Management is working with and through people to achieve defined organisation goals and objectives

Management is working with and through people to achieve defined organisation goals and objectives. Other authors defined management as the ability to forecast, to plan, to organize, to command, to coordinate and control activities of others ( Henri Fayol).
Behavioural approach or the human relations management approach is used extensively in management to implement a host of activities and behaviours into an organization. The behavioural approach to management helps the organization understand what motivates a particular employee and how this can be used to enhance productivity. The behavioural management theories were developed by different writers who mainly focused on different approaches in management.
Marlow’s theory of human needs focused on employee Hierarchy of needs as a motivator at a work place, he discovered that a need becomes a motivator and once the preceding lower level need is satisfied and these both cease to operate at the level of self – actualization.
Mc Gregor in his X (Negative theory) and Y (positive) theories assumed that managers could use different approaches towards employees to achieve company goals. He assumed that theory X, workers would show little interest in the absence of an incentive and will try to avoid responsibility. A major weakness of this theory is that it limits the worker’s potential. And in theory Y the manager assumes that workers are trustworthy and able to assume responsibility; hence they need space to develop their creativity and imagination. He assumes that a manager who uses theory Y will be more successful in managing his employees that one using theory X. (Mohamed et al, 2013).
Hawthorne further carried out different experiments to show that different aspects motivate employees to work and increase productivity, studies included changing working conditions like the illumination of the working room, having conversations with employees to establish how they feel about their job, colleagues and supervisors, then the also realised that there are always informal groups within the formal work setting that greatly influence productivity in a work place.
Herzberg believed that though the factors leading to satisfaction are different from those leading to dissatisfaction; they cannot be seen as opposites of one another. He reasoned that there are two distinct human needs; physiological needs that can be met by money or material things and psychological needs to grow that can only be met by activities that make one achieve or develop (Jeanne Dininni, 2011).
Classical management theory is mainly based on the belief that workers only have physical and economic needs. It does not take into account social needs or job satisfaction, but instead advocates a specialization of labour, centralized leadership and decision-making, and profit maximization. (Villanova university, Pennsylvania,) This management approach may be further divided into different management approaches ie Scientific management, Administrative principles and bureaucratic organisation.
Scientific management approach was founded by Frederick Winslow Taylor, and his theories were intended to create safer working conditions so workers would have less risk of injuries while carrying out their tasks (Sky Mark, 2015).
Henri Fayol (1916) developed the Administrative management theories ,believed in life all our activities rotate around the following six functions which are; planning, coordinating, staffing, organizing, commanding and controlling (Gaurav Akrani, 2011). In his theory he also further gave fourteen (14) principles of management and in his definition of management, he proposed that it takes place within a definite organizational makeup with specific duties and it is directed towards the attainment of goals by influencing the effects of others (Rhyszard Barnat, 2014).
Max Weber a German sociologist then proposed the bureaucratic organisation theory that focused It focused on a stratified structure, it further outlined apparent assignment of authority providing managers with a constitutional control over their workers. He stated that managers would be obeyed just because of their position as managers (O’ Connor, T., 2013). His theories had two dominant characteristics which are the stratification of authority and the system of rules, his emphasis was on and organisation operating on the following guidelines for achieving organisation goals; Authority, Formal selection of employees, Rules and regulations, impersonality, career orientation and division of labour.
Uganda health care system is faced with number of management challenges that range from Infrastructure, personnel, funding and many others that will be discussed here below.
Abseentism and presentism of health workers at their respective duty stations in health facilities that they are attached to. In one of his 14 principles of management Henri Fayol encouraged the subordination of individual interests to organisational interests. This requires that staff at different work stations require that their work takes precedence over their own interests ,however we find that many of them work less than the required time and also some report to work but do not perform their duties. In a study done on staff abseentism at health facilities in Bushenyi ,discovered that some staff were absent on duty due to a number of factors which included, family responsibilities, having another job, studying without study leave, qualification for a job were among factors contributing to staff(s) absenteeism.( Nancy Namweya et al October,2017). Besides abseentism, health workers being at work but neglecting their duties in public health facilities also highly promotes increased utilisation of alternative health service providers which may include drug shops which at times are not manned by qualified staff, self-medication traditional healers and private clinics which an average Ugandan may not afford.( Women only FDG,2014 BASELINE SURVEY , Apac district).
Max Weber in his bureaucratic organisation theory emphasises the application of Rules and regulations to all staff in an effort to limit human behaviour with impersonality. However in majority of the public health facilities in Uganda, staff do not report on time and even the supervisors cannot take disciplinary action against them since they also report late though after the late reporting staff (ACODES policy research series 77,2016 Pg18) . Poor time management by health workers not only frustrates the waiting patients but also can lead to loss of lives as patients wait in long queues. In Bugiri District, Uganda a mother lost her child after having waited in a long queue, was not attended to in time and the child died ( Women FDG,2014 Baseline study ,Bugiri District. This calls for strict following of the rules and regulations of time of arrival at the workplace and action should be taken on those who go against this rule.
Another pressing health care issue in Uganda is understaffing in most of the Health facilities in the country. According to WHO there is a global shortage of medical doctors ,nurses and midwives (WHO, 2014). Uganda is one of the 57 priority countries that fell below the threshold of 2.3 doctors ,nurses and midwives per 1000 people (GHWA, May 2014). Majority of these facilities have overwhelming number of patients to serve but they fall short of man Power. Henri Fayol in another one of his fourteen (14) principles of management encourages stability of tenure of personnel, which also covers for replacement of staff to fill vacancies however the government of Uganda has a low health budget to cover this. This issue is couples together with ability to attract and retain staff in certain parts of this country, dependent of location of health facilities, remuneration, electricity, accommodation and other incentives. Marslow in this human relations approach theory together with Herzberg explore the importance of staff motivation as one of the factors that would retain employees on their jobs. However with no motivation factors or once a motivating factor has been achieved and the next one cannot be achieved at the same work place the employees will leave and those that will remain will be understaffed hence a big workload.
The unethical code of conduct by health workers in health facilities both private and government is also another pressing issues that has also greatly affected the quality of health care services in Uganda. Majority of patients visiting public health facilities decry of extortion of money by health workers in return for a desired service which is supposed to be free. The state minister for health in Uganda disguised as a patient in Naguru Hospital and was asked to pay for the laboratory tests to be done on her by the laboratory technologist on duty which was un ethical given that services at this facility are free of charge ( Daily monitor ,Sept 15,2017). There have also been several reports from the general public complaining of Private hospitals usually carrying our caesarean sections on pregnant mothers with the aim of getting more money, doctors advise for this to be done since the hospitals have an agreed percentage given to them for each of these operations done. This kind of conduct is un ethical and unacceptable clearly opposed to Max Weber’s bureaucratic emphasis on rules and regulations that govern human behaviour and organisations. Obstetricians perform more caesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.( Shankar Vedantam ,August 20,2013).
Inadequate specialised personnel coupled together with poor maintenance of medical equipment in health facilities does not only cost lots of money in repairs and acquisition of new equipment but also may lead to poor quality results given to patients or delayed service to patients in cases where the equipment totally breaks down. The newly-installed Cobalt60 cancer treatment machine at the Uganda Cancer institute (UCI) again developed technical glitches, hardly two months after its repair following a similar breakdown in June 2018.
This forced the (UCI) to halt all radiotherapy services, catching patients by surprise and, for some, without alternative. Dr Orem also told the general public that the institute’s management had already contacted the manufacturer and the machine would be repaired and start operating normally in a week. (Lillian Namagembe, Daily monitor, August 2018). If Uganda had trained Biomedical engineers, specialised in such equipment to repair the machine there would be no delay of waiting for the manufacturer to rectify this problem. Fredrick Taylor in his scientific management approach explored and emphasized the importance of training all employees on standard operating procedures in organisations they are recruited to, this should apply to all staff that they are trained on equipment they use ,learn practice their maintainace periodically to avoid frequent breakdowns. Preventive and periodic maintainace of all equipment should also be done to ensure that machines are operated as per the recommendations of the manufacturer.