2. Learning objectives
2
By the end of this chapter, the student will be able to;
Define health planning
Discuss the difference type of planning process
Describe the steps of planning process
Conduct SWOT analysis
Identify the role of the healthcare manager in the planning
process
3. What is Planning?
3
Blum (1974)
• Planning is defined as:
“ The deliberate introduction of desired social change in orderly and
acceptable ways”
Planning involves synthesis in terms of putting together plans,
policy, programs or something else new (Creating change).
Hoch (1994): Described good planning as the popular adoption of
reforms in the provision of public goods.
4. What is Planning?
4
Planning is the effort to control social or collective uncertainty
by taking action now to secure the future.
Planning is the compiling & analyzing information,
dreaming up ideas, using logic and imagination &
judgment in order to arrive at a decision about what should be
done.
Planning is the process of deciding & establishing an
organizational goals/objectives and charting out suitable course
of actions for achieving these goals/objectives
5. What is planning?
5
Planning is a continuous process involving decisions or choices,
about alternatives, with the aim of achieving goals in the future.
Is instrument to guide/monitor the process of change
Planning is a means to:
Make a choice
Allocate resources
Achieve goals
Schedule activities for the future
6. Basic questions to raise during Planning sessions
6
Five Basic Questions:
(1) Where are we now? (The Situation)
(2) How did we get there? (Our Momentum)
(3) Where are we going? (The Direction)
(4) Where should we be going? (Desired Direction)
(5) How will we get there? (The Strategic Plan)
7. Definition of Health Sector Planning
7
Is the process of defining community health problems
Identifying needs and resources
Establishing priority goals
Setting out the administrative action needed to reach those
goals.
8. Health Service Planning
8
‘
Health services planning’is a term used with
increasing frequency today and reflects the
growing interest in the topic in the 21st century.
The term can mean different things to different
people
9. Health service Planning
9
‘
Health services planning’has been described as,
A process that appraises the overall health needs of a geographic
area or population & determines how these needs can be met in the
most effective manner through the allocation of existing and
anticipated future resources (Thomas 2003).
Ultimately, all planning comes down to:
Identifying the needs of the target population
Determining the best means for meeting those needs
10. Initiating Health Services Planning
10
There are many reasons for initiating a health services
planning process, which can emerge from;
The community, an organization or the interest of a
particular group or individual
However, any health care services plan reflects the
influence of the political, social and economic
considerations that are within that particular healthcare
environment.
11. What initiates Health Service Planning?
11
On the basis of change arising from:
Health care reforms which have changed accountability
and decision making within the Health system
e.g. The development of Health Extension Programs,
Introduction of Health Insurance System
Health care needs which can change over time according
to:
- The age structure and health profile in a population;
e.g. the increasing numbers of older people mean a
concomitant increase in disability and illness, in particular
those of Hypertension, musculoskeletal and cardiovascular
diseases, and sensory impairment.
- Health and social systems need to address the treatment
and care of the increasing numbers of people with these
problems.
12. Initiates Health Service Planning--
12
Technological advances which continuously challenge
the health service to put in place a robust and integrated
ICT infrastructure
e.g. Technology and medical advances are major drivers
of health expenditure and have significant potential to
improve the outcomes and the efficiency of the health
service.
Evidence-base programs setting quality standards and
specifying services
13. Purposes of Planning
13
Reach the objectives of the organization (Fundamental)
Minimize the risk by reducing uncertainties
(Protective Purpose)
Increase the degree of organizational success
(Affirmative purpose)
14. Reasons for planning
14
Provide direction
Sets standards to facilitate control
Minimize waste and redundancy
Reduces the impact of change
16. Attributes of Planning
16
1. Futuristic:
• Anticipate the future (clear vision/mission, goal & objectives)
• What is required & how it will be accomplished
2. Decision making:
• Determine what is to be done, when, where, how and for what
purpose
• Choosing among alternatives
• Resource allocation
17. Attributes of planning
17
3. Dynamic & Continuous
• Because planned activities are affected by internal & external
factors
• A collective efforts of different bodies/parties
4. Tap-root (baseline) for the other elements of management
process
18. What does Planning include?
18
Planning includes the ability to:
Identify opportunities
Analyze problems
Establish priorities and needs
Allocate available resources
Planning also includes the ability to establish:
Policies and procedures
Objectives and standards of performance
Forecasts and budgets
Programs and schedules
19. Conditions for Successful Planning
19
Practical (Attainable)
- Should be doable (technically)
- Obtainable required resources
- Organization for its implementation
Desirable
- Socially acceptable
- Involvement of stakeholders
- Acceptable to all stakeholders
- Economically feasible & sustainable
20. Hierarchy of Plans
20
Strategic Plan
Operational Plan
Team Action Plan
Individual work plan
22. Classification of plans----
22
Repetitive plan
Standing Plans:
- Can be used again & again
- Are followed each time a given situation encountered
- Include mission, goal/objective, strategy, policy. Procedure, method
and rule
Single-use Plans
- Are those plans that are not used up once the objective is
accomplished
- Used only once
- Include: programs, budgets, projects
23. Classification of plans----
23
Time dimension:
(1) Long-range planning
- Distant future
- Time may range from 5-10years
(2) Intermediate-range planning
- Ranges between long & short range plans
(3) Short-term planning
- Complementary of long-range plans
- Constitutes as step towards implementation of long-range plans
- Ranges from 1 to 2 years
24. 24
Scope/breadth dimension
Activity planning
- Relates to the setting of monitorable timetables & schedules
for the implementation of pre-set activities
Operational plans
- contain details for carrying out or implementing those
strategic plans in day to day life
25. 25
Allocative planning: the making of decision as to how resources
should be spent
Strategic plans: are designed by high-ranking managers and define the
broad goals for the organization.
It is a road map for the organization
Focuses on establishing your organizations direction.
Setting priorities & identifying obstacles & opportunities that may
limit or enable you to carry out your mission
26. 26
Strategic Planning: is the process of identifying a desired
future state for an organization and a means to achieve it.
Through an ongoing analysis of the organization’s
environment, matched against its own internal capabilities an
organization’s leadership is able to identify strategies that will
derive the organization from its present condition to that
desired future state.
27. Differences between strategic & operational plans
27
Areas of difference Operational Plans Strategic plans
Experts involved Developed by Low-
level management
Developed by upper
level management
Time horizon Cover short period (
1 week to one year)
Covers a relatively
long period 2-10
years
6 months to 2 years
Scope Narrow range of
operations
Wide range of goals
Degree of detail Detail & specific
activity
Simplistic & general
28. Planning Approaches
28
There are various approaches to health service planning which can
range from:
‘
Problem solving’
,
‘
Long-term versus shorter operational plans’
‘
Narrative approaches’which uses matrices presenting a nested
set of objectives.
Plans may also be aimed at particular services such as:
• Primary care programs (e.g. HIV/AIDS)
• Institutions (e.g. hospitals)
• Wider geographical area such as a district.
The planning would facilitate a more effective use of the scarce
resources available for health care.
Health Planning: A process of deciding how the future should be
better than present.
29. Health Service Planning
29
Who is involved?
Planning is concerned with change and the
prospect of change inevitably brings opponents
and supporters of the proposal.
The relationship between planners, policy
makers, service-managers, communities and
other stakeholders in the planning process is
critical to the success of planning.
.
30. Who is involved? ----
30
A significant number of health planners are drawn
from health professions e.g. medicine, nursing, and
public health, however one of the challenges today is
not so much a matter of trying to develop specialist
health planners but rather that of exposing a broad
range of professionals to the importance and concepts
of planning in order that they can participate in the
process.
Ensure that planning systems are designed and
operated so as to provide real (rather than token) input
from communities and users in the planning process
31. Planning is a Cyclic Process
31
Step-1. Analysis of the Health Situation.
Collection, assessment, interpretation of information and
demographic data through surveillance .
Epidemiology of diseases, mortality and morbidity data
Medical care facilities, technical manpower, training facilities.
KABP of population about disease prevention and cure.
32. Planning is a Cyclic Process
32
Step-2. Establishing Objectives & Goals.
Reduces hazard activities, uneconomical use of funds, poor
performances.
General Objectives/procedures at upper level become more
specified and detailed at lower levels.
Resources are directed properly taking into nature of objectives
(Short Term/Long Term)
Defining goals, objectives and targets.
33. Planning is a Cyclic Process
33
Step-3. Assessment of Resources
In terms of manpower, money, material, time,
knowledge, techniques and skills.
A balance is maintained what is required, what is
available and how to be utilized.
34. Planning is a Cyclic Process
34
Step-4.Fixing Priorities
Prioritizing objectives/activities in order of importance/ magnitude.
A good health manager is a PAPA ( Plans well, Analyses critically,
Prioritizes Activities and Act timely/promptly).
Formulation of alternate plans.
35. Planning is a Cyclic Process
35
Step-5. Writing of formulated Plan
Preparation of detailed plans
Working guidance to all those responsible for execution
e.g. Health Care Providers.
36. Planning is a Cyclic Process
36
Step-6. Programming and Implementation.
Effective organization like staffing, coordination, communication
etc.
A standard operating procedures for specific tasks and roles.
Selection, training, motivation, supervision and monitoring of the
manpower.
Proper management functions are required here.
37. Planning is a Cyclic Process
37
Step-7. Monitoring: “Tracking the tract”.
Following the activities during their implementation whether they
are proceeding according to predefined schedule or not.
Keeping the track of the course of activities and taking corrective
action before gross failure/deviation occurs.
38. Planning is a Cyclic Process
38
Step-8.Evaluation: To assess/measure the degree of achievements of
the stated objectives and targets
Assessment of adequacy, efficiency, effectiveness etc of final
outcomes of a health activity
Important for feed-back, opportunity for correction of deficiency
and gaps during phase of implementation
39. Pre-Planning Stages
39
Government Interest: Strong Political Will for Policies.
Legislation: Translating social & health policy to legislation.
Organization for Planning- ex Planning Commission/adhoc
groups/TWG etc
Administration Capacity: For proper and implementation at
district, state & national level.
40. Planning is a Cyclic Process of PIE
40
Planning (P)
Implementation (I)
Evaluation (E)
41. Planning Tools
41
Are techniques that help in planning process
Tools used for planning include
SWOT analysis
Consensus techniques
Scheduling
42. SWOT analysis
42
Is a strategic planning tool that includes
analysis of:
Internal (organizational) strength and
weakness
External (environmental) opportunities and
threats
44. SWOT----
44
E.g. In a health service organization:
Strength
Availability of resources and trained human
power, highly experienced and motivated staff
Weakness
Obsolete (outdated) facilities, lack of commitment
Opportunities
Supportive government policies
Presence of a functional health committee in the
communities
Threats
Poverty/Competing needs
45. Steps in Health Planning
45
1. Situation analysis
2. Priority setting
3. Option appraisal (set Objectives & Targets)
4. Identifying obstacles and limitations
5. Designing the strategies
6. Plan of action
46. Step1 - SITUATIONALANALYSIS
46
Gives improved understanding of the current situation from
various perspectives
Answers the question “where are we now?”
Two major aspects regarding the current situation need to be
described
Identification of health and health related needs of the
community
Available resources
Measurable Result:
A common reference point for the rest of the planning process
Allows the selection of priority areas of
concern for planning
47. Situation analysis …
47
Contents
1. Population characteristics
2. Area characteristics
3. Policy and political environment
4. Health need analysis
5. Analysis of health services
6. Analysis of resources
7. Review of past implementation experience
48. 1. Population characteristics
48
Study the size, composition and distribution of the
population.
Identify the target groups
Determine population size by category
Estimate overall population growth
Determine religious, educational and cultural characteristics
49. 2. Area characteristics and infrastructures
49
Geographical and topographical situations
Infrastructures – transport modes and routes, means of
communication, water supply and sanitary facilities, electric
supplies etc
Socioeconomic situations – amount and distribution of
family income
Public and private sector structure
50. 3. Policy and political environment
50
National programs should be used as a guide during
planning exercise
Review
National health policy
Other policies related to the health problems to be
addressed in the plan
Major strategic documents developed at higher levels
International priorities, strategies and guidelines
Relate actual situation in the area of concern
with these guidelines
51. 4. Health need analysis
51
Analyzing the health needs and the magnitude of health
problems is a basic prerequisite for planning
Two broad approaches
Medically perceived health needs
Community perceived health needs
A combination of the two approaches at this stage provides a
better ground for planning
52. Medically perceived health needs
52
Involves the process of identifying the needs of a community from
health professionals’ perspective
Major information sources include:
Community health survey
Morbidity rates – incidence, prevalence
Mortality rates – IMR,
Disability rates
Record review of health service contacts
Interview with health professionals
53. Community perceived health needs
53
Involves the identification of what the community feels
about their health problems.
Two commonly used information sources
Survey of the attitudes and views of community members regarding
their health needs
Using existing community structures like village health/development
committees, other social networks (Idir, Ekubs, …)
54. 5. Analysis of health services & resources
54
Analyze organizational structure, functions and resources of health
services
Number and geographical distribution of health facilities
Availability of resources in existing health facilities
Availability of services in health facilities
Service gaps
Service utilization
Identify bottle necks in organizational structure
Analysis of other resource (Finance, Personnel, Equipment, Space,
Time, Information, Technology)
55. 6. Review of past implementation
experience
55
An effective organization always learns from its
past experiences.
This involves finding out information or
experience from activities implemented in the
past
Successes
Weaknesses
Experiences/ lessons learned
56. Step 2 - PROBLEM PRIORITIZATION
56
Why?
We have only limited resources
Time, Money, Material and Others
We have unlimited needs competing for these limited
resources
Managers need to solve some problems before others
A problem is the difference that exists between:
The present situation and a desired future
57. Prioritization …
57
• While analyzing problems:
Define clearly what the problem is
Find all possible causes of the problem
E.g. What are the possible root causes of high diarrheal disease
incidence?
Inadequate water supply
Unsafe water supply
Poor sanitary conditions
Inappropriate infant feeding practice, etc
58. Grouping of problems
58
Grouping of identified problems allows managers to design
interventions for groups of activities
Environmental problems: Air pollution, poor sanitation
Diseases/health problems: Malaria, TB, HIV/AIDS
Socio-economic problems
Low per capita income, low literacy rate
Cultural and religious beliefs and values
Health services problems
Poor quality and quantity of drugs
Lack of qualified personnel
59. Prioritization …
59
Planning is usually a participatory process; involving different
members with different views to a specific situation.
Priority problems are often selected by setting selection criteria and
giving scores for each problem according to the criteria
Criteria for problem prioritization include but may not be limited
to:
Magnitude of the problem
Degree of severity
Feasibility of control measures
Government concern
Community concern
60. Criteria for problem prioritization
60
Magnitude of the problem
The public health burden imposed by the problem
Degree of severity
Consequent suffering, death and disability
Feasibility:
Cost effectiveness
Social acceptability
Local sustainability
Government concern
Political acceptability with consideration of equity
Multi-sectoral approach
Consistency with government plan and budgetary system
Community concern
How much does it relate to community perceived health needs
61. Ranking using scale
61
Ranking is then done by using criteria on 5 point scale
Very high (5)
High (4)
Moderate (3)
Low (2)
Very low (1)
62. Step 3 - SETTING OBJECTIVES AND
TARGETS
62
Describing the desired direction of a service in terms of
measurable parameters
Answers the question “where do we want to go?”
“If you don’t know where you are going, any road will get you
there.” Lewis Carroll
Clear statement of objectives enables
To decide how to achieve them
Improves efficiency by avoiding unnecessary investments
To evaluate how effective one is in achieving and reaching
objectives
63. Objectives …
63
Objectives of a program must be ‘SMART’
Specific- an observable action, behavior or achievement which
is described and also linked to a rate, number, percentage or
frequency
Measurable - A system, method or procedure has to exist
which allows the tracking and recording of the behavior or
action upon which the objective is focused. It allows
monitoring & evaluation
Achievable – capable of being reached. There is a likelihood of
success but that does not mean easy or simple. The objectives
need to be stretching and agreed by the parties involved.
64. Objectives …
64
• Relevant – it is in agreement with the general health policy or
relates to the problem to be solved or reduced. Its real
importance to the organization & the society
• Time bound (time specific) - has specified period of time
• E.g. By the year 2018, 30% of pregnant women will deliver at
health institution by skill health provider in semera town.
65. Step 4 - Identifying potential obstacles & limitations
65
Situations that may prevent the achievement of each objectives
& targets
The limitations may be
Resources
Human – lack of interest/skill
Equipment – not available/expensive
Money - lack of budget
Time - people may not have time
Information - needed for implementation not timely /well
processed
Environmental obstacles
Geographical features like lakes, rivers, mountains
Climate – affect the nature of health problems
Technical difficulties, social factors, taboos, traditions
66. OBSTACLES cont…
66
There are three groups of Obstacles
1. Obstacles that can be removed
2. Obstacles that can be reduced/modified
3. Obstacles that can’t be changed
67. Step 5 - DESIGNING STRATEGIES
67
Strategies; are the tactics or techniques that should be devised
or adopted & utilized to facilitate the achievement of objectives
& targets.
Strategies are ways of achieving objectives & targets
Potential strategies often include
Technology to be applied
Procedures to be used
Defining the role of communities and other sectors
68. STRATEGIES …
68
For each chosen strategy, the corresponding activities to be
undertaken & the resources needed should be detailed.
What is to be done?
Who will do the activities?
Which resources are needed?
How? (procedures for technical, administrative, community
workers, contribution of other sectors)
When to do it? (beginning, end)
Where the work will be done?
How would the activity be monitored and evaluated
69. Step 6 - WRITING UP THE PLAN
69
Purpose
To request funds or resources from the government or
other funding agencies
To be used as a guide for implementation
For monitoring & evaluating the implementation process
by all concerned
70. WRITING UP cont…
70
The following need to be included in the plan document:
Summary of main points
Introduction
General background
Statement of the problem
Objectives and targets
Strategies
Activities and the Gantt chart (activity schedule)
71. WRITING UP cont…
71
• Resource requirement
The type and number of resources needed
How each of the resources are going to be utilized
• Monitoring & evaluation
Mention how monitoring and evaluation is to be performed
By whom (Internal Vs External)?, When?
Indicators of effectiveness should be decided before
implementation
