2.5.1 Management levels
In healthcare management there are three levels of managers: top, middle, and frontline. Together they are responsible for the work and performance of the health sector. These managers have formal authority to use health sector resources and to make decisions appropriate to their level.
Top-level managers
Top-level managers are often called senior management or executives. In Ethiopia, the Federal Ministry of Health and Regional Health Bureau include top-level managers and they hold titles such as Minister, Head of Regional Health Bureau, and Director. Often, a group of these managers will constitute the top management team. Top-level managers make decisions affecting the entirety of the health sector. Top managers do not direct the day-to-day activities of the sector; rather, they set goals for the health sector and direct others to achieve them.
Middle-level managers
Middle-level managers are those in the levels below top managers. Middle-level managers are responsible for carrying out the goals set by top management. They also set goals at their level and perhaps for other units they are responsible for. Middle-level managers can motivate and assist frontline managers to achieve the sector objectives. They may also communicate upwards, by offering suggestions and feedback to top managers.
Frontline managers
First-level or frontline managers are responsible for the daily management of health activities in the community. Health Extension Practitioners, for example, are frontline managers of the primary healthcare services. Although lower-level managers typically do not set goals for the nation, they have a very strong influence on the sector and do have to set goals for their own work. These are the managers that interact most with the larger community on a daily basis.
What level of management is each of these: Health Extension Worker, Health Centre Director, Health Extension Practitioner, Minister of Health, Health Volunteer, Head of Regional Health Bureau?
Health Extension Practitioners and Workers are frontline managers. The Head of the Regional Health Bureau and the Minister of Health are top-level managers. The Health Centre Director is middle-level. Although Health Volunteers don’t have a formal management role they still do important work within the health service and may have to help organise what actually happens in your community.
2.5 Management roles and levels