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Introduction to Planning for nursing/Public Health Students

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Introduction to Planning for Nursing/Public Health Students

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Introduction to Planning for nursing/Public Health Students

  1. 1. Hari Prasad Kaphle Assistant Professor (Public Health) Pokhara University 1Introduction to Planning Hari Prasad Kaphle
  2. 2. Introduction  Planning is the process of determining the future course of action i.e. what action, why an action, how to take action, when to take action, who is responsible for that action.  These why, what, how and when are related with different aspects of planning process.  Planning is a future oriented process of setting goal/objective/target and choosing the best way to achieve these goals 2Introduction to Planning Hari Prasad Kaphle
  3. 3. Introduction  Planning includes the determination of specific objectives, determination of project and programme, setting policies and strategies, rules and procedures and preparing budget.  Planning also can be viewed as looking for the most appropriate way to go from the current situation to the desired situation. 3Introduction to Planning Hari Prasad Kaphle
  4. 4. Definition  Planning can be defined as the process of 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. – Brotherston (1974)  Planning may be broadly defined as a concept of executive action that embodies the skill of anticipating, influencing, and controlling the nature and direction of change. - Mc Farland (1974) 4Introduction to Planning Hari Prasad Kaphle
  5. 5. Definition  Planning is the selection and relating of facts and making and using of assumptions regarding the future in the visualization of proposed activities believed necessary to achieve desired result. - George R Terry (1998)  A plan is a commitment to a particular course of action considered necessary or desirable to achieve specific results. 5Introduction to Planning Hari Prasad Kaphle
  6. 6. Health Planning  Health planning is defined as the orderly process of defining community health problems, identifying unmet needs of people and surveying the resources to meet the established priority goals that are realistic and feasible and projecting administrative actions to accomplish the purpose of the proposed programs. 6Introduction to Planning Hari Prasad Kaphle
  7. 7. Characteristics/features of planning  Planning is goal-oriented.  Planning is made to achieve desired objective of business.  The goals established should general acceptance otherwise individual efforts & energies will go misguided and misdirected.  Planning identifies the action that would lead to desired goals quickly & economically.  It provides sense of direction to various activities. 7Introduction to Planning Hari Prasad Kaphle
  8. 8. Characteristics/features of planning  Planning is an intellectual process.  Planning is a mental exercise involving creative thinking, sound judgment and imagination.  It is not a mere guesswork but a rotational thinking.  A manager can prepare sound plans only if he has sound judgment, foresight and imagination.  Planning is always based on goals, facts and considered estimates. 8Introduction to Planning Hari Prasad Kaphle
  9. 9. Characteristics/features of planning  Planning is looking ahead (futuristic).  Planning is concerned with looking into the future.  It contains something that is going to do in future.  It requires peeping in future, analyzing it and predicting it.  Thus planning is based on forecasting.  A plan is a synthesis of forecast.  It is a mental predisposition for things to happen in future. 9Introduction to Planning Hari Prasad Kaphle
  10. 10. Characteristics/features of planning  Planning involves choice & decision making.  Planning essentially involves choice among various alternatives.  Therefore, if there is only one possible course of action, there is no need planning because there is no choice. Thus, decision making is an integral part of planning.  A manager is surrounded by number of alternatives. He has to pick the best depending upon requirements & resources of the enterprises. 10Introduction to Planning Hari Prasad Kaphle
  11. 11. Characteristics/features of planning  Planning is the primary function of management (primacy of planning).  Planning lays foundation for other functions of management.  It serves as a guide for organizing, staffing, directing and controlling.  All the functions of management are performed within the framework of plans laid out by planning.  Therefore planning is the basic or fundamental function of management. 11Introduction to Planning Hari Prasad Kaphle
  12. 12. Characteristics/features of planning  Planning is a continuous process of management.  Planning is a never ending function due to the dynamic business environment.  Plans are also prepared for specific period of time and at the end of that period, plans are subjected to reevaluation and review in the light of new requirements and changing conditions for further planning. 12Introduction to Planning Hari Prasad Kaphle
  13. 13. Characteristics/features of planning  Planning is all pervasive.  It is required at all levels of management and in all departments of an enterprise.  But, the scope of planning may differ from one level to another.  The top level may be more concerned about planning the organization as a whole whereas the middle level may be more specific in departmental plans and the lower level plans implementation of the same. 13Introduction to Planning Hari Prasad Kaphle
  14. 14. Characteristics/features of planning  Planning is designed for efficiency.  Planning leads to accomplishment of objectives at the minimum possible cost.  It avoids wastage of resources and ensures adequate and optimum utilization of resources.  A plan is worthless or useless if it does not value the cost incurred on it. Therefore planning must lead to saving of time, effort and money.  Planning leads to proper utilization of men, money, materials, methods and machines. 14Introduction to Planning Hari Prasad Kaphle
  15. 15. Characteristics/features of planning  Planning is flexible.  Planning is done for the future. Since future is unpredictable, planning must provide enough room to cope with the changes in customer’s demand, competition, government policies etc.  Under changed circumstances, the original plan of action must be revised and updated to make it more practical 15Introduction to Planning Hari Prasad Kaphle
  16. 16. 16Introduction to Planning Hari Prasad Kaphle
  17. 17. Elements of Planning Vision Statement:  Vision represents the imagination of future events and prepares the organization for it. It is a mental perception of a kind of environment a person/organization desires to create in future.  A Vision Statement states that “What do we want to become in future (e.g. in next 5yerars, 10 years, 20 years and so on)”. 17Introduction to Planning Hari Prasad Kaphle
  18. 18. Elements of Planning  Vision Statement  Mission Statement  Goal  Objectives  Targets  Policies  Strategies  Activities 18Introduction to Planning Hari Prasad Kaphle  Programme  Project  Procedure/SOP  Rules  Schedule/Work plan  Budget
  19. 19. Elements of Planning Vision Statement:  Developing a vision statement is the first step in strategic planning. Most of the vision statements are written in single sentence.  A world Free of TB, Feed the hungry serve the nation, Global excellence in health care, Getting to zero: Zero infection, zero transmission etc. 19Introduction to Planning Hari Prasad Kaphle
  20. 20. Elements of Planning Mission Statement:  Mission is the purpose or reason of existence of an organization. It tells what an organization providing to society- a product or service?  A mission statement identifies the scope of a firm’s operation in product and market terms. It addresses the basic question that feels all strategists. “What is our business?” 20Introduction to Planning Hari Prasad Kaphle
  21. 21. Elements of Planning Mission Statement:  A clear mission Statement discusses the values and priorities of an organization.  A mission statement broadly charts the future directions of an organization.  The mission statements are quite longer than vision statement . It should not be too long and too short.  It should be long enough to cover everything, but short enough to be attractive. 21Introduction to Planning Hari Prasad Kaphle
  22. 22. Elements of Planning Apollo Hospital  Vision: 'Touch a Billion Lives'.  Mission: Our mission is to bring healthcare of International standards within the reach of every individual. We are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity. 22Introduction to Planning Hari Prasad Kaphle
  23. 23. Elements of Planning CDC: Global Immunization Division  Vision Statement: A world without vaccine- preventable disease, disability, and death  Mission Statement: To protect the health of global citizens by preventing disease, disability, and death through immunization 23Introduction to Planning Hari Prasad Kaphle
  24. 24. Elements of Planning Nepal Health Sector Programme II  Vision: Improve the health and nutritional status of the Nepalese population and provide an equal opportunity for all to receive quality health care services affordably or free of charge, thereby contributing to poverty alleviation. 24Introduction to Planning Hari Prasad Kaphle
  25. 25. Elements of Planning Nepal Health Sector Programme II  Mission: Promote the health of Nepal’s people by facilitating access to and utilization of essential health care and other health services, emphasizing services to women, children, the poor and excluded, and changing the dangerous lifestyles and behavior of the Most-at-risk Populations (MARPs) through Behaviour Change Communication (BCC) interventions. 25Introduction to Planning Hari Prasad Kaphle
  26. 26. Elements of Planning Goal:  Goal is an ultimate desired state towards which objectives and resources are aimed.  Goal is broad and generalized, is not time constrained or bounded. It is formulated at high level and is described in terms of:  What is to be attained?  Extent to which it should be attained?  What to be achieved?  Population or section or environment concerned  Geographical area of concerned one, the length of time to achieve goals. 26Introduction to Planning Hari Prasad Kaphle
  27. 27. Elements of Planning National policy on skilled birth attendants, 2006  Goal: To reduce maternal and neonatal morbidity and mortality by ensuring availability, access and utilization of skilled care at every birth. Safe motherhood policy, 1998  Goal: To reduce mortality and morbidity among women during pregnancy, childbirth and the postnatal period through the adoption of a combination of health and health related measures. 27Introduction to Planning Hari Prasad Kaphle
  28. 28. Elements of Planning National Immunization Programme  Goal: To reduce child mortality, morbidity and disability associated with vaccine preventable diseases. Adolescent sexual and reproductive health  Goal: to promote the sexual and reproductive health status of adolescents. National Tuberculosis Programme  Goal: To reduce mortality, morbidity and transmission of tuberculosis until it is no longer a public health problem 28Introduction to Planning Hari Prasad Kaphle
  29. 29. Elements of Planning Objectives:  It is a planned end point of activities. Objectives are the statements of what one hopes to achieve or accomplish over a period of time.  Objectives can be defined as specific results that an organization seeks to achieve in perusing its basic mission.  Objective is the precisely stated end to which efforts are directed, specifying the population outcome, variable to be measured. – John M. Last (1995). 29Introduction to Planning Hari Prasad Kaphle
  30. 30. Elements of Planning  All objectives should be SMART  S=Specific (concerned with specific area or activity),  M=Measurable (the outcomes can be measured to demonstrate that the objective has been achieved),  A=Attainable (the outcome is possible to achieve),  R=Realistic (achievable with available resources),  T=Time-framed (achievable within the time).  We need to constantly review our objectives by measuring the outcomes, so that we can change the way that we are working, if necessary. 30Introduction to Planning Hari Prasad Kaphle
  31. 31. Elements of Planning Targets:  Targets are the desired end- results of specific activities to be achieved in finite period of time.  A target often refers to a discrete activity which permits the concept of degree of achievement.  Targets are thus concerned with the factors involved in a problem where as objective are directly concerned with problems itself. 31Introduction to Planning Hari Prasad Kaphle
  32. 32. Elements of Planning Safe motherhood policy, 1998  Specific objectives  To increase the accessibility, availability and utilization of maternal health care facilities.  To strengthen the technical capacity of maternal health care providers at all levels of the health care system.  To strengthen referral services for maternity care, particularly at the district level and with specific emphasis on appropriate referral of high-risk cases.  To increase the availability and use of contraceptives for child spacing and family planning purposes.  To raise public awareness about the importance of the health care of women and in particular, maternal health care and safe motherhood.  To improve the legal and socio-economic status of women. 32Introduction to Planning Hari Prasad Kaphle
  33. 33. Elements of Planning Safe motherhood policy, 1998  Targets  Reduce maternal mortality rate from 850 per 100,000 live birth to 750 by 1996 and to 400 by the year 2000.  Increase contraceptive prevalence rate (CPR), with particular focus on spacing methods, from 24% to 30% by 1996 and to 38% by the year 2000.  Increase the coverage of antenatal care services from 18% to 25% by 1996 and to 50% by the year 2000.  Ensure that at least 25% of all deliveries are attended by trained health workers by 50% by the year 2000.  Increase the number of first level referral hospitals with capacity to provide essential obstetric functions from the present number of 14 to 24 by 1996.  Reduce anaemia (i.e., Hb <11gm%) in pregnant women from 78% to 70% by 1996 and to 50% by the year 2000. 33Introduction to Planning Hari Prasad Kaphle
  34. 34. Elements of Planning Safe motherhood policy, 1998  Targets  Increase the enrollment of female students in primary school from 54% to 76% by 1996 and to 100% by the year 2000.  Ensure the completion of primary education by girl children from the present estimate of 27% to 55% by 1996 and to 70% by the year 2000.  Increase the female literacy from the present rate of 21% to 38% by 1996 and to 61% by the year 2000.  Initiate policy development on legal and programmatic aspects of abortion and work toward the legalization of abortion.  Introduce (mother and encourage) the enforcement of the legal age of marriage in the coordination with the relevant government entities. 34Introduction to Planning Hari Prasad Kaphle
  35. 35. Elements of Planning Objective of the health policy 1991  To upgrade the health standards of the majority of the rural population by extending Basic Primary Health Services up to the village level and to provide the opportunity to the rural people to enable them to obtain the benefits of modern medical facilities by making the facilities accessible to them 35Introduction to Planning Hari Prasad Kaphle
  36. 36. Elements of Planning Targets of the National Health Policy 1991 By the year 2000 AD., the following targets will be attained:  The infant mortality rate will be reduced to 50 per thousand from the present 107 per thousand.  The mortality rate of children below 5 years will be reduced to 70 per thousand from the present 197 per thousand.  The total fertility rate will be reduced to 4 from the present 5.8 children per women of child bearing age.  The maternal mortality rate will be reduced to'4 per thousand from the present 8.5 per thousand live births.  The average life expectancy will be raised to 65 years from the present 53 years. 36Introduction to Planning Hari Prasad Kaphle
  37. 37. Scope of Objectives Target Objective Goal Mission Vision 37Introduction to Planning Hari Prasad Kaphle
  38. 38. Elements of Planning Policies:  These are the guiding principles stated as an expectation, not as command.  Policies are also plans (standing plan) in that they are general statements or understandings which guide or channel in decision making.  Policy is a consistent guide to be followed under a given set of circumstances. 38Introduction to Planning Hari Prasad Kaphle
  39. 39. Elements of Planning Policies:  Policies define an area within which a decision is to be made and ensure that the decision will be consistent with, and contribute to, an objective.  Policies help to decide the issues before it becoming problems.  It also allows deciding for the same problem which occurs again and again 39Introduction to Planning Hari Prasad Kaphle
  40. 40. Elements of Planning Policies:  Policies define an area within which a decision is to be made and ensure that the decision will be consistent with, and contribute to, an objective.  Policies help to decide the issues before it becoming problems.  It also allows deciding for the same problem which occurs again and again 40Introduction to Planning Hari Prasad Kaphle
  41. 41. Elements of Planning National Blood Policy 2050 (1993 AD) The following guiding principles govern Nepal’s blood services:  The collection of blood is based on voluntary non-remunerated blood donation,  The provision for blood and blood products must be on non- profit basis,  No harm should be caused to the blood donor and recipients of blood and blood products  Every citizen of Nepal or any other country who needs blood and blood products as recommended by the treating physician in any health facilities in Nepal should have equal, prompt and affordable access to blood and blood products, 41Introduction to Planning Hari Prasad Kaphle
  42. 42. Elements of Planning National Blood Policy 2005  Partnership between Ministry of Health and Nepal Red Cross for blood donor recruitment, collection, processing, storage, supply and overall management for provision of safe blood is vital and therefore must be strengthened at all levels central, regional, districts and below by formation of joint committees as guided by regulatory body.  National blood services standards must ensure that services and products conform to high quality standards,  Blood transfusion is a medical intervention that should be indicated and prescribed by medical practitioners registered with Nepal Medical Council.  The rights and duties of blood donors, staffs of the blood program patients and physicians should be observed.  Minimum wastage of blood should be ensured through effective supply and demand management.  NBA shall develop appropriate legal framework for enforcement of provisions of the National Blood Policy. 42Introduction to Planning Hari Prasad Kaphle
  43. 43. Elements of Planning  National Health Policy 2071 1 National Health Policy 2071.pdf 43Introduction to Planning Hari Prasad Kaphle
  44. 44. Elements of Planning  National Health Policy 2071 44Introduction to Planning Hari Prasad Kaphle
  45. 45. Elements of Planning  National Health Policy 2071 45Introduction to Planning Hari Prasad Kaphle
  46. 46. Elements of Planning Strategy:  In its most basic form, a strategy is simply a declaration of intent. How we are going to perform certain activities? What will our approach in performing certain activities?  It’s purpose is to provide the framework for guiding decisions and actions towards a predefined goal.  Strategy is a plan to achieve the mission and objective of an organization.  Strategy of an organization is a comprehensive master plan stating how the organization will achieve its mission and objective. 46Introduction to Planning Hari Prasad Kaphle
  47. 47. Elements of Planning  National Health Policy 2071 1 National Health Policy 2071.pdf 47Introduction to Planning Hari Prasad Kaphle
  48. 48. Elements of Planning  National Health Policy 2071 48Introduction to Planning Hari Prasad Kaphle
  49. 49. Elements of Planning CB‐IMCI: strategies 1. Improving knowledge and case management skills of health service providers CB‐IMCI aims to improve the knowledge and skills of health service providers through  Training on integrated management of childhood illnesses including follow up and onsite coaching for improved performance;  Regular integrated review and refresher trainings to health service providers emphasizing on recent updates in CBIMCI protocols;  Technical support visit from higher levels to respective institutions; central to regional to district to HFs to FCHVs  Capacity building training to the CB‐IMCI focal persons of the districts  Inclusion of CB‐IMCI component in the curriculum of pre‐service medical and paramedical schools 49Introduction to Planning Hari Prasad Kaphle
  50. 50. Elements of Planning CB‐IMCI: Strategies 2. Improving overall health systems  Carry out CB‐IMCI program maintenance activities as per the recommendations made by IMCI technical working group  Improve logistic supply of key commodities.  Ensure transferred and new health workers are skilled in CBIMCI program  Regularize community based activities of FCHV and outreach clinics including reactivating health mother’s group meeting.  Strengthen supervision and monitoring of the program within regular integrated supervision.  Strengthen recording and reporting system of the CBIMCI program at all levels. 50Introduction to Planning Hari Prasad Kaphle
  51. 51. Elements of Planning CB‐IMCI: Strategies 3. Improving family and community practices  Disseminate key behavioral message through FCHVs, outreach clinics and health facilities to individuals, families and communities using localized IEC materials.  Reach the disadvantaged and hard‐to‐reach communities through reactivated and socially inclusive health mothers’ group and planned outreach clinics.  Create an enabling environment for practicing key individual and family behaviors through continuous advocacy and social mobilization for child health promotion at national, district and community level 51Introduction to Planning Hari Prasad Kaphle
  52. 52. Elements of Planning Procedure:  A procedure (sometimes called as standard operating procedure) is a sequence of steps for completing a given activity.  Formal procedures provide specific and detailed instructions for the execution of plans.  It is a standing plan that outlines a series of related actions that must be taken to accomplish a particular task. 52Introduction to Planning Hari Prasad Kaphle
  53. 53. Elements of Planning Procedure:  Procedures and policies are linked to each other.  For example, a Purchasing policy of an enterprise may states purchasing from lowest bidding party.  To implement this policy an enterprise should establish a procedure containing sequence of activities how it will purchase from lowest bidding party. 53Introduction to Planning Hari Prasad Kaphle
  54. 54. Elements of Planning Procedure:  Policy: Recruitment of employee through open competition  Procedure: advertisement, collecting application, screening, knowledge test, interview, verification of certificates, reference checking, selection, placement of selected employees etc. 54Introduction to Planning Hari Prasad Kaphle
  55. 55. Elements of Planning Programme:  A programme a combination of regular ongoing activities which contributes to achieve specific goals.  A programme provides base to carryout interrelated activities  Programme is a sequence of activities desired to implement activities to achieve objectives  programme is step-by-step approach to guide the action necessary to reach a predetermined goals. 55Introduction to Planning Hari Prasad Kaphle
  56. 56. Elements of Planning Programme:  Programs are a complex of goals, policies, procedures, rules, tasks, and assignments, steps to be taken, resources to be employed and other elements necessary to carry out a given course of action, and ordinarily supported by budgets.  A program is a group of related projects managed in a coordinated way. 56Introduction to Planning Hari Prasad Kaphle
  57. 57. Elements of Planning Programme:  National Immunization Programme  National Nutrition Programme  National Programme for STI and AIDS Control  National Tuberculosis Programme  National Malaria Control Programme  Adolescent Reproductive and Sexual Health Programme  Family Health Programme 57Introduction to Planning Hari Prasad Kaphle
  58. 58. Elements of Planning Project:  A Project is a group of milestones or phases, activities or tasks that support an effort to accomplish something.  A project is a temporary endeavor (attempt) undertaken to produce a unique product or service or result. 58Introduction to Planning Hari Prasad Kaphle
  59. 59. Elements of Planning Project:  A project is a temporary attempt to produce/provide unique service or product.  A project has a clearly defined starting point and end point.  It has clearly defined scope.  Project activities are elaborated in detail so that their no room for misinterpretation. 59Introduction to Planning Hari Prasad Kaphle
  60. 60. Elements of Planning Project  Project especially work in unusual field or provides unusual service and hence involves maximum risk and uncertainty.  Project utilizes the fund from unusual sources.  After accomplishment of per determined objective or after completing defined periods project automatically terminated . 60Introduction to Planning Hari Prasad Kaphle
  61. 61. Elements of Planning What are not Projects?  Past activities that are repeated in exactly the same way on the periodic basis,  Activities with no clearly defined goals,  Activities which can be repeated or translated anywhere at any moment and  Regular ongoing organizational activities 61Introduction to Planning Hari Prasad Kaphle
  62. 62. Elements of Planning Project examples on HIV/AIDS  Western highway project in HIV/AIDS for transport worker and their partners.  Increasing access to care and treatment in HIV/AIDS among Migrant in Kaski.  Prevention of HIV/AIDS among injecting drug users in Kaski.  Prevention of HIV/AIDS among Commercial Sex Workers in Pokhara Valley.  PMTCT (Prevention of Mother‐to‐Child Transmission) of HIV/AIDS 62Introduction to Planning Hari Prasad Kaphle
  63. 63. Elements of Planning Some more examples of projects  BPCR (Birth Preparedness and Complication Readiness)  CMAM (Community‐based Management of Acute Malnutrition)  IMNMP (Intensification of Maternal and Neonatal Micronutrient Program)  RBM (Roll Back Malaria) Initiatives  WASH Water, Sanitation and Hygiene  Suaahara: An integrated Nutrition Program in Nepal  School Health and Nutrition  ODF Campaign 63Introduction to Planning Hari Prasad Kaphle
  64. 64. Elements of Planning Schedule:  It is a time sequence for work to be done. Schedule is a commitment of resources and labor to tasks with specific time frames. 64Introduction to Planning Hari Prasad Kaphle
  65. 65. Elements of Planning Budget:  Budget is a single use financial plan that covers a specified length of time.  Budget refers to the cost of programme usually in terms of monetary value usually in US$.  It describes in numerical terms resources allocated to organizational activities.  By budgeting, managers identify resources such as money, material and human resource. It also communicates performance expectations. 65Introduction to Planning Hari Prasad Kaphle
  66. 66. Elements of Planning Budget:  A budget is a financial statement of expected results in numerical terms.  For examples Government Annual Budget, Annual Health Budget, Annual budget for HIV/AIDS programme, Tuberculosis control programme etc. MoHP Budget-Prog 2068-69.pdf 66Introduction to Planning Hari Prasad Kaphle
  67. 67. Introduction to Planning Hari Prasad Kaphle 67
  68. 68. Types of Planning Breadth Time frame Specificity Frequency of use Approach adopted Degree of formalization Strategic Long term Directional Single use Proactive Formal Operational Short term Specific Standing Reactive Informal 68Introduction to Planning Hari Prasad Kaphle
  69. 69. Strategic and Operational Planning:  Strategic planning sets the long term direction of the organization in which it wants to proceed in future. It is applied to the entire organization and establishes the organization’s overall objectives, and seeks to position the organization in terms of its environment.  Top-level managers, formulate long-term strategic planning to reinforce the firm’s mission (the mission clarifies organizational purpose).  Strategic plans are specified for five years period or more; but circumstances dictate the planning horizon Introduction to Planning Hari Prasad Kaphle 69
  70. 70. Strategic and Operational Planning:  Operational plans specify the details of how the overall objectives are to be achieved.  Operational planning is accomplished by fist-line managers.  Operational planning is most concerned with budgets, quotas and schedules.  Time horizon for operational planning is very short.  Most plans at this level reflect one operational cycles.  Operational objective are narrow in scope, short-lived and subject to sadden change. Introduction to Planning Hari Prasad Kaphle 70
  71. 71. Short-term and Long-term Planning:  Short-term planning also known as operational or tactical planning usually covers one year or less than one year. These are aimed at sustaining organization in its production and distribution of current product and services to the existing markets.  The long term planning involves the analysis of environmental factors (external and internal) to set its direction for future. Long term plans are strategic in nature and usually cover 5 year or more. Introduction to Planning Hari Prasad Kaphle 71
  72. 72. Standing and Single-use Plans:  Standing plans are ongoing, and provide guidance for repeatedly performed actions in an organization. Standing use plans- are those that are used on a continuous basis to achieve consistently repeated objectives. Standing plans take the form of policies, procedures and rules.  Single-use plans are used to meet the needs of particular or unique situation. Single use plans are those that are used once to achieve unique objectives or objectives those are seldom repeated. They are communicated through programs, budget and schedule. Introduction to Planning Hari Prasad Kaphle 72
  73. 73. Specific and Directional Planning:  In specific planning all the objectives and activities are clearly defined and leave no room for misinterpretation.  In directional Planning only general guidelines are expressed in plan so that these plans are flexible and the way of implementation of this plan depends upon the situation Introduction to Planning Hari Prasad Kaphle 73
  74. 74. Proactive and Reactive Planning:  Proactive planning involves designing suitable course of action in anticipation of likely changes in the relevant environment.  In reactive planning, organizations response comes after the environmental changes have taken place. After the change takes place, the organization starts planning.  For example disaster preparedness and prevention plan is a proactive plan while disaster relief plan is a reactive plan. Introduction to Planning Hari Prasad Kaphle 74
  75. 75. Formal and Informal Planning:  Formal planning is in the form of well-structured process involving different steps. At the end of planning process, the organization has well structured and documented plan with clear objective and activities.  In this types of planning all level of management are involved in planning process and carried out all steps of planning in an organizations. Introduction to Planning Hari Prasad Kaphle 75
  76. 76. Formal and Informal Planning:  In informal planning, planning is based on manager’s memory of events, institutions and got-feeling rather than based on systematic evaluation of environmental happenings.  In fact informal plan are not true plans. These types of planning are generally undertaken by smaller organizations. Introduction to Planning Hari Prasad Kaphle 76
  77. 77. Introduction to Planning Hari Prasad Kaphle 77
  78. 78. Process/Cycle of Planning  Stage 1: Situational analysis  Stage 2: Problem identification and prioritization  Stage 3: Identify resources  Stage 4:Setting objectives  Stage 5: Preparation of action plan  Stage 6: Plan Implementation  Stage 7: Monitoring and Evaluation Introduction to Planning Hari Prasad Kaphle 78
  79. 79. Situational analysis  Population characteristics – population size, age and sex composition, vital statistics  Socio economic characteristics of population –income, education, occupation, cultural practices  Morbidity and mortality profile of major health problems  Epidemiology and geographic distribution of the disease under consideration  Availability healthcare facilities – type, infrastructure structure and available health services  Availability technical manpower – number, category and knowledge and skill level  Awareness level of the community regarding health and diseases etc Introduction to Planning Hari Prasad Kaphle 79
  80. 80. Problem identification & prioritization Introduction to Planning Hari Prasad Kaphle 80 Health problems Health service problems Community health problems Malaria Diarrhea Malnutrition Lack of supervision Insufficient drugs Lack of trained personnel Lack of safe water supply
  81. 81. Problem identification & prioritization Introduction to Planning Hari Prasad Kaphle 81 SN Problem identified Score for each criterion Total scor e Priori ty rank Magnitud e Severity Feasibil ity Govt. concern Commu nity concern 1 Malaria 4 5 5 4 3 21 4 2 HIV/AIDS 3 5 3 4 3 18 6 3 Tuberculosis 3 5 5 4 3 20 5 4 Diarrhoea 5 5 5 5 5 25 1 5 ARI 5 5 5 5 4 24 2 6 PEM 4 4 5 5 4 22 3
  82. 82. Assessment of Resources:  This involves identifying and quantifying the shortfalls (if any) between what is and what ought to be. Analysis of external and internal environment provides potential shortfalls.  This may include assessment of available internal and external resources to fulfill the goal and objectives. Resources are Man, Money, Materials, skill, techniques, knowledge which are utilized to carryout health activities. Introduction to Planning Hari Prasad Kaphle 82
  83. 83. Setting Directions:  This step involves setting the goals and objectives towards which the performance of health system is compared. This step is meant to identify the desirable future state (expressed as outcomes) for the issue under consideration.  At the central level, the objectives would be more general and with each successive level, the objectives will become more specific. Introduction to Planning Hari Prasad Kaphle 83
  84. 84. Setting Directions: Introduction to Planning Hari Prasad Kaphle 84 Goal To improve the health status of community A Objective To provide safe drinking water to community A To improve environmental condition of community A Target To supply safe drinking water to the 90% of households of community A by the year 2018. To support to 95% of households of community A for constructing sanitary latrine by the year 2018.
  85. 85. Preparation of Detail Action Plan (Programming & Budgeting):  This step involves the preparation of detail action plan to fulfill the established goals and objectives based on available resources.  An action plan describes the sequences of activities, timeline to conduct each and every activity, responsible person for each and every activity and resources (financial and non financial) required for each and every activity and indicators to monitor the performance. Introduction to Planning Hari Prasad Kaphle 85
  86. 86. Preparation of Detail Action Plan (Programming & Budgeting): Introduction to Planning Hari Prasad Kaphle 86 Objectives Proposed Activities Approach (strategy) Responsibl e person Resources Cost Time line Performance Indicator Objective 1: Objective 2:
  87. 87. Program Implementation:  This step involves implementation of the chosen solutions. It requires detail description (write up) of formulated plan or action plan for carrying out activities.  It may include development of hiring land/buildings, infrastructures, purchasing equipments, medicines, logistics, selection and recruitment of health professionals and initiation and continuation of services/clinics. Implementation of plan should be accordingly detail action plan. Introduction to Planning Hari Prasad Kaphle 87
  88. 88. Monitoring and Evaluation:  This step may begin with development of an evaluation plan well before evaluation actually takes place. It may also involve development of ongoing monitoring methods to be used to continuously identify and assess the intended and unintended consequences of implementation actions.  Monitoring refers to the assessment of the day to day functioning of the program. Evaluation refers to the assessment of the final outcome of the plan. Introduction to Planning Hari Prasad Kaphle 88
  89. 89. Monitoring and Evaluation: Introduction to Planning Hari Prasad Kaphle 89 S N Activity Key indicator Base line Target Means of verificatio n Frequency of Data Collection Important assumption 1 ANC service 1st ANC Coverage 4th ANC Coverage IFA coverage TT2 coverage 40 % 25% 41% 55% 80% 50% 90% 95% Clinic report Monthly and Quarterly Community support Coordination with SHP/HP 2 INC service Institutional delivery Skill birth Attendance 16% 31% 70% 85% Clinic report Monthly and Quarterly ” 3 PNC service PNC coverage Postnatal Vitamin A coverage 19% NA 50% 100% Clinic report Monthly and Quarterly ” 4 New Born Care Birth weight BCG Coverage NA 85% 85% 95% Clinic report Monthly and Quarterly ”
  90. 90. Planning Cycle Situational analysis Problem identification and prioritization Resources Assessment Setting objectives Preparation of action plan Plan Implementation Monitoring and Evaluation Feedback Introduction to Planning Hari Prasad Kaphle 90
  91. 91. Components of (Operational) a Plan  Executive summary  Introduction  Problem Statement  Objectives and targets  Strategies and activities  Budget  Work Plan  Monitoring and Evaluation  References  Annex Introduction to Planning Hari Prasad Kaphle 91
  92. 92. Introduction to Planning Hari Prasad Kaphle 92
  93. 93. Strategic Planning  Strategic Planning is a long-term, future-oriented process of assessment, goal-setting, and strategy building that maps an explicit path between the present and a vision of the future, that relies on careful consideration of an organization’s capabilities and environment, and leads to priority-based resource allocation and other decisions. Introduction to Planning Hari Prasad Kaphle 93
  94. 94. Strategic Planning  A strategic plan develops a clear statement of the organization’s mission and vision, identifies a set of goals and objectives and formulates key strategies that address those factors that are essential to the its success.  Strategic plan is prepared by the comprehensive scanning of internal (strengths and weaknesses) and external (opportunities and threats) environment. Introduction to Planning Hari Prasad Kaphle 94
  95. 95. Strategic Planning Strategic Planning answers the following questions  Where are we now?  Current status  Where do we want to be?  Desired status  How do we get there?  Strategies  How do we insure we will be there?  Monitor and control system Introduction to Planning Hari Prasad Kaphle 95
  96. 96. Strategic Planning Introduction to Planning Hari Prasad Kaphle 96 T1 T2 Gap Desired Status Present Status Planning Required Time Stat us
  97. 97. Strategic Planning Steps I. Environmental scanning II. Determination of the organizational vision and mission III. Determination of organizational goal and objectives IV. Determination of performance objectives V. Generation, evaluation and decision on strategic options VI. Preparing action plan VII. Developing monitoring and control System VIII. Strategy implementation Introduction to Planning Hari Prasad Kaphle 97
  98. 98. Environmental Scanning External Appraisal:  External appraisal involves analyzing the external environment in which an organization operates in terms of the risks and uncertainties it faces, its current competitive position, and opportunities or threats which it needs to address. Introduction to Planning Hari Prasad Kaphle 98
  99. 99. Environmental Scanning External Appraisal  In the case of a private organization this would include considering the change in technology, the demand from consumers and the actions of competitors.  In the case of public service bodies political, social and economic trends are of major importance. Introduction to Planning Hari Prasad Kaphle 99
  100. 100. Environmental Scanning Internal Appraisal:  Internal appraisal entails examining the resources (employees: number, level, knowledge and skill; finance: capacity to collect and invest; material: equipments, machine, producing capacity and its technology) to find out its strengths and weaknesses that an organization possesses in order to assess its strategic capability so that choices of future strategies can be made. Introduction to Planning Hari Prasad Kaphle 100
  101. 101. Environmental Scanning Internal Appraisal:  This will enable management to decide what resources and skill bases are required for each potential activity and which ones the organization currently possesses. Introduction to Planning Hari Prasad Kaphle 101
  102. 102. SWOT Analysis Opportunities Weakness Threats Strengths
  103. 103. SWOT analysis Introduction to Planning Hari Prasad Kaphle 103 Strengths • Highly skilled manpower • Latest technology • Sufficient investment • Global presence • Well defined distribution mechanism • Alternative products or services Weaknesses • Non experienced managers • Old technology • Lack of investment • Low position in business • Conflict b/n management and employees Opportunities • Favorable government policy • Availability of raw materials • Availability of raw materials at low costs • Availability of latest technology (PID, e-business, telecommunication) • Stable government Threats • Liberal government policy • Threats of new entrance • Hyper competition • Threat of substitute products • Bargaining powers of buyers • Strict environmental laws
  104. 104. Determination of the organizational vision and mission statement  We should have to assess our current mission and objectives and determine future vision and mission based on circumstances identified by environmental scanning  Examples of vision statement may be “Healthy people in health community”; “A world free of vaccine preventable diseases”; “A world free of TB”; “Global excellence in providing health and medical services”. Introduction to Planning Hari Prasad Kaphle 104
  105. 105. Determination of the organizational vision and mission statement  An example for the mission statement for privately run hospital may be “As a leading private hospital in Nepal, we are committed to the provision of comprehensive healthcare services in all medical and surgical specialties in a safe, modern, and patient-centered environment; for the well-being of the whole community. We strive to achieve excellence in serving our patients, regardless of their cultural, ethnic, or social differences”. Introduction to Planning Hari Prasad Kaphle 105
  106. 106. Determination of organizational goal and objectives  An organization’s goal states the intentions behind the organization’s actions. An organizational goal is the general ends toward which it directs its efforts. A goal addresses issues by stating policy intention. It may be both qualitative and quantifiable, but not usually quantified. Introduction to Planning Hari Prasad Kaphle 106
  107. 107. Determination of organizational goal and objectives  An organization’s goal states the intentions behind the organization’s actions. An organizational goal is the general ends toward which it directs its efforts. A goal addresses issues by stating policy intention. It may be both qualitative and quantifiable, but not usually quantified Introduction to Planning Hari Prasad Kaphle 107
  108. 108. Determination of performance objectives  These will be quantified long term and short term performance targets which the organization wishes to achieve.  These unit objectives relate to the specific objectives of individual services or business units within an organization.  These should be SMART – Specific, Measurable, Attainable, Relevant and Time Bound. Introduction to Planning Hari Prasad Kaphle 108
  109. 109. Second Long Term Health Plan (1997-2017) Objectives  To improve the health status of the population of the most vulnerable groups, particularly those whose health needs often are not met-women and children, the rural population, the poor, the underprivileged, and the marginalized population.  To extend to all districts cost-effective public health measures and essential curative services for the appropriate treatment of common diseases and injuries.  To provide the appropriate numbers, distribution and types of technically competent and socially responsible health personnel for quality healthcare throughout the country, particularly in under-served areas  To improve the management and organization of the public health sector and to increase the efficiency and effectiveness of the healthcare system  To develop appropriate roles for NGOs, and the public and private sectors in providing and financing health services.  To improve inter-and intra-sectoral co-ordination and to provide the necessary conditions and support for effective decentralization with full community participation. Introduction to Planning Hari Prasad Kaphle 109
  110. 110. Second Long Term Health Plan (1997-2017) Targets  To reduce the infant mortality rate to 34.4 per thousand live births;  To reduce the under-five mortality rate to 62.5 per thousand;  To reduce the total fertility rate to 3.05;  To increase life expectancy to 68.7 years;  To reduce the crude birth rate to 26.6 per thousand;  To reduce the crude death rate to 6 per thousand;  To reduce the maternal mortality rate to 250 per hundred thousand births;  To increase the contraceptive prevalence rate to 58.2 percent;  To increase the percentage of deliveries attended by trained personnel to 95%;  To increase the % of pregnant women attending 4 antenatal visits to 80%;  To reduce the % of iron-deficiency anaemia among pregnant women to 15%;  To increase the % of women of child-bearing age (15-44) who receive TT2to 90%;  To decrease the percentage of newborns weighing less than 2500 grams to 12%;  To have essential healthcare services (EHCS) in the districts available to 90% of the population living within 30 minutes' travel time of facilities;  To have essential drugs available at 100% of facilities;  To equip 100% of facilities with full staff to deliver essential health care services;  To increase total health expenditures to 10% of total government expenditures. Introduction to Planning Hari Prasad Kaphle 110
  111. 111. Generation, Evaluation and Decision on Strategic Options  Growth strategies take advantage of the organization’s internal strengths and the environment’s opportunities to grow (S, O).  Reinforcement strategies force the organization to overcome its internal weaknesses in order to take advantage of the opportunities the environment offers (W, O).  Response strategies use the organization’s internal strengths to respond to and address the environment’s threats (S, T).  Withdrawal strategies ensure survival when faced with internal weaknesses and the environment’s threats, the organization withdraws to seek the most favorable conditions (W, T). Introduction to Planning Hari Prasad Kaphle 111
  112. 112. WOST Matrix Introduction to Planning Hari Prasad Kaphle 112 Opportunities Strengths Weaknesses Growth Strategies  Expansion  Maintenance  Development and Innovation  Diversification Reinforcement Strategies  Reorientation  Approach  Specialization Threats Response Strategies  Market segmentation  Differentiation  Diversification  Leadership development  Strategic alliances  Political actions Withdrawal Strategies  Reorientation  Approach  Specialization  Segmentation  Differentiation  Leadership  Alliances  Political actions
  113. 113. Generation, Evaluation and Decision on Strategic Options  Examples of strategies include in health care setting may be improve employee retention and recruitment, establish new services that promote the continuum of care, improve the profitability from payers (e.g., by reviewing contracts and utilization patterns), develop distinctive tertiary services that position the hospital as the preeminent regional referral center, generating funds from unusual sources (e.g. renting spaces within the premises of the hospital for cafes and restaurants), achieve a culture of quality that produces superior patient care outcomes and customer satisfaction levels etc. Introduction to Planning Hari Prasad Kaphle 113
  114. 114. Sample strategies of a hospital By the end of 2020 the institution must:  To position its institutional image in the minds of the country’s population as the best option to care for their health problems, through its excellent quality of care and the implementation of innovate market strategies;  To have the most comfortable facilities available, equipped with state-of-the-art technology, prioritizing the areas with the highest demand;  To strengthen the staff’s development and foster a harmonious working environment, offering the best working conditions and incentives in accordance with staff performance and the delivery of quality services;  To maintain client satisfaction levels above 95% at all institutional facilities, especially those that come in direct contact with clients. Introduction to Planning Hari Prasad Kaphle 114
  115. 115. Preparing action plan  Action Plan is a detailed description of the strategies used to implement an objective.  Action plans break strategies into manageable parts for coordinated implementation of goals and objectives.  Task specification includes staff assignments, material resource allocations, and schedules for completion.  Action plans specify detailed cost and expenditure information and are often referred to as the step of “operational plans” or “implementation plans”. Introduction to Planning Hari Prasad Kaphle 115
  116. 116. Developing Monitoring and Control System  An organization should plan for monitoring and tracking performance which is a description of the methods the organization is using to determine if the strategic plan is being accomplished.  Emphasis should be placed on describing how progress to achieve the objective is currently being monitored by using performance measures, as well as describing the projected plan for each of the other future fiscal years.  The description should evaluate the results of past actions implemented. Introduction to Planning Hari Prasad Kaphle 116
  117. 117. Strategy Implementation  Strategy implementation includes long term and short term resource planning and budgeting. Plans for developing new services, methods of delivery and alternative locations for delivery need to be established.  These long term plans should then be coordinated and translated into financial terms by projecting the financial impact of current and future activities for several years. Introduction to Planning Hari Prasad Kaphle 117
  118. 118. Strategy Implementation  They provide a statement of the key initial targets and actions required by an organization to achieve its strategic plans.  Capital expenditure plans will also normally originate from the long term planning process.  Once completed the long term plan should be continually reviewed and revised to ensure its continued relevance. Introduction to Planning Hari Prasad Kaphle 118
  119. 119. Contents of Strategic Plans 1. Executive Summary 2. Table of Contents 3. Internal/External Assessment Summary 4. Vision Statement 5. Mission Statement 6. Principles and core values 7. Goals 8. Objectives 9. Targets (Performance Measures) 10.Resource Assumptions 11.Action Plans 12.Plan for Monitoring and Tracking Performance 13.References 14.Annex Introduction to Planning Hari Prasad Kaphle 119
  120. 120. Hari Prasad Kaphle Assistant Professor (Public Health) Pokhara University Introduction to Planning Hari Prasad Kaphle 120
  121. 121. Scope of Planning in Public Health  Health is worldwide social goal.  It is multi-sectoral and its goal cannot be achieved by health system alone.  It is the responsibility of all public as well as private sectors.  So the scope of health planning cannot be viewed as health services planning by the state.  But it includes all comprehensive, interdisciplinary and disjointed & fragmented planning by state and private sector which affects health of populations directly and indirectly. Introduction to Planning Hari Prasad Kaphle 121
  122. 122. Scope of Planning in Public Health  The scope of health planning includes planning for preventive, promotive, curative and rehabilitative care.  The scope of health planning also includes planning for all level of health system: primary, secondary, tertery Introduction to Planning Hari Prasad Kaphle 122
  123. 123. Scope of Planning in Public Health  It’s scope also includes planning for public sector as well as planning for private sectors (both private for profit and private for non profit)  It’s scope also include planning in other sector to provide health related service: education, nutrition, environment, agriculture, social development etc. Introduction to Planning Hari Prasad Kaphle 123
  124. 124. Scope of Planning in Public Health Introduction to Planning Hari Prasad Kaphle 124 Planning for private-for-profit •Planning for health care industries, pharmaceuticals, private nursing homes and hospitals •Planning for other business sectors e.g. food industries, planning for occupation health and safety Planning for private-for- nonprofit •Planning for international nongovernmental organizations •Planning for national nongovernmental organizations •Planning for religious organizations and charitable trusts Development sector planning •Planning for education •Planning for infrastructure development •Planning for land reform Interdisciplinary planning •Planning for population development •Planning for agriculture & veterinary •Planning for forestry •Financial & mgt planning Health sector Planning •Planning for public health & PHC •Planning for medical education & service •Planning for indigenous system •Planning for health research and politics Publicsectorplanning Privatesectorplanning
  125. 125. Education sector  Sound education sector planning is essential for production of health manpower of all cadre insufficient number to provide health services throughout the country. Introduction to Planning Hari Prasad Kaphle 125
  126. 126. Development Sector  Appropriate design and construction of trade apartments, industrial estate, public buildings and residential area becoming challenging works now a day.  Appropriate design and construction of roads, sewage system, water supply system is of great public health importance.  This discipline of public health is also regarded as public health engineering.  Planned development helps in reduction of exposure from many hazards and hence reducing public health problems. Introduction to Planning Hari Prasad Kaphle 126
  127. 127. Planning for land reform  It is core element in all aspects of life and livelihood. The production of farm depends on how well the resources are mobilized.  Redistribution and reuse and management plan for unused land is of great importance in public health for reducing food insecurity in populations. Introduction to Planning Hari Prasad Kaphle 127
  128. 128. Health Sector Planning:  Planning for public health and primary health care: Water and sanitation, control of communicable diseases, endemic and epidemics of diseases, reproductive health and family planning, maternal and child health, immunization and health promotion and behavior changes actions fall under the domain of public health and primary health care planning. Introduction to Planning Hari Prasad Kaphle 128
  129. 129. Health Sector Planning:  Planning for medical education and service: It includes the planning and development health manpower and appropriate management of all categories of health manpower. Health services may range from preventive to promotive, curative and rehabilitative ones. Similarly it deals with the management of health institutions and provision of health services. Introduction to Planning Hari Prasad Kaphle 129
  130. 130. Health Sector Planning:  Planning for indigenous systems of medicine: Various systems of medicines have been growing with their particular importance. For example ayurveda, unani, naturopathy and others. Planning is essential to establish their scope, coverage and efficacy. Introduction to Planning Hari Prasad Kaphle 130
  131. 131. Health Sector Planning:  Planning for health research and politics: Research is one that strives to establish new facts or verify old facts. It needs appropriate planning which guides for action. Planning for research work, data management, dissemination and implication plan have been given due importance. Similarly health sector development requires political commitment and implementation work schedule. Introduction to Planning Hari Prasad Kaphle 131
  132. 132. Interdisciplinary Planning:  The Interdisciplinary planning is the integrated planning with disciplines which had close relationship with public health.  Such disciplines are demography and population studies, management and finance, veterinary sciences and animal husbandry, agriculture and forestry, environment science etc.  Interdisciplinary planning helps to achieve the goal of both public health as well as goal of concerned sector.  Planning is essential for these sectors to support others also.  Coordination and joint planning of department of health services and department of animal health for the control of avian influenza and zoonotic diseases is an example of interdisciplinary planning. Introduction to Planning Hari Prasad Kaphle 132
  133. 133. Planning for Private for Nonprofit:  Various multilateral organizations (e.g. UN agencies: WHO, UNDP, UNFPA, CDC, UNICEF etc.) bilateral organizations (e.g. GTZ, KFW, DFID, JICA, SDC etc.) and unilateral organizations (FHI, PSI, OXFAM, CARE, Save the children Fund etc.) working in the field of public have important role in health planning and policy development. These organizations provide technical as well as financial support for planning, implementation and evaluation of health services. Introduction to Planning Hari Prasad Kaphle 133
  134. 134. Planning for Private for Nonprofit:  Similarly community based organization (CBOs), national nongovernmental organizations (NNGOs) working for particular geographical area and for particular segment of population also plans separately or in coordination with local government agencies to provide health service to that segment of population.  In many countries some religious organization and charitable trusts also influencing health planning process since they are providing faith-based health–care still today. Introduction to Planning Hari Prasad Kaphle 134
  135. 135. Planning for Private for Profit:  Private for Profit includes two types of enterprise: first that directly provides health care services (e.g. private hospital, nursing homes, medical colleges etc.) and pharmaceuticals industries those produce medical products and second other business sectors (e.g. food industries) that do not provide health care service but may influence the health of public with great importance. Introduction to Planning Hari Prasad Kaphle 135
  136. 136. Planning for Private for Profit:  The role of government is to monitor these enterprises constantly to protect the health of the public. Similarly business industries (public or private) should plan for occupation health and safety for their employees. Introduction to Planning Hari Prasad Kaphle 136
  137. 137. Hari Prasad Kaphle Assistant Professor (Public Health) Pokhara University Introduction to Planning Hari Prasad Kaphle 137
  138. 138. Nursing Philosophy  Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. Introduction to Planning Hari Prasad Kaphle 138
  139. 139. Scope and Application of planning in Nursing  Planning for different field (specialty) of nursing  Public health nursing  Community nursing  Maternal child health nursing  Pediatric nursing  Obstetric and gynecological/Midwifery nursing  School health nursing  Oral health nursing  Hospital nursing/clinical nursing Introduction to Planning Hari Prasad Kaphle 139
  140. 140. Scope and Application of planning in Nursing  Planning for different field (specialty) of nursing  Cancer nursing (Oncology)  Cardiac care nursing  Ophthalmology nursing  Mental health nursing  Emergency nursing  Adult health nursing  Family health nursing  Gerentological nursing Introduction to Planning Hari Prasad Kaphle 140
  141. 141. Scope and Application of planning in Nursing  Planning to provide nursing care  Short term care  Long term care  Intensive care  Emergency care Introduction to Planning Hari Prasad Kaphle 141  Out patient care  Inpatient care  Home care  Individual care  Institutional care
  142. 142. Scope and Application of planning in Nursing  Planning for effective management of different department regarding nursing care  Emergency  OPD  ICU  NICU  CCU  OT Introduction to Planning Hari Prasad Kaphle 142  Labor  Post partum  Pediatric  Medical  Surgical  Orthopedic  Laundry etc.
  143. 143. Scope and Application of planning in Nursing  Planning for production of Nursing professional  Universities, colleges  Professional council  Planning to provide nursing leadership  Development of various rules, regulations, ethics, SOPs, protocols to provide nursing service  Regulation of nursing employees  Research to establish the evidence based practice Introduction to Planning Hari Prasad Kaphle 143
  144. 144. Hari Prasad Kaphle Assistant Professor (Public Health) Pokhara University Introduction to Planning Hari Prasad Kaphle 144
  145. 145. Benefits of Planning  Planning provides the direction to an organization.  Planning helps to carryout all other managerial function.  Planning helps focus organizational attention on objectives.  Planning minimizes the risk and uncertainty.  Planning helps to grasp the opportunity available in external environment.  Planning provides the direction to all employees to carryout their responsibilities. Introduction to Planning Hari Prasad Kaphle 145
  146. 146. Benefits of Planning  Planning provides the bases for control.  Planning helps in coordination and communication  Planning helps to increase organizational effectiveness  Planning helps to increase efficiency  Planning encourages motivation and creativity  Provides the status to a manager and organization  Planning help to adopt the change  Planning helps to adopt the technology Introduction to Planning Hari Prasad Kaphle 146
  147. 147. Limitations of planning  It depends up on facts and information. To get reliable information may not possible always.  To prepare an effective plan it needs highly experienced managers.  Planning needs team efforts.  Planning may lead to internal inflexibilities and procedural rigidities.  Planning is an elaborative process needs more paper work.  It is a time consuming and expensive process.  Planning is rigid and may discourage innovation. Introduction to Planning Hari Prasad Kaphle 147
  148. 148. Barriers in effective planning 1. Difficulty of accurate premising 2. Problem of rapid change 3. Internal barriers a. Capital investment b. Psychological factors c. Policy and procedure 148Introduction to Planning Hari Prasad Kaphle
  149. 149. Barriers in effective planning 4. External Barriers a. Government policy b. Political climate c. Trade union 5. Lack of sufficient time for planning 6. Lack of sufficient cost for planning 149Introduction to Planning Hari Prasad Kaphle
  150. 150. Introduction to Planning Hari Prasad Kaphle 150
  151. 151. Introduction to Policy  Definition  Types  Benefits  Limitations Introduction to Planning Hari Prasad Kaphle 151
  152. 152. Definition  A policy is a statement of principle made by those in authority (usually government) to be used as guide for all subordinate action.  A policy is a guiding principle or a plan of action agreed to by a group of people with power to carry it out and enforce it. Introduction to Planning Hari Prasad Kaphle 152
  153. 153. Definition  Policy represents the way in which an organization (usually government) seeks to achieve the objectives it has set.  Bridgman and Davis (1988) defined as “Policy is a shorthand description for everything from an analysis of past decisions to the imposition of current thinking.” Introduction to Planning Hari Prasad Kaphle 153
  154. 154. Definition  Daneke and Steiss (1978) defined it as “A broad guide to present and future decisions, selected in light of given conditions from a number of alternatives; the actual decision or set of decisions designed to carry out the chosen course of actions; a projected program consisting of desired objectives (goals) and the means of achieving them”. Introduction to Planning Hari Prasad Kaphle 154
  155. 155. Types of policies  Policies can be categorized into distributive, regulatory, self-regulatory, and redistributive policies  Policies can also be categorized into macro policies and micro policies Introduction to Planning Hari Prasad Kaphle 155
  156. 156. Distributive policies  Distributive policies involve allocation of services or benefits to particular segments of the population (individuals, groups, corporations, and communities). Introduction to Planning Hari Prasad Kaphle 156
  157. 157. Distributive policies  Some distributive policies may provide benefits to one or a few beneficiaries; others may provide benefits for vast numbers of persons such as free education policy, agricultural income-support policy, tax deductions policy for home mortgage interest payments.  Distributive policies typically involve using public funds to assist particular groups, communities, or industries. Introduction to Planning Hari Prasad Kaphle 157
  158. 158. Regulatory policies  Regulatory policies impose restrictions or limitations on the behavior of individuals and groups.  That is, they reduce the freedom or discretion to act of those regulated.  In this sense they clearly differ from distributive policies, which increase the freedom or discretion of the persons or groups affected. Introduction to Planning Hari Prasad Kaphle 158
  159. 159. Regulatory policies  Some examples of regulatory policies are environmental protection act; regulations for the control of criminal offence, pornography, abortion, personal behavior (restrictions of alcohol consumption, smoking in public place; driving limit etc.); consumer protection act; food act; policies for media/television broadcasting etc. Introduction to Planning Hari Prasad Kaphle 159
  160. 160. Regulatory policies  Some regulatory policies, those restrict entry into a business known competitive regulatory policies.  They limit the number of providers of specific goods and services.  They also may regulate the quality of services that can be provided to consumers.  For example television broadcasting regulation; of the several applicants for a television broadcast license for a city only one or few can be propitiated. Introduction to Planning Hari Prasad Kaphle 160
  161. 161. Self-regulatory policies  Self-regulatory policies are similar to regulatory, except that the persons or groups regulated possess considerable authority and discretion to formulate and police the regulations governing them.  Public health workers, nurses, physicians, dentists, medical technicians, optometrists, pharmacists, psychologists, sanitarians, social workers and other professions, for example, receive authority from government to license practitioners, thus determining who may and who may not practice the profession. Introduction to Planning Hari Prasad Kaphle 161
  162. 162. Self-regulatory policies  Such groups often also develop and administer their own codes of ethics, enforce discipline, and help to govern the schools that produce the professionals.  Self-regulatory policies are usually more controlled by the regulated group as a means of protecting or promoting the interests of its members. Introduction to Planning Hari Prasad Kaphle 162
  163. 163. Redistributive policies  Redistributive policies involve deliberate efforts by the government to shift the allocation of wealth, income, property, or rights among broad classes or groups of the population.  Redistribution involves not only the allocation of benefits or services to certain parts/groups of the population, but the taxing of other parts/groups of the population to generate the funds.  These involve taxing relatively more affluent members of society in order to provide income assistance, food, housing, or health insurance to the less affluent. Introduction to Planning Hari Prasad Kaphle 163
  164. 164. Redistributive policies  Redistributive policies are difficult to enact because they involve the reallocation of money, rights, or power.  Because money and power are good coinage in the political realm, those who possess them have ample means to resist their diminution.  Such as health insurance package for poorer, agricultural subsidies, income taxes based on ability to pay are examples of redistributive polices. Introduction to Planning Hari Prasad Kaphle 164
  165. 165. Macro policies  Some policies have boarder scope and have implication across the most or areas such as health, education, agriculture, economic and social development sector, whose actors have limited influence over them.  Fiscal policies, civil service policies etc. are falls under this category and termed as macro policies. Introduction to Planning Hari Prasad Kaphle 165
  166. 166. Macro policies  These policies have solely political character and their implication is influenced politically.  Such policies are influenced by political system, stability of government, economic trend, population growth, technology advancement and external pressure Introduction to Planning Hari Prasad Kaphle 166
  167. 167. Macro policies  Within the health sector such policies are various sectoral policies such as primary health care, essential health service, basic health care package, decentralization, health sector reform, sector wide approaches in health and alternative financing mechanisms etc. which affect most aspects of health service delivery and applicable for all or most levels or services or populations. Introduction to Planning Hari Prasad Kaphle 167
  168. 168. Micro policies  Other policies, of strictly technical nature, address narrower issues, of public concerns.  Such micro policies having technical character have implication for certain issues of particular sector.  As for examples communicable disease (tuberculosis, malaria, and HIV/AIDS etc.) control strategy, non communicable disease (diabetes, cancer, coronary heart disease etc.) control strategy, drug quality control etc have narrower implications and the sectoral actors have sufficient influence over them. Introduction to Planning Hari Prasad Kaphle 168
  169. 169. Micro policies  Other examples of these categories of policies are pesticides control in agriculture, food standard and food safeties in nutrition have narrower implication with respect to macro policies.  These micro policies with technical implications are influenced by narrower issues such as epidemic of cholera, increase in HIV/AIDS in general population, resistance of anti-tubercular drugs, increasing in suicidal rates among adolescents, out breaks of poliomyelitis etc. provides special attention to authorities of health sector. Introduction to Planning Hari Prasad Kaphle 169
  170. 170. Vertical and horizontal policies  Vertical policy (sometimes called corporate or framework policy) is developed within an organization that has authority and resources for implementation. Introduction to Planning Hari Prasad Kaphle 170
  171. 171. Vertical and horizontal policies  Horizontal policy, sometimes referred to as integrated policy, is developed by two or more organizations and or departments of same organization having same level, each of which has authority or ability to deal with only a part of the situation. The distinction reflects how clearly a mandate rests with one department, unit or agency, and its capacity to address the root cause of the issue with existing resources. Introduction to Planning Hari Prasad Kaphle 171
  172. 172. Vertical and horizontal policies  Horizontal policy can itself be divided into three categories.  Policy developed within a sector is referred to as sectoral policy.  When more than one sector is involved, the policy becomes multi-sectoral.  When the groups developing the policy are able to determine a shared, super-ordinate goal and to work collaboratively to achieve policy that addresses root causes as well as symptoms, the policy is said to be integrated policy. Introduction to Planning Hari Prasad Kaphle 172
  173. 173. Health policy  “A formal statement or procedure within institutions (notably government) which defines priorities and the parameters for action in response to health needs available resources and other political pressures.” – World Health Organization (1998)  “The decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.” - Encyclopedia of Medical Concept Introduction to Planning Hari Prasad Kaphle 173
  174. 174. Health policy  “A set of statements and decisions defining health priorities and main directions for attaining health goals.” -Dictionary of Public Health (2007)  "The aggregate of principles, stated or unstated, that…characterize the distribution of resources, services, and political influences that impact on the health of the population" -Miller (1987) Introduction to Planning Hari Prasad Kaphle 174
  175. 175. Health policy  “...courses of action (and inaction) that affect the sets of institutions, organizations, services and funding arrangements of the health system. It includes policy made in the public sector (by government) as well as policies in the private sector. But because health is influenced by many determinants outside the health system, health policy analysts are also interested in the actions and intended actions of organizations external to the health system which has an impact on health (for example, food, tobacco or pharmaceutical industries).” - Buse, Mays & Walt (2005) Introduction to Planning Hari Prasad Kaphle 175
  176. 176. Health policies of Nepal  National Health Policy 2071  National Population policy 2070  National Health Policy1991  Tenth Plan Poverty Reduction Strategic Paper (2002-07)  Free Health Care policy 2007  National Ayurveda Health Policy 2052(1996)
  177. 177. Health policies of Nepal  National Drug Policy 1995  National Medicines Policy 2007  Safe Motherhood Policy  National Policy on Safe birth Attendance  National Safe Abortion Policy 2003  Vital Registration Act 2033  National Oral Health Policy  Mental Health (Treatment and Protection) Act 2006  Policy on Quality Assurance in Health Care Services 2064
  178. 178. Health policies of Nepal  Health Care Technology Policy 2006  Water Resource act 2049  Nepal National Policy on Sanitation  National Policy on Rural Water Supply and Sanitation 2004  Policy on NGO participation in WATSAN Program1996  Natural Disaster Management Act  Natural Calamity (relief) act 1982  National Blood Policy 2050(1993)  National Health Research Policy
  179. 179. Benefits of policy  Outlines the working principles  Provide the framework for providing public services  Provide base for decision making  Provide the roadmaps for the concerned sector  Outline the government/organizational priorities  Specify the strategies to achieve the goal and objectives  Regulate governmental/organizational actives  Distribute/redistribute resources to public Introduction to Planning Hari Prasad Kaphle 179
  180. 180. Limitations of Policy  Leave room for misinterpretation  Restrict certain behavior e.g. Environmental protection act, regulation regarding health care waste management, regulation regarding housing  Some service/program/population may get less priority  Collection and distribution of resources may not be fair always  sometime may outline political priorities and real problems may not get priority  May be difficulty to translate policy into programmatic language Introduction to Planning Hari Prasad Kaphle 180
  181. 181. Hari Prasad Kaphle Assistant Professor (Public Health) Pokhara University Introduction to Planning Hari Prasad Kaphle 182
  182. 182. Approaches of Planning 1. Top- Down approach 2. Bottom – up approach 3. Participatory approach 4. Team approach
  183. 183. Top – down Approach  Top level management formulation plans and goals and plans are communicated to middle and lower level management for implementation and control.  It is generally used in highly centralized organizations  Only top level managers have a role in planning  Those who are responsible for implementation are not involved in the planning process.  It may not be sensitive to local conditions
  184. 184. Bottom –up Approach  The plans are formulated at the operational level  They travel bottom to top level  It is decentralized approach of planning
  185. 185. Participatory Approach  This methods is a blend of top down and bottom-up methods of planning.  The top management provides broad premises, parameters and guidelines for planning to operational level management  Then operational level formulates the plans and forwards to the top level which reviews and finalizes the plans
  186. 186. Team Method of planning  The job of planning is entrusted to a team  The members of the team possess multiple skills in planning.  The team prepares draft plans which are forwarded to the top management, which are reviewed and finalized by top management
  187. 187. Setting Objectives  Virtually, all organizations have a formal, explicitly recognized, legally specified organ for setting the initial objectives.  Generally, top management determines the overall objectives which the members of the organization unite to achieve.  In large corporate entities, such bodies as board of directors, governing board, or executive committee may set the objectives.
  188. 188. Setting Objectives  Setting of organizational objectives depends upon various factors such as  value system of mangers particularly at the top level,  organizational strengths and weaknesses, and  external environment.
  189. 189. Guidelines for setting objectives  Objectives must be clearly specified.  Objectives must be set taking into account the various factors affecting their achievement.  Objectives should be consistent with organizational mission.  Objectives should be rational and realistic rather than idealistic.  Objectives should be achievable but must provide challenge to those responsible for achievement.
  190. 190. Guidelines for setting objectives  Objectives should yield specific results when achieved.  Objectives should be desirable for those who are responsible for the achievement.  Objectives should start with the word 'to' and be followed by an action verb.  Objectives should be consistent over the period of time.  Objectives should be periodically reviewed.
  191. 191. Hari Prasad Kaphle Assistant Professor (Public Health) Pokhara University
  192. 192. Management by objectives  Management by objectives is defined as “a process by which supervisors and subordinate managers jointly identify their common objectives, set the result that should be achieved by the subordinates, assess the contribution of each individual, and integrate individuals with the organization so as to make best use of organizational resources”.
  193. 193. Management by objectives  Management by Objectives (MBO) is a process of agreeing upon objectives within an organization so that management and employees agree to the objectives and understand what they are in the organization.
  194. 194. Management by objectives  Management by objectives (MBO) is a system of allowing employees to work with their supervisors in setting performance objectives in an effort to achieve organizational outcomes.
  195. 195. Management by objectives  MBO is a comprehensive managerial system that integrates many key managerial activities in a systematic manner and that is consciously directed towards the effective and efficient achievement of organizational and individual objectives.  The term "management by objectives" was first popularized by Peter Drucker in his 1954 book 'The Practice of Management'.
  196. 196. Management by objectives  The value of MBO is that it communicates the mission, goals and objectives of the organization to the lower levels.  The lower level managers work out their plans and targets in consultation with their subordinates, then sent to higher levels for consideration.  MBO allows employees to participate in planning and control of their own work.
  197. 197. Management by objectives  This involvement of employees increases their motivation and commitment to their work.  MBO includes continuous tracking of the processes and providing feedback to reach the objectives.
  198. 198. Organizational Objectives Divisional Objectives Departmental Objectives Individual Objectives Management by Objectives
  199. 199. Process of MBO  Setting the preliminary objectives at the top,  Clarifying Organizational role,  Setting subordinates role,  Recycling objectives.
  200. 200. MBO Advantages  MBO programs continually emphasize what should be done in an organization to achieve organizational goals.  Improvement in managing  Clarification of organizational roles and structure  Clarification of individuals roles within the organization  Encouragement in personal commitment (encourages people to commit themselves to their goals)  Development of effective controls
  201. 201. MBO Disadvantages  The development of objectives can be time consuming, leaving both managers and employees less time in which to do their actual work.  The elaborate written goals, careful communication of goals, and detailed performance evaluation required in an MBO program increase the volume of paperwork in an organization.  Failure to teach philosophy of MBO
  202. 202. MBO Disadvantages  Failure to give guidance to goal setters  Difficulty of setting goals: time consuming and complex  Emphysis on short run goals  Danger of inflexibility  Based on quantity rather than quality
  203. 203. Hari Prasad Kaphle Assistant Professor (Public Health) Pokhara University Introduction to Planning Hari Prasad Kaphle 205
  204. 204. Procedure  A procedure (sometimes called as standard operating procedure) is a sequence of steps for completing a given activity.  Formal procedures provide specific and detailed instructions for the execution of plans.  It is a standing plan that outlines a series of related actions that must be taken to accomplish a particular task. 206Introduction to Planning Hari Prasad Kaphle
  205. 205. Procedure  Procedures and policies are linked to each other.  For example, a Purchasing policy of an enterprise may states purchasing from lowest bidding party.  To implement this policy an enterprise should establish a procedure containing sequence of activities how it will purchase from lowest bidding party. 207Introduction to Planning Hari Prasad Kaphle
  206. 206. Procedure  Policy: Recruitment of employee through open competition  Procedure: advertisement, collecting application, screening, knowledge test, interview, verification of certificates, reference checking, selection, placement of selected employees etc. 208Introduction to Planning Hari Prasad Kaphle
  207. 207. Relationship b/n Policy and Procedure  Policies are board guidelines to both thinking and action where as procedures are definite and specific guide to action.  Policies are board therefore are subject to interpretation, where as procedures are more fixed to follow through a defined area of policy. Introduction to Planning Hari Prasad Kaphle 209
  208. 208. Relationship b/n Policy and Procedure  Policies mostly guide to thinking and action of people working at a higher level, where as procedures generally guide the actions of people at the lower level.  Policies indicate the principles to be followed in achieving the organizational objectives, where as procedures guide us how to implement the policies. Introduction to Planning Hari Prasad Kaphle 210
  209. 209. Relationship b/n Policy and Procedure  Policies are not followed in any chronological order/sequence, where as procedures are always followed in a chronological sequence. Introduction to Planning Hari Prasad Kaphle 211
  210. 210. Benefit of Procedures  Procedures helps the workers to perform a task in a standardized way.  Procedures simplify the work by eliminating unnecessary and overlapping steps.  Procedures specifies the certain steps to perform certain task  Procedure provide specific and detailed instructions by outlying a series of related actions Introduction to Planning Hari Prasad Kaphle 212
  211. 211. Benefit of Procedures  Procedures help to perform activity repeatedly in a same way  Procedure help in implementing policies  Procedure help in increasing staff performance  Procedure helps in increasing organizational effectiveness and efficiency  Procedure provides the basis for managerial control Introduction to Planning Hari Prasad Kaphle 213
  212. 212. Limitation of Procedures  May hider creativity  Rigid and inflexible  May not practical in all conditions  May lead to decrease motivation to employees  May provide lengthy process to perform certain task Introduction to Planning Hari Prasad Kaphle 214
  213. 213. Winners do not do different things, they just do same thing differently. Work smart not hard to be a successful manager !!!

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