District Health Management Tools Facilitator's Manual Dr. Barbara Kloss-Quiroga (Ed.

) Berlin 2004

Since 1992, InWEnt - Public Health Division (formerly DSE/Public Health Promotion Centre) has organised management trainings for health managers from Africa, Asia, Latin America and Europe. The positive feedback and great demand for this training programme led to the idea to develop a training manual to reach a wider audience. Assembling ten years of experience, this manual compiles the most successful training units and strategies. The manual is intended to be used as a training guide and source of information and reference by trainers, facilitators or presenters who will have some experience with District Health Management. It contains background readings as well as descriptions of procedures, teaching materials, instructions and proposals for possible further action. It answers practical questions on how to organise the training sessions, how to employ convenient methods, how to convey specific contents to name only a few. The following pages introduce the rationale and approach of the training course, the structure of the manual, and summarise training contents and objectives of each training module. Module 5 presents not only a summary but also provides detailed background information for facilitators/trainers, a description of the procedures, as well as selected exercises, handouts and transparencies taken from the manual.

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Rationale and Approach The approach to District Health Management presented in this manual is based on the concept and principles of Primary Health Care. Since the mid 1980s, the health district as an operational unit has become the essential element of health policy concepts in low income countries (Harare conference in 1987). Structural adjustment and health sector reform promote the decentralisation of decision making power and financial responsibility to the district level. The complex task of building up and managing a modern health system requires professional training that goes beyond the classical transfer of knowledge. Besides sound technical knowledge, District Health Managers need qualifications like good leadership ability, communications skills, process-oriented thinking and the capacity to co-operate in local and regional networks. The experiential, participatory, problem-oriented training approach outlined in this manual, promotes practical knowledge and skills, gender/diversity-sensitivity, and the exchange of ideas, personal experiences and perspectives.

Structure of the Manual The facilitator's manual is divided into four parts: Part I is an introduction to the training course giving an overview of the rationale, objectives and target groups for the course. It includes an overall explanation on how to use the manual and about its structure, giving recommendations on training methods and course schedules. Part II and Part III present the actual training contents, methods, didactic materials and additional literature recommended to cover two broad content areas: "The Basics of District Health Management" and "A System's Approach to District Health Management". Part IV, the annex, describes the authors of this manual, provides a glossary of terms and acronyms, gives materials for intermittent and final course evaluation, and presents a list of abbreviations and a pre/post-test questionnaire.

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Training Modules The overall training programme guides you through nine training modules, each composed of specific training units. Part I: Course Introduction: Module 1: How to Use the Manual Part II: The Basics of District Health Management Module 2: Training Course Introduction Module 3: The Essential Manager Module 4: Managing the District Part III: A System's Approach to District Health Management Module 5: Input - Situation Analysis Module 6: Process - Planning and Programming Module 7: Human Resources Development Module 8: Financial Management Module 9: Output - Evaluation and Quality Assessment Part IV: Annex

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Module 2 Training Course Introduction by Barbara Kloss-Quiroga Every training course starts with the introduction for the participants and training team to get acquainted with one another. Some time needs to be reserved for the expression of expectations and fears of participants. The course introduction includes the presentation of course objectives, its content and programme as well as training approach and methodology. This module presents different techniques to start the training course and build a strong learning community.

Objectives The training team and participants have introduced themselves and stated their expectations and fears. The participants know the objectives, contents and the proposed programme schedule for the course. They have been introduced to the training approach and methods used, e.g. visualisation and participation and have agreed on the work procedure throughout the course.

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Module 3 The Essential Manager by Barbara Kloss-Quiroga and Gerlinde Reiprich Managing a very complex, demand-driven, resource-limited public service is a job for a very well trained, skilled and competent manager. Besides having sound technical knowledge, communication and interpersonal skills are of utmost importance in dealing successfully with individuals, the interests of the community, providing good management practice, and political goals.

Objective At the end of the module participants have acquired basic knowledge and skills in issues relevant to management at various health system levels, such as: communication, facilitation, leadership, gender and diversity, motivation and conflict management. Unit 1 Basic Skills in Communication Unit 2 Visualisation/Facilitation Unit 3 Leadership Unit 4 Gender and Diversity in Management Unit 5 Team Building and Team Work Unit 6 Staff Motivation Unit 7 Conflict Management

Unit 1

Basic Skills in Communication

Due to their role and function in the health system, health professionals need to be multi-talented and skilled communicators; interacting with patients, relatives of patients, colleagues, subordinates, superiors, officials, community representatives, and others. Communication does not merely consist of one person speaking and another listening. Human communication is a very complex process involving a sender, who intends to get a particular message content across to the receiver, who in turn needs to interpret the message correctly. This unit gives an introduction to the model of human communication.

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Specific Objectives of the Unit At the end of the unit the participants: are able to distinguish the different steps of the communication model; are aware of the important role of feedback in communication and know basic rules for giving and receiving feedback; have worked out a course contract/course rules; understand the different unsaid messages a sender can transmit to the receiver or the receiver can read from the sender.

Unit 2: Visualisation/Facilitation Good modern management is based on the active involvement and creativity of all members of working groups, teams, departments or divisions, etc. Group members need opportunities to contribute with their ideas, thoughts and feelings. The manager's or leader's role is it to provide these opportunities and to guide the communication towards a defined or agreed upon goal/aim, assuring the contribution of all participants. The manager thereby becomes a facilitator/moderator. One important tool in facilitating group activities is to visualise ideas, statements and comments in order to value participation, document results and structure communication processes.

Specific Objectives of the Unit By the end of the module participants: are able to visualise theories, results, messages, ideas, thoughts, etc., for presentation purposes or in group/team work; have acquired basic knowledge on facilitating meetings, group work sessions, seminars, conferences, etc., using questions and answers as instruments

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Unit 3: Leadership Leadership is a way of directing and motivating people. It is less of a technical skill and depends more on personal qualities like social and communicative competence, intuition and emotional intelligence, and ability to cope with given socio-cultural settings, interpersonal relationships and unpredictable or irrational behaviour. In this manual, we refer to a set of leadership concepts we consider to be essential in health management.

Specific Objectives of the Unit At the end of the unit participants are able to: identify functions and roles of a leader; distinguish between management and leadership; diagnose their own leadership styles; develop an idea or vision of their future leadership behaviour.

Unit 4: Gender/Diversity Issues in Management Diversity is defined as "those human qualities that are different from our own and outside the group's to which we belong, yet are present in other individuals and groups". Primary dimensions of diversity are age, ethnicity, gender, physical abilities/attributes, and sexual orientation. Secondary dimensions of diversity are those that can be changed, and include educational background, geographic location, income, marital status, parental status, religious beliefs, and work experiences. In particular, gender relations form a social system which is supported by values, rules, routine activities and division of resources in all forms of social organisation. Gender roles and relations are strongly related to power structures within societies, they are often unequal and hierarchical. Health managers need to consider the different characteristics of the people they are working with and the population covered by their catchment area. Such differences between men and women or between groups are often not taken into consideration, or are taken for granted in a way that hinders work efficiency.

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Specific Objectives of the Unit At the end of the unit, participants: have raised their awareness concerning gender issues in society; distinguish between gender and diversity, equity and equality; consider gender aspects in analysing health problems applying systematic frameworks (Harward Analytical Framework/ Guidelines for the Analysis of Gender and Health); analyse gender issues through the examples of HIV/AIDS, malaria, and TBC and their impact on men and women; know the developmental concepts of "Women in Development (WID)" and "Gender and Development (GAD)".

Unit 5: Team Building and Team Work Working as a team means working in a group with shared objectives, under specific rules/regulations and with equal members, which have different but complementary competencies to fulfil a specific task. In successful teams that function properly, people care for each other; they are open, truthful and have a high level of trust. Decisions are made by consensus, there is strong commitment and conflicts are addressed and worked through. The manager's role within a team is to initiate group processes, to achieve commitment, and to promote group ownership by relinquishing some control, thereby enabling the group to attain its own process and success.

Specific Objectives of the Unit At the end of the unit participants will: describe the concepts and principles of team work; be aware of the differences between groups and teams; understand the different stages of a team development process recognise their own roles as members of a team; apply management principles related to team work.

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Unit 6: Staff Motivation by Marie Claude Foster Motivation is a complex issue which does not easily fit in with the cause and effect Newtonian model used by many scientific researchers in the field. Having both conscious and unconscious drives, motivation changes, and ability to exert choice differentiates humans from the machine-like state applied to the cause and effect model. Most importantly, behavioural change cannot be forced on other human beings; people must choose to change themselves. While realising that change is an individual decision, it is also important for managers to reflect on the environment, attitude, belief system, structure and culture of organisations that inhibit people from working in balanced harmony within the workplace. The aim of this unit is to get participants to reflect on such complexities while using theoretical frameworks as guides.

Specific Objectives of the Unit At the end of the unit participants: appreciate the complex factors surrounding the issue of motivation at work; are familiar with a few of the classical theories on motivation; reflect on the topic of motivation in the workplace.

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Unit 7: Conflict Management by Marie Claude Foster In order to contend with the complex, and at times chaotic, challenges that arise, managers have to invent new approach strategies and support staff needs to execute their work creatively. The clash which occurs when ideas are disagreed upon can be a potential source of creativity and solution. Conflict about ideas causes a disturbance of the status quo, which when dealt with appropriately can lead to creative problem solving. Therefore, managers have to learn to welcome conflicting views. Working environments not only need to tolerate discussions, but invite debate on conflicting ideas, which stimulate people to find creative solutions to their problems. Differing views become problematic when they are seen as a personal attack, leading to unsolved conflict. Therefore, it is important to understand what happens in discussion, to know how to assess the interpersonal level and to be skilled in resolving conflict.

Specific Objectives of the Unit At the end of the unit participants: appreciate the importance of conflict in the workplace and how conflicting ideas lead to creativity; understand and have an insight on how to be able to deal with interpersonal conflict in the workplace.

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Module 4 Managing the District by Alois Drlemann and Barbara Kloss-Quiroga This module describes the conceptual framework that will be applied to the following modules of the training course. Before we start to plan or implement any health programme or intervention, we need to have a close look at the environment that influences and shapes our work as managers. We need to know the influential structures, needs and demand of the people and the attributes of the community we care for. We need to analyse the structures in which we are working and consider the wider context of our work. Finally, it will be useful to look at our work systematically in order to be more effective and efficient.

Objective The participants relate their tasks as district health managers to the broader conceptual background of the PHC approach in the organisation and management of health services at different levels, in particular at district level. Unit 1 Introduction to Community Health Unit 2 The District Concept Unit 3 The Kissidougou Case Study

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Unit 1: Introduction to Community Health The definition of health goes beyond the absence of disease and the traditional medical concept of health. Healthy communities actively work to improve the health and quality of life of all their residents. Besides health care, environmental protection, social and educational services, adequate nutrition, and a host of other activities belong to the concept of community health. 'Community' ought to reflect not only a geographical location, but community of interest, whose specific health needs are acknowledged and addressed.

Specific Objectives of the Unit At the end of the unit participants: are able to describe the characteristics of a community; are aware of the historical, cultural and individual patterns of a health concept and its different levels of definition; know the WHO definition of health and can compare it to their own definition; relate the concept of health to its broader environment and have been introduced to a system's approach to health; understand the relativity of health needs and their different aspects; are familiar with the concept of primary health care and its further developments; understand the motives and necessities for a further development of PHC in the global political environment of development co-operation.

Unit 2: The District Concept The district health concept is one of the essential aspects of nearly every health care system in low-income countries. The district is considered the most appropriate level to co-ordinate health activities. It is big enough the ensure efficiency of the work, yet small enough to promote and guarantee community participation. Intersectoral co-operation may be easier at this level, as personal contacts between the human resources are more likely to occur. The development of a district health system should be based on the same principles of PHC, incorporating: equity, accessibility, emphasis of promotion and prevention, intersectoral action, community involvement, decentralisation of decision making power, integration of health programmes (horizontal programmes) and co-ordination of all activities and actors in the system.

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Specific Objectives of the Unit At the end of the unit participants: reflect on their own district health systems and compare structures in different countries; are able to describe in detail the characteristics of the district concept and the district health pyramid; describe the steps in the planning cycle and apply the systematic of the cycle to the system's approach; relate the different aspects of District Health Management to their tasks as managers.

Unit 3: The Kissidougou Case Study The case study presented in this manual is based on project data and experiences in a rural health district in Guinee. The document is a rather extensive collection of different information about the project viewed from different angles. It provides a description of the district structure, the situation of the population and the situation of health services. The data provided are real data, sometimes incomplete, sometimes changed according to the needs of the training course. The exercises in the following modules are based on this case study. If possible facilitators should try to obtain data from the working environment of their trainees. Then the training will become more realistic and relevant to them.

Specific objectives of the unit At the end of the unit participants: are able to describe essential characteristics of the Kissidougou health district case, which will be the reference case for the following modules; identify missing information necessary for a complete analysis of the district; are able to use the information provided in the case study to systematically analyse the situation in the model district.

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Module 5 Input - Situation Analysis by Axel Kroeger and Barbara Kloss-Quiroga In the health sector, activities are generally planned when the annual plans are elaborated. It is then planned how to best allocate resources and often also how to work best despite lacking resources. In earlier modules the planning cycle was introduced to structure the tasks of the district health management team. In the following modules, we use the planning cycle as a systematic tool to organise the work in the district. Applying the system's approach to planning, we look into structure (input), process and results (output) and finally impact aspects. Module 5 deals with the first step in the planning process: doing the situation analysis.

Objective At the end of the module, the participants will be able to use basic tools for district health management like the nine epidemiological questions to assess the health situation in a district, analyse and prioritise health problems applying epidemiological tools and plan for an adequate intervention. They will be able to analyse the problems of the health services by the means of indicators as a basis to develop systematic managerial solutions for the identified problems.

Unit 1 Introduction to Health Problems: The Nine Epidemiological Questions Unit 2 Priority Setting Unit 3 Introduction to Health Services Problems

Unit 1: The Nine Epidemiological Questions This first unit of the module deals with an epidemiological approach to identifying health problems in populations by asking a series of pertinent questions. Normally, epidemiology is seen as being closely related to statistics, a science which is feared by many health professionals. Therefore, one goal of this unit is to remove such fears from participants by introducing the descriptive aspects of epidemiology and encouraging the participants to use this powerful tool in their routine public health practise.

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Specific objectives of the unit At the end of the unit participants: identify relevant data sources for the analysis of health problems and health services problems; use the "9 epidemiological questions" and are able to explain their relevance in health management planning; are able to interpret rates, proportion, ratio as a means of quantifying health information; can distinguish seasonal variations of different health problems and visualise them in an endemic curve; can draw simple geographical maps to identify relevant population patterns; are able to describe the concepts of the risk approach and discuss its scope and applications.

Details Time Schedule Background Information Description of the Procedure Exercises: E5-1-1 Health Problems and Health Services Problems E5-1-2 Statistics as an Instrument for Epidemiological Analysis E5-1-3 Seasonal Variation E5-1-4 Endemic Curve E5-1-5 Mapping E5-1-6 Risk Factors and Health Problems E5-1-7 Measles Epidemic Handouts: H5-1-1 Health Indicators H5-1-2 Health Indicators: Comparison Transparencies

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Unit 2: Priority Setting There are limited health care resources at district level, especially in developing countries. In the context of health sector reforms, more and more tasks are decentralised to lower levels of the health system but very often there is a gap between these tasks and the available resources. This gap will be the focus of the following unit: what kind of decision making tools do we have as health managers to rationally allocate the scarce resources and have the greatest impact on the health situation of the population?

Specific objectives of the unit At the end of the unit participants: are able to describe different techniques of priority setting; are able to critically analyse the relevance of different priority setting techniques for their work at district level; are able to use a simple matrix to identify priority health problems and priority health services problems based on the case study and their own experiences; are able to analyse advantages and disadvantages of the matrix method.

Details Time Schedule Background Information Description of the Procedure Exercise: E5-2-1 Priority Setting Handouts: H5-2-1 Developing District Priorities H5-2-2 Definitions on Needs and Demands Transparencies

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Unit 3: Introduction to Health Services Problems Concerning the analysis of health services, a systematic approach is needed to provide a comprehensive picture. On the one hand, we need to consider what resources and information we have to work with, on the other hand, we need to analyse what we are doing or have already accomplished with what we have. Additionally, we need to know what results our activities have had. In short, this represents the conceptual framework of the analysis of health services. To monitor progress in implementing health programs, and to evaluate their impact on the health status of the population, indicators help to analyse the present situation, to make comparisons and measure change over time.

Specific objectives of the unit At the end of the unit participants: have been introduced to a conceptual framework for the evaluation of health services; are familiar with health service performance indicators and are able to relate them to the systems approach (input, process, output); have systematically analysed health service performance by the means of indicators on the basis of data provided in the case study; have reflected on strategies to improve health service performance.

Details Time Schedule Background Information Description of the Procedure Exercise: E5-3-1 Analysis of Health Services Transparencies

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Module 6 Process - Planning and Programming by Barbara Kloss-Quiroga, Alois Drlemann, Michael Marx The process of planning involves a wide range of decisions, from establishing the overall goal of the organisation or a project to the day to day operating schedules; planning is therefore one of the essential functions of a manager. Module 5 introduced methods and tools to identify and prioritise health and health services problems. Planning and programming start with an in-depth analysis of problems. Following the sequence of the nine epidemiological questions, there is a need to answer now the questions why does a specific problem occur (6), what have we done so far (7), what were the results (8), and what else could be done (9). Target Oriented Project Planning (ZOPP) and the Logical Framework approach are useful tools in intervention planning, as well named Project Cycle Management. They are used by the EC, the World Bank and international agencies and NGOs. This module introduces planning methods and tools and gives an introduction to monitoring and quality management.

Objectives At the end of the module participants know the different steps of ZOPP (Target Oriented Project Planning), the project planning matrix (PPM) as well as the logical framework. They are able to prepare and conduct a planning workshop in their working environment and develop and monitor a comprehensive plan of action. They are familiar with quality management systems (QM) in health. Unit 1 Introduction to Project Planning Methods Unit 2 Objectives oriented planning: analytical steps Unit 3 Monitoring, Quality Management (QM)

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Unit 1: Introduction to Project Planning Methods The planning cycle displays the different steps in planning: situation analysis with the identification of needs and problems, priority setting, plan: analyse problems and determine objectives , programme: define activities to reach objectives, programme interventions mobilising resources, implement, control and evaluate. This unit gives a general introduction to different planning methods and tools, which are applicable at district level. Specific objectives of the unit The participants are able to describe different planning methods (strategic planning, objectives oriented planning, SWOT analysis, PRA and rights based approach) and their essential characteristics

Unit 2: Objectives oriented planning: analytical steps Objectives oriented planning and the logical framework approach are very similar planning methods. The ZOPP approach (objectives oriented planning) is a set of principles, techniques and tools designed to facilitate the planning process emphasising the participation of all actors involved and the common formulation of decisions. It is characterised by the following principles: participation of all important stakeholders and actors, consensus between all involved which includes negotiation and compromising, transparency of decisions, systematic decision making, flexible adaptation.

Specific objectives of the unit The participants are able to explain the principles of the ZOPP, and logframe approach to planning to conduct a planning workshop based on the ZOPP approach and develop a project planning matrix (PPM) to develop a realistic and achievable plan of action

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Unit 3: Monitoring, Quality Management (QM) To assure or improve the quality of health care in either a defined medical setting or a programme, planned interventions and activities need constantly to be monitored and followed up. The concept of quality management (QM) is a comprehensive and structured approach to organisational management and seeks to improve the quality of services through ongoing refinements in response to continuous feedback.

Specific objectives of the unit The participants are able to describe the basic principles of Quality Management and use one or more Quality Management tools/Monitoring

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Module 7 Human Resources Development by Gerlinde Reiprich and Barbara Kloss-Quiroga The district health management team is responsible for a wide range of managerial and technical functions: organisation of health programmes, care for adequate health care delivery in health centres and hospitals, links to the community, other sectors and other levels of the health system, budgeting, etc. All these activities need human resources to be planned, scheduled, implemented, monitored and evaluated. Human Resources Development (HRD) has been defined as an organised learning experience, conducted in a definite time period, to increase the possibility of improving job performance and growth. HRD consists of three main categories: training, education and development. Unit 1 Human Resources Management Unit 2 Target Setting and Job Planning Unit 3 Supervision and Coaching Unit 4 Training Unit 1: Human Resources Management The objective of human resource management is to ensure that the health district obtains and retains the quality and quantity of human resources needed and makes the best use of them. The district health management team needs detailed information about the health workforce with regards to number, qualification, distribution and productivity. Very often part of the information exists in form of lists or records, but neither includes specifications like special competencies, hindrances, interests, career desires nor any information on actual personnel performance. The development of a human resources inventory is a first step on the road to effective and efficient health manpower planning. Specific objectives of the unit At the end of the unit participants: know the importance of distributing the district health personnel according to their knowledge, skills, personal competencies and interests according to the tasks compiled in the district health plan; understand the importance of compiling a human resources inventory.

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Unit 2: Target Setting and Job Planning In the past the elaboration of job descriptions for health workers has been carried out in the context of quality control and performance monitoring and evaluation. But regarding the various functions in the health system it is quite difficult to define the exact tasks of a health worker, because besides technical skills, they include great flexibility, intuition and empathic behaviour. Therefore, more and more the approach of individual, participatory target-setting replaces the traditional role of job descriptions. Job descriptions are now mainly used in job advertisements. Setting individual performance standards and targets integrates both health service as well as individual needs and objectives and tries to minimise demotivating factors for the individual health worker.

Specific objective of the unit At the end of the unit participants: have developed their individual performance targets have elaborated a plan of action for their work place/work unit.

Unit 3: Supervision and Coaching In the beginning, the supervision system applied in the health district was a means of quality control and stressed aspects like controlling registers and bookkeeping. More recently, the aim of supervision has become to provide professional back-stopping at close intervals to improve job understanding, promote more effective job performance and employee development, and encourage the flow of communication between different levels in the district. This approach demands a new relationship between the management and health workers, one which builds on trust, maturity, and communication.

Specific objective of the unit: At the end of the unit participants are aware of the possible benefits from support supervision and individual coaching; are motivated to improve the supervision system in their district. are able to apply the instrument of supportive supervision Unit 4: Training

- To be developed

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Module 8 Financial Management and Health Care Financing by Meinolf Kuper and Manfred Strmer The success of decentralisation initiatives depends upon better and more efficient use of scarce resources for improved service delivery to the people in a transparent and accountable manner. This includes resource mobilisation and financial management, for example planning and budgeting, accounting and reporting, financial control and auditing, and transparency and accountability at district level. Most countries introduced user fees for services in order to supplement their tax financing of health care systems. User fees, however, do create severe problems for poor populations, often delaying, or in the worst case, denying them access to health services. In order to address these problems, alternative concepts may be applicable solutions at local level. Pre-payment schemes and health insurance systems are two examples receiving increasing attention.

Objectives Participants get familiar with essential tools for financial management at district level, including cost calculation, accounting and budgeting know alternative concepts for health care financing applicable at district level. Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Unit 6 Unit 7 Unit 8 Financial Documentation Cost Calculation and Budgeting Revolving Funds Financial Control Sources of Health Care Financing User Fees Pre-Payment Schemes Health Insurance

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Module 9 Evaluation and Adjustment (E&A) To be developed, will contain the following units: Unit 1: Quality Assessment, -Assurance, -Control Unit 2: Health Management Information Systems Unit 3: Evaluation Methods Unit 4: Re-Planning

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How to Order the Manual If you are working for health care and you are interested in the complete manual, containing all modules which are finished so far, you may order a printed version or a CD-ROM - for non-commercial use - from

InWEnt - Internationale Weiterbildung und Entwicklung gGmbH Capacity Building International, Germany Health Section Ralf Panse Tulpenfeld 4 53113 Bonn Germany

Tel.: +49 (0) 228-2434-5 Fax: +49 (0) 228-2434-844

E-Mail: ralf.panse@inwent.org Web: www.inwent.org

D i s t r i c t H e a l t h M a n a g e m e n t T o o l s C o p y r i g h t : I n W E n t , H e a l t h D i v i s i o n , B o n n , G e r m a n y w w w . i n w e n t . o r g - P a g e 25

Feedback This manual is not a magic bullet for resolving district management problems: the editors and contributors are aware of its shortcommings to reach a broader, or not so specialised audience. InWEnt welcomes comments and suggestions to improve this original version from course instructors and users, including health workers who have used this manual for the management of district systems.

Dr. Barbara Kloss-Quiroga barbara.kloss-quiroga@inwent.org Gerlinde Reiprich reiprich@health-focus.de Axel Kroeger kroegera@who.int Alois Drlemann a.doerlemann@health-focus.de Michael Marx michael.marx@urz.uni-heidelberg.de Meinolf Kuper mkuper@aol.com Manfred Strmer manfred_d@web.de Sylvia Sax sylvia.sax@urz.uni-heidelberg.de

Managing Editor

Modules 3 (Unit 1-5), 7 and 9

Modules 1 and 5

Modules 4, 6 and 9

Module 6

Module 8

Module 8

Module 9

D i s t r i c t H e a l t h M a n a g e m e n t T o o l s C o p y r i g h t : I n W E n t , H e a l t h D i v i s i o n , B o n n , G e r m a n y w w w . i n w e n t . o r g - P a g e 26

Imprint InWEnt - Internationale Weiterbildung und Entwicklung gGmbH Capacity Building International, Germany Health Section Tulpenfeld 4 53113 Bonn Germany

Tel.: +49 (0) 228-2434-5 Fax: +49 (0) 228-2434-844

E-Mail: info@inwent.org Web: www.inwent.org

Responsible for the Content of the Manual "District Health Management": Dr. Barbara Kloss-Quiroga, Managing Editor barbara.kloss-quiroga@inwent.org Copyright: Copyright 2003 by InWEnt, Health Section, Bonn The text, images, graphics, and their arrangement on the website concerning "District Health Management" are all subject to copyright and other intellectual property protection. These objects may not be copied for commercial use or distribution, nor may these objects be modified or reposted to other sites. Concept & Design: EYES-OPEN Agency for Text & Design Web: www.eyes-open.de

D i s t r i c t H e a l t h M a n a g e m e n t T o o l s C o p y r i g h t : I n W E n t , H e a l t h D i v i s i o n , B o n n , G e r m a n y w w w . i n w e n t . o r g - P a g e 27