District health planningDistrict health planning

Dr. Vishal SoyamDr. Vishal Soyam

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PLAN OF PRESENTATIONPLAN OF PRESENTATION• Definition

• Brief history of planning

• Why District Health Planning

• District health Planning process

• Components of district health planning

• Steps of District Health Action Plan

• Example

• References

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PLANNINGPLANNING

DEFINITION : It is a process of identifying a

course of action systematically in an organized

manner to achieve the objectives by utilizing the

available resources skillfully in a cost – effective way.

Purpose : To match the limited resources To eliminate the wasteful expenditure To develop the best course of action

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HEALTH PLANNINGHEALTH PLANNING

DEFINITION : It is the process of

Defining community health problems,

Identifying unmet needs & surveying the resources to

meet them,

Establishing priority goals that are realistic & feasible &

Projecting administrative action to accomplish the

purpose of the programme.

Purpose : To improve health services

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Brief history of decentralized Brief history of decentralized planningplanning

Decentralized planning started for the first time in the First Five Year Plan (1951-56), when it was suggested that the planning process be undertaken at the state and district levels too.

73rd and 74th Amendments of the Constitution mandating the establishment of Panchayats at the district, intermediate and village levels. Reversal of the centralised approach to district planning

Establishment of the District Planning Committee (DPC) for consolidating plans

Little progress except in very few states

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Brief history of decentralized Brief history of decentralized planningplanning

Decided that the ‘district plan process’ should be an integral part of the process of preparation of state’s Five Year Plan and the annual plan since 2005.

NRHM proposed the decentralisation of health NRHM proposed the decentralisation of health planning so that the state health plan represents planning so that the state health plan represents the needs and priorities of respective blocks and the needs and priorities of respective blocks and districts in the state.districts in the state.

Transforming a vertical planning process into a Transforming a vertical planning process into a horizontal processhorizontal process

Village is envisaged as the primary unit for planning

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Relevance of District Health Relevance of District Health PlanningPlanning

Inter district variations – bridging disparityInter district variations – bridging disparity

Planning based on local evidence & needsPlanning based on local evidence & needs

To partner with Community To partner with Community

Area specific strategies to achieve NRHM Area specific strategies to achieve NRHM goalsgoals

Cost effective and practical solutionsCost effective and practical solutions

Move from budget based plans to outcome Move from budget based plans to outcome oriented plansoriented plans

Requirement of GoI – no funds if no plansRequirement of GoI – no funds if no plans77

District Health PlanningDistrict Health Planning

District is the basic unit for dispensing of health services

Consistent with specific needs of the people, the growth potential of the area & budgetary allocation available

District is the micro decision making unit, it can implement innovation & experimentation to ameliorate their own problems & satisfy the basic needs.

District have framework of the NHP, central five yr plan , state plan and their priorities , keeping them in view district make plan according to local specific needs. 88

Planning Process…Planning Process…Participatory/Bottom Up Approach – under NRHMParticipatory/Bottom Up Approach – under NRHM

V V V VV V V V V V V 99

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Contd…Contd…

Planning process require setting up of Planning process require setting up of planning planning

teams & committeesteams & committees at different level: at different level:

Village - VHSCVillage - VHSC

Gram Panchayat / Sub-centre –GP Pradhan, ANM, Gram Panchayat / Sub-centre –GP Pradhan, ANM,

MPW, few VHSCMPW, few VHSC

PHC - PHC health planning & monitoring committeePHC - PHC health planning & monitoring committee

CHC/Block level – Block planning & monitoring CHC/Block level – Block planning & monitoring

committeecommittee

District level – District health committeeDistrict level – District health committee

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Institutional Framework for Institutional Framework for Convergent Action Convergent Action

State Health Mission/Society

District Health Mission/Society

Block Health & Sanitation

Committee

Village Health & Sanitation

Committee

Partners and Members in above mentioned Societies and Committees-

– DWCD; PRI/RD; Education; PHED and AYUSH

District level organization chart

District health mission

Integrated District health society

DPMU

Implementation of program

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District Health MissionDistrict Health MissionThe DHM would get the district plan prepared covering The DHM would get the district plan prepared covering

health as well as the other determinants of health.health as well as the other determinants of health.

Chaired by dist. Magistrate/Collector/deputy commissionerChaired by dist. Magistrate/Collector/deputy commissioner

At the district level all existing societies have been merged At the district level all existing societies have been merged

into the District Health Society with its apex body performing into the District Health Society with its apex body performing

the functions of the District Health Mission(DHM)the functions of the District Health Mission(DHM)

Roles and Responsibilities of District Health Mission includes:– District health planning, implementation and monitoring

– Coordination across relevant Department

– Management of cash flows

– Financial accounting/ administration 

Components of District PlanComponents of District PlanBackground Background

Planning processPlanning process

PrioritiesPriorities as per the background and planning as per the background and planning processprocess

Annual planAnnual plan for each of the health institutions for each of the health institutions based on facility surveysbased on facility surveys

Community action planCommunity action plan

Financing of health care managementFinancing of health care management

Structure to deliver the programStructure to deliver the program

Partnership for convergent actionPartnership for convergent action

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Components of District PlanComponents of District PlanCapacity Building Plan

Human Resource Plan

Procurement and Logistics Plan

Non-governmental Partnerships

Community Monitoring Framework

Action Plan for Demand generation

Sector specific plan for maternal health, child health, adolescent health, disease control, disease surveillance, family welfare etc.

Budget

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District Health Action PlanDistrict Health Action Plan Preparation of annual plans for the district

called DHAP Suggests district specific interventions District health mission is responsible for

preparation of DHAP by constituting planning team

DHAPs contain inputs on the needs of the districts in terms of programme implementation and hence the funds required for the same.

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District Health Action PlanDistrict Health Action Plan STEPSSTEPS

1.1. Introduction : The settingIntroduction : The setting

2.2. Situation analysisSituation analysis

3.3. Goals and ObjectivesGoals and Objectives

4.4. StrategiesStrategies

5.5. ActivitiesActivities

6.6. Work Plan/ ScheduleWork Plan/ Schedule

7.7. Monitoring and evaluationMonitoring and evaluation

8.8. BudgetBudget1616

Example – RI Strengthening in Example – RI Strengthening in migratory population migratory population

Gurgoan DHAPGurgoan DHAP

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1. District Planning – Background1. District Planning – Background

Location Location

DemographyDemography

Socio-economicSocio-economic

Agro-economicAgro-economic

ResourcesResources

InfrastructureInfrastructure

Sectoral Sectoral

GeologicalGeological

Ground waterGround water

SoilSoil

ForestForest

Land utilizationLand utilization

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District Gurgaon At a Glance

Total Population : 1.8 Million

Urban and Peri-urban Population : 1.2 Million

Migratory Population : 0.8 Million

No. of Blocks : 04

No. of CHCs : 03

No. of PHCs : 13

No. of Sub-Centres : 76

No. of Anganwadi Centres : 265

No. of ASHA Workers : 393

Birth Rate : 31.1

IMR : 51.8

MMR : 286/lac

TFR : 2.6

Name of BlockAppox. No of Household/

Families

Total Population

Appox. No. of 0-5 year Children

Appox. No. of <15 year Children

Gurgaon (U) 49631 155463 22209 59224

Sohna 8804 29841 4263 11368

Pataudi 13169 43981 6283 16755

Farukhnagar 195337 573377 81911 218429

Total 266941 802662 114666 305776

Migratory Population of the District

2. District Planning – Situation Analysis2. District Planning – Situation Analysis

Analysis of health situation:Analysis of health situation:1.1. Assessment of present health situationAssessment of present health situation

2.2. Projection of the future health situationProjection of the future health situation

Situation analysis : By DataSituation analysis : By Data– Collection Collection – Assessment/analyzeAssessment/analyze– interpretationinterpretation

Use various data sources- district level dataUse various data sources- district level data

Interpreted in terms of characteristics of population, Interpreted in terms of characteristics of population, data on health facilities, data on available data on health facilities, data on available resources, data on training institutions etc.resources, data on training institutions etc. 2222

2. District Planning – Situation Analysis2. District Planning – Situation Analysis

Compare district parameter with the state parameterCompare district parameter with the state parameter

Identify the problems, problems at various levelIdentify the problems, problems at various level

Identify the causesIdentify the causes

Do resource analysisDo resource analysis

Map the problem geographically, groups & vulnerability Map the problem geographically, groups & vulnerability

& the resources& the resources

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Migratory population is settled in Urban and Peri-urban areas Migratory population is settled in Urban and Peri-urban areas of Gurgaon, they are from UP, Bihar, MP, Orissa and of Gurgaon, they are from UP, Bihar, MP, Orissa and Rajasthan Rajasthan

Incidence of VPDs are much more in them, recently in 2008 Incidence of VPDs are much more in them, recently in 2008 WPV (P3) detected in MigrantsWPV (P3) detected in Migrants

RI status in these population is around 30%RI status in these population is around 30%

No Anganwadi/ ASHAs in migratory colonies No Anganwadi/ ASHAs in migratory colonies

Health Health sub-centerssub-centers are overburdened, 30,000 population/ are overburdened, 30,000 population/ sub-centresub-centre

Grossly inadequate health delivery system Grossly inadequate health delivery system

Gurgoan Ex. – situation analysis

Areas of the concern are in the Migratory Population

0

20

40

60

80

100

Yr 2005-06 Yr 2006-07 Yr 2007-08 Yr 2008-09

Haryana Gurgaon Migratory

% Fully Immunized Children

StrengthsStrengths : :– Receptive District Health Administration Receptive District Health Administration

– Adequate budget for RI strengthening Adequate budget for RI strengthening

– Well functioning cold chain system at the DistrictWell functioning cold chain system at the District

– Adequate supply of vaccines and logistics at Adequate supply of vaccines and logistics at DistrictDistrict

– Excellent support staff for smooth data entry at Excellent support staff for smooth data entry at District and Block level. District and Block level.

SWOT AnalysisSWOT Analysis

– Low capacity to devise, supervise, monitor and Low capacity to devise, supervise, monitor and implementation of RI micro plansimplementation of RI micro plans

– Poor immunization infrastructure in Urban and Peri-urban Poor immunization infrastructure in Urban and Peri-urban areasareas

– Lack of adequate trained human resource Lack of adequate trained human resource

– Weak management of fund flow to the health facility level Weak management of fund flow to the health facility level

– High drop outs – poor IEC and social issues High drop outs – poor IEC and social issues

Weaknesses Weaknesses

– Capacity building of the staffCapacity building of the staff

– Inter-sectoral coordination between health and ICDS staffInter-sectoral coordination between health and ICDS staff

– Public-private partnership (Role of IAP/IMA and NGOs)Public-private partnership (Role of IAP/IMA and NGOs)

– Exploring immunization sites in the migratory campsExploring immunization sites in the migratory camps

– Innovative IEC in the migratory camps (Through schools)Innovative IEC in the migratory camps (Through schools)

OpportunitiesOpportunities

ThreatsThreats

– Sustainability of the program Sustainability of the program

– Availability of motivated, trained manpowerAvailability of motivated, trained manpower

– Other competing priorities of the health system Other competing priorities of the health system

– Fatigue factor and motivation of the staff working in the Fatigue factor and motivation of the staff working in the migratory camps ????migratory camps ????

– More immunization, more AEFI and community reaction More immunization, more AEFI and community reaction ??

3. District Planning – Goals & Objectives3. District Planning – Goals & Objectives

Goals:Goals:– Societal in natureSocietal in nature– Not necessarily attainableNot necessarily attainable– Responsive to people needs & demandResponsive to people needs & demand

Objectives: Objectives: – SMARTSMART

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Objectives Objectives 1.1. To increase immunization coverage in the To increase immunization coverage in the

migratory camps from current level of 30% to migratory camps from current level of 30% to 80% by 2010-1180% by 2010-11

2.2. To increase the demand generation of the To increase the demand generation of the community through innovative IECcommunity through innovative IEC

3.3. To reduce the VPDs and IMR in the HRAs To reduce the VPDs and IMR in the HRAs

Goal

Reduce child mortality

Example

4. District Planning – Strategies4. District Planning – Strategies

How do we aim to achieve the objectives?How do we aim to achieve the objectives?

The choice of strategiesThe choice of strategies

Are these strategiesAre these strategies– Technically soundTechnically sound– Capability & manpower wise feasible?Capability & manpower wise feasible?– Budget-wise feasible?Budget-wise feasible?– Does it have capacity to manage the identified Does it have capacity to manage the identified

constraints?constraints?

Choosing alternative strategiesChoosing alternative strategies3232

Strategy Strategy

– Strengthening of RI micro plans in HRAs through Strengthening of RI micro plans in HRAs through identification, enlisting and mapping of HRAs sub-identification, enlisting and mapping of HRAs sub-centre wisecentre wise

– Capacity building of the Health Staff Capacity building of the Health Staff

– BCC and IEC in the community BCC and IEC in the community

– Bringing immunization sites closure to the Bringing immunization sites closure to the community community

Example

5. District Planning – Activities5. District Planning – Activities

What are the activities needed to achieve the What are the activities needed to achieve the objectives under specified strategy should be objectives under specified strategy should be stated.stated.

Who is responsible for the particular activity also Who is responsible for the particular activity also specified specified

Resources required for each activity estimatedResources required for each activity estimated

Sources of fund – from where expenditure incurred Sources of fund – from where expenditure incurred (eg. office expenditure, NRHM, DFW etc)(eg. office expenditure, NRHM, DFW etc)

Time frame for each activityTime frame for each activity

Any constraint for any activityAny constraint for any activity

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Activities Activities – Developing RI micro plans at district and health facility levelDeveloping RI micro plans at district and health facility level

– Preparation of micro plans for outreach camps

– Identification of fixed immunization sites in terms of time/place/person Identification of fixed immunization sites in terms of time/place/person

– Availability of vaccine and logistics and its transport to the facility level. Availability of vaccine and logistics and its transport to the facility level.

– Outsourcing of human resources. Outsourcing of human resources.

– BCC and IEC activity BCC and IEC activity

– Training of the health staff for routine immunization Training of the health staff for routine immunization

– Interaction with RWAs /Builders association and stakeholdersInteraction with RWAs /Builders association and stakeholders

– Monitoring and evaluation Monitoring and evaluation

Example

6. District Planning – Schedule6. District Planning – Schedule

In a matrix form and how activities will be In a matrix form and how activities will be conducted with special references to time conducted with special references to time frame and identify responsible official frame and identify responsible official /agency/agency

Preparation of Gantt chart to ensure the Preparation of Gantt chart to ensure the activity going according to planactivity going according to plan

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Activity No Name of the Activity July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar.

1 Identification of slum areas/ high risk areas

                 

2 Preparation of micro plans for outreach camps

                 

3 Hiring or recruitment of Health workers for these sessions

                 

4 Capacity Building of Health Staff

5 Availability of Vaccine and Logistics

                 

6 Interaction with RWAs / Builder and stakeholders

                 

7 Availability of Budget                  

8 Preparation of Tracking bags                  

9 IEC activities                  

10 Monitoring and evaluations                  

Example Gantt chart

7. District Planning – Monitoring & 7. District Planning – Monitoring & EvaluationEvaluation

Flow of data from different level i.e. service Flow of data from different level i.e. service delivery, community monitoring and long scale data delivery, community monitoring and long scale data sets to be considered (RIMS) .sets to be considered (RIMS) .

Decide what is to be monitor ?, who will monitor ? Decide what is to be monitor ?, who will monitor ? How to monitor? Process of monitoring etcHow to monitor? Process of monitoring etc

Set the indicator for monitoringSet the indicator for monitoring

Monitoring process finalised by training & clear Monitoring process finalised by training & clear instructionsinstructions

Resources required for monitoring & evaluationResources required for monitoring & evaluation

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Tickler bags has to be given for tracking dropoutsTickler bags has to be given for tracking dropouts Tickler bags are to be supplied for all the RI Tickler bags are to be supplied for all the RI

sites.sites. Self monitoring Immunization chart for DPT1 and Self monitoring Immunization chart for DPT1 and

DPT3 at S/C, PHC and DHQDPT3 at S/C, PHC and DHQ Standard Monitoring format is to be used by all Standard Monitoring format is to be used by all

the Supervisors for RI sessions.the Supervisors for RI sessions. All field officers/Supervisors are supposed to do All field officers/Supervisors are supposed to do

monitoring regularly and send the report monthly monitoring regularly and send the report monthly within the time frame.within the time frame.

Initiatives in Monitoring and SupervisionExample

Tickler bag being used in the State

EVALUATIONEVALUATION

By internal agency Or by external agency: By internal agency Or by external agency: Are we going in a right direction?Are we going in a right direction? Is there any input lacking?Is there any input lacking? Are there any gaps found?Are there any gaps found? Have we achieved the goals and objectives prepared Have we achieved the goals and objectives prepared

for this action plan?for this action plan? Whether re-planning needed, if not heading towards Whether re-planning needed, if not heading towards

the desired results?the desired results?

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8. District Planning – Budget8. District Planning – Budget

Unit cost should be given for each costed Unit cost should be given for each costed activity and source of funding also should be activity and source of funding also should be reflectedreflected

Costs should, as far as possible be Costs should, as far as possible be estimated separately for each activity in the estimated separately for each activity in the work planwork plan

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S. S. No.No.

ActivityActivity Responsible Responsible PersonPerson

Duration Duration & date& date

Item Item RequiredRequired

Budget Budget RequiredRequired

1 Identification of slum areas/ high risk areas

MOIC, PPC Sohna, Pataudi, Farukhnagar with DIO

July Govt. Vehicle- 4* 4 Days 400*4= 1600

2 Preparation of micro plans for outreach camps

MOICs of each area with DIO

August Stationery Required 500* 4= 2000

3 Hiring or recruitment of Health workers for these sessions

DIO September, October

Advertisement and interviews

Approx. 3,50,000 per month

4 Capacity Building of Health Staff DIO October, November

Training Material and trainers

5000*4= 20000

5 Availability of Vaccine and Logistics DIO September, October, November

Vaccine and Logistics

DGHS

6 Interaction with RWAs / Builder and stakeholders

DIO/ MOICs December Venue, Tea and Snacks

10000

7 Availability of Budget DIO October, November, December

- DGHS

8 Preparation of Tracking bags MOICs January 40 Tracking Bags 40*200= 8000

9 IEC activities DIO/MOICs October, November, December

Poster & Banners 40000

10 Monitoring and evaluations DIO/ District Program Officer/SMOs/ MOs

January, February, March

Vehicle 8*400*12

8*400*1238400 per month

THANK YOU

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