Formulating%20 Strategies Milan


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  • Distinguished participants We would like to share the experience on implementation of the strategic approach to improve quality of contraceptive services in Vietnam, in which many colleagues participated. The approach was implemented through a collaboration between the Ministry of Health, the National Committee for Population and Family Planning, and Vietnam Women’s Union, and was supported by WHO, UNFPA and GTZ.
  • At the time of the strategic assessment, Vietnam already had a strong family planning programme and high contraceptive prevalence. However, the method mix was very skewed. IUD users accounted for 72% of all modern method users in 1996. Programme managers wished to diversify the method mix by introducing DMPA (the three-monthly injectable) and Norplant ( contraceptive implant). However, previous experience with DMPA in small trials had shown very high discontinuation rate and they were seeking an effective introduction strategy.
  • The Strategic Approach is based on a framework that considers the relationships between : Users or potential clients, including their reproductive health needs and perspectives, The service delivery system (policies, programmes, access, availability, quality of care), and The characteristics of available technologies It examines the interactions between these components, as well as how these interactions are influenced by the broader social, cultural, political, resource and health reform context. It is based on the idea that appropriate decisions concerning policy and programme development should be based on an understanding of the relationships between clients, the service delivery system and the mix of services and technologies being provided.
  • The strategic assessment showed that unbalanced information, strong provider biases and client misperceptions contributed to the skewed method mix. The counseling was very directive and there were a variety of weaknesses in technical quality of care such as maintenance of asepsis, management of side effects, and inadequate capacity of staff to provide appropriate care for RTIs. The assessment concluded that, therefore, priority should be given t o improving quality of care for available methods and introduction of new methods in the programme should be approached with caution.
  • To develop and test a strategy for introduction of DMPA while improving quality of care for all methods, several service delivery and managerial interventions were tested in 4 districts and 32 communes: Training, IEC, user cards, supervision, clinic organization and logistics The community was sensitized to quality of care issues including Women’s Union at commune level.
  • The research showed that the experience of DMPA in terms of continuation rate, side effects and reasons for discontinuation were similar to international experience. Availability of DMPA expands choice for women. Women feel more free to select a method of their choice. While quality of care for all methods improved, counseling and infection prevention needed further attention as it proved difficult to change long-established behaviours.
  • Formulating%20 Strategies Milan

    1. 1. Program Development: Formulating Strategies Milan K.Dinda Ph.D
    2. 2. What leads to success?
    3. 3. Political science Why are some princes successful and others are not? … Is it a matter of luck?... Machiaveli
    4. 4. Political science Why are some princes successful and others are not? … Is it a matter of luck?... For it is those princes who match their actions to circumstances that survive and other do not Machiaveli
    5. 5. Biology It is not the strongest species that survives, nor the most intelligent, but the ones most responsive to change Charles Darwin
    6. 6. Why Strategies? <ul><li>What determines success? </li></ul><ul><ul><li>Match actions to circumstances: Users, service delivery system, technologies, social, political and economic context </li></ul></ul><ul><ul><li>Use resources optimally to achieve goals </li></ul></ul><ul><ul><li>Direct energies of the whole organization towards achieving goals </li></ul></ul>
    7. 7. Strategy Match action to circumstances
    8. 8. But what about implementation?
    9. 9. Strategic Management S trategy S tructure S taff S ystems S kills S tyle S hared values/vision?
    10. 10. Strategic leadership Goals Objectives Vision Vision-reality gap Inspire/ empower Planning organizing Monitoring/Evaluating Leadership Management Doing the right thing And Doing them right Focus on self
    11. 11. USER TECHNOLOGY SERVICES Socio-economic Status, User Perspectives Gender Policies, Programmes, Access, Availability Quality of Service Availability, Characteristics Social, Cultural, Economic and Political Context
    12. 12. What is a strategy? <ul><li>Its is a fundamental choice affecting a mission, values, product or service level and mix, clients or users, cost, financing, organization or management of a program. </li></ul><ul><li>What is fundamental? </li></ul><ul><ul><li>Would make a significant difference </li></ul></ul><ul><ul><li>Is long term </li></ul></ul><ul><ul><li>Will affect the status of the program/organization </li></ul></ul><ul><ul><li>Other </li></ul></ul>
    13. 13. <ul><li>Program strategy: </li></ul><ul><li>Which services/information to be provided to whom and in what sequence </li></ul><ul><li>Functional strategy: </li></ul><ul><ul><li>How to mobilize demand? </li></ul></ul><ul><ul><li>How to mobilize services (access, availability, affordability,qualityofService)? </li></ul></ul><ul><ul><li>How to mobilize resources (financial, physical, others)? </li></ul></ul>
    14. 14. Program Development: Need for Strategic Approach <ul><li>A large number of problems need to be addressed </li></ul><ul><li>Many interventions are possible </li></ul><ul><li>Need to ensure quality of service </li></ul><ul><li>Need to choose carefully </li></ul>
    15. 15. Program Development: Need for Strategic Approach <ul><li>Any interventions need to be culturally sensitive, technologically appropriate and financially affordable </li></ul><ul><li>One strategy may not work everywhere so district and local level strategies are needed </li></ul><ul><li>Multiple disciplines need to be involved </li></ul><ul><li>some interventions need to be tested before their large scale implementation </li></ul>
    16. 16. Program Development: Need for Strategic Approach <ul><li>For success: </li></ul><ul><ul><li>formulate right strategies </li></ul></ul><ul><ul><li>implement them right </li></ul></ul><ul><ul><li>Involve implementers in formulating strategies </li></ul></ul><ul><ul><li>Increase their skills in implementation </li></ul></ul><ul><ul><li>Monitor and evaluate </li></ul></ul>
    17. 17. <ul><li>Manual </li></ul><ul><li>Situation analysis </li></ul><ul><li>Response analysis </li></ul><ul><li>Develop strategies </li></ul><ul><li>Mobilize resources </li></ul>
    18. 18. Common approach to strategy development <ul><li>1. Where are we now? </li></ul><ul><li>2. Where do we want to go? </li></ul><ul><li>3. How do we get there? </li></ul><ul><li>1. Situation and response analysis </li></ul><ul><li>2. Strategic objectives </li></ul><ul><li>3. Strategy </li></ul>
    19. 19. 3. What are the different ways of developing visions and strategies? <ul><li>1. Conventional way - Start with situational analysis. </li></ul><ul><li>2. The new way - Start with defining a shared vision. </li></ul>
    20. 20. Disadvantages of common practice <ul><li>1. Situation analysis is often more descriptive (indicators list) and less analytical. </li></ul><ul><li>2. “Visions” are set lower because reference point is the current situation (often depressing). </li></ul><ul><li>3. Encourages only incremental changes, not fundamental ones. </li></ul>
    21. 21. Should visions be based on situation analysis? <ul><li>Should we want only what we can have given the current situation? </li></ul><ul><li>Should we aim for what we truly want and change the current situation? </li></ul>
    22. 22. An alternative way <ul><li>1. Where do we want to go? </li></ul><ul><li>2. Where are we now? </li></ul><ul><li>3. Why is there a difference? </li></ul><ul><li>4. What needs to change? </li></ul><ul><li>5. How do we get there? </li></ul>
    23. 23. An alternative way - different wording <ul><li>1. What do we want to happen? </li></ul><ul><li>2. What is happening now? </li></ul><ul><li>3. Why is there a difference? </li></ul><ul><li>4. What needs to change? </li></ul><ul><li>5. How do we create the change? </li></ul>
    24. 24. Comparison <ul><li>OLD WAY </li></ul><ul><li>Situation </li></ul><ul><li>analysis </li></ul><ul><li>Strategic objectives </li></ul><ul><li>Strategy </li></ul><ul><li>NEW WAY </li></ul><ul><li>Shared vision </li></ul><ul><li>Situation statement Root cause analysis </li></ul><ul><li>Strategic objectives </li></ul><ul><li>Strategy </li></ul>
    25. 25. Formulating Strategies S trengths, W eaknesses, O pportunities, T hreats (SWOT) analysis Results based analysis Strategic issues management Stakeholder analysis
    26. 26. <ul><li>SWOT Analysis </li></ul><ul><li>Build on strengths </li></ul><ul><li>Remedy weaknesses </li></ul><ul><li>Exploit opportunities </li></ul><ul><li>Protect against threats </li></ul>
    27. 27. Results Chain or Pyramid Resources Staff Funds Facilities Supplies Training INPUTS ACTIVITIES OUTPUTS/ OUTCOMES IMPACT IEC Counseling Treatment Care/service Other Outputs Technology availability No. of persons trained Outcomes Behavior change Attitude change Change in income,status Increase in social support/ social capital Long-term changes in HDI Household Economic Sustainability Social norms Coping capacity in the community Economic impact
    28. 28. Reduce vulnerability Reduce risk Reduce impact Where to Focus
    29. 29. Types of Strategies Focus on key factors of success Build on strengths Pursue new initiatives Exploit where, when and how services are delivered Improve operations
    30. 30. Log Frame Matrix