Planning of Health Services was presented over several chapters. Chapter II introduced health services and discussed strategy formulation and elements of planning like setting objectives, management by planning, and management by objectives. It defined health systems and services in Nepal and discussed the existing health service network from central to community levels. It also reviewed existing health plans, policies, and regulations. Current health programs in Nepal including child health, reproductive health, and disease control were outlined. The importance of strategic planning, various planning approaches and types were explained. Key steps in planning like analyzing opportunities, setting goals, developing premises, and evaluating alternatives were described.

1. Planning of Health Services
Nabin Lamichhane
Lecturer
Purbanchal University

2. CHAPTER II
Introduction of Health Services
Strategy Formulation
Elements of Planning
Setting Objectives: Operational research for
Planning
Management by Planning
Management by Objectives (MBO)

3. Introduction of Health Services
• The term health services cover a wide spectrum
of personal and community services for the
treatment of disease, prevention of illness and
promotion of health.
• The purpose of health services is to improve the
health status of population. To be effective, the
health services must reach the social periphery,
equitably distributed, accessible at a cost the
country and community can afford and socially
acceptable.

4. Health services
Act of healthful activities intended to maintain
or improve health of individuals through
– preventive
– promotive
– curative
– and rehabilitative services.
The organized provision of such services may
constitute a health care system.

6. Health System
• A health system is the complex of interrelated
elements that contribute to health in homes,
educational institutions, work place and
communities as well as in the physical and
psychological environments and health related
social activities.
• Health system is the sum total of all the
organizations, institutions and resources
whose primary purpose is to improve health.

7. Health care services in Nepal
Modern Healthcare systemTraditional health care system
Private sector;
Non-profit,
Profit.
Government
sector
With formal system:
Ayurveda, Homeopathy,
Unani, Nautropathy etc.
Without
system:
Dhami, Jhankri,
Gurau, Jharphuke,
Gubaju, Tantrik,
Lama

8. Existing Health Service Network in
Nepal
Central Level MOHP/DOHS/ Specialized Hospitals /
Divisions and centers
Regional Level Regional Directorates, Training centers
stores and Hospitals
Zonal Level Zonal Level Hospitals
District Level District Public Health office/ District
Hospitals
Electoral Level ( 1991 policy) Primary Health care Centers
Ilaka Level (3 -5 VDCs) Health Post
VCD Level Sub-Health Post
Ward Level FCHV

9. Central Level Divisions 7
Centers 5
Central Hospitals 8
Regional Level-5 Regional Health Directorate 5
Regional Hospital 3
Sub-regional Hospitals 2
Regional Training Centre 5
Regional Medical store 5
Regional TB centre 1
Zonal Level-14 Zonal Hospital 10
District Level -75 District Public Health Office 15
District Hospital 65
District Health office 60
Electoral Constituency Level-
207
Primary Health Care Centers/HC 207
VDC/Municipality Level-3973 Health Post 679
Sub Health Post 3114
Community Level PHC ORC 13811
EPI Outreach 16220
FCVH 48549

11. Exiting Plans, policies, acts and
regulation
• Health Act and Regulations
• National Health Policy 1991
• Second Long term Health Plan – Essential health
Care
• National Health Sector reform
– Strengthen service delivery
– Institutional capacity Management and development
• Millennium Development goals ( Goals 4,5 & 6)
• Three Years Interim Plan
• Free Health care Policy 2006

12. Current Health Programs
• Child Health Program
– National Immunization Program
– Nutrition Program
– CB-IMCI Program (2 months to five years)
– CB–NCP Program

13. Reproductive Health
• Family planning
• Safe mother hood and Newborn Health
• FCHV Program
• PHC outreach Program
• Demographic and RH health research

14. Disease Control Program
• Malarial Control
• Kala-azar Elimination Program
• Lymphatic Filiariasis Program
• National TB control Program
• Leprosy control Program (Declared Elimination in 19th Jan. 2010)
• HIV/AIDS and STI control Program

15. Supporting Programs
• National Health Training
• National Health Education, information and
communication
• Logistic Management
• National Public Health Laboratories Services
• Administrative Management
• Financial Management
• Management

16. Health Related council
• Nepal Health Professional Council
• Nepal Medical Council
• Nepal Pharmacy Council
• Nepal Nursing Council
• Nepal Ayurvedic Council
• Nepal Health Research Council

17. Before Starting PLANNING

18. Purpose or Mission
Objectives
Strategies
Policies: Major or minor
Procedures
Rules
Programs: Major or minor and Supporting
Budgets: numberrized or dollarized Programs
Hierarchy of
elements of
Planning

19. Before Starting Planning…..
• Vision
– A Vision Statement states that “What do we want
to become? Developing a vision Statement is the
first step in Strategic planning. Many vision
statements are written in single sentence.
Example: Vision Statement of eye Hospitals
“Our Vision is to take care of your Vision”

20. Before Starting Planning
• Mission
– A clear mission Statement discusses the values
and priorities of an organization. A mission
statement broadly charts the future directions of
an organization.
– Example; Mission of the Health Promotion
Program
To provide a wide variety of primary prevention
activities for residents of the community

21. Before Starting PLANNING…….
• Plan:
– Plan is a blue print for taking action. It consists of
five major elements: Objectives, policies,
Programmes, Schedules and budget.
• Programme
– A Programme is the Sequence of activities
designed to implement policies and accomplish
objectives. A programme gives a step by step
approach to guide the action necessary to reach a
predetermined goal.

22. Before Starting PLANNING
• Schedule:
– A schedule is a time sequence for the work to be
done.
• Procedure:
– Procedure are set of rules for carrying out work
which when observed by all help to ensure the
maximum use of the resources and efforts.

23. • Policies:
– Policies are the means by which the objectives will be
achieved. These include guidelines, rules and
procedures established to support efforts to achieve
stated objectives.
• Strategy
– Strategy can be defined as “the determination of the
long term goals and objectives of an enterprise and
the adaptation of the course of action and the
allocation of resources necessary for carrying out
these goals”.

24. PLANNING

25. Planning
• Primary function of Management.
• Looking ahead and Pre-determining Future.
• Select Future course of action/Alternatives.
• Helps to fulfill the “strategic Gap”.
• Stephen P. Robbins, “ Planning is deciding in
advance about what to do, how to do it, when
to do it, and who is to do it. It provides the
ends to be achieved”

26. Few Definition of Planning
• Ricky Griffin:
– Planning is setting an organization's goals and
deciding how be to achieve them.
• Koontz and Weihrich
– Planning involves selecting missions and objectives
and the actions to achieve them.
• Richard Steers
– Planning is the process by which managers define
goals and take necessary steps to ensure these goals
are achieved.

27. Planning……
• organized conscious and continual attempt to select
the best available alternatives to achieve specific goal.
• Deciding how the future should be better than the
present, what changes are necessary to make these
improvements and how these changes should be
implemented.
• Start of process by which an individual or business may
turn empty dreams into achievements.
• Planning enables one to avoid the trap of working
extremely hard but achieving a little.

28. Health Planning
Health planning is the orderly process of
defining community health problems,
Identifying unmet needs, surveying of
resources to meet them, establishing priority
goals that are realistic and feasible and
projecting administrative action to accomplish
the purpose of the proposed program – WHO

29. Purposes of Planning
– To match the limited resources with many
problems
– To eliminate the wasteful resources or duplication
of expenditure
– To develop best course of action to accomplish a
defined objectives

30. Characteristics of Planning
• Plans have flexibility
• Change adaptability: time and space
• Plan balances between idealistic and practical
• A fundamental function of management
• Logical Procedure is followed
• Related to the specific goal
• Anticipating changes and updates in existing plan
• Planning for the unknown
• Planning is a cyclic process, goal and specific
objectives are recycled

31. Importance/Benefits/Advantages of
Planning
• Provides direction
• Provide opportunities to analyze alternative courses of
actions.
• Reduce uncertainties
• Minimize impulsive and arbitrary decision
• King-pin Function
• Resource allocation
• Resource use efficiency
• Anticipated Action
• Environmental adoption
• Better coordination
• Commitment………………………………………and so on.

32. Types of Planning (On the basis of
Management Hierarchy)
1.Corporate Plan ( Strategic Plan)
2. Tactical Plan ( Divisional Plan)
3. Operational Plan ( Unit plan or Functional
Plan)

33. Corporate Plan (Strategic Plan)
• Organization wide.
• Overall mission, goals and
strategies.
• Long term plans ( five or more
years)
• Prepared by Top Management
• Based on SWOT analysis
• Long term directions and scopes

34. Tactical Plan (Departmental or
Divisional Plan)
• Tactical goals implementing corporate plan.
• Identifies the priorities of divisional activities.
• Prepared for each department or division.
• Prepared by middle level management.
• They are medium term ( usually 1 to 5 years)
• Might be based on SWOT Analysis.
• Consistent with corporate plan.

35. Operational Plan (Unit Plan)
• Concerned with day to day activities.
• Action plan for each unit
• Prepared by lower management
• Short term, annual, quarter, month.
• Measurable and flexible.
• Consistent with tactical plan.

36. Corporate, Tactical and Operational Plan
Type of Plan
Corporate
Plan
Tactical Plan
Operational
Plan
Time Horizon
Long Term
Medium Term
Short Term
Responsibility
Top
Management
Middle
Management
Lower
Management

37. Types of Planning on the basis of
approach adopted
• Pro-active
• Reactive

38. Pro-active Planning (Future Creating)
• Proactive planning involves designing suitable
courses of action in anticipation of likely
change in the relevant environment. Most of
the successful organizations generally
follow/adapt proactive approach.

39. Reactive Planning
• In reactive planning, organization's responses
come after the environmental changes have
taken place. After the changes take place,
these organizations start planning. In such
situation, organization loses opportunities to
these organizations which adopt proactive
approach because by the time reactors are
ready with their plans.

40. On the basis of Use
• Single use Plan
• Standing use plan

41. Single use plan
• Develop to meet the needs of a particular
situation.
• Pre-pared for non repetitive activities.
• E. Project Budget

42. Standing use plans
• Developed for ongoing repetitive activities.
Examples : Mission, goals, policies, strategies,
procedures.
• Guidance for the repeatedly performed
actions.

43. Types of Planning on the basis on the
basis of time
• Long Term
• Medium Term
• Short Term

44. Long Term Planning
• Long term planning is of strategic nature and
involves more than one year and extending to
Twenty years. Long term planning involves the
analysis of environment factors.

45. Medium Term
• Those planning which are not Short term or
Long term.

46. Short term Planning
• Short term planning is also known as
operational or tactical planning, usually covers
one year. E. g. Annual plan, monthly planning.

47. Steps in Planning
• Analyze opportunities
• Set Goals
• Develop premises
• Determine and evaluate alternatives
• Select a course of action
• Formulate action Plan
• Prepare Budget
• Evaluation

48. 1. Analyze Opportunities
• Based on SWOT
• Be aware of opportunities
• Environmental scanning
• Resources assessment to find the availability
of resources.

49. 2. Set Goals
• Goals are results to be achieved.
• Set for entire organizations and for divisions
and units.
• Further break down in to the objectives.
– Specific
– Measurable
– Acceptable
– Realistic
– Time bound

50. 3. Develop Premises
• Under what environment our plans will
operates.
• Key assumptions about the future
environment.
• Forecasting is important for planning.
• About services, quality of care, technology.
• Premises should be developed about all the
critical aspects of plans.

51. Premises
• Anticipated environment.
– Demographic trends.
– Future health status.
– Political-legal environment
– Technological changes and innovations.
– Conditions of markets
– Resources availability
– Socio-cultural forces.
• Internal and External Premises
• Tangible and intangible premises
• Controllable and uncontrollable premises.

52. 4. Determine and evaluate Alternatives
• Most attractive alternatives are identified for
evaluation.
• Evaluated in terms of contribution to goals
achievement.
• Quantitative tools
• Highest profit and lowest cost.
• Low input good quality of care.

53. 5. Selects a course of actions
• Best course of action.

54. 6. Formulate Action Plan
• Action plan for each activity is prepared.
• Set time bound targets.
• Action plans answer
– Activities.
– Responsibilities
– Timeliness
– Methods

55. 7. Prepare Budget
• Financial Plan.
• Actions plans are converted into budgets.
• Prepared for each activity.

56. 8. Evaluation
• Systematic and purposeful analysis of the
achievements.

57. Planning Cycle
Identification
of Problem
Determination
of Priorities
Identification
of Resources
Program
Supervision
and
Monitoring
Implementation

58. District Health Planning
Participation
Where
we are
now?
Where
to go?
How we
will get
there?
Where
we
reached?

59. Methods of Planning
• Top Down (Inductive)
– Prepared by Top Management.
– Centralized
• Bottom up (Deductive)
– Prepared by middle and lower level managers
– Decentralized
• Participative
– Combined approach of Top down and Bottom Up approach.
– Also called Management by Objective
– Prepared the plan and sent for review and approval to top management
• Team Method
– A separated group is formulated for the planning.
– Consist both managers and line staffs with technical skills.
– Prepared the plan and sent for review and approval to top management.

61. There is no strategy, no plan, no
leadership at the State Level - no
strategy, no plan, no leadership at
the Local Level
- Henry Nicholas
National Union of Hospital and Health Care Employees.

62. What Does Strategy Mean?
Origin: Greek Word “STRATEGO” meaning “to
plan the destruction of ones enemies through
effective use of resources”
Hence, a lot of term commonly used in
relation to strategy - objectives, mission,
strengths, weaknesses - were developed by
the military.

63. Strategic Planning, Strategy and
Strategic Management Definitions
A strategy is a pattern in a stream of decisions
positioning an organization within its environment
and resulting in the “behavior” of the organization.
Additionally, a strategy is a future-oriented plan that
provides decision-making guidelines for managers
Strategic planning is the set of processes used in an
organization to understand the situation and develop
decision-making guidelines (the strategy) for the
organization.
.

64. Strategic management is a philosophy of
managing the organization that is extremely
oriented and links strategic planning to
operational decision-making. Strategic
management attempts to achieve a productive
and creative fit between the organization’s
external environment and its internal situation.

65. Strategy as a Behavior of the Organization
Manageme
nt Values
and Culture
What the
organization
wants to do
Integration of what the
organization should do, wants to
do, and can do in order to
develop decision making
guidelines
(Strategic Planning)
The
Plan
External
Environment
What the
organisation
should do
External
Environment
What the
organization
should do
Internal
Environment
What the
organization
can do

66. Why strategic management?
- Demographic Shifts
- Population mobility
- Increasing Costs
- Increasing Competition
- Shortage of resources
- Changing role for public health

67. The Benefits of Strategic Management
-Strategic management will improve long-term
financial performance.
-Provides the organization with a self-concept, specific
goals, guidance, and consistency in decision making.
-Managers/Administrator understand the present, think
about the future, and recognize the signals that suggest
change.

68. Strategic management requires managers to
communicate both vertically and horizontally.
Overall coordination within the organization is often
improved in strategically managed organizations.
Strategic management encourages innovation and
change within the organization to meet the needs of
changing situation.

69. Strategy Links Today with Tomorrow
Profile of the
Organization
Today Strategy
Vision (Hope)
of the
Organization
in the Future

70. Fig. Process of strategic Planning

71. Steps of Strategy formulation
• Define organization’s missions, goals,
strategies.
• Analyze external environment
• Identify opportunities of competitive
advantage
• Analyze Internal Environment
• Identifying strengths and weakness
• Match Resources with opportunities

72. Define organization’s mission, goals,
strategies
 Mission-
◦ Reason for existence of organization.
◦ Defines nature and competitive scope of organization.
◦ Provides direction to the organization for a long term.
 Goals
◦ Desired outcomes.
◦ End results to be achieved.
 Strategies
◦ Broad action plans for achieving objectives.
◦ Identify sustainable competitive advantages.

73. Analyze External environment
• To detect trends and create scenarios.
– Political-legal
– Economic
– Socio-cultural
– Technological forces
• Opportunities and threats

74. Identify Opportunities of competitive
Advantage
• Position of superiority in relation to
competitors.
• Superior skills, resources, controls or
customers values.

75. Analyze Internal Environment
• Resources Analysis
• Human, Financial, Physical, information.
• Organization’s Resource capability and
availability determination.
• Analysis of goals, policies, structures and
cultures.

76. Identify strength and weakness
• Assessment of internal environmental factors.
• Identify core competencies.

77. Match resources with Opportunities
• Matching the resources with opportunities of
competitive advantage.
STRATEGY
FORMULATION

79. SWOT ANALYSIS
Strength: Resources, capacity and capability for
attainment of goals
Weakness: limitation, fault and defect in the
organization which obstructs effective use of resources
Opportunity: favorable environment for the
organization which it can take advantage of but is not in
the control of the organization
Threat: situation potentially damaging to the
organization and is not under the control of the
organization

80. When Strategic Management Fails?
- Less than full commitment from top management
- too little emphasis on building the data base needed
for decision making
- Misconceptions that, once set, objectives will take
care of themselves
- failure to integrated planning and budgeting
- lack of attention to implementation strategies.

81. Others Methods…..
• PEST Analysis
– Political
– Economic
– Social
– Technological

82. Other Methods..
• STEER
– Socio-cultural
– Technological
– Economic
– Ecological
– Regulatory factors

83. Others methods…..
• EPISTEL
– Environmental
– Political
– Informatics
– Social
– Technological
– Economic
– Legal

84. MANAGEMENT BY OBJECTVES

85. Approaches to Goal Formation
• Top Down approach: Management driven
– Top level managers determine goals
• Bottom-up Approach: Subordinate Driven
– Middle and lower managers set goals and
presents them to top level managers.
• MBO Approach: Driven by both Management
and Subordinates.

86. Management By Objectives
• The process of collaborative goal setting by
manager and subordinate , the extent to
which goals are accomplished is major factor
in evaluating and rewarding the subordinate’s
performance. (Google)

87. MBO
Prof. DR. Govinda Ram Agrawal
– MBO is a mixed approach where superiors and
subordinates collaborate in specific goal setting.
– It works from the bottom up as well as from the top
down.
– Secures commitments to goals for a specific time
period.
– PA is focused on Results which is periodically
reviewed.
– Rewards are linked to goal achievement.
– Feedback facilitate self-control of Performance by
subordinates.

88. MBO
Stephen P. Robbins
– Process of setting mutually agreed upon goals and
using those goals to evaluate employee
performances.

89. Nature and Purpose of MBO
• To give subordinates a voice in the goal setting
and planning process.
• Clarification to the subordinate’s what they
are exactly expected to accomplish in a given
time.
• Concerned with goal setting and planning for
individual managers and their units or work
groups.

90. Management by Objectives
• According to Stephen P. Robins MBO has four
elements
– Goal specificity
– Participative Decision Making
– An Explicit Time Period
– Performance Feedback

91. MBO as a Cyclical Process
MBO
Collaborative
Goal Setting
Action Plan
Development
Periodic
Review of
Performance
Performance
Appraisal
Starting MBO
1. Collaborating Goal
Setting
2. Action plan
development
3. Periodic Review and
evaluation
4. Performance Appraisal
Fig. MBO as a Cyclical Process

92. Benefits of MBO
• Increased motivation of employees
• Enhanced Communication
• More objectives performance appraisal
• Helps in finding managerial talents
• Ensures effective control

93. Problems associated with MBO
• Improper Implementation
• Lack of top level management support
• Lack of commitment at lower level
• Too much emphasis on quantitative goals.

94. Others Approaches
2. Management by Discussion (MBD)
– In this case, the manager discusses objectives and activities with his
team, obtain their views and makes a decision.
3. Management by mushroom (MBM)
– This manger treats his employees like mushrooms; he keeps them in
the dark and never informs them about anything. He is frightened of
his employees and doubts his own advancement.
4. Management by illusion (MBI)
– This manager is tricky; no one quite knows what his real aims are. He
may say something and mean something else. Usually he is only
concerned for his own advancement.
5. Management by Exception
– Management by Exception is system of identification and
communication that signals to the manager when his attention is
needed.

95. SETTING OBJECTIVES

96. Setting objectives
• Generally top management determines the overall
objectives which the members of organization unite to
achieve.
• In large entities, the bodies as board of directors,
governing board, executive committee may set the
objectives.
• On the basis of interaction, management should set general
objectives. General objectives are quiet broad in nature and
show the direction in which the organization will like to
proceed.
• Managers determine specific objectives which they and
their units will seek to attain most of these objectives tends
to be of shorter range.

97. Guidelines for objectives setting
• Objectives must be clearly specified.
• Objectives must be set taking account of the various factors
affecting their achievement.
• Objectives should be consistent with organizational mission.
• Objectives should be rational and realistic rather than idealistic.
• It must be achievable.
• It should yield specific result.
• Objectives should start with word to and followed by an action
verb.
• Objective should be consistent with time.
• It should be periodically reviewed.

98. SMART
• Specific
• Measurable
• Achievable
• Realistic
• Time bound
Example
“To make 95% of the participants will be able to
say any two harmful health consequences of T
and A consumption after one day orientation”

99. OPERATIONAL RESEARCH
FOR PLANNING

100. Operational Research for Planning
• Concept of operation research developed
from Second World War.
• Based on probability theory.
• In the recent years this theory is applying in
economic and political problems.

101. Operational research……
Operation research, which is the application of
scientific method to study alternatives, is a
problem situation to obtain a quantitative
basis for reaching at best solutions among the
various tools for planning and controlling. The
example of the tool is Inventory Planning and
control.

102. Operational Research……
Operational research emphasized defining
“the problem and goals, carefully collecting
and evaluation of data, developing and testing
of hypothesis, determining the relationship
among data. Developing and checking
predictions based on hypothesis and devise
measures to evaluate effectiveness of course
of actions”.

103. Characteristics of operation research
applied to decision making
• It emphasizes on the logical representation of a reality or
problem. It shows the relationship among the variables
involved.
– It emphasizes goals in a problem area and the development of
measures of effectiveness in determining whether, the given
solutions shows promise of achieving those goal
– It incorporates in a model and the variables in a problem.
– It put the model, and its variables, constrains, and goal in
mathematical terms so that they can be clearly identified.
– It quantifies the variable in a problem to the extent possible
– It supplements much unavailable data with such mathematical
and statistical devices as probability in a solution.

104. System approach to planning
• It is modern type of approach in management.
• A system has boundaries but also they interact with the
external environment; i.e. organizations are open systems.
System is a goal oriented, composed of part that are
interacting and interrelated. The total system is greater
than the sum of parts. The system theory views the
organization as a unified whole, composed of interacting
and interrelated subsystems. Subsystem is the part of
organization. Activity of one parts of the organization
affects the other parts.
• This process views organization as an input/output system.
It is regarded as one of the recent development in
management theory. There are various subsystems within a
system.

105. Subsystems are
• People- person working in organization.
• Technology- equipments, methods, process
and skills.
• Structure- activities and integration of efforts.
• Management related to the organization and
its environment

106. Inputs
Output
External Environment
Reenergizing the system
Process
Fig: Systems Approach

107. REFRENCES
• MANAGEMENT, Stephen P. Robbins, Marry
Coulter, Neharika Vohra, 10th Edition.
• Principles of Management in Nepal. GR
Agrawaal.
• Essential of Management by Koontz.
• Management by Pramila Thapa
• Current Annual Report
• Wikepedia /google

108. THANK YOU