Health & Planning Manpower Planning Proper Orientation IPHS Guidelines Bhor Committee and othe healthcare initiation committees

1. HEALTHCAR
E PLANNING
1

2. BASIC CONCEPTS
2

3. PLANNING
3
▷ —The process of setting goals, developing strategies, and outlining
tasks and schedules to accomplish the set goals.
▷ Decided in advance what to do, how to do and who is to do it, hence
bridges the gap between where we are and where we want to go.
▷ Purpose:
○ Tomatch limited resources with many problems.
○ Toeliminate wasteful expenditure.
○ Todevelop best course of action to accomplish an objective.
▷ Includes 3steps:
○ Plan formulation
○ Execution
○ Evaluation

4. HEALTHCARE PLANNING
4
▷ —Orderlyprocess of:
○ Defining community health problems,
○ Identifying unmetneeds,
○ Surveying resources to meet them,
○ Establishing priority goals, that are realistic and feasible; and
○ Projecting administrative action to accomplish the purpose of proposed
programs

5. IMPORTANT TERMS
5
▷ Resources: manpower, money, material, time and skills.
▷ Target:is discreet activity. It is the degree of achievement. E.g.-no. of
blood films, no. of vasectomies, etc.
▷ Goal: ultimate desired state towards which objectives and resources
are directed. Described in terms of:
○ What is to be attained
○ Extent to which it is be obtained
○ Population involved
○ Geographical area
○ Length of time required for attaining the goal

6. IMPORTANT TERMS
6
▷ Plan: is a blueprint for taking action.
▷ Has 5 elements:
○ Objective: planned end point of all activities and is concerned with the
problem itself.
○ Policy: guiding principles stated as an expectation
○ Programme: sequence of activities
○ Schedule: is time sequence for work to be done
○ Budget

7. PLANNING CYCLE
7

8. PLANNING CYCLE
8
▷ Analysis of the health situation:
○ Population
○ Statistics of morbidity and mortality
○ Epidemiology
○ Medicalcare facilities
○ Manpower
○ Attitudesand beliefs

9. PLANNING CYCLE
9
▷ Establishment of objectives and goals:
○ It should be set by a person having authority
○ The goal should be realistic
○ It should be specific
○ Acceptability
○ Easily measurable
▷ Assessment ofresources:
○ Manpower
○ Money
○ Materials
○ Skills and knowledge
○ Technical needs

10. PLANNING CYCLE
10
▷ Definingpriorities:
○ Whatdetermines priorities?
▷ Write formulatedplans:
○ Detailed detecting input and output
○ Contained working guidance for execution
○ Evaluation should be built in

11. PLANNING CYCLE
11
▷ Programming andimplementation:
○ Assign and fix responsibilities
○ Define roles and tasks
○ Selection, training, motivation and supervision
○ Organizationand communication
○ Efficiency of health institutions

12. PLANNING CYCLE
12
▷ Monitoring: continues process of observing, recording and reporting
on the activities of the organization or project.
▷ Evaluation: measures the degree to which objectives and targets
are fulfilled and the quality of results obtained.

13. TOOLS for PLANNING
13
▷ SituationalAnalysis:
○ Epidemiological analysis (time, place & person)
○ Stakeholders analysis
○ SWOT analysis
○ Problem tree analysis - fish bone analysis
○ Bottleneck analysis
○ Criticalpath analysis
▷ Objectives, target setting and indicators
▷ Ganttchart preparation
▷ Budgeting

14. HEALTHCAR
E PLANNING
in INDIA 14

15. INTRODUCTION
15
▷ Health planning in India is an integral part of national socio-economic
planning.
▷ The guidelines for national health planning were provided by various
committees appointed by GOI:
○ Bhorecommittee 1946
○ Mudaliarcommittee 1962
○ Chadah committee1963
○ Mukerji committee 1965 & 66
○ Jungalwalla committee1967
○ Kartar Singh committee 1973
○ Shrivastav committee1975
○ Rural health scheme 1977
○ Health for all by 2000 AD

16. PLANNING COMMISSION
16
▷ Was an institution formed in March 15, 1950 by GOI, which
formulated India’s Five Year Plan, among other functions.
▷ Established in accordance with article 39 of the constitution which is
a part of directive principles of state policy.
▷ Members:
○ Chairman
○ Deputy Chairman
○ 5 other members - Ex-officio members

17. INDIA’s GROWTH
PERFORMANCE
17

18. 12th FIVE YEAR PLAN
18
▷ Expansion, strengthening public healthcare sector
▷ GDP - 2.5%for Health
▷ Financial & managerial systems
▷ PPP
▷ Rashtriya Swasthya Bima Yojna (RSBY) - ‘cashless’ inpatient
treatment for eligible beneficiaries
▷ Availability for skilled human resources
▷ Holistic health-systems-approach
▷ Essential healthpackage

19. OUTCOME INDICATOR for
12th PLAN
Rates Target 2014 MDG
IMR(per 1000) 25 44 27
MMR (per 1lac) 100 178 109 (reduce 3/4th by 2015)
TFR 2.1 2.5 -
Undernutrition in 20% -40% 29% 26%
Anaemia among women 28% 55.3% -
19
children under 3 yrs
aged 15-49yrs

20. OUTCOME INDICATOR for
12th PLAN
Rates Target 2014 MDG
Child sex ratio in 0-6 yrs 914- 950 943 -
Reduction of poor
household’s out of pocket 1.97%GDP - -
expenditure
20

21. NATIONAL HEALTH GOALS for
COMMUNICABLE DISEASES
Diseas
e
21
Goal
Tuberculosis Reduce annual incidence and mortality by half
Leprosy
Reduce prevalence to <1/10000 population and incidence
to zero in all districts
Malaria Annual malaria incidence of <1/1000
Filariasis <1%microfilaria in all districts
Dengue Sustaining case fatality rate of <1%
Chikungunya Containment of outbreaks
JE Reduction in mortality by 30%
Kala-azar Elimination by 2015, i.e. <1/10000 population in all blocks

22. NATIONAL HEALTH GOALS for
COMMUNICABLE DISEASES
Diseas
e
22
Goal
Kala-azar Elimination by 2015, i.e. <1/10000 population in all blocks
HIV / AIDS
Reduce new infection to zero and provide comprehensive
care and support to all PLHA and treatment services for all
those who require it

23. INTERVENTIONS for
NON-COMMUNICABLE
DISEASES
Diseas
e
23
Intervention
Tobacco Control
● Raise taxes on tobacco
● Clean indoor air legislation
● Tobacco advertisingban
○ Information andlabelling
○ Brief advice to help quit smoking
○ Counselling to quit
CVD Prevention
● Salt reduction to processed food via voluntary
agreement with industry and/or via legislation
● Health education through mass media
● Treatment for High BP and Cholesterol

24. INTERVENTIONS for
NON-COMMUNICABLE
DISEASES
Diseas
e
24
Intervention
Diabetes & Complications
● Health education on diet and physical activity
● Diabetes detection and management in primary
healthcare
● Intensive glycemiccontrol
● Retinopathy screening and photocoagulation
● Neuropathy screening and preventive foot care
Cancer
● Screening for cervical, breast and oral cancer
● Strengthening of cancer therapy in district hospitals
Dental Caries
● Education on oral health & hygiene
● Reducing dietarysugars
● Reducing waterfluoridation

25. INTERVENTIONS for
NON-COMMUNICABLE
DISEASES
Diseas
e
25
Intervention
General Measures
● Promote physical activity in schools and society
● Restrict marketing of and access to food products
high in salt, sugar or unhealthy fats
● Targeted early detection and diagnosis using
inexpensive technologies

26. HEALTHCAR
E
MANPOWER 26

27. INTRODUCTION
27
▷ Health manpower deals with people who are trained to promote
health, to prevent and cure disease, and to rehabilitate the sick.
▷ It includes:
○ Those health workers who are already working in the field of health
services
○ Prospective health workers, i.e. those who receiving education and
training that will prepare them for employment in the health sector

28. TYPES
28
▷ Doctors (Allopathic & AYUSH)
▷ Nurse
▷ Pharmacists
▷ Lab technicians
▷ Radiographers
▷ Health assistant (male & female)
▷ Malehealth worker
▷ ANM
▷ ASHA
▷ Anganwadi worker
▷ Trained dai
▷ Others - health inspectors, skilled birth attendants

29. EVOLUTION
29
▷ Bhore committee,1946
○ Each PHC caters to 40,000 population.
○ Should have:
■ 2 Medical officers
■ 4 PHNs
■ 1 Nurse
■ 4 Midwives
■ 4Trained dais
■ 2 Health assistants
■ 1Pharmacist, and
■ 15 Other class four employees
▷ Chadha committee,1963
○ 1 lab technician per 30,000 population
○ 1 health inspector per 20,000 population
○ 1 basic health worker per 10,000 population

30. EVOLUTION
30
▷ Kartar Singh committee,1974
○ 1 male and female health worker each for 3000-3500 population at the
grassroots, i.e. within a distance of less than 5 km.

31. IPHS GUIDELINES for SC
31
▷ Most peripheral and first point of contact between the primary healthcare
system and the community.
▷ Purpose: largely preventive and promotive, but it also provides a basic
level ofcurative care.
▷ 1 SC - for every 5000 population in plain areas
▷ 1 SC - for every 3000 population in hilly/tribal/desert areas.
▷ Current stats: 147069 Sub-centers, as per Rural Health Statistics Bulletin,
March 2010.

32. IPHS GUIDELINES for SC
▷ Manpower
▷ The assured services of a Sub-centre would change considerably with the
pattern of staff availability.
▷ Where there is only one ANM, Reproductive and Child Health services would
have the first priority. Good logistics support is essential for maximizing the
work output of the Sub-centre.
32

33. IPHS GUIDELINES for PHC
33
▷ An integrated curative and preventive health care to the rural population
with emphasis on preventive and promotive aspects of healthcare.
▷ 1 PHC - for every 30,000 rural populations in the plains
▷ 1 PHC - for every 20,000 population in hilly, tribal and desert areas
▷ Current stats
○ 23673 PHCs, as per Rural Health Statistics Bulletin, March 2010
○ PHCs functioning on 24x7 - 9107 (ason 31-3-2011)
○ PHCs where three staff Nurses are - 7629 (ason 31-3-2011)

34. IPHS GUIDELINES for PHC
34
▷ Manpower
○ Under NRHM, PHCs are being operationalized for providing 24 X 7
services in various phases by placing at least 3 Staff Nurses in these
facilities.
○ If the case load is there, operationalization of 24 X 7 PHC may be
undertaken in a phase-wise manner according to availability of
manpower. This is expected to increase the institutional deliveries which
would help in reducing maternal mortality.
○ From Service delivery angle, PHCs may be of two types, depending upon
the delivery case load:
■ Type A - with delivery load of less than 20 deliveries in a month
■ Type B - with delivery load of 20 or more deliveries in a month

35. IPHS GUIDELINES for PHC
35

36. IPHS GUIDELINES for SDH
36
▷ Act as First Referral Units for the Tehsil/Taluk/block population.
▷ Important link between SC, PHC and CHC on one end and District Hospitals
on otherend.
▷ Saves travel time for the cases needing emergency care and reduces the
workload of the district hospital.
▷ 1 subdivision hospital caters to about 5-6 lakhs people.
▷ Current stats: 1200 such hospitals with a varying strength of number of beds
ranging from 31 to 100 beds or more.

37. IPHS GUIDELINES for SDH
37

38. IPHS GUIDELINES for SDH
38

39. IPHS GUIDELINES for SDH
39

40. IPHS GUIDELINES for SDH
40

41. IPHS GUIDELINES for DH
41
▷ Essential component of the district health system and functions as a
secondary level of healthcare which provides curative, preventive and
promotive healthcare services to the people in the district.
▷ Current stats: 605 district hospitals in 640 districts of the country as per
NRHM data as on 30-6-2010

42. IPHS GUIDELINES for DH
42

43. IPHS GUIDELINES for DH
43

44. IPHS GUIDELINES for DH
44

45. IPHS GUIDELINES for DH
45
▷ District Public Health Unit - Responsible for carrying out & coordinating the
activities required for preventing & controlling public health emergency
situations.
○ Activities include:
■ Integrated diseasesurveillance
■ Epidemic investigations
■ Establishing community and laboratory diagnosis
■ Implementing public health measures
○ Manpower:
■ 1 Epidemiologist
■ 1 Entomologist
■ 1 Microbiologist
■ 1 IEC Officer
■ 1 District Public Health Nursing Officer
■ 1 District Data Analyst / Demographer

46. IPHS GUIDELINES for DH
46

47. IPHS GUIDELINES for DH
47
▷ Specific requirements for nursing staff - calculated according to Indian
Nursing Council Norms.
○ 1 nurse for 6 beds for General Ward
○ 1 Nurse for 4 beds Special ward
○ 1 Nurse for 1 bed for ICU
○ 2 Nurse for one OT Table
○ 2 Nurse for one Labour room
○ 1 Nurse for a load of 100 patient
○ Injections 45%leave reserve

48. SUGGESTED NORMS
48
Category ofhealth
personnel
Norms
suggested
Doctor 1 per 1000 population
Nurse 1 per 500 population
1 per 5000 population in plain area
Health worker (male & female)
1 per 3000 population in tribal/hilly/hard to reach area
1 per 30000 population in plain area
Health assistant (male & female)
1 per 20000 population in tribal/hilly/hard to reach area
Pharmacist 1 per 10000 population
Lab technician 1 per 10000 population
Anganwadi worker 1 per 400-800 population
ASHA 1 per 1000 population
Trained Dai 1 per village
Source: Govt. of India (2008), Annual report 2007-08,Ministry of health and family welfare, New Delhi

49. REASONS for SHORTFALL
49
▷ Skewed production of health manpower
▷ Uneven human resource deployment and distribution
▷ Disconnected education and training
▷ Lack of job satisfaction
▷ Professional isolation
▷ Lack of rural experience

50. HEALTHCAR
E
ECONOMICS 50

51. INTRODUCTION
51
▷ Best use of available resources against competing demands - attain
given goals.
▷ Macro economics - GDP; percentage expenditure; policy; universal
coverage; national programs; fund allocation; budgeting; equality;
equity; accessetc
▷ Micro economics - cost per unit; utility; break even point; cost of
package etc
▷ Managerial economics - tools to analyze for microeconomics

52. HEALTHCARE ECONOMICS
52
▷ A branch of economics concerned with issues related to allocation of
resources for health and healthcare
▷ Also referred to as health financing
▷ Manpower, time and money key issues

53. SCOPE of HEALTH ECONOMICS
53
▷ Factors influencing health (other than health care)
▷ Definition of health and its value
▷ The demand for health care
▷ The supply of health care
▷ Microeconomic evaluation at treatment level
▷ Market Equilibrium
▷ Evaluation at whole system level; and
▷ Planning, Budgeting and monitoring mechanisms

54. MACRO HE
54
▷ Whois covered
▷ What services are covered
▷ How much of the cost is covered
▷ How funds are to be raised and administered
▷ Broad picture for direction

55. KEY OBJECTIVES for SERVICE
DELIVERY
55

56. CHALLENGES
56

57. GROWTH
57

58. DEMAND for HEALTHCARE
58
▷ Can be an expression of felt need.
▷ Factors influencing the demand:
○ Economic variables
■ Income
■ Price of the commodity
○ Socioeconomic variables
■ Education
■ Marital status
■ Age andgender
■ Access to health facility
■ Household size
■ Qualityand competition

59. MANPOWER SUPPLY
59
▷ Factors affecting the supply of manpower:
○ Necessity of pursuing higher education
○ Continuedmedical education
○ Low wages compared to other countries
○ Increase in immigration and overseas employment

60. OPPORTUNITIES
60
▷ There are lots of opportunities for enterprises to impact Indian
Healthcare System, such as:
○ Make it affordable
○ Increase accessibility
○ Provide good quality of care

61. CONCLUSION
61
▷ Study of health economics essential for planning and evaluation
▷ While complex problems may be worked out by experts, decision
makers require a sound understanding of health economics
fundamentals
▷ More health from the money and more money for health- Economic
Imperative

62. Thanks!
Any
questions?You can find me at:
debraj364@gmail.com
Debraj Mukhopadhyay
MPH, DPSRU, New Delhi