1. Health planning Dr. M. Logaraj Professor of Community
medicine Chettinad hospital & Research Institute
2. Concept of health planning, monitoring and evaluation 1.
What is health planning? 2. Purpose of health planning 3. What are
health needs and demands? 4. What are objectives, targets and
goals? 5. Steps in planning cycle 6. What is monitoring? 7. What is
evaluation? And basic steps in evaluation. 8. Elements of
evaluation 9. National health policy
3. Health planning 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. WHO
4. Why planning? The increasing demand for medical and health
care services, in the face of limited resources, has brought out
the need for careful planning and management of health services The
purpose of planning: 1. To match the limited resources with many
problems 2. To eliminate wasteful expenditure and avoid duplication
3. To develop the best course of action to accomplish a defined
objective.
5. Health needs and demands The purpose of health planning is
to meet the health needs and demands of the people. Health needs is
defined as the deficiencies in health that call for preventive,
curative, control and eradication measures. The needs for safe
water supply and sanitation, control of communicable diseases,
medical care including hospitals, dispensaries and primary health
centres, public health services, family planning, adequate
nutrition, immunization are all community health needs. In
democratic country/ developing country peoples needs may be
presented as demands.
6. Objectives, targets and goals An important element of
planning is the setting of clear cut objectives, targets and goals.
Objective: It is a planned end point of all activities. It is
stated in term of measured amount of progress towards goal.
Targets: When the objective is split into discrete activity it
becomes target like number of sputum smear collected or Tubectomy
done. Goal: An ultimate desired state towards which the objectives
and resources are directed. Goal is not constrained by time,
resources nor are they necessarily attainable. They are formulated
at top level and they are generally broad for example Health for
all.
7. Planning for health involves 3 types of activities 1.
Assessment of the current status 2. Identification of the desired
state in the future 3. Specification of interventions and other
activities to achieve the new desired state.
8. Planning cycle Planning is a dynamic process it involves
three steps. Planning Implementation Evaluation. If no favourable
outcome, change the plan, implement and re-evaluate. Evaluation is
an ongoing process repeats itself in a cyclic manner is called
planning cycle
9. Planning involves following steps Analysis of health
situation Establishment of objectives and goals Assessment of
resources Fixing priorities Write up of formulate plan Programming
and implementation Evaluation.
10. Analysis of health situation: The minimum essential
requirement of health planning includes 1. The population its age
and sex structure 2. Mortality and morbidity statistics 3. The
Epidemiology and geographical distributions of diseases 4. Medical
care facilities available such as hospitals, health centres and
other private and public health agencies. 5. The man power
available 6. Training facilities available 7. Beliefs and attitude
of people towards health, disease, its cure and prevention. .The
analysis of the above data brings out health problems, needs and
demands of the population.
11. Establishment of goals and objectives Objectives are the
guide for action. Objectives needed for economical and better
performance of programme. Objectives should be established at all
levels at upper level it is more general and lower level it is more
detail and specific. Objectives may be long term and short term. In
setting up these objectives time and resources are important
factors Objectives shout be - SMART
12. Assessment of resources: Man power Money Materials Skills
Knowledge and techniques needed or available for the implementation
of the health programmes.
13. Fixing priorities Establish the priorities in the order of
magnitude of health problems. Prioritisation is based on financial
constraint, mortality and morbidity data, diseases which can be
prevented at low cost, political and community interest. Once
priorities are established alternative plans are formulated and
assessed to determine whether they are practicable feasible.
Alternate plan with greater effectiveness are chosen.
14. Write-up formulated plan The plan should be complete in all
aspect. The input required for the health programme and the output
expected Cost and time needed for each stage of implementation of
the health programme. Working guidance for all those involved in
the implementation of the health programme. It must contain a built
in system of evaluation
15. Programming and implementation: Once the plan is approved
by policy making authorities programme and implementation are
begun. The effective implantation of the programme depends upon the
existence of effective organization. The main consideration at
implementation stage include 1. Defining of the role and task 2.
Selection, training, motivation and supervision of the manpower
involved 3. Organization and communication 4. The efficiency of the
implementing institution
16. Evaluation: It is the final step of planning cycle. It
should be both concurrent and terminal. The purpose of evolution is
to assess the achievements of stated objectives, its adequacy,
efficiency and its acceptance by the people. Evaluation measures
the degree to which objectives and targets are fulfilled and the
quality of the results obtained. It measures the productivity of
the available resource in achieving measured output. Evaluation
makes it possible the reallocation of priorities and of resources
on the basis of changing health needs.
17. Components of the evaluation process: Relevance: Relevance
relates to the rationale for adopting health policies in terms of
their response to social and economic policy; and to having
programmes, activities, or services, in terms of their response to
essential human needs. For example vaccination against small pox is
now irrelevant because the disease is eradicated.
18. Adequacy: Adequacy implies that sufficient attention has
been paid to certain previously determined course of action, such
as the various issues to be considered during broad programming.
Progress; Progress is concerned with the comparison of actual with
schedule activities, the identification of reason for achievements
or shortcomings and indications for remedies for any shortcomings.
Progress evaluation track of ongoing activities, milestones
achieved, personnel matters, supplies and equipment, money spent in
relation to budgets allocated.
19. Efficiency: Efficiency is an expression of the relationship
between the results obtained from a health programme or activity
and the efforts expended in terms of human, financial and other
resources, health processes and technology and time. Effectiveness;
effectiveness is an expression of the desired effect of a
programme, services, institution or support activity in reducing a
health problem or improving an unsatisfactory health situation.
Thus effectiveness measures the degree of attainment of the
predetermined objectives and targets of the programme, services or
institution.
20. Impact: Impact is an expression of overall effect of a
programme, service or institution on health and related
socioeconomic development. Aimed at identifying any necessary
change in the direction of health programmes so as to increase
their contribution to overall health and socioeconomic
development
21. Basic steps of evaluation Determine what is to be evaluated
Establish standards and criteria Plan the methodology Collect
information Analysis and interpretation of the results Taking
action Re-evaluation
22. Determine what is to be evaluated: There are types of
evaluation Structure evaluation- evaluation of the resources used
in the programme like personnel, money, materials or buildings etc.
Process evaluation- the way in various activities of the programme
is carried out is evaluated by comparing with the predetermined
standard. How the inputs are utilized to produce an output of a
service. Outcome evaluation this is concerned with the end result
of the programme. The types and quantities of goals and services
produced by the programme.
23. Evaluation can also be classified as a) terminal evaluation
b) continuous evaluation c) periodic evaluation based whether
evaluation is planned at the end of the programme or along with the
programme continuously or periodically.
24. Establishment of standards and criteria: Establishment of
standards and criteria are necessary to determine how well
objectives have to be attained. Structure criteria: physical
facilities, personnel and equipments Process criteria: no. of
antenatal visits to be made, no. of blood smear to be collected.
Outcome criteria: no. of death to be prevented no of patients
cured.
25. Methodology: methodology of evaluation should be based on
the purpose of evaluation. Gathering information: evaluation
requires collection of data or information. The amount of data
required will depend on the purpose and the use of the
evaluation.
26. Analysis of results: analysis of the data and
interpretation of data and feedback to all individuals concerned
should take place which will provide opportunity for discussing the
evaluation results. Taking action: Based on the evolution results
actions are taken to strengthen or modify the programme, which may
call for shifting priorities, revising the objectives etc.
Re-evaluation: Evaluation is an ongoing process which is needed to
make health programmes more relevant, efficient and effective
27. National Health Policy Policy: A policy may be thought of
as a system which provides the logical framework and rationality of
decision making for achievement of intended objectives. Health
policy: Policy related to health aim to satisfy basic human needs
and therefore influence other social, economic, human and
developmental goals. National health policy: Is an expression of
goals for improving the health situation, the priorities among
those goals, and the main directions for attaining them.
28. The National health policy adopted by the Government of
India in 1983 covers almost all systems and subsystems required for
health development and for moving towards health for all by 2000AD.
Since then there has been significant changes in the determinants
factors relating to the health sector, necessitating revision of
policy, and a new national health policy 2002 was evolved.
29. National Health Policy 2002 Objective: The main objective
of this policy is to achieve an acceptable standard of good health
amongst the general population of the country.
30. Approach The approach would be to increase access to
decentralized public health system by establishing new
infrastructure in the existing institutions. Overriding importance
would be given to ensure a more equitable access to health services
across the social and geographical expanse of the country. Primacy
will be given to prevent and first line curative initiatives at
primary health level. The policy is focused on those diseases which
are principally contributing to disease burden such as
tuberculosis, malaria, blindness and HIV/AIDS. Emphasis will be
laid on rational use of drugs within the allopathic system. To
translate above objectives into reality the health policy has laid
down specific goals to be achieved by year 2005, 2007, 2110 and
2015.
31. National health policy 2002: Goals to be achieved by 2015
Eradicate Polio and Yaws 2005 Eliminate Leprosy 2005 Eliminate
Kala-azar 2010 Eliminate Lymphatic Filariasis 2015 Achieve zero
level growth in HIV/AIDS 2007 Reduce mortality by 50% on account of
TB, Malaria and other vector and water borne diseases 2010 Reduce
prevalence of blindness to 0.5% 2010 Reduce IMR to 30/1000 and MMR
to 100/lakhs 2010 Increase utilization of public health facilities
from current level of 20% to > 75% 2010
32. Establish an integrated system of surveillance National
health accounts and health statistics 2005 Increase health
expenditure by government From existing 0.9% of GDP to 2.0% of GDP
2010 Increase share of central grants to constitute at least 25% of
total health spending 2010 Increase state sector health spending
from 5.5% to 7% of the budget 2005 Further increase to 8% of the
budget 201