District health planning

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planning at the district level.

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  • Realize that it is necessary to involve basic unit of operation such as panchayat and PHC in planning and decision.
  • In addition to centrally assisted , state & regional schemes district have their own scheme.
  • District computer system under nat resource data management system
  • District health planning

    1. 1. District health planningDistrict health planning Dr. Vishal SoyamDr. Vishal Soyam 11
    2. 2. PLAN OF PRESENTATIONPLAN OF PRESENTATION • Definition • Brief history of planning • Why District Health Planning • District health Planning process • Components of district health planning • Steps of District Health Action Plan • Example • References 2
    3. 3. PLANNINGPLANNING  DEFINITION : It is a process of identifying a course of action systematically in an organized manner to achieve the objectives by utilizing the available resources skillfully in a cost – effective way.  Purpose :  To match the limited resources  To eliminate the wasteful expenditure  To develop the best course of action 3
    4. 4. HEALTHPLANNINGHEALTHPLANNING  DEFINITION : It is the process of  Defining community health problems,  Identifying unmet needs & surveying the resources to meet them,  Establishing priority goals that are realistic & feasible &  Projecting administrative action to accomplish the purpose of the programme.  Purpose :  To improve health services 4
    5. 5. Brief history of decentralizedBrief history of decentralized planningplanning Decentralized planning started for the first time in the First Five Year Plan (1951-56), when it was suggested that the planning process be undertaken at the state and district levels too. 73rd and 74th Amendments of the Constitution mandating the establishment of Panchayats at the district, intermediate and village levels. Reversal of the centralised approach to district planning Establishment of the District Planning Committee (DPC) for consolidating plans Little progress except in very few states 55
    6. 6. Brief history of decentralizedBrief history of decentralized planningplanning Decided that the ‘district plan process’ should be an integral part of the process of preparation of state’s Five Year Plan and the annual plan since 2005. NRHM proposed the decentralisation of healthNRHM proposed the decentralisation of health planning so that the state health plan representsplanning so that the state health plan represents the needs and priorities of respective blocks andthe needs and priorities of respective blocks and districts in the state.districts in the state. Transforming a vertical planning process into aTransforming a vertical planning process into a horizontal processhorizontal process Village is envisaged as the primary unit for planning 66
    7. 7. Relevance of District HealthRelevance of District Health PlanningPlanning Inter district variations – bridging disparityInter district variations – bridging disparity Planning based on local evidence & needsPlanning based on local evidence & needs To partner with CommunityTo partner with Community Area specific strategies to achieve NRHMArea specific strategies to achieve NRHM goalsgoals Cost effective and practical solutionsCost effective and practical solutions Move from budget based plans to outcomeMove from budget based plans to outcome oriented plansoriented plans Requirement of GoI – no funds if no plansRequirement of GoI – no funds if no plans 77
    8. 8. District Health PlanningDistrict Health Planning District is the basic unit for dispensing of health services Consistent with specific needs of the people, the growth potential of the area & budgetary allocation available District is the micro decision making unit, it can implement innovation & experimentation to ameliorate their own problems & satisfy the basic needs. District have framework of the NHP, central five yr plan , state plan and their priorities , keeping them in view district make plan according to local specific needs. 88
    9. 9. Planning Process…Planning Process… Participatory/Bottom Up Approach – under NRHMParticipatory/Bottom Up Approach – under NRHM V V V VV V V V V V V 99
    10. 10. 1010 Contd…Contd…  Planning process require setting up ofPlanning process require setting up of planningplanning teams & committeesteams & committees at different level:at different level: Village - VHSCVillage - VHSC Gram Panchayat / Sub-centre –GP Pradhan,Gram Panchayat / Sub-centre –GP Pradhan, ANM, MPW, few VHSCANM, MPW, few VHSC PHC - PHC health planning & monitoringPHC - PHC health planning & monitoring committeecommittee CHC/Block level – Block planning & monitoringCHC/Block level – Block planning & monitoring committeecommittee District level – District health committeeDistrict level – District health committee
    11. 11. 1111 Institutional Framework forInstitutional Framework for Convergent ActionConvergent Action State Health Mission/Society District Health Mission/Society Block Health & Sanitation Committee Village Health & Sanitation Committee Partners and Members in above mentioned Societies and Committees- – DWCD; PRI/RD; Education; PHED and AYUSH District level organization chart District health mission Integrated District health society DPMU Implementation of program
    12. 12. 1212 District Health MissionDistrict Health Mission The DHM would get the district plan prepared coveringThe DHM would get the district plan prepared covering health as well as the other determinants of health.health as well as the other determinants of health. Chaired by dist. Magistrate/Collector/deputy commissionerChaired by dist. Magistrate/Collector/deputy commissioner At the district level all existing societies have been mergedAt the district level all existing societies have been merged into the District Health Society with its apex body performinginto the District Health Society with its apex body performing the functions of the District Health Mission(DHM)the functions of the District Health Mission(DHM) Roles and Responsibilities of District Health Mission includes: – District health planning, implementation and monitoring – Coordination across relevant Department – Management of cash flows – Financial accounting/ administration
    13. 13. Components of District PlanComponents of District Plan BackgroundBackground Planning processPlanning process PrioritiesPriorities as per the background and planningas per the background and planning processprocess Annual planAnnual plan for each of the health institutionsfor each of the health institutions based on facility surveysbased on facility surveys Community action planCommunity action plan Financing of health care managementFinancing of health care management Structure to deliver the programStructure to deliver the program Partnership for convergent actionPartnership for convergent action 1313
    14. 14. Components of District PlanComponents of District Plan Capacity Building Plan Human Resource Plan Procurement and Logistics Plan Non-governmental Partnerships Community Monitoring Framework Action Plan for Demand generation Sector specific plan for maternal health, child health, adolescent health, disease control, disease surveillance, family welfare etc. Budget 1414
    15. 15. District Health Action PlanDistrict Health Action Plan  Preparation of annual plans for the district called DHAP  Suggests district specific interventions  District health mission is responsible for preparation of DHAP by constituting planning team  DHAPs contain inputs on the needs of the districts in terms of programme implementation and hence the funds required for the same. 1515
    16. 16. District Health Action PlanDistrict Health Action Plan  STEPSSTEPS 1.1. Introduction : The settingIntroduction : The setting 2.2. Situation analysisSituation analysis 3.3. Goals and ObjectivesGoals and Objectives 4.4. StrategiesStrategies 5.5. ActivitiesActivities 6.6. Work Plan/ ScheduleWork Plan/ Schedule 7.7. Monitoring and evaluationMonitoring and evaluation 8.8. BudgetBudget 1616
    17. 17. Example – RI Strengthening inExample – RI Strengthening in migratory populationmigratory population Gurgoan DHAPGurgoan DHAP 1717
    18. 18. 1. District Planning – Background1. District Planning – Background LocationLocation DemographyDemography Socio-economicSocio-economic Agro-economicAgro-economic ResourcesResources InfrastructureInfrastructure SectoralSectoral GeologicalGeological Ground waterGround water SoilSoil ForestForest Land utilizationLand utilization 1818
    19. 19. District Gurgaon At a Glance Total Population : 1.8 Million Urban and Peri-urban Population : 1.2 Million Migratory Population : 0.8 Million No. of Blocks : 04 No. of CHCs : 03 No. of PHCs : 13 No. of Sub-Centres : 76 No. of Anganwadi Centres : 265 No. of ASHA Workers : 393 Birth Rate : 31.1 IMR : 51.8 MMR : 286/lac TFR : 2.6
    20. 20. Name of Block Appox. No of Household/ Families Total Population Appox. No. of 0-5 year Children Appox. No. of <15 year Children Gurgaon (U) 49631 155463 22209 59224 Sohna 8804 29841 4263 11368 Pataudi 13169 43981 6283 16755 Farukhnagar 195337 573377 81911 218429 Total 266941 802662 114666 305776 Migratory Population of the District
    21. 21. 2. District Planning – Situation Analysis2. District Planning – Situation Analysis Analysis of health situation:Analysis of health situation: 1.1. Assessment of present health situationAssessment of present health situation 2.2. Projection of the future health situationProjection of the future health situation Situation analysis : By DataSituation analysis : By Data – CollectionCollection – Assessment/analyzeAssessment/analyze – interpretationinterpretation Use various data sources- district level dataUse various data sources- district level data Interpreted in terms of characteristics of population,Interpreted in terms of characteristics of population, data on health facilities, data on availabledata on health facilities, data on available resources, data on training institutions etc.resources, data on training institutions etc. 2222
    22. 22. 2. District Planning – Situation Analysis2. District Planning – Situation Analysis Compare district parameter with the state parameterCompare district parameter with the state parameter Identify the problems, problems at various levelIdentify the problems, problems at various level Identify the causesIdentify the causes Do resource analysisDo resource analysis Map the problem geographically, groups & vulnerabilityMap the problem geographically, groups & vulnerability & the resources& the resources 2323
    23. 23. Migratory population is settled in Urban and Peri-urban areasMigratory population is settled in Urban and Peri-urban areas of Gurgaon, they are from UP, Bihar, MP, Orissa andof Gurgaon, they are from UP, Bihar, MP, Orissa and RajasthanRajasthan Incidence of VPDs are much more in them, recently in 2008Incidence of VPDs are much more in them, recently in 2008 WPV (P3) detected in MigrantsWPV (P3) detected in Migrants RI status in these population is around 30%RI status in these population is around 30% No Anganwadi/ ASHAs in migratory coloniesNo Anganwadi/ ASHAs in migratory colonies HealthHealth sub-centerssub-centers are overburdened, 30,000 population/are overburdened, 30,000 population/ sub-centresub-centre Grossly inadequate health delivery systemGrossly inadequate health delivery system Gurgoan Ex. – situation analysis
    24. 24. Areas of the concern are in the Migratory Population 0 20 40 60 80 100 Yr 2005-06 Yr 2006-07 Yr 2007-08 Yr 2008-09 Haryana Gurgaon Migratory % Fully Immunized Children
    25. 25. StrengthsStrengths :: – Receptive District Health AdministrationReceptive District Health Administration – Adequate budget for RI strengtheningAdequate budget for RI strengthening – Well functioning cold chain system at the DistrictWell functioning cold chain system at the District – Adequate supply of vaccines and logistics atAdequate supply of vaccines and logistics at DistrictDistrict – Excellent support staff for smooth data entry atExcellent support staff for smooth data entry at District and Block level.District and Block level. SWOT AnalysisSWOT Analysis
    26. 26. – Low capacity to devise, supervise, monitor andLow capacity to devise, supervise, monitor and implementation of RI micro plansimplementation of RI micro plans – Poor immunization infrastructure in Urban and Peri-urbanPoor immunization infrastructure in Urban and Peri-urban areasareas – Lack of adequate trained human resourceLack of adequate trained human resource – Weak management of fund flow to the health facility levelWeak management of fund flow to the health facility level – High drop outs – poor IEC and social issuesHigh drop outs – poor IEC and social issues WeaknessesWeaknesses
    27. 27. – Capacity building of the staffCapacity building of the staff – Inter-sectoral coordination between health and ICDS staffInter-sectoral coordination between health and ICDS staff – Public-private partnership (Role of IAP/IMA and NGOs)Public-private partnership (Role of IAP/IMA and NGOs) – Exploring immunization sites in the migratory campsExploring immunization sites in the migratory camps – Innovative IEC in the migratory camps (Through schools)Innovative IEC in the migratory camps (Through schools) OpportunitiesOpportunities
    28. 28. ThreatsThreats – Sustainability of the programSustainability of the program – Availability of motivated, trained manpowerAvailability of motivated, trained manpower – Other competing priorities of the health systemOther competing priorities of the health system – Fatigue factor and motivation of the staff working in theFatigue factor and motivation of the staff working in the migratory camps ????migratory camps ???? – More immunization, more AEFI and community reactionMore immunization, more AEFI and community reaction ??
    29. 29. 3. District Planning – Goals & Objectives3. District Planning – Goals & Objectives Goals:Goals: – Societal in natureSocietal in nature – Not necessarily attainableNot necessarily attainable – Responsive to people needs & demandResponsive to people needs & demand Objectives:Objectives: – SMARTSMART 3030
    30. 30. ObjectivesObjectives 1.1. To increase immunization coverage in theTo increase immunization coverage in the migratory camps from current level of 30% tomigratory camps from current level of 30% to 80% by 2010-1180% by 2010-11 2.2. To increase the demand generation of theTo increase the demand generation of the community through innovative IECcommunity through innovative IEC 3.3. To reduce the VPDs and IMR in the HRAsTo reduce the VPDs and IMR in the HRAs Goal  Reduce child mortality Example
    31. 31. 4. District Planning – Strategies4. District Planning – Strategies How do we aim to achieve the objectives?How do we aim to achieve the objectives? The choice of strategiesThe choice of strategies Are these strategiesAre these strategies – Technically soundTechnically sound – Capability & manpower wise feasible?Capability & manpower wise feasible? – Budget-wise feasible?Budget-wise feasible? – Does it have capacity to manage the identifiedDoes it have capacity to manage the identified constraints?constraints? Choosing alternative strategiesChoosing alternative strategies 3232
    32. 32. StrategyStrategy – Strengthening of RI micro plans in HRAs throughStrengthening of RI micro plans in HRAs through identification, enlisting and mapping of HRAs sub-identification, enlisting and mapping of HRAs sub- centre wisecentre wise – Capacity building of the Health StaffCapacity building of the Health Staff – BCC and IEC in the communityBCC and IEC in the community – Bringing immunization sites closure to theBringing immunization sites closure to the communitycommunity Example
    33. 33. 5. District Planning – Activities5. District Planning – Activities What are the activities needed to achieve theWhat are the activities needed to achieve the objectives under specified strategy should beobjectives under specified strategy should be stated.stated. Who is responsible for the particular activity alsoWho is responsible for the particular activity also specifiedspecified Resources required for each activity estimatedResources required for each activity estimated Sources of fund – from where expenditure incurredSources of fund – from where expenditure incurred (eg. office expenditure, NRHM, DFW etc)(eg. office expenditure, NRHM, DFW etc) Time frame for each activityTime frame for each activity Any constraint for any activityAny constraint for any activity 3434
    34. 34. ActivitiesActivities – Developing RI micro plans at district and health facility levelDeveloping RI micro plans at district and health facility level – Preparation of micro plans for outreach camps – Identification of fixed immunization sites in terms of time/place/personIdentification of fixed immunization sites in terms of time/place/person – Availability of vaccine and logistics and its transport to the facility level.Availability of vaccine and logistics and its transport to the facility level. – Outsourcing of human resources.Outsourcing of human resources. – BCC and IEC activityBCC and IEC activity – Training of the health staff for routine immunizationTraining of the health staff for routine immunization – Interaction with RWAs /Builders association and stakeholdersInteraction with RWAs /Builders association and stakeholders – Monitoring and evaluationMonitoring and evaluation Example
    35. 35. 6. District Planning – Schedule6. District Planning – Schedule In a matrix form and how activities will beIn a matrix form and how activities will be conducted with special references to timeconducted with special references to time frame and identify responsible officialframe and identify responsible official /agency/agency Preparation of Gantt chart to ensure thePreparation of Gantt chart to ensure the activity going according to planactivity going according to plan 3636
    36. 36. Activity No Name of the Activity July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. 1 Identification of slum areas/ high risk areas                   2 Preparation of micro plans for outreach camps                   3 Hiring or recruitment of Health workers for these sessions                   4 Capacity Building of Health Staff 5 Availability of Vaccine and Logistics                   6 Interaction with RWAs / Builder and stakeholders                   7 Availability of Budget                   8 Preparation of Tracking bags                   9 IEC activities                   10 Monitoring and evaluations                   Example Gantt chart
    37. 37. 7. District Planning – Monitoring &7. District Planning – Monitoring & EvaluationEvaluation Flow of data from different level i.e. serviceFlow of data from different level i.e. service delivery, community monitoring and long scale datadelivery, community monitoring and long scale data sets to be considered (RIMS) .sets to be considered (RIMS) . Decide what is to be monitor ?, who will monitor ?Decide what is to be monitor ?, who will monitor ? How to monitor? Process of monitoring etcHow to monitor? Process of monitoring etc Set the indicator for monitoringSet the indicator for monitoring Monitoring process finalised by training & clearMonitoring process finalised by training & clear instructionsinstructions Resources required for monitoring & evaluationResources required for monitoring & evaluation 3838
    38. 38.  Tickler bags has to be given for tracking dropoutsTickler bags has to be given for tracking dropouts  Tickler bags are to be supplied for all the RITickler bags are to be supplied for all the RI sites.sites.  Self monitoring Immunization chart for DPT1 andSelf monitoring Immunization chart for DPT1 and DPT3 at S/C, PHC and DHQDPT3 at S/C, PHC and DHQ  Standard Monitoring format is to be used by allStandard Monitoring format is to be used by all the Supervisors for RI sessions.the Supervisors for RI sessions.  All field officers/Supervisors are supposed to doAll field officers/Supervisors are supposed to do monitoring regularly and send the report monthlymonitoring regularly and send the report monthly within the time frame.within the time frame. Initiatives in Monitoring and Supervision Example
    39. 39. Tickler bag being used in the State
    40. 40. EVALUATIONEVALUATION  By internal agency Or by external agency:By internal agency Or by external agency:  Are we going in a right direction?Are we going in a right direction?  Is there any input lacking?Is there any input lacking?  Are there any gaps found?Are there any gaps found?  Have we achieved the goals and objectives preparedHave we achieved the goals and objectives prepared for this action plan?for this action plan?  Whether re-planning needed, if not heading towardsWhether re-planning needed, if not heading towards the desired results?the desired results? 4141
    41. 41. 8. District Planning – Budget8. District Planning – Budget Unit cost should be given for each costedUnit cost should be given for each costed activity and source of funding also should beactivity and source of funding also should be reflectedreflected Costs should, as far as possible beCosts should, as far as possible be estimated separately for each activity in theestimated separately for each activity in the work planwork plan 4242
    42. 42. S.S. No.No. ActivityActivity ResponsibleResponsible PersonPerson Duration &Duration & datedate ItemItem RequiredRequired BudgetBudget RequiredRequired 1 Identification of slum areas/ high risk  areas MOIC, PPC Sohna,  Pataudi,  Farukhnagar with  DIO July  Govt. Vehicle-  4* 4 Days 400*4= 1600 2 Preparation of micro plans for  outreach camps MOICs of each area  with DIO August Stationery Required 500* 4= 2000 3 Hiring or recruitment of Health  workers for these sessions DIO September,  October Advertisement and  interviews Approx.  3,50,000 per month 4 Capacity Building of Health Staff DIO October,  November Training Material  and trainers 5000*4= 20000 5 Availability of Vaccine and Logistics DIO September,  October,  November Vaccine and  Logistics DGHS 6 Interaction with RWAs / Builder and  stakeholders DIO/ MOICs December Venue, Tea and  Snacks  10000 7 Availability of Budget DIO October,  November,  December - DGHS 8 Preparation of Tracking bags MOICs January 40 Tracking Bags 40*200= 8000 9 IEC activities DIO/MOICs October,  November,  December Poster & Banners 40000 10 Monitoring and evaluations DIO/ District  Program  Officer/SMOs/ MOs January,  February, March Vehicle  8*400*12 8*400*12 38400 per month
    43. 43. THANK YOU 44

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