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Health Planning & ManagmentPlanning:

To match the limited resources with many problems. To eliminate wasteful expenditure or duplication of expenditure. To develop the best course of action to accomplish a defined objective.

Planning includes three steps : Plan formulation Execution EvaluationDevelopment Planning: Continuous ,systematic, coordinated, planning for the investment of the resources of a country in programmes aimed at most rapid economic and social development possible.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.Resources:Implies the manpower , money , materials, skills knowledge , techniques and time needed or available for the performance or support of action directed towards specified objectives.

Objective : It is precise , concerned directly with the problem. Planned end point of all activitiesTarget : It permits concept of degree of achievement ; concerned with factors involved in a problem.Goal : The ultimate desired state towards which objectives and resources are directed.Plan : Blue print for taking action It has five major elements: Objectives, policies, programmes, schedule & budget Policies : Guiding principles stated as an expectation , not as a commandment. Programmes : Sequence of activities designed to implement policies and accomplish objectives.

Schedule : Time sequence for the work to be done.

Procedures : Set of rules for carrying out work which , when observed by all help to ensure the maximum use of the resources and efforts.

Pre planning: Preparation for planning. Important preconditions are: Government interest Legislation Organization for planning Planning commission of India Administrative capacity Central & State Ministries of Health

PLANNING CYCLE: Defined as a process of analyzing a system or defining a problem, assessing the extent to which the problem exist as a need , formulating goals and objectives to alleviate or ameliorate those identified needs , examining and choosing from among alternative intervention strategies , initiating the necessary action for its implementation of the plan and evaluating the results of intervention in the light of stated objectives.Steps: Analysis of health situation: involves the collection , assessment and interpretation of information in such a way as to provide a clear picture of the health situation. Establishment of objectives and goals Assessment of resources Fixing priorities5. Write up of formulated plan6. Programming and implementation7. Monitoring 8. Evaluation

MANAGEMENT purposeful and effective use of resources manpower , materials and finances for fulfilling a pre-determined objective. Consists of four basic activities: Planning Organizing Communicating Monitoring Management methods and techniques

Based on behavioral sciences Quantitative methods1. Organizational design 1.Cost Benefit Analysis 2.Personnel management 2.Cost Effective Analysis 3.Communication 3.Cost Accounting4.Information Systems 4.Input Output Analysis5.Management by objectives 5.Model 6.System Analysis 7.Network Analysis 8.PPBS 9.Work Sampling 10.Decision Making

1) Cost Benefit Analysis: Economic benefits of any programme are compared with cost of that programme.

Benefits are expressed in monetary terms to determine whether a given programme is economically sound and to select best out of several alternate programmes.2) Cost Effective Analysis: Similar to cost benefit analysis except that benefit instead of being expressed in monetary terms is expressed in terms of results achieved.3) Cost Accounting: Provides basic data on cost structure of any programme. Has 3 important purpose in health services: Cost control , planning and allocation of people & pricing of cost reimbursement.

4) Input Output Analysis: Input refers to all health service activities which consume resources. Output refers to such useful outcomes as cases treated and lives saved. An input output table shows how much of each input is needed to produce a unit amount of each output. Enables calculations to be made of the effects of changing the inputs. 5) Model: An aid to understand how the factors in a situation affect one another. Is an abstraction of the reality.6) Systems Analysis: To help the decision maker to choose an appropriate course of action by investigating his problem, searching out objectives, finding out alternative solutions, evaluation of alternatives in terms ,re-examination of objectives if necessary & finding the most cost effective alternative.7) Network Analysis: Network is a graphic plan of all events and activities to be completed in order to reach an end objective. Two common types of network technique: PERT(Programme Evaluation and Review Technique) CPM ( Critical Path Method)

PERT(Programme Evaluation and Review Technique):Technique which makes possible more detailed planning & more comprehensive supervisionEssence of PERT is to construct an Arrow diagram, which represents the logical sequence in which events must take placeTime taken to complete each activity can be calculatedCan identify paths which are critical

CPM ( Critical Path Method):It the longest path of the networkIf any activity along the critical path is delayed, the entire project will be delayed

Plan ServiceStaff recruitedEquipment orderedStaff TrainedEquipment installedStart providing ServiceSTARTTERMINAL EVENT2 months4 months2 months10 months1 month1 month8) Planning Programming Budgeting System(PPBS): A system to help decision makers to allocate resources so that the available resources of an organization are used in the most effective way in achieving its objectives. It calls for grouping of activities into programmes related to each objective. Another approach is Zero Budget Approach i.e all budget starts at zero & no one gets any budget that he cannot specifically justify on a year to year basis9)Work Sampling: Is a systematic observation and recording of activities of one or more individuals, carried out at predetermined or random intervals It provides quantitative measurement of the various activities. It helps in standardizing the method of performing jobs and determining the manpower needs in any organization.10) Decision Making: It does not follow that the best decisions are always made at the top of an organizationAn adage that decisions should be made at the level where the best decisions can be madeDecisions should not be made with incomplete data.Health planning in IndiaIntegral part of national socio economic planning

Government of India appoints different committees from time to time to review existing health situations and recommend measures for further actions

Hence guidelines for national health planning were provided by number of committees Bhore committee,1946Health survey & development committeeIntegration of preventive & curative services at all administrative levelsPHC cater to 40,000 population with a 2* health centre to serve as supervisory, coordinating & referral institution3 million plan- 3 months training in PSM to prepare social physiciansMudaliar committee,1962Health survey and planning committeeStrengthening of existing PHCs before new centers were establishedStrengthening of District hospitals with specialist servicesEach PHCs not to serve more than 40000 populationConsolidations of advances made in first two five year plansConstitution of an All India Health Service on the pattern of Indian Administrative serviceChadah committee, 1963National malaria eradication programme responsibility of general health services, i.e., PHC at block levelMonthly home visits by basic health worker for vigilance operations of MalariaOne basic health worker/ 10000 populationBasic health worker also called multipurpose worker, entrusted to look after duties like vital statistics, family planning etcMukherji committee, 1965 & 19661965:Delinked malaria and family planning programmesSeparate staffs for both programmes

1966:Worked out Basic Health Service which should be provided at block level

Jungalwalla committee, 1967Committee on Integration of Health ServicesIntegration from the highest to the lowest level in the services, organization & personnelUnified cadreCommon seniorityRecognition of extra qualificationsEqual pay for equal workSpecial pay for specialized workNo private practiceKartar Singh committee, 1973The committee on Multipurpose Workers under Health & Family PlanningANM to be replaced by Female Health Worker & Basic health workers, Malaria surveillance workers, vaccinators etc to be replaced by Male Health WorkerOne PHC for 50000 populationEach PHC should be divided into 16 sub centers which caters to 3000 3500 populationEach sub centre to be staffed by a team of one male and one female health workerDoctors in charge of PHC should have overall charge of all supervisors and health workers in his areaShrivastav committee, 1975Group on Medical Education & Support ManpowerCreation of bands of Para & semi professional health workers from within the community itselfDevelopment of a Referral Services Complex Establishment of a Medical & Health Education Commission for planning & implementing the reforms needed in health & medical educationRecommends one male & female health worker for 5000 populationHealth assistant should be located at the sub centre, not at the PHCRural Health Scheme, 1977Steps were initiated for involvement of medical colleges in the total health care of selected PHCs with the objective of reorienting medical education to the needs of rural people

Reorienting training of MPWs engaged in the control of various communicable disease programmes into Unipurpose workersHealth for all by 2000 ADReport of working group, 1981National Health Policy - 2002Eradicate Polio & Yaws - 2005Eliminate leprosy - 2005Eliminate Kala- Azar - 2010Eliminate Lymphatic Filariasis - 2015Achieve zero level growth of HIV/AIDS - 2007Reduce mortality by 50% on account of TB, Malaria & other vector & water borne disease - 2010Reduce the prevalence of blindness to 0.5% - 2010Reduce IMR to 30/1000 & MMR to 100/ Lakh - 2010Increase state sector health spending from 5.5% to 7 & of the budget - 2005Eleventh Five Year Plan (2007-2012)Reducing MMR to 1 per 1000 live birthsReducing IMR to 28 per 1000 live birthsReducing TFR to 2.1Providing clean drinking water for all by 2009Reducing malnourishment among children of age group 0-3 to half its present levelReducing anemia among women & girls by 50%Raising the sex ratio for age group 0-6 years to 935 by 2011-12 & 950 by 2016-17

Twelfth Five Year Plan (2012-2017)Health System In IndiaCentral Level:Union Ministry of Health & Family WelfareDirectorate General of Health ServicesCentral Council of Health

State Level:State Ministry of HealthState Health DirectorateHealth System In India contd..District Level: The CollectorAdministrative areas under district:Sub divisionsTahsils (Talukas)Community Development BlocksMunicipalities & corporationsVillagesPanchayats PANCHAYATI RAJ:

Three tier structure of rural local self government in India

All developmental programmes are channeled through these bodies

Links the village to the district

The three institutions are Panchayat at village levelPanchayat Samiti at block levelZilla parishad at district levelEvaluation of Health ServicesGeneral steps of evaluation:Determine what is to be evaluatedEstablish standards and criteriaPlan the methodology to be appliedGather informationAnalyze the resultsTake actionRe-evaluate