BASIC CONCEPTS OF HEALTH PLANNING

IntroductionPlanning is making current decisions in the light of their future effects.

Health planning is a process culminating in decisions regarding the future provisions of health facilities and services to meet health needs of the community.

Types of health planning Based on time frame

1. Short term planning (generally 1-3 years) Meeting needs as defined by current trends Using available resources and re-allocation of resources

2. Medium-term planning (5-10 years) Modify demands Recognize new needs Obtain new resources

3. Long-term planning (10-20 years) Select a desired future Design a way of reaching it

Based on hierarchy of goals

1. Health policy planning

Long term health goals

2. Health programme planning

Medium term objectives

3. Operational health planning

More specific & localised

Main characteristics Policy linkage- problems, priorities, directions and strategy

Future orientation- Analysis of past, assessment of present, projection and action towards future

Multidimensionality- epidemiology, demography, medicine, economics, administration, social science

Multisectoral approach- Health, education, environment, social service

Team work- sharing of experience, resources, knowledge

Rationale for health planning

Cope with major health issues in a sustainable manner. Ensure effective coordination and avoid unnecessary

duplication Promote optimum utilization of resources Ensure equitable distribution of health resources and

services Facilitate monitoring and evaluation of health services

Steps of preparing a plan1. Situation analysis2. Problem identification, prioritizationAnalysis3.Set goals, objectives and targets4. Determination and analysis of strategies5. Major activities6. Finance and budgeting7. Monitoring and evaluation

1. Situation analysis

A methodology to assess where we are now?.

A comprehensive analysis of the past & present situation in terms of a selected number of variables.

Identify & assess achievements & limitations of the past and ongoing health interventions.

Information needs for situation analysis

Demographic data Epidemiological data

(morbidity/mortality) Health services data Vital statistical data Socio-economic data

Methods of collecting data

Existing data- published, routine

Surveys- qualitative , quantitative

2. Problem identification,prioritization and analysis

A problem is difficulty or obstacle seen to exist between a present situation and a desired future objective

A perceived gap between what it is and what it should be.

Problem has to be analysed for It’s magnitude Causes consequences

The task of prioritization involves analysis, assessment and grading of problems in order of relative importance.

Criteria for ranking health problems

MagnitudeSeverityFeasibilityCost of interventionPolitical commitment

Different methods to prioritize 80:20 rule Urgent and important model Nominal group technique Modified delphi technique

Problem analysis tools

Cause and effect diagrams Fishbone analysis Problem tree

Define the problem

Problem tree

Fish bone analysis/Ishikawa diagram

3.Set goals, objectives and targets

Goals--- a broad and future oriented statement of the desired condition

objectives—intended result of a successful activity/programme, should be SMART

Targets---quantified statement of desired change in a key indicator over a given time period in a specified geographic area

4. Determination and analysis of strategies A strategy denotes a broad line of action

to be undertaken at different levels of administration in and outside the sector in order to achieve the desired goals and objectives.

To implement a strategy, a variety of activities with specific outcomes are needed for a specific time duration.

In order to identify program/project strategies, it is first necessary to examine internal and external data related to your program.

Internal data

Internal data describe the current status of your program and how it operates, gathered from your situational analysis

External data

External data describe the population that the program serves and the environment in which your program operates.

Use these internal and external data to conduct a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis of the program.

Environmental analysis

Internal External

Favourable Strengths Opportunities

Unfavourable Weaknesses Threats

Environment

Effect

Program strengths

Program strengths are the elements internal to the health program that facilitate reaching the program goals

Program weaknesses

Program weaknesses are internal elements that are barriers to reaching the program goals

Program opportunities

Program opportunities are aspects of the external environment that facilitate reaching program goals

Program threats

Program threats are aspects of the external environment that are barriers to reaching program goals

Use the results of SWOT analysis to determine the best approaches of the program to meet its stated goals. These approaches are the strategies

5. Major activities

Identify the major activities for each selected strategy.

Determine their sequence and timeframe

Prepare a plan of action including activities, time frame and responsibility

6. Finance and budgeting

Estimate financial requirements for the necessary resources: Physical, Material, Human resources etc.

A detailed description of the costs of the project should be prepared.

The budget should cover the whole project period year-wise.

List each strategy and the activities associated with it List the materials and equipment required for each activity List operating costs under appropriate heads such as

personnel, communication, transport, etc.

Contributions made by the organization such as manpower, equipment or buildings should be stated explicitly.

Summary capital cost by items Recurrent cost by items

7. Monitoring and evaluation

Monitoring

Regular ongoing process to ensure that operations are proceeding as planned and on schedule

Monitoring tools- Schedules- Activity designs- Progress reports- Gannt charts -etc.

Evaluation

A systematic way of learning from experience and using the lesson learned to improve the current activities and promote better planning by careful selection of alternative for future actions

Input evaluation Process (Audit) evaluation Efficiency (output) evaluation Cost efficiency evaluation Effectiveness (out come) evaluation Impact evaluation

Relevance and the adequacy of each components are considered in evaluation

Item Monitoring Evaluation

Frequency Regular/ongoing episodicMain action Keeping track AssessmentBasic purpose Improving efficiency Improve effectivenessFocus Inputs, outputs,

process outcomes, work plans

Effectiveness, relevance, efficiency, impact, sustainability

Source of information Routine databases, field visits, stakeholder meetings, output reports

SurveysSpecial studies

Conducted by Project manager, funders etc

External evaluator

Some technical terms

Project Vs Programme

Definition of a ProjectA project is a temporary entity established to deliver specific (often tangible) outputs in line with predefined time, cost and quality constraints

Definition of a ProgrammeA program is a portfolio comprised of multiple projects that are managed and coordinated as one unit with the objective of achieving (often intangible) outcomes and benefits for the organization. 

Efficient Vs Effective

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