Planning and management Defined as “continuous ,systematic coordinated planning for the investment of resources of a country in programme aimed at achieving the most economical & social development.

1. HEALTH PLANNING
AND
MANAGEMENT
Dr Lipilekha Patnaik
Professor, Community Medicine
Institute of Medical Sciences & SUM Hospital
Siksha ‘O’Anusandhan deemed to be University
Bhubaneswar, Odisha, India

2. PLANNING
v Defined as an
organized conscious and
continual attempt to
select the best available
alternative to achieve
specific goals
MANAGEMENT
vIt is the act of securing
maximum results with
minimum efforts to
achieve maximum
prosperity & happines
and give public the best
service.

3. National development planning
• Health planning is a part of National
development planning.
• Defined as “continuous ,systematic coordinated
planning for the investment of resources of a
country in programme aimed at achieving the
most economical & social development.
• Required for economical utilisation of material,
man power & financial resources.

4. National Health planning
• Orderly process of defining national health
problem, identifying unmet needs, & surveying
resources to meet them, establishing priority
goals that are realistic &feasible & projecting
administrative action to accomplish the purpose
of the proposed programme.
• PURPOSE-1) to match limited resource with
many problems.2)to eliminate wasteful
expenditure.3)to get the best course of action
with a defined objective.

5. Health Needs and Demands
Ø Defined as “deficiency in health that call
for preventive, curative, control
measures
Ø Ex.* need for medical care * safe water
supply * adequate nutrition* family
planning * immunisation.
Resources- *
man power *money *material *time
*skill *knowledge and *technique.

6. OBJECTIVE, TARGET & GOALS
üObjective-planned end point of all activities.
üTarget- refers to a discrete activity. It permits
the concept of degree of achievement.
üObjectives are concerned directly with the
problems itself but targets-with the factors
in problem.
üGoals-ultimate desired state towards which
objective &resources are directed.

7. Planning
ØPlan is a blue print for taking action.
ØSteps of planning—
vAnalysis of health situation
vIdentifying the health problems
vFormulating the goals & objectives
vAssessment of resources
vSelection of priorities
vWrite up of formulated plan
vProgramming & implementation
vMonitoring and evaluation

8. Planning cycle
formulate health problems
Choose priority among problems
Formulate Individual priority
Problem For planning solution
Define Programme objective
And goal
Assign priorities
Among objectives
Design Alternate Programme to
Solve problems
Select best Programme
(feasibility cost /effectiveness)Combine Programme &
Develop integrated plan
Plan implementation
Orient & train personal
Initiate integrated Programme
Operate Programme
Collect data for evaluation
Evaluate results
Goal achieved?
Goals satisfactory?
no
yes

9. 1) Analysis of health situation – collection,
assessment and interpretation of information to
provide a clear picture.
üData on morbidity and mortality
üThe population, its age, sex
üData on health facility –hospital,
clinics
üEpidemiological &geological
distribution of different diseases
üData on training institution
üData on available resource (man,
money, material)

10. 2)Identifying health problems
Problems in 9th five year plan—
vGap in man power & infrastructure
vPoor referral services
vHospitals with inappropriate manpower,
diagnostic & therapeutic services.
vSub-optimal intersectoral coordination.
vIncrease in burden of communicable and non-
communicable diseases
vAvailability & utilization of services are poor in
most needy states/districts.

11. Establishment of objectives & goals
Unless objectives are established, there is chance of—
haphazard activity
--uneconomical use of funds
--poor performance
May be short term or long term.
Assessment of resources
what is required and what is available .
Selection of priorities
• financial constraints
• Mortality & morbidity data
• Disease- prevented at low cost
• Political & community interest & pressure
• Saving the lives of younger people.

12. Write up the formulated plan
*preparation of detailed plan
* complete in all respect
* resources (input) required related to the results
(output)
* each stage of plan is defined & costed
Programming & Implementation
* starts after selected & approved by policy making authority.
* Implementation requires co-ordination, co-operation, and
commitment at all levels starting with the ministry of health at
the union and state level.

13. Monitoring
It is a continuous process of observing, recording and
reporting on the activities of the project.
• It is day to day follow up of activities during their
implementation to ensure that they are proceeding
as planned and are on schedule.
Evaluation
• Measures the degree to which objectives and
target are fulfilled &quality of result obtained.
• Measures productivity of available resources &
whether output is cost effective.
Monitoring = day to day activities
Evaluation = final outcome

14. Management
Administration / management / organization
ADMINISTRATION = means getting thing done.
It is the direction, coordination & control of many
persons to achieve some purpose /objective.
MANAGEMENT = the effective use & coordination of
resources i.e. money, material & manpower to
achieve the defined objectives with maximum
efficacy. FUNCTION = *planning
*implementation *evaluation
ORGANISATION = it is a group of people whose
activities are consciously coordinated towards a
common objective.

15. Management techniques
1) ORGANISATIOAL DESIGN :
• Poor organization results in wastage of
precious resources
• designed to meet the health needs & demand
of the people.
• Reviewed every year due to changing concepts
or purpose, changing problems & technology.

16. 2) Personal management (HUMAN RESOURCE
DEVELOPMENT)
- Its aim is to use the human resources
skillfully and efficiently.
- Fundamental techniques –
1) Proper selection
2) Training & motivation
3) Division of responsibility
4) Providing incentives
5) Promotion & opportunity for professional
advancement.

17. 3) Communication
Better communication leads to better functioning of organization
.
Various communication road-blocks are between
*doctor-patient *doctor-nurse
*senior officer-juniors
*directorate –health ministry
Communication barrier leads to –
1)Delay in regular reporting & notification
2)Delay in compilation of statistics, release of salaries & supplies
3)Delay in institution of prompt remedial measures.

18. 4) Management Information system (MIS)
• Information is needed for day to day management
of the health system.
• A bad information ---bad management
• Function :1)collection 2)classification
3)transmission 4)storage
5)transfofmation 6)display of information
• Components : a) data collection b) data flow
c) data analysis, monitoring,&
evaluation.

19. 5) Management by objectives
• Objectives are set forth for different units and
subunits, each of which prepares its own plan
of action – usually on a short-term basis.
• This helps in achieving the results more
effectively and smoothly.

20. 6) Cost benefit analysis
• The economic benefit of a Programme is compared
with the cost of resources & results expressed with
monetary terms .
• Drawback – benefit can’t be expressed always in
monetary term .i.e. how many births / deaths
prevented, illness avoided, leprosy cases cured.
7) Cost effective analysis
Similar to CBA except benefit is expressed not in
monetary form, but in terms of result achieved.
i.e. no. of lives saved, no. of days free of disease .

21. 8) Cost accounting
• Provides basic data on cost structure of any
pogramme.
• Purposes in health : 1) cost control
2) pricing of cost reimbursement
3)planning & allocation of people
& financial resources.
9) Input – output analysis
- Economic technique.
- INPUT : all the health services that need resources
- OUTPUT : useful outcomes - cases treated, live saved

22. 10) Systems analysis
• Its purpose is to choose an appropriate course of action by –
* investigating the problem *
searching out objectives *finding out the most effective
alternative
11) Network analysis
• NETWORK: It is a graphic plan of various events & activities
to reach the end objective.
• Two types of network techniques 1) PERT (pogramme
evaluation & review technique 2)CPM (critical path
method)
Both use an arrow diagram to illustrate the logical
sequence in which events & activities take place

23. PERT
• More detailed planning and more
comprehensive supervision.
• Uses an arrow diagram
• It calculates time to complete each activity.
CPM
• The longest path of the network
• If any activity along the path is delayed, the
entire project is delayed.

24. 12) Planning programming budgeting system
(PPBS)
• It does not calls for changes in existing organization.
• Calls for grouping of activities into Programme related
to each objective.
13) Work sampling
-it is a systematic observation & recording of activities of
one / more individuals.
-judgment is done on appropriateness of current staff ,
training, & job description.
14. Decision making – made about dev. of resources,
work load, strategies for providing health care

25. Health planning in India
• Govt. of India set up a planning
commission in 1952 and started 5-year
plan system for socio-economic
development of the country.
• Prime minister is the chairman of the
commission
• The 11th five year plan :2007-2012
• The 12th five year plan : 2012-2017

26. Levels of planning
1) Central level -to increase no of CHC to
1/ 1 lakh by 2015
-to increase no of ANM to
25000 by 2010
2) State level -prioritization of districts need
additional resources like
ANMs, Doctors, Male
health workers
3)District level -which PHC need support
-which sub-centre does not
have an ANM posted

27. References
1) PARK textbook of PSM – edn.17
2) Textbook of PSM –by B.K. Mahajan-3rd
3) National Health programme –J .Kishore
4) Epidemiology and community health in
warm climate countries – Crickshank &
standard
5) Epidemiology and Management for health
care for all -2nd edition, by Sathe and sathe