaders and capable manager in order
to be administrated. Finally, processes is the criterion with the highest proportion in the
assessment system (14%). It refers to how organizations design, manage and improve the
processes intending to satisfy its stakeholders. TQM and Business Excellence philosophy
underlines the importance of everyone’s involvement in processes and procedures design, in order
to meet customers’ (internal and external) expectations. Therefore, it is really important to identify
leadership contribution in the journey for succeeding Business Excellence but first line managers’,
team managers’, and individuals’ offer must not be ignored or underestimated. Roles between Leadership and Management Essay.
 Balanced Scorecard
In early 90’s David Norton and Robert Kaplan came up with a comprehensive framework named
Balanced Scorecard. Aim of this framework is to give managers and leaders a comprehensive view
of the business and allow them to focus on critical areas, as customer perspective, financial
perspective, Internal Business perspective and Innovation and Learning (Wongrassamee, Gardiner
and Simmons, 2003). The balance Scorecard is shown in Figure 2.
Financial Perspective
Goals Measures
Customer Perspective
Goals Measures
Internal Business Perspective
Goals Measures
Innovation & Learning
Goals Measures
How do we look to
our stakeholders?
What must we excel at?
Can we continue to
improve and create value?
How do customers see us?
Figure 2: The Balanced Scorecard (Kaplan, Norton, 2005)
This framework does not have direct requests for leadership commitment and manager
involvement. But studying it in depth, different conclusions are emerging. Balanced Scorecard
demands that managers translate customer requests into specific measurements. Customers want
good time, quality, performance and service. To put this framework to work leaders should be
aware of these four requirements and determine relevant goals. Managers in all levels should also
focus on those critical internal business processes that enable them to satisfy customers. Leaders
on the other hand, have to identify their company’s core competencies and critical technologies
needed and give all the resources in order to succeed customer delight. But the targets for success
keep changing. Global market and strong competition command organizations to make continuous
improvements to their existing products/services and processes and have the ability to introduce
new products into the market. Leaders have the responsibility to identify the need for change and
set the directions, when managers should participate in this procedure and suggest solutions. At
last financial performance is regarding to leaders and managers. Leaders need to know how the
organization is going and develop the policy and strategy, while managers should know the results
of the operational actions and their areas for improvement (Kaplan and Norton 1993, 2005).
 Performance Pyramid or “SMART” System
The Strategic Measurement Analysis and Reporting Technique (SMART) system was proposed by
Cross and Lynch in 1992, as a result of dissatisfaction with traditional performance measures such
as productivity and financial variances. The objective was to devise a management control system
with performance indicators designed to define and sustain success (Ghalayini, Noble, 1996). Roles between Leadership and Management Essay.
The Performance Pyramid includes four levels of objectives that address the organization’s
effectiveness and its internal efficiency. As it is shown in figure 3, there isn’t a direct request for
leadership and management involvement. Nevertheless, leaders develop vision (first level of the
system) and they translate stakeholders’ needs into individual business and unit objectives. The
second level of the pyramid indicates that managers set short-term targets when leaders determine
long term goals of growth and market position. Middle managers bridge the gap between top-level
measures and day-to-day operational measures, as customer satisfaction, flexibility and
productivity. Finally, first line managers measure on a daily basis indicators that effect
performance, as quality, delivery, cycle time and waste (Tangen, 2004).
Operations
The
vision
Market
Measures
Financial
Measures
Customer
Satisfaction
Flexibility Productivity
Quality Delivery Process Time Cost
Business Unit
Business
Operating Units
Department
and work
centres
Objectives Measurements
Figure 3: The Performance Pyramid (Neely, Bourne, Kennerley, 2000)
 Performance Prism
The Performance Prism (Figure 4) is a performance measurement framework that addresses the
key business issues to which a wide variety of organizations, will be able to relate. It asks critical
questions and encourages managers and leaders to think through the links between measures in a
way that other frameworks do not intuitively suggest (Neely, Adams and Crowe, 2001).
Stakeholders Satisfaction
Stakeholders Contribution
Strategies
Capabilities
Processes
 Corporate
 Business Unit
 Brands/Products/Services
 Operating
 Develop Products & Services
 Generate Demand
 Fulfill Demand
 Plan & Manage Enterprise
 People
 Practices
 Technology
 Infrastracture
Figure 4: The Performance Prism (Neely, Adams and Crowe, 2001)
This framework suggests that stakeholders’ wants and needs must be considered first. Then leaders
can formulate the strategies, identify capabilities and plan processes (Tangen, 2004). When on the
other hand managers of all levels participate in the procedures and follow instructions.
Conclusion
Based on the above it is obvious that there is an underlying strong request for leadership, even in
the areas where the request is either verbally or actually of a managerial nature. Managers of all
levels play an important role in the development of a self assessment project through the known
Business Excellence/ Performance Evaluation Models and have a high impact on the
organizations’ journey to Excellence. Further research on how organizations comprehend this
strong request of leadership involvement and commitment and how do excellent organizations
manage to sustain the competitive advantage is important to be held out. Nevertheless, it cannot be
debatable that the contribution of leadership and management on the organizations’ success is high
and it is clearly shown by reviewing the wider known Business Excellence / Performance
Management/Assessment Frameworks and Models. Roles between Leadership and Management Essay.

Th e aim of good management is to provide services to the community in an
appropriate, effi cient, equitable, and sustainable manner. Th is can only be
achieved if key resources for service provision, including human resources,
fi nances, hardware and process aspects of care delivery are brought together
at the point of service delivery and are carefully synchronized. Critical
management considerations for assessment and planning, managing the care
process, human resources, interacting with the community, and managing
information are covered in the Planning, Human Resources, Integration
and Monitoring chapters. Th is chapter fi rst discusses good management and
leadership in general, then outlines relevant considerations for managing
relations with patients and the district team, as well as fi nances and hardware
and management schedules.
10.2 MANAGERS AND LEADERS
Management and leadership are important for the delivery of good health
services. Although the two are similar in some respects, they may involve
diff erent types of outlook, skills, and behaviours. Good managers should strive
to be good leaders and good leaders, need management skills to be eff ective.
Leaders will have a vision of what can be achieved and then communicate this
to others and evolve strategies for realizing the vision. Th ey motivate people
and are able to negotiate for resources and other support to achieve their goals.
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 265
Managers ensure that the available resources are well organized and applied to
produce the best results. In the resource constrained and diffi cult environments
of many low – to middle-income countries, a manager must also be a leader
to achieve optimum results. Roles between Leadership and Management Essay.
What are the attributes of a good leader? Leaders oft en (but not necessarily
always):
■ have a sense of mission;
■ are charismatic;
■ are able to infl uence people to work together for a common cause;
■ are decisive;
■ use creative problem solving to promote better care and a positive working
environment.
Leadership is creating a vision
Managers who have these leadership qualities are a credit to the services they
manage. However managers must ensure that day-to-day processes run well
to produce the desired results. Certain attributes are required for a manager
to be eff ective, including:
■ clarity of purpose and tasks;
■ good organizational skills;
■ ability to communicate tasks and expected results eff ectively;
■ ability to negotiate various administrative and regulatory processes;
■ good delegation skills.
Management is getting things done
266 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
10.3 CONDITIONS FOR GOOD MANAGEMENT
Certain conditions are important for creating good management, including:
■ managers and team members need to be selected on merit;
■ managers need to earn the respect of their staff , patients, and supervisors;
■ managers need to have the knowledge, skills and understanding of the role,
tasks and purpose of the services they deliver;
■ basic support systems function well; clear staff administration rules and
regulations; well planned and timely delivered supplies, equipment and drugs;
clear and transparent financial processes; and well planned and monitored
activities. Roles between Leadership and Management Essay.
Management is getting things done through balanced involvement of people
As a health facility manager there are important questions to discuss with the
district management team and to ask yourself:
■ What exactly am I supposed to do as a manager?
■ Will the resources needed be here and be on time?
■ How free am I to take decisions, e.g. to move staff around?
■ How can I balance my managerial and clinical duties?
■ How can I reduce the time spent on the many routine reports I need to
write?
■ What and where are the tools and techniques to help me do the job well?
Conditions for being an effective manager are best when these questions have
clear and positive answers so that tasks are clear, the delegation of authority is
known and managers know where and when to seek support for their decisions.
Management also flourishes when the manager and the staff agree about the
objectives of the work that they are doing, and can make decisions easily and
with minimal risks.

OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 267
10.4 HOW TO LEARN AS A MANAGER
Health care delivery and patient circumstances are constantly changing,
and managers have to continue to learn new abilities and skills to keep up.
A significant portion of management involves skills and competencies such
as motivating staff , communicating and negotiating with stakeholders, and
maintaining certain attitudes and behaviours that maximize staff discipline and
performance. Managers also need to understand the basic technical aspects of
the services delivered. Roles between Leadership and Management Essay.For most of these competencies, training courses, while
effective, are oft en not sufficient to provide all the necessary skills.
How can managers create and foster an environment in which they, and the
people they manage, are constantly learning? One way is to clearly and regularly
identify challenges that the service faces, and the skills and knowledge that the
team needs to overcome these challenges. Th e ways to acquire the necessary
skills and competencies may include:
■ continuous education and learning (including self-learning programmes)
■ structured “academic” courses; the most common form of management
training; Roles between Leadership and Management Assignment.
■ Secondments, attachments, shadowing/observation and study tours provide
practical learning and examples of how others handle situations you will likely
face;
■ Mentoring and coaching relationships – experienced mentors provide insights
into managing partnerships and relationships, opportunities to seek advice
and explore options when managers are faced with diffi cult situations;
■ Peer to peer learning – an opportunity to meet other managers at regular
intervals, share experiences, challenges and solutions, build a common
understanding of processes, and to support each other.
Other peer learning techniques include:
■ Learning cycles/groups – groups of team members who meet regularly to
discuss issues and help develop or improve management systems;
268 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
■ Networks – managers from within and outside your health centre with a
common interest in understanding and improving their situation;
■ Reflection sessions – managers and their teams set aside a regular time to
review their work, identify areas that need improvement, and ways to improve
the service;

These methods can be used by the managers as part of their planned selfdevelopment, and should be linked to challenges they face in delivering
services. Every manager needs clear learning objectives and plans and available
time for these activities (e.g. put aside a half day every two weeks for team or
personal learning). Roles between Leadership and Management Essay.
10.5 OVERVIEW: A MANAGER’S ROLE AND TASKS
Certain roles and responsibilities all general managers need to manage,
include:
■ type and coverage of services to be delivered;
■ resources (staff , budgets, drugs and supplies, equipment, buildings and other
infrastructure and information) available for use;
■ people, including patients, partners, suppliers and staff that are important
for delivering functional quality services.
Th e specifi c functions carried out by health facility managers are discussed
here and in other chapters, However, no matter what type of service is off ered,
managers need to devise and implement strategies, make plans and budgets,
seek resources, implement, monitor and evaluate the plans, learn lessons, and
then design new plans.
A manager delegates some tasks to other staff members and supports and
coaches them to achieve desired results. Managers use team and staff meetings
and other forms of communication to communicate the appropriate messages
to staff about what is to be achieved and how.
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 269
A major management task is reviewing the important information and data
concerning service delivery and using this data to make decisions about how
services can be modified and improved. Managers are responsible for the
finances available to the service, ensuring that these are used to produce the
maximum possible benefits for patients and staff . Keeping a firm focus on
the overall goal of the service and reminding staff , partners and clients of this
goal is a major task for managers. Management involves developing staff /
skills mentoring persons with high potential, and resolving conflicts while
maintaining ethics and discipline
Managers must also develop “management improvement/action plans” that
target:
■ difficulties in management systems
■ bottlenecks/barriers to service delivery
■ tasks that need to be delegated, and
■ expected results of the management functions.
Management is about making decisions
10.6 HOW TO MANAGE RELATIONS WITH THE
DISTRICT TEAM/ SUPERVISOR
In most health systems, health facilities are linked to the
national health system through the district and threfore are
accountable to district management teams. All operational
health system activities are implemented via the district
including drugs and commodities procurement, human
resources, infrastructure, and technical support. Local facility
managers and district managers must have clear lines of communication, and
ensure optimal off -site support and supervision, and that reporting to districts
is accurate. Roles between Leadership and Management Assignment.
District Team Support
270 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
Facility managers must communicate all challenges to the district level to
make sure there is continued service delivery at facility level. District managers
should communicate new policies and management tools to local managers
to ensure compliance. A strong relationship between the two levels is key to
sustained service delivery at the facility level.
10.7 HOW TO MANAGE PATIENT RELATIONS AND
ACHIEVE PATIENT SATISFACTION
Health facilities exist for the sole purpose of providing health services to
patients in communities. Therefore managers need to ensure that client
satisfaction is of utmost importance. Th is is why all staff must be trained to
understand patients’ rights.
Staff should not be judgmental and must provide information
to patients so they can make informed decisions regarding
treatment options, as well as lifestyle and behaviour
modifi cations that may be required to improve their health
status. Staff must also be able to assist patients to understand
their responsibilities, including:
■ to live a healthy lifestyle;
■ not to participate in risky behaviour;
■ to participate in their care by attending appointments, asking questions, and
playing a part in their own health improvement;
■ to be open and honest about the problems they face;
■ to have the best health outcome by adhering to treatment regimes.
Th e attitude of staff towards patients infl uences patients’ willingness to o
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 271
Assessing patient satisfaction
Appropriate tools should be used by the health centre and district supervisors
to assess patient satisfaction, or to assess how patients perceive the health
establishment in general. Th ese include:
■ client satisfaction surveys
■ suggestion boxes
■ community consultation committees.
These concrete measures ensure patients’ voices are heard. Anonymous
mechanisms for eliciting suggestions should be encouraged, such as a
“suggestion box” placed in the waiting area (with paper and pen), in which
patients can put anonymous messages. Th e box should be emptied regularly
and comments discussed with the staff .
10.8 PATIENTS’ RIGHTS
Patients’ rights, include the right to:
1. health information
2. full range of accessible and affordable health services
3. privacy when they are receiving health care
4. be treated with dignity and respect when they are receiving health care
5. be assured that personal information will remain confi dential
6. be given an explanation of the processes that they go through when they are receiving
health care
7. be treated by people who are trained and knowledgeable about what they do
8. continuity of services
9. be treated by a named provider
10. express the views on the services provided and to complain about unsatisfactory health
services
11. gender equality
12. a healthy and safe environment
13. make free informed choices

10.9 HOW TO MANAGE FINANCES
Th e degree to which health centres are involved in managing funds and
fi nancial resources varies with the nature of the health centre, its size, and the
structure of the national health services. Yet, all health services have to manage
two types of funds:
■ “Invisible funds”, or budgetary allocation. Th ese are not physically handled,
but represent a “credit” that is provided by the district management team or
other entity that will handle how they are spent;
■ “Visible money” or cash: Th is money is seen and handled in the centre. Money
can be kept for spending (usually small in amounts, called “petty cash”1
), or
be received for services or sales of goods.
Managing money and fi nances in a health centre is complex and responsible
work. Ultimately, the facility manager bears responsibility for the correct
handling of all fi nancial aspects. Good fi nancial management is the core of good
service delivery. Th e facility manager needs to ensure that fi nancial resources
are committed to those activities that contribute to organizational goals.
Regular use of the good fi nancial management checklist below can help ensure
that the fi nancial procedures in place conform to good fi nancial practises.
1 Petty cash – the fi nancial term for this is imprested fund
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 273
A good fi nancial management checklist ensures that:
• All accounting registers, journals and ledgers are up to date.
• All fi nancial reports are prepared and submitted in a timely manner.
• Procedures for the use of petty cash are properly developed.
• All expenses other than petty cash are paid by cheque.
• Financial activities are separated in such a way that one person alone never registers,
reviews and authorizes any complete transaction.
• Procedures for authorizing purchases are being followed.
• Security measures are in place to protect the assets, books and registers from tampering
or theft.
• A physical inventory of fi xed assets and supplies is conducted at least once a year.
• The bank statement is reconciled monthly.
• There is a financial plan and/or a fi nancial strategy leading to improved cost recovery.
• Financial administration staff is involved in both programme and financial planning
processes.
• A realistic annual budget is developed from the work plan.
• The organization has a unifi ed budget, as well as sub-budgets for different programmes
and/or donors. The accounting system adequately allocates expenses to different
programmes and/or donors.
• The line items in the chart of accounts, the budget and management financial reports
correspond with each other.
• Cash fl ow is adequately monitored and is projected for the year so there are no periods
of cash shortage.
• Actual expenditures are compared quarterly with the budget and corrective action is
taken as a result of these comparisons. Roles between Leadership and Management Essay.
Oft en, health centres have no dedicated financial offi cers to handle budgets and
financial control is exerted by the overall facility manager. A minimum set of
financial management tasks includes:
■ budget preparation and cash fl ow projection
■ budget allotments and expenditures
■ management of cash income and expenses
■ financial monitoring and reporting
■ the use of financial information to make decisions.
274 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
How to prepare a budget and cash flow projection
A health centre budget outlines how financial resources will be used over a
defined period of time, usually one year. Roles between Leadership and Management Essay.Two main steps in budget preparation
include projecting all expenses that will be incurred at the health centre, and
matching them with expected revenues and budget allocations. Additional
cash fl ow projections help to ensure that income and expenditure match
throughout the year, and the health centre is able to meet costs as they incur.
Budget development is an essential part of the planning process.
Determining resource needs and associated costs
Th e starting point for budgeting is a list of the resources needed to carry out
all activities throughout the year required to maintain the health centre and to
provide its services. It is useful to also list resources that are directly provided
to the centre and that are fi nanced from other budgets (e.g. staff or medication
paid directly by the district authorities).Roles between Leadership and Management Essay. Leaving out these in-kind contributions
hides the real cost of services delivery, and makes it hard to determine how to
make the service sustainable in the future. Th e budget includes two types of
resource needs and costs:
■ Fixed costs: remain constant and are independent from the exact level of
activity within the capacity of the centre. Such costs include most salaries,
equipment leases or payments, rent and utilities. Some fi xed costs also change
with the level of activity – such as the number of staff needed.
■ Variable costs: depend on the level of activity such as the number of patients
treated. Such costs include care consumables, drug costs and transportation
costs for home visits etc. Variable costs are usually specifi ed “per unit” of
delivery (e.g. drug needs and costs for one patient on fi rst-line ART) and
multiplied by an estimated “number of units” (e.g. the number of patients
expected to be on fi rst-line ART in the facility). Roles between Leadership and Management Essay.
It is recommended to use a budgeting sheet (see Annex 10.1: Budget Sheet)
and to sub-divide the list of resources into various categories. For each
resource (e.g. staff ), you need to specify the type of costs associated (e.g. salary)
and time period, (usually 12 months), and at what cost per unit (e.g.
US 300 Dollars (USD) per month). Standard categories are recommended
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 275
by district authorities and ideally the same categories are used for budgeting,
accounting and reporting. Th ose categories may include:
■ staff ;
■ physical infrastructure and building operating costs;
■ medical supplies, equipment and consumables;
■ communication;
■ transportation including vehicle operating costs and travel;
■ replacement costs (depreciation) – Th is is a provision for long-term assets
(such as vehicles/machinery/computers/lab equipment) that deteriorate over
time and have to be replaced at the end of their usefulness. Some money
needs to be set aside every year for future purchases to replace these assets
(see section – 10.10 – Managing Hardware). Roles between Leadership and Management Essay.
Determining funding sources
For many public programmes there will be only one source of funding, i.e.
the district health service, or the provincial or national health department.
However, some public facilities – and usually all private facilities – might also
receive private funding or charge fees to generate income.
Th e “unifi ed budget” prepared in the previous step will be of great help in managing
incoming funds. Th is is because the same listing of activities and resource needs
can be used to demonstrate which funds are used towards what purpose. Th is is
a process of “earmarking” that will ensure that the use of funds remains within
the originally intended purpose. It will also facilitate donor reporting. Assigning
incoming funds to expenditures is best achieved by appending specifi c “donor
columns” to the budgeting sheet. (Annex 10.1 -Budget Sheet)
Projecting cash fl ow
Cash fl ow projections are needed to ensure that each month enough money
is available (in cash or in the allotment) to cover all anticipated fi nancial
276 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
obligations. Cash fl ow projections are done on the basis of the health centre’s
budget, detailing the amount of expenditures, and when they occur. (See Annex
10.2 Cash Flow Projection Sheet).
Cash fl ow projections are best made for each month of the budget year, and
should outline:
■ how much money is available a the beginning of the month;
■ what funds will be received during the month; and
■ How much money is expected to be spent during the month. Roles between Leadership and Management Essay.
Th e remaining balance should be zero or a positive amount and should be carried
forward to the next month. Prudent fi nancial management requires that as part
of cash fl ow processes, management fi xed management costs be prioritized over
other expenses; otherwise operations could be brought to a halt.
How tomanage allotments
“Invisible money” is allocated to a health centre based on a budget (see previous
sub-section) that defi nes certain expenditure categories. To keep track of
expenditures against such allotments, a logbook of all expenditures should be
kept that will allow the manager to track how much money has been spent, and
how much money is still available. Th is logbook is usually called “allotment
ledger” (see Annex 10.3 – Allotment Ledger).
In the ledger, the manager registers all fund allocations (credits) and all
expenditures (debits). For each transaction, the date is registered, as well as a
reference to further documentation on the transaction (see below). At any point
in time, the amount debited can be totalled and deducted from the amount
credited. Th e ledger can combine all expenditure categories, or break them
down according to main categories. Usually, the district offi ce will provide a
specifi c format for such a ledger.
Expenditures against allotments are made in the form of “purchase orders”
or “vouchers”, that will allow the allotment holder (e.g. the district health
administration) to make the payment. Each purchase order needs to be duly
signed at the health centre and by the health district administration. Purchase
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 277
orders and payment vouchers are usually pre-printed and serially numbered
(see Annex 10.4 – Purchase order / Voucher).
Managers who have the responsibility of authorizing expenditures and
purchases need to ensure that; 1) the purchase is justifi ed and within the scope
of planned activities; 2) the cost is competitive; 3) the transaction is properly
documented, and; 4) sufficient funds are available to make the purchase.
How to manage cash
Most health centres need to have some reserves to cover small cash expenses
(“petty cash”). Th is cash is advanced to the manager based on the budget, and
subtracted from the allotment. Th e provision of a cash advance for specifi c
purposes is called a “petty cash fund”. Th e types of expenses that can be covered
by the petty cash fund vary from place to place but may include:
■ transportation such as bus fares, petrol;
■ communication such as stamps and phone calls;
■ cleaning needs such as soap, detergent;
■ stationary such as paper, envelopes. Roles between Leadership and Management Essay.
■ sundries such as matches, candles, tea, emergency supplies.
A petty cash fund is a fi xed amount of cash (e.g. $US 50) from disbursements
that are made for the purchase of goods or services. Th e cash is kept in a safe
place to which only the manager has access. It is important that each time cash
is taken out, the transaction is documented in a logbook (“petty cash book”),
and supported by evidence for its use (“voucher” and “receipt”). When the
petty cash fund is nearing its exhaustion (e.g. aft er having spent $US 40) the
manager will total all expenditures. Th e remaining balance will be “brought
forward (B/F)” and the petty cash fund will be replenished to the original level
(e.g. by adding $US 40 to reach the original level of $US 50).
Petty cash books are usually standardized to list – (in table form) each
transaction, the date, the purpose, the number of a referring voucher/purchase
order, and the amount paid or received. It is possible to add additional columns
to break down expenses by certain categories (see Annex 10.5 – Petty Cash
278 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
Book). Th e voucher documenting each transaction is fi lled out when funds are
given out and signed by both the authorizing offi cer and the receiving staff (e.g.
the driver). It is important to attach the original receipt for expenditures to all
purchase orders and vouchers if possible (e.g. a receipt from a petrol station
– see Annex 10.6 – Cash Voucher). Certain health centres may also receive cash,
usually in form of service fees or from sales of drugs or other commodities. For
each transaction, a receipt is issued in three duplicates: one for the client, one
to accompany the cash, and one that stays in the receipt book. Such receipts
are usually provided in the form of books of numbered receipts see Annex
10.7 – Cash Receipt). Roles between Leadership and Management Essay.
Just as with expenditures, all cash revenues are kept in a safe place and are
recorded in a “revenue book” (see Annex 10.8 – Revenue Book), indicating
clearly for each transaction the date, amount, and purpose. Periodically, the
manager will turn over funds to the district fi nancial offi cer, together with
copies of used and unused receipts.
How to report on the use of funds
Th e manager is expected to show the appropriate use of fi nances and to
demonstrate how their use relates to expenses set out in the work plan and
budget. One’s ability to do so depends on the availability of a well developed
budget and well kept up to date allotment records. In some cases, the facility
manager will be able to complement records held at the health centre with
offi cial records and fi nancial statements from the allotment holder (usually the
district administration). Implementation progress reports and fi nancial reports
are normally required to comply with specifi c formats and to cover defi ned
time periods see Annex 10.9 – Financial Reporting Form).
Financial controls
Financial control procedures are essential for eff ective resource management.
Even for a facility that employs accountants and other fi nancial personnel, the
facility manager bears the ultimate responsibility for ensuring all resources
entrusted to him or her are fully accounted for. It is important that the
facility puts in place guidelines, policies and rules and an eff ective fi nancial
control system that ensures fi nancial accountability see the good fi nancial
management checklist). Finally, it is advisable that at least once a year, the
fi nancial transactions of the facility are audited.
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 279
10.10 HOW TO MANAGE HARDWARE
A number of tangible goods and structures are needed to successfully provide
services at the health centre, including:
■ physical infrastructure and buildings
■ equipment and machinery, including vehicles
■ drugs, commodities and supplies.
Various chapters in this manual describe how to design appropriate space
distribution and use, how to choose and maintain laboratory equipment, and
how to plan for eff ective procurement of drugs and commodities. However, as a
manager, you are expected to ensure that all of this hardware remains functional
all the time. To this end, you will need to make plans and reserve budget for:
■ regular maintenance of all hardware, including machinery, vehicles, and
buildings;
■ supplies to use hardware, such as test kits for lab equipment and petrol for
vehicles;
■ repair of failing hardware;
■ replacement of hardware once it has reached a predefined period of use or
fails beyond repair.
From a practical point of view it is recommended that all maintenance and
replacement actions be marked in the yearly facility planner to avoid a lack
of critical hardware in the centre (see below; How to design Management
Schedules). In addition, if replacement hardware needs to be purchased by
the health centre, a budget allocation for “depreciation” of the hardware needs
to be made.

The facility manager is challenged to juggle a range of important management
responsibilities and tasks, and at the same time to ensure the smooth running of
the health centre. Th e key challenge for any manager is the limited availability of
time. A fi rst step to managing your time as effi ciently as possible is to examine
how your working time is actually spent. Normally, managers will spend
signifi cant portions of their time on:
■ management and administrative tasks, including development of work plans,
budgets and reports;
■ meeting with health workers help them work better together as a team;
■ meeting with patients, the community and other external partners;
■ interacting with the district level authorities;
■ travelling and attending of workshops;
■ learning and continued education;
■ clinical work. Th e aim of good management is to provide services to the community in an
appropriate, effi cient, equitable, and sustainable manner. Th is can only be
achieved if key resources for service provision, including human resources,
fi nances, hardware and process aspects of care delivery are brought together
at the point of service delivery and are carefully synchronized. Critical
management considerations for assessment and planning, managing the care
process, human resources, interacting with the community, and managing
information are covered in the Planning, Human Resources, Integration
and Monitoring chapters. Th is chapter fi rst discusses good management and
leadership in general, then outlines relevant considerations for managing
relations with patients and the district team, as well as fi nances and hardware
and management schedules. Roles between Leadership and Management Essay.

Management and leadership are important for the delivery of good health
services. Although the two are similar in some respects, they may involve
different types of outlook, skills, and behaviours. Good managers should strive
to be good leaders and good leaders, need management skills to be eff ective.
Leaders will have a vision of what can be achieved and then communicate this
to others and evolve strategies for realizing the vision. Th ey motivate people
and are able to negotiate for resources and other support to achieve their goals.
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 265
Managers ensure that the available resources are well organized and applied to
produce the best results. In the resource constrained and diffi cult environments
of many low – to middle-income countries, a manager must also be a leader
to achieve optimum results. Roles between Leadership and Management Assignment.
What are the attributes of a good leader? Leaders oft en (but not necessarily
always):
■ have a sense of mission;
■ are charismatic;
■ are able to infl uence people to work together for a common cause;
■ are decisive;
■ use creative problem solving to promote better care and a positive working
environment.
Leadership is creating a vision
Managers who have these leadership qualities are a credit to the services they
manage. However managers must ensure that day-to-day processes run well
to produce the desired results. Certain attributes are required for a manager
to be effective, including:
■ clarity of purpose and tasks;
■ good organizational skills;
■ ability to communicate tasks and expected results eff ectively;
■ ability to negotiate various administrative and regulatory processes;
■ good delegation skills.
Management is getting things done
266 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
10.3 CONDITIONS FOR GOOD MANAGEMENT
Certain conditions are important for creating good management, including:
■ managers and team members need to be selected on merit;
■ managers need to earn the respect of their staff , patients, and supervisors;
■ managers need to have the knowledge, skills and understanding of the role,
tasks and purpose of the services they deliver; Roles between Leadership and Management Essay.
■ basic support systems function well; clear staff administration rules and
regulations; well planned and timely delivered supplies, equipment and drugs;
clear and transparent fi nancial processes; and well planned and monitored
activities. Roles between Leadership and Management Assignment.
Management is getting things done through balanced involvement of people
As a health facility manager there are important questions to discuss with the
district management team and to ask yourself:
■ What exactly am I supposed to do as a manager?
■ Will the resources needed be here and be on time?
■ How free am I to take decisions, e.g. to move staff around?
■ How can I balance my managerial and clinical duties?
■ How can I reduce the time spent on the many routine reports I need to
write?
■ What and where are the tools and techniques to help me do the job well?
Conditions for being an eff ective manager are best when these questions have
clear and positive answers so that tasks are clear, the delegation of authority is
known and managers know where and when to seek support for their decisions.
Management also fl ourishes when the manager and the staff agree about the
objectives of the work that they are doing, and can make decisions easily and
with minimal risks.
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 267
10.4 HOW TO LEARN AS A MANAGER
Health care delivery and patient circumstances are constantly changing,
and managers have to continue to learn new abilities and skills to keep up.
A signifi cant portion of management involves skills and competencies such
as motivating staff , communicating and negotiating with stakeholders, and
maintaining certain attitudes and behaviours that maximize staff discipline and
performance. Managers also need to understand the basic technical aspects of
the services delivered. For most of these competencies, training courses, while
eff ective, are oft en not suffi cient to provide all the necessary skills.
How can managers create and foster an environment in which they, and the
people they manage, are constantly learning? One way is to clearly and regularly
identify challenges that the service faces, and the skills and knowledge that the
team needs to overcome these challenges. Th e ways to acquire the necessary
skills and competencies may include:
■ continuous education and learning (including self-learning programmes)
■ structured “academic” courses; the most common form of management
training;
■ Secondments, attachments, shadowing/observation and study tours provide
practical learning and examples of how others handle situations you will likely
face; Roles between Leadership and Management Essay.
■ Mentoring and coaching relationships – experienced mentors provide insights
into managing partnerships and relationships, opportunities to seek advice
and explore options when managers are faced with diffi cult situations;
■ Peer to peer learning – an opportunity to meet other managers at regular
intervals, share experiences, challenges and solutions, build a common
understanding of processes, and to support each other. Roles between Leadership and Management Assignment.
Other peer learning techniques include:
■ Learning cycles/groups – groups of team members who meet regularly to
discuss issues and help develop or improve management systems;
268 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT Roles between Leadership and Management Assignment.
■ Networks – managers from within and outside your health centre with a
common interest in understanding and improving their situation;
■ Refl ection sessions – managers and their teams set aside a regular time to
review their work, identify areas that need improvement, and ways to improve
the service;
Th ese methods can be used by the managers as part of their planned selfdevelopment, and should be linked to challenges they face in delivering
services. Every manager needs clear learning objectives and plans and available
time for these activities (e.g. put aside a half day every two weeks for team or
personal learning). Roles between Leadership and Management Essay.
10.5 OVERVIEW: A MANAGER’S ROLE AND TASKS
Certain roles and responsibilities all general managers need to manage,
include:
■ type and coverage of services to be delivered;
■ resources (staff , budgets, drugs and supplies, equipment, buildings and other
infrastructure and information) available for use;
■ people, including patients, partners, suppliers and staff that are important
for delivering functional quality services.
Th e specifi c functions carried out by health facility managers are discussed
here and in other chapters, However, no matter what type of service is off ered,
managers need to devise and implement strategies, make plans and budgets,
seek resources, implement, monitor and evaluate the plans, learn lessons, and
then design new plans.
A manager delegates some tasks to other staff members and supports and
coaches them to achieve desired results. Managers use team and staff meetings
and other forms of communication to communicate the appropriate messages
to staff about what is to be achieved and how.
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 269
A major management task is reviewing the important information and data
concerning service delivery and using this data to make decisions about how
services can be modified and improved. Managers are responsible for the
finances available to the service, ensuring that these are used to produce the
maximum possible benefits for patients and staff . Keeping a fi rm focus on
the overall goal of the service and reminding staff , partners and clients of this
goal is a major task for managers. Roles between Leadership and Management Assignment.Management involves developing staff /
skills mentoring persons with high potential, and resolving conflicts while
maintaining ethics and discipline
Managers must also develop “management improvement/action plans” that
target: Roles between Leadership and Management Assignment.
■ difficulties in management systems
■ bottlenecks/barriers to service delivery
■ tasks that need to be delegated, and
■ expected results of the management functions.
Management is about making decisions
10.6 HOW TO MANAGE RELATIONS WITH THE
DISTRICT TEAM/ SUPERVISOR
In most health systems, health facilities are linked to the
national health system through the district and threfore are
accountable to district management teams. Roles between Leadership and Management Essay.All operational
health system activities are implemented via the district
including drugs and commodities procurement, human
resources, infrastructure, and technical support. Local facility
managers and district managers must have clear lines of communication, and
ensure optimal off -site support and supervision, and that reporting to districts
is accurate. Roles between Leadership and Management Assignment.

District Team Support
270 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
Facility managers must communicate all challenges to the district level to
make sure there is continued service delivery at facility level. District managers
should communicate new policies and management tools to local managers
to ensure compliance. A strong relationship between the two levels is key to
sustained service delivery at the facility level.
10.7 HOW TO MANAGE PATIENT RELATIONS AND
ACHIEVE PATIENT SATISFACTION
Health facilities exist for the sole purpose of providing health services to
patients in communities. Therefore managers need to ensure that client
satisfaction is of utmost importance. Th is is why all staff must be trained to
understand patients’ rights. Roles between Leadership and Management Essay.
Staff should not be judgmental and must provide information
to patients so they can make informed decisions regarding
treatment options, as well as lifestyle and behavior
modifications that may be required to improve their health
status. Staff must also be able to assist patients to understand
their responsibilities, including:
■ to live a healthy lifestyle;
■ not to participate in risky behavior;
■ to participate in their care by attending appointments, asking questions, and
playing a part in their own health improvement;
■ to be open and honest about the problems they face;
■ to have the best health outcome by adhering to treatment regimes.
Th e attitude of staff towards patients infl uences patients’ willingness to o
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 271
Assessing patient satisfaction
Appropriate tools should be used by the health centre and district supervisors
to assess patient satisfaction, or to assess how patients perceive the health
establishment in general. Th ese include:
■ client satisfaction surveys
■ suggestion boxes
■ community consultation committees.
These concrete measures ensure patients’ voices are heard. Anonymous
mechanisms for eliciting suggestions should be encouraged, such as a
“suggestion box” placed in the waiting area (with paper and pen), in which
patients can put anonymous messages. Th e box should be emptied regularly
and comments discussed with the staff .
10.8 PATIENTS’ RIGHTS
Patients’ rights, include the right to:
1. health information
2. full range of accessible and affordable health services
3. privacy when they are receiving health care
4. be treated with dignity and respect when they are receiving health care
5. be assured that personal information will remain confi dential
6. be given an explanation of the processes that they go through when they are receiving
health care
7. be treated by people who are trained and knowledgeable about what they do
8. continuity of services Roles between Leadership and Management Assignment.
9. be treated by a named provider
10. express the views on the services provided and to complain about unsatisfactory health
services
11. gender equality
12. a healthy and safe environment
13. make free informed choices
272 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
10.9 HOW TO MANAGE FINANCES
Th e degree to which health centres are involved in managing funds and
financial resources varies with the nature of the health centre, its size, and the
structure of the national health services. Yet, all health services have to manage
two types of funds:
■ “Invisible funds”, or budgetary allocation. Th ese are not physically handled,
but represent a “credit” that is provided by the district management team or
other entity that will handle how they are spent;
■ “Visible money” or cash: Th is money is seen and handled in the centre. Money
can be kept for spending (usually small in amounts, called “petty cash”1
), or
be received for services or sales of goods. Roles between Leadership and Management Assignment.
Managing money and finances in a health centre is complex and responsible
work. Ultimately, the facility manager bears responsibility for the correct
handling of all financial aspects. Good financial management is the core of good
service delivery. Th e facility manager needs to ensure that financial resources
are committed to those activities that contribute to organizational goals.
Regular use of the good financial management checklist below can help ensure
that the financial procedures in place conform to good financial practises.
1 Petty cash – the financial term for this is imprested fund
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 273
A good financial management checklist ensures that:
• All accounting registers, journals and ledgers are up to date.
• All financial reports are prepared and submitted in a timely manner.
• Procedures for the use of petty cash are properly developed.
• All expenses other than petty cash are paid by cheque.
• Financial activities are separated in such a way that one person alone never registers,
reviews and authorizes any complete transaction. Roles between Leadership and Management Assignment.
• Procedures for authorizing purchases are being followed.
• Security measures are in place to protect the assets, books and registers from tampering
or theft. Roles between Leadership and Management Essay.
• A physical inventory of fixed assets and supplies is conducted at least once a year.
• The bank statement is reconciled monthly.
• There is a financial plan and/or a financial strategy leading to improved cost recovery.
• Financial administration staff is involved in both programme and financial planning
processes. Roles between Leadership and Management Assignment.
• A realistic annual budget is developed from the work plan.
• The organization has a unifi ed budget, as well as sub-budgets for different programmes
and/or donors. The accounting system adequately allocates expenses to different
programmes and/or donors.
• The line items in the chart of accounts, the budget and management fi nancial reports
correspond with each other.
• Cash fl ow is adequately monitored and is projected for the year so there are no periods
of cash shortage.
• Actual expenditures are compared quarterly with the budget and corrective action is
taken as a result of these comparisons. Roles between Leadership and Management Assignment.
Oft en, health centres have no dedicated fi nancial offi cers to handle budgets and
fi nancial control is exerted by the overall facility manager. A minimum set of
financial management tasks includes:
■ budget preparation and cash fl ow projection
■ budget allotments and expenditures
■ management of cash income and expenses
■ fi nancial monitoring and reporting
■ the use of fi nancial information to make decisions.
274 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
How to prepare a budget and cash fl ow projection
A health centre budget outlines how financial resources will be used over a
defined period of time, usually one year. Two main steps in budget preparation
include projecting all expenses that will be incurred at the health centre, and
matching them with expected revenues and budget allocations. Additional
cash fl ow projections help to ensure that income and expenditure match
throughout the year, and the health centre is able to meet costs as they incur.
Budget development is an essential part of the planning process. Roles between Leadership and Management Assignment.
Determining resource needs and associated costs
Th e starting point for budgeting is a list of the resources needed to carry out
all activities throughout the year required to maintain the health centre and to
provide its services. It is useful to also list resources that are directly provided
to the centre and that are financed from other budgets (e.g. staff or medication
paid directly by the district authorities). Leaving out these in-kind contributions
hides the real cost of services delivery, and makes it hard to determine how to
make the service sustainable in the future. Th e budget includes two types of
resource needs and costs: Roles between Leadership and Management Assignment.
■ Fixed costs: remain constant and are independent from the exact level of
activity within the capacity of the centre. Such costs include most salaries,
equipment leases or payments, rent and utilities. Some fi xed costs also change
with the level of activity – such as the number of staff needed. Roles between Leadership and Management Assignment.
■ Variable costs: depend on the level of activity such as the number of patients
treated. Such costs include care consumables, drug costs and transportation
costs for home visits etc. Variable costs are usually specifi ed “per unit” of
delivery (e.g. drug needs and costs for one patient on first-line ART) and
multiplied by an estimated “number of units” (e.g. the number of patients
expected to be on first-line ART in the facility). Roles between Leadership and Management Assignment.
It is recommended to use a budgeting sheet (see Annex 10.1: Budget Sheet)
and to sub-divide the list of resources into various categories. For each
resource (e.g. staff ), you need to specify the type of costs associated (e.g. salary)
and time period, (usually 12 months), and at what cost per unit (e.g.
US 300 Dollars (USD) per month). Standard categories are recommended
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 275
by district authorities and ideally the same categories are used for budgeting,
accounting and reporting. Th ose categories may include:
■ staff ;
■ physical infrastructure and building operating costs;
■ medical supplies, equipment and consumables;
■ communication;
■ transportation including vehicle operating costs and travel;
■ replacement costs (depreciation) – Th is is a provision for long-term assets
(such as vehicles/machinery/computers/lab equipment) that deteriorate over
time and have to be replaced at the end of their usefulness. Some money
needs to be set aside every year for future purchases to replace these assets
(see section – 10.10 – Managing Hardware). Roles between Leadership and Management Essay.
Determining funding sources Roles between Leadership and Management Assignment.
For many public programmes there will be only one source of funding, i.e.
the district health service, or the provincial or national health department.
However, some public facilities – and usually all private facilities – might also
receive private funding or charge fees to generate income.
Th e “unified budget” prepared in the previous step will be of great help in managing
incoming funds. Th is is because the same listing of activities and resource needs
can be used to demonstrate which funds are used towards what purpose. Th is is
a process of “earmarking” that will ensure that the use of funds remains within
the originally intended purpose. It will also facilitate donor reporting. Assigning
incoming funds to expenditures is best achieved by appending specific “donor
columns” to the budgeting sheet. (Annex 10.1 -Budget Sheet)
Projecting cash flow
Cash fl ow projections are needed to ensure that each month enough money
is available (in cash or in the allotment) to cover all anticipated fi nancial
276 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
obligations. Cash fl ow projections are done on the basis of the health centre’s
budget, detailing the amount of expenditures, and when they occur. (See Annex
10.2 Cash Flow Projection Sheet).
Cash fl ow projections are best made for each month of the budget year, and
should outline:
■ how much money is available a the beginning of the month;
■ what funds will be received during the month; and
■ How much money is expected to be spent during the month.
Th e remaining balance should be zero or a positive amount and should be carried
forward to the next month. Prudent financial management requires that as part
of cash fl ow processes, management fixed management costs be prioritized over
other expenses; otherwise operations could be brought to a halt.
How to manage allotments
“Invisible money” is allocated to a health centre based on a budget (see previous
sub-section) that defines certain expenditure categories. To keep track of
expenditures against such allotments, a logbook of all expenditures should be
kept that will allow the manager to track how much money has been spent, and
how much money is still available. Th is logbook is usually called “allotment
ledger” (see Annex 10.3 – Allotment Ledger).
In the ledger, the manager registers all fund allocations (credits) and all
expenditures (debits). For each transaction, the date is registered, as well as a
reference to further documentation on the transaction (see below). At any point
in time, the amount debited can be totalled and deducted from the amount
credited. Th e ledger can combine all expenditure categories, or break them
down according to main categories. Usually, the district offi ce will provide a
specifi c format for such a ledger. Roles between Leadership and Management Essay.
Expenditures against allotments are made in the form of “purchase orders”
or “vouchers”, that will allow the allotment holder (e.g. the district health
administration) to make the payment. Each purchase order needs to be duly
signed at the health centre and by the health district administration. Purchase
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 277
orders and payment vouchers are usually pre-printed and serially numbered
(see Annex 10.4 – Purchase order / Voucher). Roles between Leadership and Management Assignment.
Managers who have the responsibility of authorizing expenditures and
purchases need to ensure that; 1) the purchase is justified and within the scope
of planned activities; 2) the cost is competitive; 3) the transaction is properly
documented, and; 4) sufficient funds are available to make the purchase.
How to manage cash
Most health centres need to have some reserves to cover small cash expenses
(“petty cash”). Th is cash is advanced to the manager based on the budget, and
subtracted from the allotment. Th e provision of a cash advance for specific
purposes is called a “petty cash fund”. Th e types of expenses that can be covered
by the petty cash fund vary from place to place but may include:
■ transportation such as bus fares, petrol;
■ communication such as stamps and phone calls;
■ cleaning needs such as soap, detergent;
■ stationary such as paper, envelopes. Roles between Leadership and Management Assignment.
■ sundries such as matches, candles, tea, emergency supplies.

A petty cash fund is a fixed amount of cash (e.g. $US 50) from disbursements
that are made for the purchase of goods or services. Th e cash is kept in a safe
place to which only the manager has access. It is important that each time cash
is taken out, the transaction is documented in a logbook (“petty cash book”),
and supported by evidence for its use (“voucher” and “receipt”). When the
petty cash fund is nearing its exhaustion (e.g. aft er having spent $US 40) the
manager will total all expenditures.Roles between Leadership and Management Assignment. The remaining balance will be “brought
forward (B/F)” and the petty cash fund will be replenished to the original level
(e.g. by adding $US 40 to reach the original level of $US 50).
Petty cash books are usually standardized to list – (in table form) each
transaction, the date, the purpose, the number of a referring voucher/purchase
order, and the amount paid or received. It is possible to add additional columns
to break down expenses by certain categories (see Annex 10.5 – Petty Cash
Book). Th e voucher documenting each transaction is filled out when funds are
given out and signed by both the authorizing officer and the receiving staff (e.g.
the driver). It is important to attach the original receipt for expenditures to all
purchase orders and vouchers if possible (e.g. a receipt from a petrol station
– see Annex 10.6 – Cash Voucher). Certain health centres may also receive cash,
usually in form of service fees or from sales of drugs or other commodities. For
each transaction, a receipt is issued in three duplicates: one for the client, one
to accompany the cash, and one that stays in the receipt book. Such receipts
are usually provided in the form of books of numbered receipts see Annex
10.7 – Cash Receipt).
Just as with expenditures, all cash revenues are kept in a safe place and are
recorded in a “revenue book” (see Annex 10.8 – Revenue Book), indicating
clearly for each transaction the date, amount, and purpose. Periodically, the
manager will turn over funds to the district fi nancial offi cer, together with
copies of used and unused receipts. Roles between Leadership and Management Essay.
How to report on the use of funds Roles between Leadership and Management Assignment.
Th e manager is expected to show the appropriate use of fi nances and to
demonstrate how their use relates to expenses set out in the work plan and
budget. One’s ability to do so depends on the availability of a well developed
budget and well kept up to date allotment records. In some cases, the facility
manager will be able to complement records held at the health centre with
offi cial records and fi nancial statements from the allotment holder (usually the
district administration). Implementation progress reports and financial reports
are normally required to comply with specific formats and to cover defined
time periods see Annex 10.9 – Financial Reporting Form).
Financial controls Roles between Leadership and Management Assignment.
Financial control procedures are essential for effective resource management.
Even for a facility that employs accountants and other financial personnel, the
facility manager bears the ultimate responsibility for ensuring all resources
entrusted to him or her are fully accounted for. It is important that the
facility puts in place guidelines, policies and rules and an effective financial
control system that ensures financial accountability see the good financial
management checklist). Finally, it is advisable that at least once a year, the
financial transactions of the facility are audited.
OPERATIONS MANUAL FOR STAFF AT PRIMARY HEALTH CARE CENTRES l 279
10.10 HOW TO MANAGE HARDWARE
A number of tangible goods and structures are needed to successfully provide
services at the health centre, including:
■ physical infrastructure and buildings
■ equipment and machinery, including vehicles
■ drugs, commodities and supplies.
Various chapters in this manual describe how to design appropriate space
distribution and use, how to choose and maintain laboratory equipment, and
how to plan for eff ective procurement of drugs and commodities. However, as a
manager, you are expected to ensure that all of this hardware remains functional
all the time. To this end, you will need to make plans and reserve budget for:
■ regular maintenance of all hardware, including machinery, vehicles, and
buildings;
■ supplies to use hardware, such as test kits for lab equipment and petrol for
vehicles;
■ repair of failing hardware;
■ replacement of hardware once it has reached a predefined period of use or
fails beyond repair.
From a practical point of view it is recommended that all maintenance and
replacement actions be marked in the yearly facility planner to avoid a lack
of critical hardware in the centre (see below; How to design Management
Schedules). In addition, if replacement hardware needs to be purchased by
the health centre, a budget allocation for “depreciation” of the hardware needs
to be made.
280 l CHAPTER 10 l LEADERSHIP AND MANAGEMENT
10.11 HOW TO DESIGN MANAGEMENT
SCHEDULES
Th e facility manager is challenged to juggle a range of important management
responsibilities and tasks, and at the same time to ensure the smooth running of
the health centre. Th e key challenge for any manager is the limited availability of
time. A fi rst step to managing your time as effi ciently as possible is to examine
how your working time is actually spent. Normally, managers will spend
signifi cant portions of their time on:
■ management and administrative tasks, including development of work plans,
budgets and reports;
■ meeting with health workers help them work better together as a team;
■ meeting with patients, the community and other external partners;
■ interacting with the district level authorities;
■ travelling and attending of workshops;
■ learning and continued education;
■ clinical work. Roles between Leadership and Management Assignment.
Th e challenge is to reduce time spent on lower priorities and to free time for
priority tasks that would otherwise be neglected. Some proven “time savers”
and “time managers” are:
■ learn to say “no”
■ rationally delegate and distribute work within the team
■ use meetings wisely; run meetings effectively
■ have a strategy for dealing with interruptions
■ be aware of time wasters. Roles between Leadership and Management Assignment.

Roles between Leadership and Management Assignment.