Health planning
- 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 people’s 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
- 33. Thank you