HEALTH PLANNING
Professor Syed Amin Tabish
FRCP (London), FRCP (Edin.), FAMS, MD (AIIMS)
Postdoc Fellowship, Bristol University (England)
Doctorate in Educational Leadership (USA)

Responsibilities of a Doctor
 Patient Care: Disease
Prevention, Health Promotion,
Medical care with advanced
technology
 Some level of teaching
competence with
professionalism
 Research

Pressures of Changes
 Knowledge Explosion
 Technological Advances
 Information
Superhighway
(Internet/World Wide
Web)

Roles of Physician
 Medical Expert (clinical decision-
maker)
 Communicator / Educator
 Collaborator (team leader)
 Manager/Leader: managing resources
 Health advocate
 Scientist/Scholar
 Professional: to provide high quality
care with honesty & compassion

What are the responses
 A New Curriculum: Outcome-
based, community-based
 New Educational strategies: PBL,
SDL, Integrated learning, task-
based learning, Core curriculum
& student-selected components
 New Curriculum models:
Communication skills,
preparation for practice, team
work, EB practice

Health Planning
 During the 20th century, the
expectation of life in all parts
of the world has been
transformed
 Concerns for efficient use of
health resources
 Importance of health
planning widely recognized

Planning
 Deciding how resources
should be allocated
 Determining how to
implement these decisions
 Judicious health planning
is crucial

Planning
 A method of trying to
ensure that the
resources available
now and in future are
used in the most
efficient way to obtain
explicit objectives

Planning
 A system of making decisions
about how an organization
will use its resources in the
future
 It involves making of choices
 Requires possibility of real
alternatives
 Resources are limited

Important components
 Where are we going? –
Objectives
 With what? –
Resources
 How? - (efficient
implementation)
 When? – (future)

Health care
 Public Health Services
(environmental sanitation)
 Personal Preventive
Services (immunization)
 Personal Curative Services
(hospitals, health centres)

PLANNING SPIRAL
 Situational Analysis
 Priority Setting
 Option appraisal
 Programming & budgeting
 Implementation &
monitoring
 Evaluation

Situational Analysis
 Assessment of present
situation
 Examine the current &
projected health situation,
the demographic pattern,
and present & future
health needs

Situational Analysis
 Looks at the general
socioeconomic & provision
of non-health services &
infrastructure
 Analysis the infrastructure
of health sector & the
pattern of services
provided

Situational Analysis
 Examines the current &
future resources of the health
sector in terms of both
financial resources & real
resources (personnel,
equipment, buildings, etc.)
 Analysis the efficiency &
effectiveness within which
the health sector operates

Situational analysis
 General country
characteristics
 Health Status Needs
 Health Service availability
 Policy & political
environment

Demographic information
 Absolute size & distribution
of population
 Vital statistics (births,
deaths, fertility)
 Population growth rate
 Age & sex structure

Priority Setting
 Determination of goals,
objectives & targets of the
organization
 Ensuring that the
priorities are set are
feasible within the social
& political climate

Option Appraisal
 Generation and
assessment of various
options for achieving each
of the set objectives and
targets
 Appraisal info:
effectiveness, efficiency,
equity, acceptability,
feasibility, resource
availability

Programming & Budgeting
 Translate the results of
the earlier decision into a
series of programmes
each with a budget and
resources
 Option chosen
 Budgetary info
 Resources

Implementation & Monitoring
 Transforming the broad
programs into more specific
times and budgeted sets of
tasks and activities
 Involves the drawing up of a
more operational plan of a
work
 Monitoring of the
implementation of activities

Implementation
Management info at
service provision stage:
 Utilization of services
 Cost
 Constraints

Evaluation
Provides the basis for
the next situational
analysis

Primary Health Care
The Alma-Ata
Declaration (1978)
endorsed PHC as
the key to
achieving HFA goal
National Rural
Health Mission

Essential Components of PHC
 Education concerning
prevailing health problems
and methods of prevention &
control
 Promotion of food
supply/nutrition
 Safe water & basic sanitation
 MCH/RCH

Components of PHC (contd)
 Immunization
 Prevention & control of
locally endemic diseases
 Treatment of common
diseases
 Provision of essential
drugs

Equity
Emerging Issues in HC:
 Equal health
 Equal access to health care
 Equal access to HC according to
need
 Equal utilization of HC according
to need
 Planning requires identification
of disadvantaged groups and
address their needs

Approach to planning
 A clear definition of equity
 A clear process for involving
communities in decision
making about strategies to
improve their health
 A clear process for involving
other sectors in health-
promotive strategies

Approaches to planning
Management
structures consistent
with the principles of
PHC
Criteria for assessing
the appropriateness
of approaches chosen

Data Collection/Information
 Surveys
 Vital registration
 Treatment records
 Notifiable diseases return
 Management reports & return
 Informed opinion (meeting with
individuals/groups)
 Information from other
ministries, institutions, agencies

Information on Health Needs
Basic requisite for a plan
Medically perceived Health Needs:
 Morbidity rates
 Mortality rates
 Disability rates
 Antenatal care
Community perceived Health Needs:
 Service deficiencies

Information of Services/Resources
 Socioeconomic situation &
infrastructure
 Socioeconomic & cultural
characteristics
 Geographical & topographical
characteristics
 Infrastructure
 Services provided by other sectors
(education, water, sanitation,
agriculture, public works)

Information (contd.)
Health Services
 Service facilities (hospitals,
beds)
 Service utilization
(occupancy rates,
immunization)
 Service gaps (areas not
covered by basic facilities;
projected service gaps)

Health service organizational
arrangements
 The degree of
centralization of decision
making
 Opportunities for
community participation
in decision making
 Linkage between sectors

Resources
 The resources currently deployed
in the health sector
The resources likely to be available
in future
 Financial resources (budget)
 Personnel
 Building, land, equipment &
vehicles
 Efficiency, effectiveness, equity
of current services

Setting Priorities
First Stage:
 Involves the production of a
macro situational analysis
setting out the key information
at national level
Second stage:
 Discussion by a national-level
planning group, involving
representatives of major health
related sectors

Priority Setting (contd.)
Third stage:
 The development of local-
level situational analysis
by local level health &
other professionals &
community
representatives

Priority Setting (contd)
Fourth Stage:
The review of these
policies by National
Health Planning Unit
Priority setting involves
a combination of
technique & judgement

Human Resource Planning
 To ensure that there is the
right number of personnel
with the appropriate skills
available in the right place at
the right time
 Health facilities are highly
labour intensive
 50-70% of the health budget
spent on human resources

Human Resource Planning
 Supply of HR: available
personnel
 Demand for HR: funded
requirement for personnel
 An equilibrium (Balance)
situation is required: where
Demand & Supply are equal
for each set of staff for each
year

Human Resource Planning
 Estimating projections
of each side of the
supply & demand
equation
 Estimate demand for
each category (ideally
for a decade)

HR Planning (contd)
 Estimation of the present &
future supply of each
category of health
professionals
 Comparison of demand &
supply
 Establishment control
 Development of training plan

Human Resource Planning
 Demand should be based on
the plans for service implicit
in the broader sectoral plan
 Planning system should be
sustainable
 Ensure that the planning
function will continue despite
broader organizational
changes

HR Planning (contd.)
Disciples required in
planning include:
economics, sociology,
social epidemiology,
community
development,
operations research,
law

Creating a structure for success
A carefully organized
and well-defined
planning structure is
essential
Planning process for
success

Creating a structure for success
There are several options
for developing
steering committees,
advisory committees,
and other structures to
carry out planning work
and involve people in
the process.

SWOT Worksheet
 SWOT is an examination of a
group’s internal strengths
and weaknesses, as well as
the environment’s
opportunities and threats. It
should be used in the
beginning stages of decision
making and strategic
planning.

SWOT
 Strengths What are your state’s
particular strengths? Do you do
something particularly unique?
What could be an asset in
developing objectives for your
state plan?
 Weaknesses Where is your
state lacking? What do others
seem to accomplish that you
cannot? What could limit your
state planning efforts?

Identifying & securing
Resources
“It takes a village to raise a child
(or develop a state plan).”
 Identify resources needed to
develop state plan
 Identify existing internal
resources
 Develop budget # Identify
potential external resources,
including potential donated
resources

Resources (contd.)
 Plan to integrate the plan
into state planning,
budgeting, and programming
processes
 Develop staff and technical
support plan
 Secure identified resources
and develop alternative
resources if necessary

Ask the right questions early
 What is the scope of the state
planning process?
► What does the state want to
accomplish through this process?
► Why should taxpayers or others
fund the development of the
state plan?
► What will it take to support the
planning initiative?

Plan for the future
 Don’t forget to plan for the future—
it’s not over when the plan is released
► Identify resource needs to carry out
a ten-year plan to monitor progress,
publish periodic reviews, and sustain
activities
► Keep a wish list ready for future
funding (e.g., resources for a business
companion document, a special health
disparities consortium, or other ideas
generated planning)

Align the planning structure
with goals

THANK you
Very much

Health Service Providers(1)
 Ministry of Health (MOH)
 King Faisal Specialist Hospital &
Research Center (KFSH&RC)
 Ministry of Defense (MODA)
 Ministry of Interior (SFH)
 National Guard (NGHA)
 Universities Hospitals
 Private Sector

Current Status (1)
 Ministry of Health (MOH)
 195 hospitals
 1760 PHCC
20 are running different HIS & no connection
between them
40 has a connection to MOH WAN but does not
have HIS
A system has been developed in-house for
PHCC’s and applied in 9 of them which has
connectivity
The system can be accessed remotely by dialup

Current Status (2)
 King Faisal Specialist Hospital
 2 hospitals (1 in Riyadh & 1 in Jeddah)
The most advanced EMR in the country

Current Status (3)
 Ministry of Defense (MODA)
 25 hospitals
 150 clinics
(10 are running different HIS & not
connected to each other)
137 are connected to the nearest hospital

Current Status (3)
 Ministry of Defense (MODA)
 25 hospitals
 150 clinics
(10 are running different HIS & not
connected to each other)
137 are connected to the nearest hospital

Current Status (4)
 Ministry of Interior (SFH)
 1 hospital
 30 +- clinics
(hospital is running HIS)
Simple system in clinics & not connected
to the hospital

Current Status (5)
 National Guard (NGHA)
 4 hospitals
 60 clinics
( 4 hospitals are connected through ASP
model + 25 clinics)

1/27/2023 The 4th Regional conference
on e-Health
62
Current Status (6)
 Universities Hospitals
 4 hospitals
2 are running the same HIS through
connectivity
Others are running different HIS

1/27/2023 The 4th Regional conference
on e-Health
63
Current Status (6)
 Universities Hospitals
 4 hospitals
2 are running the same HIS through
connectivity
Others are running different HIS

Public Input