3. PLANNING
A systematic method of trying to attain
explicit objectives for the future through the
efficient and appropriate use of resources,
available now and in the future.
(Green, 2007)
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4. Planning Cycle / Spiral
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Situation Analysis
Implementation and
Monitoring
Evaluation
Option appraisal
Priority, goal, and
objective setting
Programming
5. SITUATION ANALYSIS
First stage – to improve the understanding
of the current situation
Purpose
provide a common reference point for rest of planning
process
provide the background for the selection of priority areas of
concern for planning
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7. SITUATION ANALYSIS is conducted to
Describe the current status (What is?)
Describe trends (past, present, future)
Project (base future)
Identify problem and reasons for their existence
Prioritize problems
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10. Key content of a situation
analysis
Population characteristics
Area characteristics & Infrastructure
Policy and political environment
Health needs
Health services
Services provided by non-health sector
Resources
Efficiency, Effectiveness, Equity and Quality of current services
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11. Population characteristics
Demographic information
Size & distribution of population
age & sex structure
vital rates - birth, death and fertility rates
immigration & emigration rates
over all population rates
ethnicity, class & geographical distribution
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12. Current situation on
baseline information
morbidity, mortality, service utilization
for service provision
for young or elderly health
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13. Population characteristics
(cont.)
Religious, educational and cultural characteristics
Important impact on health
Education level and literacy rate
eg. High literacy rate vs Low IMR
Cultural or religious characteristics
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14. Area characteristics and
infrastructure
Geographical situation
Infrastructure
Transport modes & routes
Communications
Water supply & sanitation facilities
Utilities - distribution of main electricity
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15. Area characteristics and
infrastructure (cont.)
Socio-economic situation
Linkage between economy & other sectors
pattern of economy & activities
Public and private sector structure
Information & relationship
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16. Policy and political environment
Overall national policies
Existing health policies
National Health Policy
Political environment
In order to recognize potential opponents or
supporters
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17. Health needs
Medically perceived health needs
Come from community health survey
Records of health services
Morbidity rates - Incidence and Prevalence
Mortality rates - IMR, MMR, CFR
Disability rates
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18. Health needs (cont.)
Non-illness related needs
Antenatal care & Family Planning
Burden of disease – DALY
Community perceived health needs
express in terms of service deficiencies from
community surveys of attitudes & views
existing community structure
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19. Health services
Service facilities
Type & number of services, facility capacity, location,
ownership of facilities
Service utilization
Hospital occupancy rate, attendance rates, immunization, family
planning, DOTS, water supply, Latrine
Service gap
Health service organizational arrangement
degree of centralization of decision making
community participation on decision making
Linkage between sectors
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20. Services provided by and plans of
non-health sector health services
Brief description of the main services and future plan
of sectors related to health
Education
Water & sanitation
Agriculture & forestry
Community development
Public works
Industrial and mining sectors
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22. Efficiency, Effectiveness, Equity,
Quality of current services
Evaluate the current services as situation analysis
look closely to option appraisal & economic techniques
Planning future allocation
Assess effectiveness and quality of service
Compare among different facilities/ services
Examine distribution of resources between different
population groups in compare with their needs (Equity)
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23. Techniques
Participatory Rapid Appraisal (PRA)
to obtain information from community
Health needs assessment
to collect information about health needs using a variety of
epidemiological methods
SWOT analysis
to get common understanding of issues facing a particular
organization
Stakeholder analysis
to assess attitudes of particular issues
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26. Example of SWOT analysis of NGO hospital
Strengths (Internal) Weakness (Internal)
Committed staff
Access to external donations
Poor management
Lack of lab. Staff
Old building
Opportunities (External) Threats (External)
Decentralization
Contracting of services by
government
Rise of private sector likely to
poach “private bed” patients
essential for funding
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27. Typical issues in Situation Analysis
High population growth rates
High infant and child mortality
Changing burden of disease
Poor prospects for future growth in resources for
the health sector
Inappropriate organizational structures
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28. Lack of coordination between Public sector and other
health services
Inefficient allocation of resources between
levels of facilities
Shortage of health professionals and low morale
among health workers
Inequitable distribution of resources
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29. Who should carried out?
Health professionals & service manager
Representatives of other sectors related to
health sector
Community representatives
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31. Setting Priorities
Fundamental rationale for planning - inevitable between
available resources and competing uses
Limited resources best allocation approach
Demand based market mechanism
Need based planning approach
Priorities are expressed in a hierarchy of objectives –
goals, aims, objective, targets
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32. Goals, aims, objective, targets
Goal - broad statement, one goal for service
eg. Health for All, MDG
Aim - a number of aims relating to the goal
- specific to particular health problem
eg.To raise the nutritional status of women and children
Objective - a number of objectives relating to the aim
- specified in measurable terms
eg.To ensure that 95% of children under 5 are adequately nourished
by the year 2010.
Target - a number of targets which specify various points on the
way to the attainment of the objective
eg.To ensure that 75% of children under five are adequately nourish
as pre-defined by the year 2008.32
33. Health needs
General lack of something, relate directly to the
measurement of health
Gradation of need - depending on observer
Viewed predominantly from epidemiological perspective -
emphasis on mortality and morbidity
Perceived need – needs that is neither a scientific judgment
nor the province of medical profession alone
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34. Underlying perceptions of health
Groups in different positions within health system -
different perceptions
Different health problems have varying combinations of
effects of ill health
Injury - pain and discomfort
polio - disability
cholera - death
alcoholism - social effects
Setting priority – depend on attitudes towards the particular
effects of different health problems
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35. Who should set priorities
Provision of information – health & other professionals
Decision on needs
National level - d/p on political structure
Local level - community involvement
Central - to ensure equity of resource availability, maintenance
of standards, provision of framework for determination of
local needs
Relationship between political structures at the national level
and those at community level
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36. Criteria for priorities
maximum feasible health gain within available
resources ( efficiency )
effects on equity
level of public demand
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37. Priority setting
Determination of ‘what it wants to achieve’
(hierarchy of objectives)
To ensure feasible within the social and political
climate, available resources
Clear criteria for selection are needed
Allow broad view of health
Balance decision making at national and local
Transparent process
Needs to end up with objectives that are feasible
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38. Prioritize the problem
effect on the majority of population
effect mothers and children
has high mortality
has a solution & can be solved with available resources
the community accept as a problem
the community participate in solving it
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39. Priority assessment of
Health problems and needs
Prevalence / Incidence
Severity of problem
Effective Intervention
Acceptability / Feasibility
Community involvement
Cost and Resources
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40. Prioritization of health problems was based on
Objective criteria : morbidity, mortality, trend
Subjective criteria: Political concern, community concern,
availability of preventive technology, availability of
curative technology, socio economic impact
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41. Prioritization technique
Prioritization = MIV/C
M = magnitude of the health status effected by the
problem i.e., morbidity, mortality and disability
I = importance/ extent of problems, area, risk group,
impact of disease
V = Vulnerability
C = Cost
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42. Techniques for priority setting
Economic appraisal
Combine consideration of health gain &
resources
Use cost per DALY
Applicability ?? Lack appropriate data in
developing countries
Multivariable decision matrices
Delphi technique42
43. Hypothetical example of a multi-variable
decision matrix
Weighting of
criteria
Criteria
Cost per DALY Public demand Mortality rates Disability rates
Allocated score
4 Measles AIDS AIDS Polio
3 TB Alcoholism TB Alcoholism
2 Malaria Malaria
1 Gastro-enteritis
Scoring
AIDS 8
TB 6 Measles 4
Alcoholism 6 Malaria 4
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