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Health Planning for Health Sciences and Medical Students


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Published in: Health & Medicine

Health Planning for Health Sciences and Medical Students

  1. 1. Health Service Management Lecture Notes forSecond Year Public Health Students ©Medco Bio Medical College, September 2012 Mekelle Campus, Mekelle, Tigray, Ethiopia
  2. 2. Chapter 02 Health Planning Functions (Total Time Allocated for this Chapter = 6 hrs)He who fails to plan, plans to fail!
  3. 3. Day 3Contents1. Definitions2.Rationale3.Nature and Purpose4.Scope5.Types
  4. 4. 1. Definitions• Planning is the combination of compiling and analyzing information, dreaming up ideas, using logic and imagination and judgment in order to arrive at a decision about what should be done• Planning can also be defined as systematic method of trying to attain explicit objectives for future though the efficient and appropriate use o resources, available now and in the future
  5. 5. Health planning is the process of defining community health problems, identifying needs and resources, establishing priority goals, and setting out the administrative action needed to reach those goals
  6. 6. • Planning is deciding in advance what is to be done, it is projected course of action for the future• To plan is to propose a forward program for guiding the future affairs of an organization• The planning process starts with the assumption that the future will be different from the present, and it attempts to determine how the organization can take advantage of that difference
  7. 7. • Planning thus becomes a device for change• It is clear that individual activity and organization activity without plan will be ineffective• if you don’t know where you are going no road will get you there!• All these definitions have common point, that planning is a process that lays the base for future action
  8. 8. • The important components of this and other similar definitions are concepts of – Where are we going (objectives)? – With what (resources)? – How (efficient and appropriate implementation)? – When (future)? – Degree for formalization (explicitness, systematic and method) about the process?
  9. 9. 2. Rationale• Planning is not confined to organizations• At personal level most of us plan to some degree or other• We are constantly making decisions about our future, ranging from what we will do tomorrow through holiday plans to our careers. Therefore, importance of planning is unquestionable• The importance of planning:- it helps – Coping with future uncertainty and changes – Focus attention on objectives – It obtains economic operation • Provides performance standards and facilitates control • Helps foreseeing and identifying potential risks
  10. 10. 3. Scopes of planning1. what is target client? i. Population ii. Institution iii. Program what the plan intends to address should be clearly defined2. what is the target geographical region or area? i. Village/kebele ii. District/Zonal iii. Region At what level you are planning has to be clearly defined3. For what level of comprehensiveness should service be planned?
  11. 11. Environmental Determinants Comprehensive Health Care• Diet-sanitary preparation of food • Curative• Avoidance of harmful life • Preventive style • Promotive• Housing-sanitary housing condition • Rehabilitative• Unpopulated environment• Freedom from stress
  12. 12. 4. Features of Planning1. A good plan should give – Clear vision, mission, goal and objective – A clear picture of the tasks to be accomplished – The resources needed to accomplish the task. In terms of human, material, financial, and time resources2. Planning must be collective understanding It requires the participation of  professionals (from health and other sectors)  Community (Non-governmental Organizations)  Government (Party)
  13. 13. 3. Planning takes place at all levels 1. Planning takes place at any level in health system 2. Planning takes place continually 3. Planning methods can be applied to • Large program at nations level – Malaria control program • Small one-at village level – Construction of community health post
  14. 14. 5. Types of Planning1. Strategic planning• often referred as allocative planning-normally five years or more• Strategic planning is the process of determining what an organization intends to be in the future and how it will get there• It is finding the best future for your organization and the best path to reach that destination• Due to the rapid rate of change of todays world it has become necessary for every dynamic organization to keep their plan as current as possible through strategic planning• Strategic planning is often used in place of long range planning
  15. 15. • SWOT Analysis – Is a strategic planning tool that matches internal organization strengths and weakness with external opportunities and threats – By reviewing SWOT a useful strategy for achieving objectives will become evident
  16. 16. • SWOT analysis defines the relationship between internal and external appraisals in strategic analysis• It is an exercise in identification and analysis
  17. 17. In the health sector:-1. strengths may be considered availability of resources and trained human power2. Weaknesses include lack of managerial talent and obsolete facilities3. Threats include adverse cultural believes toward modern medical practice and growing cost of essential drugs.4. Examples of opportunities are clear and supportive government policies and presence of functional health committee in the communities.
  18. 18. 2. Tactical/Operational planning – Is short-range planning that emphasizes the current operations of various parts of the organization – Short-range is defined as a period of time extending only about one year or less into the future – Managers use tactical planning to outline what the various parts of the organization must do for the organization to be successful at some point one year or less into future – Tactical plans usually are developed for organizations in the areas of production, marketing, personnel, finances and plan facilities
  19. 19.  Comparing and coordinating the two types of plans – In striving to implement successful planning systems within organizations, manger must remember several basic differences between strategic planning and tactical planning 1. since upper level managers generally have better understanding of the organization as a whole than to do lower-level managers, and since lower level managers generally have better undressing of the day to day organization operations than do upper level mangers strategic plans usually are developed by upper level mangers and tactical plans by lower level managers
  20. 20. 2. Since strategic planning emphasizes on the analyzing the every day functioning of the organization, facts on which to base strategic plans are usually more difficult to gather than are facts on which to base tactical plans3. Difference between strategic and tactical planning involves the amount of detail in the final plans4. Since strategic plans are based primary on a predication of the future and tactical plans on known circumstances that exists within the organization, strategic plans are generally less detailed than tactical plans5. Lastly since strategic focuses on the long term and tactical planning on the short term strategic plans cover a relatively long period of time
  21. 21. Areas of differences Strategic planning Tactical planningIndividuals involved Developed mainly by upper Developed mainly by lower level management level management tFacts on which to base Facts are generally difficult Facts are generally easy toplanning to gather gatherAmount of details in plans Plans contains relatively Plans contain substantial little detail amount of detailLength of time plans cover Plans cover long periods of Plans cover short periods time of time
  22. 22. Questions for Review
  23. 23. Questions ?
  24. 24. Thank You!
  25. 25. 6. Steps in Planninga) Situational analysisb) Selecting priority problemsc) Setting objectives and targetsd) Identifying potential obstacles and limitationse) Designing the strategiesf) Writing the plan
  26. 26. 1. Situational analysis –First stage in the development of a plan at all levels –Helps provide broad basis of understanding –For two reasons • It provides a common reference point for the rest of the planning process • It allows the selection of priority areas of concern for planning content of situational analysis
  27. 27. 1. Population characteristics2. Review area characteristics and Infrastructure3. Policy and political environment4. Analysis of health needs5. Analysis of health services6. Analyze resources7. Review past implementation and experience
  28. 28. • Population characteristics –Study size, composition, and distribution of the population –Identify target groups –Determine population size by category –Estimate overall population growth rate –Determine religious, educational and cultural characteristics
  29. 29. • Review area characteristics and infrastructures – Geographical and topographical situation – Infrastructure • Transport modes and routes • Communications • Water supply and sanitation facilities • Utilities-including distribution of main electricity – Socio-economic situation • Change in patter of income distribution – Public and private sector structures
  30. 30. • Policy and political environment – Consider national health policy and programs and relate it to actual situation in your own areas – Analyze political environment
  31. 31. • Analyze the health needs –There are essentially two approaches to know society health needs • Medical indicators –Community health surveys –From records of health service contacts –Perception of health professionals
  32. 32. Community perception of need –Surveys of attitudes and views of the community members as to their health needs –From existing community structures village health or development communities or indeed at the national level through democratic representative structures
  33. 33. • Community perceived health needs – Harder to define – Often expressed in terms of service deficiencies rather than health indicators• Medically perceived health needs – Morbidity rates • Incidence • Prevalence – Mortality rates • General population mortality rates • Age specific one’s – Disability rates – Non-illness related needs • Antenatal care, family planning
  34. 34. • Analyze health services –Analyze organization structure and functions of health services –Service facilities –Service utilization –Service gaps –Identify limitations/bottle neck in organization structure
  35. 35. • Analyze resources –Financial resources –Personnel –Material/equipment –Space/building –Time –Information
  36. 36. • Review past implementation experiences –Find out information or experiences from activities implemented in the past –Success –Short comings
  37. 37. 2. Selecting critical priority problems –Competing needs and limited resources –The most critical and hardest planning stage and yet cannot be avoided
  38. 38. • Problem-is a difficulty or obstacle seen to exist between a present situation and desired future objectives• It is useful to group problems under common headings – Environmental problem • Poor sanitation • Over crowding • Lack of safe drinking water – Disease or Health problems • Malaria • Malnutrition • Respiratory disease • Diarrhea
  39. 39. • Socio economic problems – Low per capital income – Illiteracy – Poor equity in distribution of health services – Cultural and religious habits• Health Service Problems – Insufficient drugs and materials – Lack of qualified personnel – Difficulty in visiting outlying areas
  40. 40. • Making such groups of problems helps seeking common solutions• There are always discrepancies between the health needs and available resources. Hence a health planner is obliged to take certain problems first• Priority problems are often selected by setting selection criteria and giving scores for each problem according to these criteria
  41. 41. • The selection criteria for priority problem are – Magnitude of the problem – Degree of severity (consequent suffering and disability) – Feasibility-in terms of cost effectiveness and social acceptability of intervention – Sustainability in terms of resources and organizational capacity – Community concern – Political and social acceptability with consideration of equity – Consistence with multi-sectoral approach
  42. 42. • Consistence with governmental planning and budgetary system• Ranking health problems can be done using criteria on five point scale• 5-very high• 4-high• 3-moderate• 2-low• 1-very low
  43. 43. 3. Setting objectives and Targets• Goals-are broad statements – There is generally one goal for a service. This might be health for all by 2000 and beyond• Aims-number of aims related to the goal – They are specific to particular health problem – One might be to raise nutritional status of women and children
  44. 44. • Objectives-for each program aim, there may be a number of objectives which are specified in measurable terms – An objective for the above aim might be to ensure that 95 percent of children are adequately nourished• Targets-For each objective there may be various targets which specify various points on the way to the attainment of the objective – They are defined in relation to a point in time. For example a target for the above objective might be to ensure that 75 percent of children are adequately nourished by 2002
  45. 45. • If the program is made to have an objective and target it must be SMART – S = Specific – M= Measurable – A = Achievable – R = Realistic – T = Time bound (Timely)• Example by the end of 2002, 90% of eligible children will be vaccinated against six target diseases in Tigray region
  46. 46. 4. Identifying Obstacles and Limitations• Identifying the presence of any situation that may prevent the achievement of each objective and target• Resources – People – Equipment – Money – Time – Information• Environment – Geographical features – climate] – Technical difficulties – Social factors
  47. 47. 5. Designing the strategies• Once objectives and targets are set, the planner assesses the different ways (strategies) for achieving them• Choosing the best strategy entails analyzing resources available and needed for each strategy• The potential strategies often include technology to be applied, procedures to be used and defining the role of communities and other sectors
  48. 48. • For each chosen strategy, the corresponding activities to be undertaken and the resources needed should be detailed, including – who will do the activities (job description of all involved personnel) – which things would be needed (equipment, and money), – where the work will be done and the methods of controlling• Determine resources required in terms of proposed strategy the time, staff, facilities/materials, and money• Estimate strategy costs and assess adequacy
  49. 49. 6. Writing the planOut line of writing a plan1. Summary2. Problem statement3. Objectives and targets4. Strategies and activities5. Resources needed and how they are going to be utilized specify budget required6. Monitoring and evaluation (periodic and end of program assessment, how, by whom , when, indicators of effectiveness)
  50. 50. • Gantt Chart-this is a bar graph with time on horizontal axis and the resources/activities to be scheduled on the vertical axis• Main weakness of Gantt Chart-it lacks information on interrelation of tasks to be performed
  51. 51. • Human resource planning – What types of people does the organization need to reach its objectives – How many of each type are needed – What steps for the recruitment and selection of these people should the organization take – Can present employees be further trained to fill future needed position
  52. 52. – How does each category of organization members improve his/her career, get promoted– At what rate are employees lost from the organization– Why are employees lost from the organization– What should be done to train competent and experienced staff
  53. 53. • Why plans fail? – The following are some important reasons why plans are not successful • Planning is not integrated into the total management system • A lack of understanding of the different steps of the planning process • Management expects that plans will be realized with little effort • Too much attempted at once • Failing to operate by the plan • Inadequate input in planning • Unforeseen (unexpected) changes in the environment
  54. 54. Questions ?
  55. 55. Thank You!