Planning, monitoring, and evaluation of health care programs involves a cyclical process with several key steps. Planning defines problems, assesses resources, establishes goals and objectives, and outlines actions. Monitoring tracks program implementation and progress. Evaluation measures achievement of objectives and assesses outcomes, impact, and resource use. The document outlines a 14-step planning process that includes situational analysis, priority-setting, developing strategies and action plans, implementation, and ongoing evaluation. Monitoring and evaluation are essential for ensuring programs proceed as intended and resources are used efficiently to maximize health impacts.

1. PLANNING, MONITORING &
EVALUATION OF HEALTH
CARE PROGRAMS
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2. OUTLINEOF PRESENTATION
Definitions
Planning cycle
Steps of planning
Monitoring
Evaluation
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3. PLANNING
Planning has been defined as “the orderly process of defining
community health problems, identifying unmet needs and surveying the resources
to meet them, establishing priority goals that are realistic and feasible and
projecting administrative action to accomplish the purpose of the proposed
programme”
Plan – Blue print for taking action
The purpose of planning is
(1) to match the limited resources with many problems
(2) to eliminate wasteful expenditure or duplication of expenditure
(3) to develop the best course of action to accomplish defined objective
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4. Planning cycle
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5. Elements of plan-
I. Objectives - Planned end-point of all activities related to alleviatea
problem.
II. Policies - It is the guiding principle with clear directives stated as an
expectation. It has to be translated into legislation by parliamentto become
effective.
III.Programs - Sequence of activities designed to implement policies and
accomplish objectives.
IV.Schedules - Time sequence for the work to be done
V. Budget - An estimate of income and expenditure for a set period of time.
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6. Monitoring
 Day-to-day follow-up of activities done
 To ensure programs are proceeding as planned and are on schedule
 Continuous process of observing, recording & reporting
 Keeping track of the course of activities
 Identifying deviations & taking corrective actions if excessive
deviations occur
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7. Evaluation
 Measures the degree to which objectives & targets are fulfilled and
the quality of the results obtained.
 Assesses how much output or cost-effectiveness is achieved
 Assesses the adequacy & efficiency of the program
 Assesses the acceptance by all parties involved
 Enables reallocation of priorities and of resources on the changing
health needs.
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8. Stepsin Planning and Evaluation of Health
Programs :
Step 1 - Laying down the premises (scope) :
This defines the general perimeters or “boundaries”
This is done in terms of place,
time,
population and disease condition,
within which the health program being planned
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9. Step 2 - Situational analysis :
Relevant Demographic
Socio-economic
Disease data
Step 3 - Resource analysis :
Data on available resources (health manpower, money
and material) is obtained and analysed.
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10. Step 4 - SWOT Analysis :
The Strengths (S), Weaknesses (W), Opportunities (O) and
Threats (T) are identified in context of the proposed programme.
S and W are permanent phenomena that exist within the
organization or community.
O and T are temporary, that exist in the externalenvironment.
Step 5 - Ensure Community participation :
Identify the community leaders, peers and voluntary groups and
involve them fully in the planning process.
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11. Step 6 - Enunciation of the “COMMUNITY NEEDS” :
The major issues which need to be addressed and which can be
feasibly addressed are decided.
‘normative’ or ‘professionally assessed needs’ are what we, as
Doctors or public health care managers, feel that the community requires
‘felt needs’ of the community are what the communitymembers
feel is their need).
work out an optimum trade-off between these two needs.
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12. Step 7 - Setting the Priorities :
Work out the “priority” areas within the proposed programme, which
are the most important requirements on given our available (and expected)
resources, can feasibly address them.
An epidemiological method for according priorities is to consider the
following three headings and give marks accordingly:
●● Importance of disease : 3 if high importance
2 if moderate importance
1 if low importance.
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13. ●● Effectiveness of Interventions :
3 if interventions known to be very effective,
2 if moderately effective,
1 if low or non effective.
●● Cost of interventions : 3 marks if cost is low,
2 if moderate cost,
1 if cost is high
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14. Step 8 - Identify the “High Risk” Groups :
High Risk groups are those who have a much higher chance of
being affected by the disease or it’s adverse consequences.
It is important, at this stage, to identify the high risk persons,
based on our situational analysis and identification of community needs, so
that extra efforts may be directed towards them.
It depends on the disease or condition being addressed.
Consequently, large amount of benefit will occur from the
programme if these groups are addressed.
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15. Step 9 - Enunciate the Goal (Aim), Objectives, Indicators and Targets of the
Programme :
Aim or the Goal is ultimate desired state towards which objectives &
resources are directed
Objectives are specific statements, through which the overall goal
would be achieved. Objectives are thus specific, quantifiable and usually
relate to a time-plan.
Indicators are parameters and Targets are discrete activity to measure
the degree of achievement.
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16. Step 9 (contd…)
This step is one of the most crucial steps in planning process is to
intelligently enunciate the goal, objectives, indicators and targets.
A lot of thought process and expert evaluation should go in atthis
stage.
They should be realistically set
should be do-able
neither too ambitious nor too under-achieving.
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17. Step 10 - Choose a Strategy and Draw an Action Plan :
The overall strategy what will be used in the proposed programme
is selected.
For eg.
Now, having decided the strategy, a detailed action plan as to how
the programme will be executed is written down.
To ensure that a “time-line” has been given for each objective,
target and indicator, the date of each end point is given.
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18. Step 11 - Address the Issues of Accessibility and Coverage :
Detailed spot maps of the concerned areas and work out the
aspects of population distribution, roads, communications and transportation.
Many times it has been observed that the beneficiaries of a prog
live in areas which are not accessible easily, so the purpose of the prog is
defeated.
Hence at this point, work out where are your high risk persons
located and how they are covered adequately.
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19. Step 12 - Organise the manpower, material, and finances :
Place the required manpower, equipment, material and other
logistics at the required places.
If some more resources are expected, make a plan as to where
they will be relocated and how.
Make out detailed, written “operations manual” including the
operative procedures for each activity, i.e. “who will do what to whom
and in what manner”.
Ensure that your personnel have been centrally trained and
tested for undertaking the procedures.
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20. Step 13 - Undertake a “Pilot Run” :
This is another very important step.
A small scale trial of your procedures is run and rectifyif
any defects are observed.
Step 14 - Conduct the Programme :
Launch the programme in a full fledged manner.
Ensure that all the deputies are there always at the sites
where the services are being delivered.
Regularly obtain and analyse data on various aspects as
the programme progresses, making changes if required.
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21. Evaluation
Step 15 - Evaluate the programme :
Evaluation is the process of assessing the extent to which our results are
commensurate with our pre-decided objectives.
It should be a continuous process as the programme progresses (concurrent
evaluation) and not simply an exercise to be undertaken at the end of the programme
(terminal evaluation).
For evaluation, we again need valid and reliable data in the same way that
we obtained in the planning stage.
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22. Broadly, evaluation is undertaken for six different facets, as follows:
●● Evaluation of Relevance :
Concurrent evaluation evaluates whether we need to
continue it as such or in some modified manner.
Terminal evaluation evaluates whether the programme was
required at all or not.
This requires obtaining and reviewing the data / intelligence
about situational analysis, resources and community needs.
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23. ●● Evaluation of Adequacy:
Whether the required amount of manpower, equipment,
logistics, other type of material and finances have been provided
adequately
& whether they have been suitably placed.
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24. ●● Evaluation of Process :
How are / were the services/ activities undertaken?
What has been the quality of services?
Were the services accessible to or provided to all the beneficiaries or
only few segments?
For example, are the targeted number of children being
vaccinated, have some areas been left out, the scheduled number of patients
being seen and the planned number of health education sessions being taken.
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25. ●● Evaluation of Efficacy, Effectiveness and Efficiency:
Effectiveness
Effectiveness is the extent to which planned outcomes, goals, or
objectives are achieved as a result of an activity, strategy, intervention or
initiative intended to achieve the desired effect, under ordinary circumstances
(not controlled circumstances such as in laboratory).
Efficiency
Efficiency is the ratio of the output to the inputs of any system.An
efficient system achieves higher levels of performance (outcome, output)
relative to the inputs (resources, time, money) consumed.
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26. ●● Evaluation of Efficacy, Effectiveness and Efficiency(contd…)
Efficacy
Efficacy is the extent to which a specific intervention, procedure, or
service produces the desired effect, under ideal conditions (controlled
environment, lab circumstances).
 Efficacy answers the question “can the programme or procedure
work” (maybe in ideal or controlled situations)
 Effectiveness addresses the question “Does it work” (i.e., in the
real life situations)
 Efficiency answers the issue “Is it the most economical way (in
terms of time or money)”.
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27. Example
The conventional combination regime of Streptomycin, INH and
Thioacetazone may still give good results for curing pulmonary TB if we were
to treat patients admitted in sanitoria for 18 months (i.e., is efficacious),
But in the real domiciliary settings, it bring about only about 30%
cure (is not effective), while MDT would cure 70 to 80% patients in reallife
domiciliary settings (is effective).
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28. Finally, comparison between the total costs of the two regimen
(drugs, duration of treatment, requirement of doctors, paramedics and
hospital buildings, commuted cost of reduction in human suffering due
to earlier cure, etc.) the overall cure rate may finally indicate that short
term MDT may be more “efficient”.
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29. REFERENCES
Park’s Text Book of Preventive and Social Medicine 23rd edition
Text book of Public Health & Community Medicine - WHO AFMC
Book
Disease Control Priorities in Developing Countries 2nd edition
Encyclopaedia of public health
oxford textbook of public health 4th edition
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30. Thank
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