PROGRAM PLANNING PROGRAM PLANNING and EVALUATION in and EVALUATION in PUBLIC HEALTHPUBLIC HEALTH

Lecturer:Lecturer:

Rosa Marie N. Flores, M.D.Rosa Marie N. Flores, M.D.

M.P.H. FPAFP,DFMM.P.H. FPAFP,DFM

OBJECTIVEOBJECTIVE ContentContent Activities Activities

Student TeacherStudent Teacher

Eva-Eva-luatiluationon

At the end of At the end of session, the student session, the student should be able should be able to :plan and to :plan and evaluate a program evaluate a program or a projector a project

:define program :define program planning,project planning,project planningplanning

KnowledgeKnowledge

♦ ♦ Why planWhy plan

♦ ♦ Definition of planning a Definition of planning a projectproject

♦ ♦ Priority setting among Priority setting among health project health project

♦ ♦ Identification of areas for Identification of areas for project dev’t project dev’t

♦ ♦ Steps in project Steps in project formulation or planning , formulation or planning , implementation, monitoring implementation, monitoring and evaluation and evaluation

♦♦Actively ♦DiscussActively ♦Discuss

Listens ♦LecturesListens ♦Lectures

♦♦ComCom

Municates Municates

♦ ♦ SGDSGD

ExamExam: : Short Short &&

LongLong

Why plan?Why plan?♦ ♦ It focuses and directs It focuses and directs your effortsyour efforts - how much you have - how much you have achieved your planachieved your plan - how to achieve your - how to achieve your planplan♦ ♦ It organizes peopleIt organizes people - it will be your duty to - it will be your duty to delineate tasks/outline delineate tasks/outline ♦ ♦ It’s a good method of communication (e.g. when you It’s a good method of communication (e.g. when you

go to the mayor, you plan )go to the mayor, you plan ) - if you are working with the C.E.O. the first part could - if you are working with the C.E.O. the first part could be the summary be the summary - but since you are planning ,your letter would start - but since you are planning ,your letter would start with an introductionwith an introduction

♦ ♦ Allows improvement of systemAllows improvement of system

--- you will know where the system is strong --- you will know where the system is strong or weakor weak

What is PlanningWhat is Planning?? ♦ ♦ It is a process of It is a process of making current decisionsmaking current decisions in in the light of their future effectthe light of their future effect ♦ ♦ It is the process of It is the process of ordering prioritiesordering priorities, , diagnosing causes of problemsdiagnosing causes of problems and and allocating allocating resources to achieve predetermined objectivesresources to achieve predetermined objectives ♦ ♦ It is an exhaustive, comprehensive review of all It is an exhaustive, comprehensive review of all alternatives (alternatives (methodsmethods) towards making a decision ) towards making a decision for future actions to allow attainment or achieve for future actions to allow attainment or achieve goals (goals (implementationimplementation) and bring about desired ) and bring about desired changes (changes (objectivesobjectives) in the client community.) in the client community.

What is planning (cont’dWhat is planning (cont’d):):♦ ♦ Planning answers the following Planning answers the following questions:questions: ♥ ♥ Where are we going ? ♥ Why are we going Where are we going ? ♥ Why are we going or or where do we want go? there?where do we want go? there? ( GOALS/OBJECTIVE SETTING) ( GOALS/OBJECTIVE SETTING) ♥ ♥ Where are we now? ♥ What resources areWhere are we now? ♥ What resources are (SITUATIONAL ANALYSIS) (SITUATIONAL ANALYSIS) at our disposal?at our disposal? -- included under plan -- included under plan formulationformulation ♥ ♥ How do we get we get there? ♥ What do we need to How do we get we get there? ♥ What do we need to

getget (STRATEGY/ACTIVITY SETTING) (STRATEGY/ACTIVITY SETTING) there?there? ♥ ♥ How do we know we are there?How do we know we are there? (EVALUATION) (EVALUATION)

PROGRAM PLANNINGPROGRAM PLANNING Objectives:Objectives: At the end of the session, the student must be able to:At the end of the session, the student must be able to:1.1. Define program planningDefine program planning2.2. Give the characteristics of health programsGive the characteristics of health programs3.3. Enumerate and give examples of types of programsEnumerate and give examples of types of programs4.4. Explain the key elements of a programExplain the key elements of a program5.5. Explain the clinical nature of the planning processExplain the clinical nature of the planning process6.6. Demonstrate how to write program objectives and set Demonstrate how to write program objectives and set

targetstargets7.7. Differentiate regular activities from developmental Differentiate regular activities from developmental

activitiesactivities

DefinitionsDefinitions Program planningProgram planning— is the formulation of strategies — is the formulation of strategies

for the achievement of a given health policy objectivefor the achievement of a given health policy objective

Health programs-Health programs--- are results of health policies , -- are results of health policies , therefore no health program means no health policy.therefore no health program means no health policy.

Note: There can be several Health Programmes for a Note: There can be several Health Programmes for a given Health Policy or a given Health Policy or several given Health Policy or a given Health Policy or several Health Policies for a given Program. Health Policies for a given Program.

♦♦ ELEMENTSELEMENTS OF PLANNINGOF PLANNING ( describes the essential nature of planning ):( describes the essential nature of planning ):

♣ ♣ CONTRIBUTION OF PLANNING TO OBJECTIVESCONTRIBUTION OF PLANNING TO OBJECTIVES ♣ ♣ PRIMACY OF PLANNINGPRIMACY OF PLANNING – – first of the managerial functions to be performedfirst of the managerial functions to be performed

♣ ♣ PERVASIVENESS OF PLANNINGPERVASIVENESS OF PLANNING

– – found at all managerial levelsfound at all managerial levels

♣ ♣ COORDINATION OF PLANNINGCOORDINATION OF PLANNING

– – coordinating the what, who, when, how, where coordinating the what, who, when, how, where

and why of planningand why of planning

♣ ♣ SELECTION OF PLANNING ALTERNATIVESSELECTION OF PLANNING ALTERNATIVES

- - concerned with planning alternatives concerned with planning alternatives

♣ ♣ EFFICIENCY AND ECONOMY OF PLANNINGEFFICIENCY AND ECONOMY OF PLANNING

- - considers potential values received from planning versus considers potential values received from planning versus

costs incurredcosts incurred

♣ ♣ FLEXIBILITY OF PLANNINGFLEXIBILITY OF PLANNING

- - ability to adjust to changing conditionsability to adjust to changing conditions

♣ ♣ CONTROL OF PLANNINGCONTROL OF PLANNING

- - provides a feedback mechanism to change plan when provides a feedback mechanism to change plan when

necessarynecessary

STEPS IN THE PLANNING PROCESS:STEPS IN THE PLANNING PROCESS:1. COMMUNITY ANALYSIS1. COMMUNITY ANALYSIS : : SITUATIONAL ANALYSIS SITUATIONAL ANALYSIS

and PROBLEM IDENTIFICATIONand PROBLEM IDENTIFICATION A. Needs assessment : Identification of the A. Needs assessment : Identification of the Problem. Problem. B. Involves collection of detailed information B. Involves collection of detailed information concerning the community under studyconcerning the community under study

General overview obtained, then specific aspects of General overview obtained, then specific aspects of community are analyzed including community health community are analyzed including community health statusstatus

Information derived from a variety of sourcesInformation derived from a variety of sources ♣ ♣ PURPOSE OF THIS STEP: is to identify within each of the PURPOSE OF THIS STEP: is to identify within each of the

four technical areas the problems and their four technical areas the problems and their underlying causesunderlying causes

♣♣1.1.COMMUNITY ANALYSISCOMMUNITY ANALYSIS has three ( 3 ) has three ( 3 ) components:components:

1.1 DESCRIPTION OF THE PRESENT SITUATION 1.1 DESCRIPTION OF THE PRESENT SITUATION (DEMOGRAPHY(DEMOGRAPHY)) 1.1.11.1.1 POPULATION POPULATION :Total number of people :Total number of people : Geographic distribution (including accessibility : Geographic distribution (including accessibility information)information) : age-sex composition: age-sex composition : vital statistical rates : vital statistical rates crude birth rate, crude birth rate, natural growth ratenatural growth rate crude death rate, crude death rate, the presence of , and the presence of , and IMR, MMR types IMR, MMR types and number of and number of , disadvantaged , disadvantaged groups groups

1.1.2. 1.1.2. HEALTH STATUSHEALTH STATUS

: leading causes of morbidity: leading causes of morbidity

: leading causes of mortality: leading causes of mortality

: leading causes of IMR: leading causes of IMR

: leading causes of MMR: leading causes of MMR

: leading causes of hospital admission / : leading causes of hospital admission /

utilizationutilization

: leading causes of consultation: leading causes of consultation

1.1.3 HEALTH RESOURCES1.1.3 HEALTH RESOURCES 1.1.3.1 Health Facilities 1.1.3.1 Health Facilities : (1.) type (unsuitable design): (1.) type (unsuitable design) : (2.)number (lack): (2.)number (lack) : (3.)geographical distribution : (3.)geographical distribution (maldistribution w/ concentration in the (maldistribution w/ concentration in the

rural areas, not optimally situated, ill- rural areas, not optimally situated, ill- equipped)equipped) : (4.)state of repair and utilization (not : (4.)state of repair and utilization (not properly supplied and maintained)properly supplied and maintained)

1.1.3.1 HEALTH FACILITIES1.1.3.1 HEALTH FACILITIES ( (cont’d)cont’d) Explanations are sought in the following:Explanations are sought in the following:

Lack of recognition of the problem by the high Lack of recognition of the problem by the high decision-makerdecision-maker

Lack of planningLack of planning Use of wrong criteria for distribution (including Use of wrong criteria for distribution (including

political, personal, and technical administrative)political, personal, and technical administrative) Defective policies in matters of personnel, supply, Defective policies in matters of personnel, supply,

and finance and defective procedures1and finance and defective procedures1

1.1.3.2 MANPOWER1.1.3.2 MANPOWER : by type : by type : number (inadequacy in number) and distribution : number (inadequacy in number) and distribution (maldistribution)(maldistribution) : the expenditures : the expenditures : the population coverage of : the population coverage of specific programs (achievements) specific programs (achievements) & & : analysis of current and recently : analysis of current and recently concluded heath resourcesconcluded heath resources

The problems usually identified regarding The problems usually identified regarding manpower are :manpower are :

1) inadequacy in number,1) inadequacy in number,

2) maldistribution, 2) maldistribution,

3) inefficient utilization, 3) inefficient utilization,

4) low quality and 4) low quality and

5) motivation.5) motivation.

Explanations are sought in the field of higher Explanations are sought in the field of higher policies in education , migration, and distribution, policies in education , migration, and distribution, training, attitudes, managerial competence, training, attitudes, managerial competence, technical and administrative policies and technical and administrative policies and procedures.procedures.

1.1.3.3 Intersectoral and 1.1.3.3 Intersectoral and intrasectoral relationships:intrasectoral relationships: The reasons for the The reasons for the absence of good working absence of good working relationships are sought.relationships are sought.

1.1 DESCRIPTION OF THE PRESENT 1.1 DESCRIPTION OF THE PRESENT SITUATIONSITUATION: DEMOGRAPHY: DEMOGRAPHY (cont’d) (cont’d)

1.1.4 HEALTH RELATED SOCIO-ECONOMIC 1.1.4 HEALTH RELATED SOCIO-ECONOMIC FACTORS/ RESOURCESFACTORS/ RESOURCES

: economic activities : agriculture: economic activities : agriculture : nutrition : industries: nutrition : industries : waste disposal : waste disposal : water supply: water supply : transportation: transportation : communication: communication : education: education : housing: housing

Three (3) Components of the Community Three (3) Components of the Community AnalysisAnalysis (cont’d) (cont’d)

Situational Analysis / Problem IdentificationSituational Analysis / Problem Identification (Cont’d)(Cont’d)

1:2 PROJECTION1:2 PROJECTION: a must in long term : a must in long term planningplanning..

The ones projected are:The ones projected are: AA. . PopulationPopulation B. The different Rates of specific disease/conditionsB. The different Rates of specific disease/conditions

(based on observed trends and possible (based on observed trends and possible impacts of programmes and trends observed in impacts of programmes and trends observed in the health-related socioeconomic factors)the health-related socioeconomic factors)

1:31:3 PROBLEM IDENTIFICATION and PROBLEM IDENTIFICATION and EXPLANATIONEXPLANATION::

The last part of the situational analysis consists of:The last part of the situational analysis consists of: - identification of the problems- identification of the problems = w/o it , planning cannot proceed in the right = w/o it , planning cannot proceed in the right - explanation of the causes- explanation of the causes - indication of areas of change (constraint/obstacles analysis) - indication of areas of change (constraint/obstacles analysis) - accurate statements of problems lead to clear objective - accurate statements of problems lead to clear objective setting setting - the product of this analysis would result to tables, detailed - the product of this analysis would result to tables, detailed descriptions, projections and some conclusionsdescriptions, projections and some conclusions

identify within each of the four technical area of the problems identify within each of the four technical area of the problems and their underlying causesand their underlying causes the 0utputs --- are a list of problems and constraints and the 0utputs --- are a list of problems and constraints and proposals for changes in areas where requiredproposals for changes in areas where required

STEPS IN THE PLANNING PROCESS (Cont’dSTEPS IN THE PLANNING PROCESS (Cont’d):):2. 2. DEFINING AND VERIFYING THE PROBLEM: DEFINING AND VERIFYING THE PROBLEM:

COMMUNITY DIAGNOSISCOMMUNITY DIAGNOSIS -the -the final stepfinal step in COMMUNITY ANALYSIS in COMMUNITY ANALYSIS -involves synthesizing all collected data and-involves synthesizing all collected data and determining gaps between health problems and determining gaps between health problems and servicesservices the gaps –indications of need within the the gaps –indications of need within the community and any subpopulation community and any subpopulation within the community that may be within the community that may be particularly affected by health particularly affected by health problems problems the group --becomes the target populationthe group --becomes the target population

Establishing program goalsEstablishing program goals - first important process - first important process - once needs are verified can be translated - once needs are verified can be translated into program goals into program goals - all subsequent activities should focus on - all subsequent activities should focus on designing program that will address an designing program that will address an identified need in particular populationidentified need in particular population Defining and assessing behavior:Defining and assessing behavior: - must define behaviors related to the problem- must define behaviors related to the problem - “the essence of health education is planned - “the essence of health education is planned behavior change” planned changes in behaviors behavior change” planned changes in behaviors

that are related to maintenance and improvement that are related to maintenance and improvement of health.of health.

3.PLAN FORMULATION / DEVELOPING A 3.PLAN FORMULATION / DEVELOPING A PROGRAM PLAN PROGRAM PLAN

3.13.1 Objective Setting and Strategy FormulationObjective Setting and Strategy Formulation 3.1.1 3.1.1 Setting of objectives/ formulation of Setting of objectives/ formulation of objectivesobjectives - The following steps are followed:- The following steps are followed: A. Setting the overall health policy w/c includes the A. Setting the overall health policy w/c includes the following: following: (1.) Main objectives….w/c should be (1.) Main objectives….w/c should be SMARTSMART SS pecific (what) pecific (what) MM easurable ( by how much) easurable ( by how much) AA ttainable ttainable RR ealistic ealistic TT ime Bound (when) ime Bound (when) (2) priority setting(2) priority setting (3) general (basic) strategy(3) general (basic) strategy

- - PlanningPlanning group must group must select educational select educational methodsmethods (chosen alternative of proven (chosen alternative of proven merit and Review of Literature is merit and Review of Literature is important here)important here)

PLANNING OF PROGRAMSPLANNING OF PROGRAMS

(HEALTH PROGRAMS)(HEALTH PROGRAMS)

=Refer to the courses of actions and necessary =Refer to the courses of actions and necessary

resources for the improvement of a given health resources for the improvement of a given health

problemproblem

= is a timed series of service activities and = is a timed series of service activities and

development efforts requiring physical, development efforts requiring physical,

human, and financial resources for the human, and financial resources for the

implementation of one or more course of implementation of one or more course of

action to achieve a given health policy objective action to achieve a given health policy objective

Examples of Health Programs:Examples of Health Programs:MCH MCH ENVIRONMENTAL ENVIRONMENTAL

HEALTHHEALTH EPI EPI COMMUNICABLE COMMUNICABLE

DISEASE CONTROLDISEASE CONTROL

NONCOMMUNICABLE NONCOMMUNICABLE

DISEASE CONTROLDISEASE CONTROL

-The distinction between a -The distinction between a strategystrategy and a and a programprogram is a matter of specificity and is a matter of specificity and feasibility. feasibility.

-Both contain -Both contain serviceservice and and developmental developmental activities.activities.

= However where these are implicit not = However where these are implicit not distinguishable from strategy, and not tested for distinguishable from strategy, and not tested for feasibility they should be quite explicit and feasibility they should be quite explicit and feasible by the time a programme is formulatedfeasible by the time a programme is formulated

Selection of Programs in the Health PlanSelection of Programs in the Health Plan

-1-1stst step is to review the existing ones, how they step is to review the existing ones, how they performed in the past, and their relevance to the performed in the past, and their relevance to the priority health problems.priority health problems.

-Experience has shown that there is very little option in -Experience has shown that there is very little option in selecting programs since most of the existing ones , selecting programs since most of the existing ones , de-emphasizing some activities or introducing de-emphasizing some activities or introducing changes in directionchanges in direction

- The main determinant in the choice of program is - The main determinant in the choice of program is the relevance to the main health problem and having the relevance to the main health problem and having established a list an assignment of an order of established a list an assignment of an order of importanceimportance

-The programs included in the list will be needed.-The programs included in the list will be needed.

PROGRAMS:PROGRAMS: 1. Programs for direction, coordination, and 1. Programs for direction, coordination, and managementmanagement - formulation of policy- formulation of policy - direction, coordination, and control of - direction, coordination, and control of program activities program activities - provision of informal and administrative support, - provision of informal and administrative support, including personnel, finance, logistic and legal including personnel, finance, logistic and legal services services 2. Health System Infrastructure2. Health System Infrastructure -planning and development of basic health facility -planning and development of basic health facility networknetwork - health manpower policies and training- health manpower policies and training - health education and public information - health education and public information

3. Technology Programs3. Technology Programs =MCH including Family Planning and =MCH including Family Planning and NutritionNutrition = Environmental Health= Environmental Health = Communicable Disease Control= Communicable Disease Control = Non-Communicable Disease Control= Non-Communicable Disease Control = Psycho-social health to include mental health, = Psycho-social health to include mental health,

alcohol and drug abusealcohol and drug abuse = Oral Health = Oral Health = Worker’s Health= Worker’s Health = Rehabilitation= Rehabilitation = Laboratory and Biological products= Laboratory and Biological products = Health of the Elderly= Health of the Elderly = Research and Protocol Dev’t = Research and Protocol Dev’t

THE KEY ELEMENTS OF A HEALTH THE KEY ELEMENTS OF A HEALTH

PROGRAMPROGRAM

KEY ELEMENTS OF A HEALTH PROGRAMKEY ELEMENTS OF A HEALTH PROGRAM:: 1. 1. NAME NAME = w/c identifies it as close as possible with a healthy = w/c identifies it as close as possible with a healthy

policy objective (s) or disease condition (s) it intends to solve/ policy objective (s) or disease condition (s) it intends to solve/ improveimprove

2. 2. A BRIEF STATEMENT OF THE PRIORITY A BRIEF STATEMENT OF THE PRIORITY DISEASE/CONDITIONS IT INTENDS TO SOLVE/IMPROVEDISEASE/CONDITIONS IT INTENDS TO SOLVE/IMPROVE

- to include the magnitude and- to include the magnitude and - extent of the problem, and a - extent of the problem, and a - comment on why it is important- comment on why it is important - the statement should also include the status of status of - the statement should also include the status of status of the program (should there be an existing one) and the the program (should there be an existing one) and the important constraints which hamper the programimportant constraints which hamper the program 3. 3. AN OBJECTIVE (S)AN OBJECTIVE (S) – which indicates quantified changes – which indicates quantified changes

from existing levels of occurrence with specifications of time from existing levels of occurrence with specifications of time frames frames

4.4. BUDGET-BUDGET- only certain specific resource. only certain specific resource.

55..Disease condition targetsDisease condition targets, which indicates , which indicates quantified charges from existing levels of quantified charges from existing levels of occurrence with specification of time framesoccurrence with specification of time frames

66.SERVICE TARGETS.SERVICE TARGETS– which include – which include percentages of the coverage of a given eligible percentages of the coverage of a given eligible population. population.

Health service targetHealth service target refers to the health refers to the health activities applied directly to the individual in the activities applied directly to the individual in the community or environment in order to improve community or environment in order to improve the health status.the health status.

7. 7. APPROACHAPPROACH—which describes the—which describes the ACTION ACTION to be pursued to be pursued such as such as MANNER OF IMPLEMENTATIONMANNER OF IMPLEMENTATION

(vertical or integrated with basic health units)(vertical or integrated with basic health units) - program tactics, clinic attendance, house - program tactics, clinic attendance, house to house campaign, etc.to house campaign, etc. - the field units responsible for the delivery - the field units responsible for the delivery of services and the role of the other unitsof services and the role of the other units - the - the principal constraints or obstaclesprincipal constraints or obstacles to to the program’s implementation noted in the pastthe program’s implementation noted in the past and what needs to be done to overcome them.and what needs to be done to overcome them. = the latter refers to the = the latter refers to the development of development of activitiesactivities that should be applied to the staff, that should be applied to the staff, facility, organization, procedures, etc. in order facility, organization, procedures, etc. in order to to overcome the principal constraints and raise overcome the principal constraints and raise the program capability the program capability to the levelto the level required to required to achieve target / objectives.achieve target / objectives.

8.8. LINKAGESLINKAGES – this should include the following – this should include the following ::

= the participation of the other government = the participation of the other government facilities outside the health ministry.facilities outside the health ministry. = the responsibilities if any of the private = the responsibilities if any of the private sector sector = the possible involvement of other related = the possible involvement of other related sectors.sectors. = it is important that specific sectors be = it is important that specific sectors be identified, approached and be made identified, approached and be made active participants in formulating an active participants in formulating an intersectoral plan of action.intersectoral plan of action.

99. . PROGRAMME REQUIREMENTSPROGRAMME REQUIREMENTS need to be need to be calculated such ascalculated such as

- the key personnel for program direction and - the key personnel for program direction and - doses of vaccine in EPI if a program will be - doses of vaccine in EPI if a program will be implemented through the existing health service implemented through the existing health service network.network. = for vertical programs the whole budget = for vertical programs the whole budget need to be estimated.need to be estimated.1010. . NEED FOR TECHNICAL COOPERATION FROM NEED FOR TECHNICAL COOPERATION FROM

EXTERNAL AGENCIESEXTERNAL AGENCIES - specify nature of needed cooperation- specify nature of needed cooperation11. 11. EVALUATION INDICATOR(S)EVALUATION INDICATOR(S) = this is decided upon considering the health policy = this is decided upon considering the health policy

objectives, the health status targets and the service objectives, the health status targets and the service targetstargets

PROGRAMME OBJECTIVES / TARGET OBJECTIVES:PROGRAMME OBJECTIVES / TARGET OBJECTIVES: ♦♦ Program ObjectivesProgram Objectives:: - Essentially the same as the health policy - Essentially the same as the health policy objective objective - the most important consideration is that - the most important consideration is that whatever objective formulation,whatever objective formulation, should stateshould state what is to be done by the what is to be done by the programprogram with regards to a priority health with regards to a priority health problem identified at the stage of problem identified at the stage of situational analysis .situational analysis .

♦ ♦ Target Objectives:Target Objectives:

♠♠ are quantified objectives with a time factorare quantified objectives with a time factor

♠♠ e.g. may be expressed as:e.g. may be expressed as:

♥ ♥ reduction of maternal mortality to a reduction of maternal mortality to a

specific level, specific level,

♥♥ reduction of cholera or TB levels to reduction of cholera or TB levels to

zero cases, etc.zero cases, etc.

♠♠ define quantity and quality of activities to define quantity and quality of activities to

be accomplished by be accomplished by disease reduction disease reduction

targets or health status targets / health targets or health status targets / health

impact objectives.impact objectives.

2 types2 types:: 1. 1. Service Targets / input targetsService Targets / input targets - act directly to reduce the disease / - act directly to reduce the disease /

condition level condition level 2. 2. Developmental activities / Developmental activities /

resource targetsresource targets : : - aim to remove the obstacles to the - aim to remove the obstacles to the

appropriate delivery of service targets appropriate delivery of service targets or strengthen the capability to such or strengthen the capability to such deliverydelivery

EXAMPLES OF TARGETSEXAMPLES OF TARGETS:: Health statusHealth status – reduction to zero levels of tetanus – reduction to zero levels of tetanus neonatorumneonatorum ServiceService – full immunization of all pregnant women – full immunization of all pregnant women

with tetanus toxoid within three yrs. with tetanus toxoid within three yrs. DEVELOPMENTAL ACTIVITIESDEVELOPMENTAL ACTIVITIES StaffStaff = assignment of a complete rural health = assignment of a complete rural health

unit for each municipality within 3 unit for each municipality within 3 yearsyears FacilitiesFacilities = construction of 50 health centers in 3 = construction of 50 health centers in 3

yrs yrs ExpendituresExpenditures = jt js necessary to determine how = jt js necessary to determine how much can be done to reduce the problems within much can be done to reduce the problems within a specified period of timea specified period of time

TargetsTargets cont’d: cont’d: = target statements are guided by removability of corresponding = target statements are guided by removability of corresponding constraintsconstraints = target statements must be very clear free from double = target statements must be very clear free from double interpretationinterpretation = plans are periodically reviewed and adjusted and careful = plans are periodically reviewed and adjusted and careful projection should take careprojection should take care Service TargetsService Targets = are discussed 1= are discussed 1stst before the disease/ condition before the disease/ condition reduction targets because the latter depends reduction targets because the latter depends on the degree of achievement of the former. on the degree of achievement of the former. = However in the writing of programmes disease/condition = However in the writing of programmes disease/condition targets are presented first.targets are presented first. = Balancing act between what is epidemiologically = Balancing act between what is epidemiologically desirable and what is administratively feasible desirable and what is administratively feasible

Operational standards to be observed for Operational standards to be observed for activities:activities:

1. Duration of activity (e.g. length of 1. Duration of activity (e.g. length of hospitalization)hospitalization)

2. Frequency of application of activity per case/2. Frequency of application of activity per case/

person/ establishment number of times OPTperson/ establishment number of times OPT

will be given per child will be given per child

3. Staff performance ( e g : consultation per 3. Staff performance ( e g : consultation per hour, per vaccination )hour, per vaccination )

4. Facility performance (e.g. bed occupancy 4. Facility performance (e.g. bed occupancy rate) rate)

ActivitiesActivities will be carried out by trained will be carried out by trained staff provided with appropriate equipments staff provided with appropriate equipments and medical supplies and with adequate and medical supplies and with adequate supervision. supervision.

Productivity and efficiency are assumed.Productivity and efficiency are assumed.

HEALTH SERVICE DESIGNHEALTH SERVICE DESIGN:- what are the :- what are the systems involved systems involved

IDENTIFICATION OF NEEDS FOR IDENTIFICATION OF NEEDS FOR PROJECTSPROJECTS

BUDGET ESTIMATESBUDGET ESTIMATES

3. Establishing Program Goals3. Establishing Program Goals - first step is - first step is

= = to to identify goals for health identify goals for health

education education

=identify the =identify the resourcesresources and and

constraintsconstraints

FORMATIVE EVALUATIONFORMATIVE EVALUATION::

= RELEVANCE and ADEQUACY of a = RELEVANCE and ADEQUACY of a plan /program is decided; plan /program is decided;

= It is done during the stage of program = It is done during the stage of program formulationformulation

4. PLANNING FOR IMPLEMENTATION: 4. PLANNING FOR IMPLEMENTATION: Two (2) activitiesTwo (2) activities included here are: included here are: 1. The planning of preparation and 1. The planning of preparation and 2. Developmental activities:2. Developmental activities: = allocation of resources= allocation of resources = securing legal authorization to start = securing legal authorization to start implementation implementation = promotional activities planning= promotional activities planning = preparation for the institution of minor changes= preparation for the institution of minor changes = refer to the institution of major changes = refer to the institution of major changes including the introduction of new including the introduction of new developmental activitiesdevelopmental activities

5. EVALUATION:5. EVALUATION:

SUMMATIVE EVALUATIONSUMMATIVE EVALUATION

= Evaluation of effectiveness and impact = Evaluation of effectiveness and impact

= done at the end of implementation= done at the end of implementation

5. 5. DESIGNING PROGRAM EVALUATIONDESIGNING PROGRAM EVALUATION = must be included in the planning process= must be included in the planning process = must have evaluation criteria or standards by which = must have evaluation criteria or standards by which

the program achievements can be assessedthe program achievements can be assessed = are assessed in terms of their accomplishment= are assessed in terms of their accomplishment = ease in drafting this depends on the way the health = ease in drafting this depends on the way the health

plan has been formulatedplan has been formulated = a good plan should have evaluation guides= a good plan should have evaluation guides = = the overriding concern of evaluation is to determine the overriding concern of evaluation is to determine

the impact on the health condition of the country.the impact on the health condition of the country. : endpoint of plan but also the start of another : endpoint of plan but also the start of another planplan : checks if the plan is successful or not: checks if the plan is successful or not : do monitoring first, revise, and evaluate : do monitoring first, revise, and evaluate

EVALUATION:EVALUATION:

Summative Evaluation= evaluation of Summative Evaluation= evaluation of effectiveness and impact; done at the end of effectiveness and impact; done at the end of implementation.implementation.

DESIGNING PROGRAM EVALUATION:DESIGNING PROGRAM EVALUATION: must be included in the planning processmust be included in the planning process must have evaluation criteria or standardsmust have evaluation criteria or standards

by which the program achievements can by which the program achievements can

be assessedbe assessed process or outcome evaluation = determine the process or outcome evaluation = determine the

extent to which the program achievements can extent to which the program achievements can

be assessedbe assessed

PROCESS OR OUTCOME EVALUATION:PROCESS OR OUTCOME EVALUATION:

= determines the extent to which the = determines the extent to which the objectives contained in policies, objectives contained in policies, programs and projects have been programs and projects have been achievedachieved

STEPS IN THE PLANNING PROCESS: (cont’d)STEPS IN THE PLANNING PROCESS: (cont’d)2. Defining and Verifying the Problem (cont’d2. Defining and Verifying the Problem (cont’d)) Establishing program goalsEstablishing program goals - First important process - First important process - Once needs are verified can be translated into - Once needs are verified can be translated into

program goals. All subsequent activities should focus program goals. All subsequent activities should focus on designing program that will address and identified on designing program that will address and identified need in particular populationneed in particular population

Defining and assessing behaviorDefining and assessing behavior -must define behaviors related to the problem.-must define behaviors related to the problem. “ “ The essence of health education is planned The essence of health education is planned

behavior change, “ planned changes in behaviors that behavior change, “ planned changes in behaviors that are related to maintenance and improvement of are related to maintenance and improvement of health. health.

3. PLAN FORMULATION / DEVELOPING A 3. PLAN FORMULATION / DEVELOPING A PROGRAM PLAN: Objective Setting and PROGRAM PLAN: Objective Setting and Strategy FormulationStrategy Formulation

Planning For ImplementationPlanning For Implementation Establishing Program GoalsEstablishing Program Goals the first step is to identify goals for health the first step is to identify goals for health educationeducation identify resources and constraintsidentify resources and constraints SETTING THE OBJECTIVES/ SETTING THE OBJECTIVES/ FORMULATION OF OBJECTIVES FORMULATION OF OBJECTIVES The following steps are followed:The following steps are followed: ( 1.)setting the overall health policy which ( 1.)setting the overall health policy which

(2.) Includes the ff: (2.) Includes the ff:

a. main objectivesa. main objectives

b. priority settingb. priority setting

c. general (or basic) strategyc. general (or basic) strategy

(3.) planning of programmes(3.) planning of programmes

(4.) health service design(4.) health service design

(5.) identification of needs for projects(5.) identification of needs for projects

(6.) budget estimates (6.) budget estimates

planning group must select educational planning group must select educational methods (chosen alternative of proven merit methods (chosen alternative of proven merit and review of literature is imp’t.and review of literature is imp’t.

Formative evaluation= relevance and Formative evaluation= relevance and adequacy of a plan/program is decided; it is adequacy of a plan/program is decided; it is done during the stage of program formulation.done during the stage of program formulation.

Planning for Implementation:Planning for Implementation:Two ActivitiesTwo Activities1. The planning for preparation and developmental 1. The planning for preparation and developmental

activitiesactivities Preparatory activities:Preparatory activities: ♥♥ allocation of resourcesallocation of resources ♥♥ securing legal authorization to start securing legal authorization to start implementation implementation ♥ ♥ promotional activities planningpromotional activities planning preparation for the institution of minor preparation for the institution of minor changeschanges Developmental activitiesDevelopmental activities ♥ ♥ refer to the institution of major changes including refer to the institution of major changes including

the introduction of new developmental activitiesthe introduction of new developmental activities2. Actual delivery of health services2. Actual delivery of health services

Are assessed in terms of their accomplishment Are assessed in terms of their accomplishment Ease in drafting this depends on the way the health plan has Ease in drafting this depends on the way the health plan has

been formulatedbeen formulated A good plan should have evaluation guidesA good plan should have evaluation guides The overriding concern of evaluation is to determine the The overriding concern of evaluation is to determine the

plan impact on the health condition of the countryplan impact on the health condition of the country

♥ ♥ endpoint of plan but also start of endpoint of plan but also start of

another plananother plan

♥ ♥ checks if the plan is successful or notchecks if the plan is successful or not

♥ ♥ do monitoring first, revise and evaluatedo monitoring first, revise and evaluate Involves synthesizing all collected data and determine gaps Involves synthesizing all collected data and determine gaps

between health problems and services. between health problems and services.

♥ ♥ the gaps– indications of need within the community that the gaps– indications of need within the community that may be particularly affected by health problemsmay be particularly affected by health problems

♥ ♥ the group– becomes the target populationthe group– becomes the target population

Characteristics of Health Characteristics of Health ProgramsPrograms

RelevantRelevant: must be based on priority : must be based on priority health problems.health problems.

EffectiveEffective: Must answer the problems they : Must answer the problems they were intended forwere intended for

Efficient: outcomes are attained with the Efficient: outcomes are attained with the least amount of resources least amount of resources

Types of ProgrammesTypes of Programmes

Programs for Direction, Coordination and Programs for Direction, Coordination and ManagementManagement

Formulation of Policy, Programmes and Formulation of Policy, Programmes and ProjectsProjects

Provision of Informational or administrative Provision of Informational or administrative support support

Health System InfrastructureHealth System Infrastructure Planning and development of basic health Planning and development of basic health

facility networkfacility network

Health manpower policies and trainingHealth manpower policies and training Health education and public informationHealth education and public information Technology programmesTechnology programmes MCH, Family planning and nutritionMCH, Family planning and nutrition Environmental healthEnvironmental health Communicable disease controlCommunicable disease control Non communicable disease controlNon communicable disease control Mental and Community Mental HealthMental and Community Mental Health

Key Elements of a Health Key Elements of a Health ProgramProgram

1. Name of program1. Name of program 2. Basis of a program2. Basis of a program 3. Health policy objectives3. Health policy objectives 4. Disease condition targets4. Disease condition targets 5. Strategies / service targets / activities5. Strategies / service targets / activities 6. Approach6. Approach 7. Linkages7. Linkages 8. Program budget8. Program budget 9. Linkages9. Linkages 10. Need for technical cooperation10. Need for technical cooperation 11. Evaluation indicators11. Evaluation indicators

Nature of Program Planning Process:Nature of Program Planning Process:

--Cyclical--Cyclical

Identification of areas of concern Identification of areas of concern

AssessmentAssessment

Formulation of alternativesFormulation of alternatives

DecisionDecision

Inclusion into the Program PlanInclusion into the Program Plan

PROJECT PLANNING:PROJECT PLANNING:

What is a PROJECTWhat is a PROJECT: : ♦ ♦ The most concrete means of translating policies and The most concrete means of translating policies and

programs into specific courses of action.programs into specific courses of action. ♦ ♦ A temporary management activity that breaks up upon A temporary management activity that breaks up upon

completion of the designed output.completion of the designed output. ♦ ♦ It is a time-limited undertaking involving a series of It is a time-limited undertaking involving a series of

interrelated activities. Its ultimate purpose is to incorporate interrelated activities. Its ultimate purpose is to incorporate such desired changes/developments into the health care such desired changes/developments into the health care system as will enable the health programme or facility to system as will enable the health programme or facility to develop or enhance its capability for delivering a specified develop or enhance its capability for delivering a specified health service. health service.

Identification of areas for planning development:Identification of areas for planning development: In program planning, In program planning, obstacles to programme delivery obstacles to programme delivery

has been listed in the situational analysis, and measures has been listed in the situational analysis, and measures to solve them have been proposed in designing the to solve them have been proposed in designing the program approach.program approach.

A review is made of these proposals of each program to A review is made of these proposals of each program to determine the degree of their interrelationships with each determine the degree of their interrelationships with each other. The review should lead to the classification of other. The review should lead to the classification of lesser numbers of but larger project efforts. If the latter is lesser numbers of but larger project efforts. If the latter is not feasible, then the changes/developments may be not feasible, then the changes/developments may be dealt with through several smaller efforts. dealt with through several smaller efforts.

Prevailing policies, the existing administrative expertise Prevailing policies, the existing administrative expertise for carrying out the proposed changes and the extent of for carrying out the proposed changes and the extent of their interrelationship with each other will influence the their interrelationship with each other will influence the choice. choice.

3 3 Groupings: Groupings: 1-Through programs and services 1-Through programs and services Ex. =Strengthening of basic health servicesEx. =Strengthening of basic health services = integration of maternal and child = integration of maternal and child health and family planninghealth and family planning = development of a national government = development of a national government pharmaceutical store pharmaceutical store 2-Through major activities2-Through major activities Ex: = trainingEx: = training = construction/infrastructure= construction/infrastructure = design of administrative subsystem= design of administrative subsystem 3- A combination of the 23- A combination of the 2

♦ ♦ NATURE OF PLANNINGNATURE OF PLANNING ♥ ♥ IMPORTANT ELEMENTS THAT DESCRIBES IMPORTANT ELEMENTS THAT DESCRIBES

THE ESSENTIAL NATURE OF PLANNING :THE ESSENTIAL NATURE OF PLANNING : ♣ ♣ CONTRIBUTION OF PLANNING TO CONTRIBUTION OF PLANNING TO OBJECTIVESOBJECTIVES ♣ ♣ PRIMACY OF PLANNING – first of the PRIMACY OF PLANNING – first of the managerial functions to be performedmanagerial functions to be performed ♣ ♣ PERVASIVENESS OF PLANNING – found PERVASIVENESS OF PLANNING – found at all managerial levelsat all managerial levels ♣ ♣ COORDINATION OF PLANNING – COORDINATION OF PLANNING – coordinating the what, who, when, how, coordinating the what, who, when, how, where and why of planningwhere and why of planning

♣ ♣ SELECTION OF PLANNING ALTERNATIVESSELECTION OF PLANNING ALTERNATIVES - concerned with potential values received - concerned with potential values received from planning versus costs incurredfrom planning versus costs incurred♣ ♣ EFFICIENCY AND ECONOMY OF EFFICIENCY AND ECONOMY OF

PLANNINGPLANNING --considers potential values received considers potential values received from planning versus costs incurred from planning versus costs incurred ♣ ♣ FLEXIBILITY OF PLANNINGFLEXIBILITY OF PLANNING - ability to adjust to changing conditions- ability to adjust to changing conditions♣ ♣ CONTROL OF PLANNING CONTROL OF PLANNING - provides a feedback mechanism to change - provides a feedback mechanism to change

plan when necessaryplan when necessary

APPROACH TO PLANNINGAPPROACH TO PLANNING::

♦♦ Flow may be TOP-DOWN or BOTTOM- UP orFlow may be TOP-DOWN or BOTTOM- UP or

♥ “♥ “Top- Down approach ”Top- Down approach ”

♥ “ ♥ “ Bottom- Up Approach ”Bottom- Up Approach ”

♥ “ ♥ “ Combined Approach “Combined Approach “

Then the listed projects are classified into HIGH Then the listed projects are classified into HIGH and LOW PRIORITY GROUPINGS accdg to and LOW PRIORITY GROUPINGS accdg to some criteria. some criteria.

The following will receive high priorityThe following will receive high priority::

1. Projects which relate to urgent problems and 1. Projects which relate to urgent problems and which have significant political implications which have significant political implications

2. Projects which relate to urgent problems and 2. Projects which relate to urgent problems and which have significant political implications.which have significant political implications.

3 Projects which will give improve effectiveness 3 Projects which will give improve effectiveness and efficiency in the utilization of resources (and and efficiency in the utilization of resources (and hence the maximization of their impacts).hence the maximization of their impacts).

Then the Then the time-span or lifetime-span or life of each project of each project is roughly calculated and indication is is roughly calculated and indication is given as to when it will be started.given as to when it will be started.

Resource requirements in monetary Resource requirements in monetary termsterms are calculated and incorporated are calculated and incorporated into the plan budget.into the plan budget.

Approved list of projects w/indicationApproved list of projects w/indication of priorityof priority Prepare specific objectives of each projectPrepare specific objectives of each project

Determine activities and formulate a plan of work for each projectDetermine activities and formulate a plan of work for each project

Prepare monitoring scheme for each projectPrepare monitoring scheme for each project

Prepare requirements for the administration of each projectPrepare requirements for the administration of each project

Write the project document for each project Write the project document for each project

Secure authorization to implement projectsSecure authorization to implement projects

FLOWCHART ON PROJECT PLANNINGFLOWCHART ON PROJECT PLANNING

ANALYSIS OF THE HEALTH SECTORANALYSIS OF THE HEALTH SECTOR Objectives:Objectives: 1.Review and evaluate the available resources 1.Review and evaluate the available resources

for the delivery of health carefor the delivery of health care 2. Identify deficiencies and weaknesses within 2. Identify deficiencies and weaknesses within

the health care delivery systemthe health care delivery system 3. Evaluate the relevance of present 3. Evaluate the relevance of present

policies/strategies in improving healthpolicies/strategies in improving healthSubtypes:Subtypes: 1.comonents of the health sector1.comonents of the health sector 2. study of intersectoral relationship2. study of intersectoral relationship 3. analysis of intrasectoral relationship3. analysis of intrasectoral relationship 4. Analysis of health facilities4. Analysis of health facilities 5. Analysis of health manpower5. Analysis of health manpower

PROJECT DEVELOPMENTPROJECT DEVELOPMENT

1.1. Problem identificationProblem identification

Problem explanation (CONSTRAINTS, Problem explanation (CONSTRAINTS, OBSTACLES, ANALYSIS)OBSTACLES, ANALYSIS)

2. Problem preparation- assessing the viability of 2. Problem preparation- assessing the viability of the project from the technical, economic, the project from the technical, economic, financial, and operational point of view.financial, and operational point of view.

3. Project appraisal and financing3. Project appraisal and financing

4. Project implementation4. Project implementation

5. Project operation5. Project operation

6. Project reappraisal6. Project reappraisal

PROBLEM ANALYSIS (PROBLEM TREE)PROBLEM ANALYSIS (PROBLEM TREE)EXAMPLE : LOSS OF CONFIDENCE IN BUS EXAMPLE : LOSS OF CONFIDENCE IN BUS COMPANYCOMPANY Passengers hurt or killed People are latePassengers hurt or killed People are late

Frequent bus accidentsFrequent bus accidents

Drivers not Bad conditions of Bad roadDrivers not Bad conditions of Bad roadCareful vehicles conditionsCareful vehicles conditions

EnoughEnough

Vehicles MaintenanceVehicles Maintenance

OBSTACLES MATRIXOBSTACLES MATRIX= basis of = basis of project planningproject planning

ObstaclesObstacles TechnologyTechnology StaffStaff ProcedureProcedure

♦ ♦ SCOPE OF THE PLAN:SCOPE OF THE PLAN: ♥ ♥ COMPREHENSIVE orCOMPREHENSIVE or ♥ ♥ PARTIALPARTIAL 1.1. Comprehensive Planning: Comprehensive Planning: a plan that includes a plan that includes all sectorsall sectors of the economy (public and of the economy (public and private)private)2. Partial planning2. Partial planning a plan that includes a plan that includes some aspectssome aspects or even just or even just one one aspectaspect of the economy of the economy

♦ ♦ SUBSTANTIALITY OF THE PLAN :SUBSTANTIALITY OF THE PLAN :1.1. if the plan covers the if the plan covers the more dominant partmore dominant part or the or the majoritymajority, , the plan is considered substantial the plan is considered substantial 2. if it covers only a 2. if it covers only a small partsmall part the plan must be changed into the plan must be changed into a a comprehensive onecomprehensive one for it to be more significant for it to be more significant

♦ ♦ TIME-SPANTIME-SPAN

♥ ♥ Long-term Planning - At least eight ( 8 ) Long-term Planning - At least eight ( 8 )

yearsyears

♥ ♥ Medium- term Planning -Four ( 4 ) to Seven Medium- term Planning -Four ( 4 ) to Seven

( 7 ) years( 7 ) years

♥ ♥ Short-term Planning-----One (1) to two ( 2 ) Short-term Planning-----One (1) to two ( 2 )

yearsyears

♦ ♦ AUTHORITATIVENESSAUTHORITATIVENESS Either:Either: ♥ ♥ INDICATIVE orINDICATIVE or ♥ ♥ PRESCRIPTIVEPRESCRIPTIVE

♥ ♥ Indicative Planning:Indicative Planning: ♣ ♣ used merely as a guide or terms of reference used merely as a guide or terms of reference ♣” ♣” indicating “ what the sector may do indicating “ what the sector may do ♣ ♣ not bindingnot binding♥ ♥ Prescriptive PlanningPrescriptive Planning ♣ ♣ command or control planningcommand or control planning ♣ ♣ has to be accepted and implementedhas to be accepted and implemented

♦ ♦ Three ( 3 )Levels of Administration and Three ( 3 )Levels of Administration and Operation Operation

♣ ♣ Top or decision –making levelTop or decision –making level

♣♣ Middle levelMiddle level

♣ ♣ First level First level

♦ ♦ Natural Expected Outputs of National Health Natural Expected Outputs of National Health Planning:Planning:

♣ ♣ National Health PoliciesNational Health Policies

♣ ♣ Health ProgrammesHealth Programmes

♣ ♣ Health ProjectsHealth Projects

♦ ♦ PRIORITIZATIONPRIORITIZATION ♥ ♥ Criteria:Criteria:1.1. Which problems has greater impact in terms Which problems has greater impact in terms

of death, days lost from work, rehabilitation of death, days lost from work, rehabilitation cost, family disorganizationcost, family disorganization

2.2. Are subpopulations at special risk?Are subpopulations at special risk?3.3. Which problem is susceptible to intervention ?Which problem is susceptible to intervention ?4.4. Which of the social problems is more Which of the social problems is more

neglected by other agencies?neglected by other agencies?5.5. Which of the problem when correctly Which of the problem when correctly

addressed has the highest potential for addressed has the highest potential for attractive yield ?attractive yield ?

6.6. Is it ranked as a national priority? Is it ranked as a national priority?

♦ ♦ HANLON’S PRIORITY METHODHANLON’S PRIORITY METHOD1.1. Size of the Problem (0-2) ) = % of population Size of the Problem (0-2) ) = % of population

affected -------------------------------------------------- aaffected -------------------------------------------------- a2.2. Seriousness of the Problem ( 0- 20 ) ------------- b Seriousness of the Problem ( 0- 20 ) ------------- b a. Urgency—Public concern? a. Urgency—Public concern? Public health concern? Public health concern? b. Severity---Mortality, Morbidity, Disabilityb. Severity---Mortality, Morbidity, Disability c. Medical Costs to individuals directly affected c. Medical Costs to individuals directly affected d. Future Needs (trends in health care needs, d. Future Needs (trends in health care needs,

forecast of potential number of persons to be forecast of potential number of persons to be affected)affected)

3. Effectiveness of the solution (0-10)-------------------c3. Effectiveness of the solution (0-10)-------------------c How well it can be solved.How well it can be solved. Defined as improvement of the service program.Defined as improvement of the service program.

Hanlon’s Priority Method ( Cont’d )Hanlon’s Priority Method ( Cont’d )4. HANLON’S PRIORITY CRITERIA: P-E-A-R-L4. HANLON’S PRIORITY CRITERIA: P-E-A-R-L

----d----d

P riority --------------------- 0-1P riority --------------------- 0-1

E conomic Feasibity----- 0-1E conomic Feasibity----- 0-1

A cceptability -------------- 0-1A cceptability -------------- 0-1

R esources------------------ 0-1R esources------------------ 0-1

L egality -------------------- 0-1 L egality -------------------- 0-1

♥ ♥ FORMULA = (a + b) c / dFORMULA = (a + b) c / d

STEPS IN THE PLANNING PROCESS:STEPS IN THE PLANNING PROCESS:1. COMMUNITY ANALYSIS1. COMMUNITY ANALYSIS : : SITUATIONAL ANALYSIS SITUATIONAL ANALYSIS

and PROBLEM IDENTIFICATIONand PROBLEM IDENTIFICATION A. Needs assessment : Identification of the A. Needs assessment : Identification of the Problem. Problem. B. Involves collection of detailed information B. Involves collection of detailed information concerning the community under studyconcerning the community under study

General overview obtained, then specific aspects of General overview obtained, then specific aspects of community are analyzed including community health community are analyzed including community health statusstatus

Information derived from a variety of sourcesInformation derived from a variety of sources ♣ ♣ PURPOSE OF THIS STEP: is to identify within each of the PURPOSE OF THIS STEP: is to identify within each of the

four technical areas the problems and their four technical areas the problems and their underlying causesunderlying causes

♣♣1.1.COMMUNITY ANALYSISCOMMUNITY ANALYSIS has three ( 3 ) has three ( 3 ) componentscomponents::

1.1 DESCRIPTION OF THE PRESENT SITUATION 1.1 DESCRIPTION OF THE PRESENT SITUATION

(DEMOGRAPHY)(DEMOGRAPHY) 1.1.1 1.1.1 POPULATION POPULATION :Total number of people :Total number of people : Geographic distribution (including accessibility : Geographic distribution (including accessibility

information)information) : age-sex composition: age-sex composition : vital statistical rates (crude birth rate, crude : vital statistical rates (crude birth rate, crude death rate, IMR, MMR, natural growth rate, death rate, IMR, MMR, natural growth rate, the presence of , and types and number of the presence of , and types and number of disadvantaged groups) disadvantaged groups)

1.1.2. HEALTH STATUS1.1.2. HEALTH STATUS

: leading causes of morbidity: leading causes of morbidity

: leading causes of mortality: leading causes of mortality

: leading causes of IMR: leading causes of IMR

: leading causes of MMR: leading causes of MMR

: leading causes of hospital admission / : leading causes of hospital admission /

utilizationutilization

: leading causes of consultation: leading causes of consultation

1.1.3 HEALTH RESOURCES1.1.3 HEALTH RESOURCES

1.1.3.1 HEALTH FACILITIES 1.1.3.1 HEALTH FACILITIES

: type (unsuitable design): type (unsuitable design)

: number (lack): number (lack)

: geographical distribution ( maldistribution : geographical distribution ( maldistribution

w/ concentration in the rural areas, not w/ concentration in the rural areas, not

optimally situated, ill-equipped)optimally situated, ill-equipped)

: state of repair and utilization (not properly : state of repair and utilization (not properly

supplied and maintained)supplied and maintained)

1.1.3.1 HEALTH FACILITIES (cont’d)1.1.3.1 HEALTH FACILITIES (cont’d) Explanations are sought in the following:Explanations are sought in the following:

Lack of recognition of the problem by the high Lack of recognition of the problem by the high decision-makerdecision-maker

Lack of planningLack of planning Use of wrong criteria for distribution (including Use of wrong criteria for distribution (including

political, personal, and technical administrative)political, personal, and technical administrative) Defective policies in matters of personnel, supply, Defective policies in matters of personnel, supply,

and finance and defective procedures1and finance and defective procedures1

1.1.3.2 MANPOWER1.1.3.2 MANPOWER : by type : by type : number (inadequacy in number): number (inadequacy in number) and distribution (maldistribution)and distribution (maldistribution) : the expenditures : the expenditures : the population coverage of : the population coverage of specific programs (achievements) specific programs (achievements) & & : analysis of current and recently : analysis of current and recently concluded heath resourcesconcluded heath resources

The problems usually identified regarding The problems usually identified regarding manpower are :manpower are :

1) inadequacy in number,1) inadequacy in number,

2) maldistribution, 2) maldistribution,

3) inefficient utilization, 3) inefficient utilization,

4) low quality and 4) low quality and

5) motivation.5) motivation.

Explanations are sought in the field of higher Explanations are sought in the field of higher policies in education , migration, and distribution, policies in education , migration, and distribution, training, attitudes, managerial competence, training, attitudes, managerial competence, technical and administrative policies and technical and administrative policies and procedures.procedures.

1.1.3.3 Intersectoral and 1.1.3.3 Intersectoral and intrasectoral intrasectoral relationships:relationships: The reasons for the The reasons for the absence of good working absence of good working relationships are sought.relationships are sought.

Preparations of the List Preparations of the List of Constraints/ Problem of Constraints/ Problem TreeTree

It is to be noted that health status It is to be noted that health status problems are explainable on the basis of problems are explainable on the basis of problems identified under health problems identified under health resources and socio-economic factors. resources and socio-economic factors.

Likewise population characteristics Likewise population characteristics contribute remarkably towards health contribute remarkably towards health service utilization and health practice and service utilization and health practice and by itself determine the incidence of by itself determine the incidence of certain illnesses. certain illnesses.

1.1 DESCRIPTION OF THE PRESENT 1.1 DESCRIPTION OF THE PRESENT SITUATIONSITUATION: DEMOGRAPHY (cont’d): DEMOGRAPHY (cont’d)

1.1.4 HEALTH RELATED SOCIO-ECONOMIC 1.1.4 HEALTH RELATED SOCIO-ECONOMIC FACTORS/ RESOURCES FACTORS/ RESOURCES

: economic activities : agriculture: economic activities : agriculture : nutrition : industries: nutrition : industries : waste disposal : waste disposal : water supply: water supply : transportation: transportation : communication: communication : education: education : housing: housing

Three (3) Components of the Community Analysis:Three (3) Components of the Community Analysis:Situational Analysis / Problem Identification (Cont’d)Situational Analysis / Problem Identification (Cont’d)

1:2 PROJECTION: a must in long term 1:2 PROJECTION: a must in long term planningplanning..

The ones projected are:The ones projected are: A. PopulationA. Population B. The different B. The different RatesRates of specific disease/conditions of specific disease/conditions

(based on (based on observed trendsobserved trends and possible and possible impacts impacts of programmes and of programmes and trends trends observed in observed in the health-related socioeconomic factors)the health-related socioeconomic factors)

1:3 PROBLEM IDENTIFICATION and 1:3 PROBLEM IDENTIFICATION and EXPLANATIONEXPLANATION::

The last part of the situational analysis consists of:The last part of the situational analysis consists of: - identification of the problems- identification of the problems = w/o it , planning cannot proceed in the right = w/o it , planning cannot proceed in the right - explanation of the causes- explanation of the causes - indication of areas of change (constraint/obstacles analysis) - indication of areas of change (constraint/obstacles analysis) - accurate statements of problems lead to clear objective - accurate statements of problems lead to clear objective setting setting - the product of this analysis would result to tables, detailed - the product of this analysis would result to tables, detailed descriptions, projections and some conclusionsdescriptions, projections and some conclusions

identify within each of the four technical area of the problems identify within each of the four technical area of the problems and their underlying causesand their underlying causes the 0utputs --- are a list of problems and constraints and the 0utputs --- are a list of problems and constraints and proposals for changes in areas where requiredproposals for changes in areas where required

STEPS IN THE PLANNING PROCESS (Cont’dSTEPS IN THE PLANNING PROCESS (Cont’d):):2. DEFINING AND VERIFYING THE PROBLEM: 2. DEFINING AND VERIFYING THE PROBLEM:

COMMUNITY DIAGNOSISCOMMUNITY DIAGNOSIS -the -the final stepfinal step in COMMUNITY ANALYSIS in COMMUNITY ANALYSIS -involves synthesizing all collected data and-involves synthesizing all collected data and determining gaps between health problems and determining gaps between health problems and servicesservices the gaps –indications of need within the the gaps –indications of need within the community and any subpopulation community and any subpopulation within the community that may be within the community that may be particularly affected by health particularly affected by health problems problems the group --becomes the target populationthe group --becomes the target population

Establishing program goalsEstablishing program goals - first important process - first important process - once needs are verified can be translated - once needs are verified can be translated into program goals into program goals - all subsequent activities should focus on - all subsequent activities should focus on designing program that will address an designing program that will address an identified need in particular populationidentified need in particular population Defining and assessing behavior:Defining and assessing behavior: - must define behaviors related to the problem- must define behaviors related to the problem - “the essence of health education is planned - “the essence of health education is planned behavior change” planned changes in behaviors behavior change” planned changes in behaviors

that are related to maintenance and improvement that are related to maintenance and improvement of health.of health.

3.PLAN FORMULATION / DEVELOPING A 3.PLAN FORMULATION / DEVELOPING A PROGRAM PLAN PROGRAM PLAN

3.13.1 Objective Setting and Strategy FormulationObjective Setting and Strategy Formulation 3.1.1 3.1.1 Setting of objectives/ formulation of Setting of objectives/ formulation of objectivesobjectives - The following steps are followed:- The following steps are followed: A. Setting the overall health policy w/c includes the A. Setting the overall health policy w/c includes the following: following: (1.) Main objectives….w/c should be (1.) Main objectives….w/c should be SMARTSMART SS pecific (what) pecific (what) MM easurable ( by how much) easurable ( by how much) AA ttainable ttainable RR ealistic ealistic TT ime Bound (when) ime Bound (when) (2) priority setting(2) priority setting (3) general (basic) strategy(3) general (basic) strategy

- Planning group must - Planning group must select educational select educational methodsmethods (chosen alternative of proven (chosen alternative of proven merit and Review of Literature is merit and Review of Literature is important here)important here)

PLANNING OF PROGRAMSPLANNING OF PROGRAMS

(HEALTH PROGRAMS)(HEALTH PROGRAMS)

=Refer to the courses of actions and necessary =Refer to the courses of actions and necessary

resources for the improvement of a given health resources for the improvement of a given health

problemproblem

= is a timed series of service activities and = is a timed series of service activities and

development efforts requiring physical, development efforts requiring physical,

human, and financial resources for the human, and financial resources for the

implementation of one or more course of implementation of one or more course of

action to achieve a given health policy objective action to achieve a given health policy objective

Examples of Health Programs:Examples of Health Programs:MCH MCH ENVIRONMENTAL ENVIRONMENTAL

HEALTHHEALTH EPI EPI COMMUNICABLE COMMUNICABLE

DISEASE CONTROLDISEASE CONTROL

NONCOMMUNICABLE NONCOMMUNICABLE

DISEASE CONTROLDISEASE CONTROL

-The distinction between a -The distinction between a strategystrategy and a and a programprogram is a matter of specificity and is a matter of specificity and feasibility. feasibility.

-Both contain service and developmental -Both contain service and developmental activities.activities.

= However where these are implicit not = However where these are implicit not distinguishable from strategy, and not tested for distinguishable from strategy, and not tested for feasibility they should be quite explicit and feasibility they should be quite explicit and feasible by the time a programme is formulatedfeasible by the time a programme is formulated

Selection of Programs in the Health PlanSelection of Programs in the Health Plan -1-1stst step is to review the existing ones, how they step is to review the existing ones, how they

performed in the past, and their relevance to the performed in the past, and their relevance to the priority health problems.priority health problems.

-Experience has shown that there is very little option in -Experience has shown that there is very little option in selecting programs since most of the existing ones , selecting programs since most of the existing ones , de-emphasizing some activities or introducing de-emphasizing some activities or introducing changes in directionchanges in direction

- The main determinant in the choice of program is - The main determinant in the choice of program is the relevance to the main health problem and having the relevance to the main health problem and having established a list an assignment of an order of established a list an assignment of an order of importanceimportance

-The programs included in the list will be needed.-The programs included in the list will be needed.

TYPES OF PROGRAMS:TYPES OF PROGRAMS:

-Field Operation or Health Impact Programs -Field Operation or Health Impact Programs

and Supporting Programsand Supporting Programs

- Direct Service Programmes and Functional - Direct Service Programmes and Functional

Support Programs Support Programs

- Direct Coordination and Management Health - Direct Coordination and Management Health

System Infrastructure and System Infrastructure and

- Technology Programs- Technology Programs

PROGRAMS:PROGRAMS: 1. Programs for direction, coordination, and 1. Programs for direction, coordination, and managementmanagement - formulation of policy- formulation of policy - direction, coordination, and control of - direction, coordination, and control of program activities program activities - provision of informal and administrative support, - provision of informal and administrative support, including personnel, finance, logistic and legal including personnel, finance, logistic and legal services services 2. Health System Infrastructure2. Health System Infrastructure -planning and development of basic health facility -planning and development of basic health facility networknetwork - health manpower policies and training- health manpower policies and training - health education and public information - health education and public information

3. Technology Programs3. Technology Programs =MCH including Family Planning and =MCH including Family Planning and NutritionNutrition = Environmental Health= Environmental Health = Communicable Disease Control= Communicable Disease Control = Non-Communicable Disease Control= Non-Communicable Disease Control = Psycho-social health to include mental health, = Psycho-social health to include mental health,

alcohol and drug abusealcohol and drug abuse = Oral Health = Oral Health = Worker’s Health= Worker’s Health = Rehabilitation= Rehabilitation = Laboratory and Biological products= Laboratory and Biological products = Health of the Elderly= Health of the Elderly = Research and Protocol Dev’t = Research and Protocol Dev’t

KEY ELEMENTS OF A HEALTH PROGRAMKEY ELEMENTS OF A HEALTH PROGRAM:: 1. 1. NAME NAME = w/c identifies it as close as possible with a healthy = w/c identifies it as close as possible with a healthy

policy objective (s) or disease condition (s) it intends to solve/ policy objective (s) or disease condition (s) it intends to solve/ improveimprove

2. 2. A BRIEF STATEMENT OF THE PRIORITY A BRIEF STATEMENT OF THE PRIORITY DISEASE/CONDITIONS IT INTENDS TO SOLVE/IMPROVEDISEASE/CONDITIONS IT INTENDS TO SOLVE/IMPROVE

- to include the magnitude and- to include the magnitude and - extent of the problem, and a - extent of the problem, and a - comment on why it is important- comment on why it is important - the statement should also include the status of status of - the statement should also include the status of status of the program (should there be an existing one) and the the program (should there be an existing one) and the important constraints which hamper the programimportant constraints which hamper the program 3. 3. AN OBJECTIVE (S)AN OBJECTIVE (S) – which indicates quantified changes – which indicates quantified changes

from existing levels of occurrence with specifications of time from existing levels of occurrence with specifications of time frames frames

4.4. BUDGET- BUDGET- only certain specific resource. only certain specific resource. Disease condition targetsDisease condition targets, which indicates , which indicates quantified charges from existing levels of quantified charges from existing levels of occurrence with specification of time framesoccurrence with specification of time frames

5.SERVICE TARGETS5.SERVICE TARGETS– which include – which include percentages of the coverage of a given eligible percentages of the coverage of a given eligible population. population.

Health service targetHealth service target refers to the health refers to the health activities applied directly to the individual in the activities applied directly to the individual in the community or environment in order to improve community or environment in order to improve the health statusthe health status

6. 6. APPROACHAPPROACH—which describes the ACTION to be pursued —which describes the ACTION to be pursued such as MANNER OF IMPLEMENTATIONsuch as MANNER OF IMPLEMENTATION

(vertical or integrated with basic health units)(vertical or integrated with basic health units) - program tactics, clinic attendance, house - program tactics, clinic attendance, house to house campaign, etc.to house campaign, etc. - the field units responsible for the delivery - the field units responsible for the delivery of services and the role of the other unitsof services and the role of the other units - the - the principal constraints or obstaclesprincipal constraints or obstacles to to the program’s implementation noted in the past the program’s implementation noted in the past and what needs to be done to overcome them.and what needs to be done to overcome them. = the latter refers to the = the latter refers to the development of development of activitiesactivities that should be applied to the staff, that should be applied to the staff, facility, organization, procedures, etc. in order facility, organization, procedures, etc. in order to to overcome the principal constraints and raise overcome the principal constraints and raise the program capability to the levelthe program capability to the level required to required to achieve target / objectives.achieve target / objectives.

7. 7. LINKAGES LINKAGES – this should include the – this should include the following :following :

= the participation of the other government = the participation of the other government facilities outside the health ministry.facilities outside the health ministry. = the responsibilities if any of the private = the responsibilities if any of the private sector sector = the possible involvement of other related = the possible involvement of other related sectors.sectors. = it is important that specific sectors be = it is important that specific sectors be identified, approached and be made identified, approached and be made active participants in formulating an active participants in formulating an intersectoral plan of action.intersectoral plan of action.

8. 8. PROGRAMME REQUIREMENTSPROGRAMME REQUIREMENTS need to be need to be calculated such ascalculated such as

- the key personnel for program direction and - the key personnel for program direction and - doses of vaccine in EPI if a program will be - doses of vaccine in EPI if a program will be implemented through the existing health service implemented through the existing health service network.network. = for vertical programs the whole budget = for vertical programs the whole budget need to be estimated.need to be estimated.9. 9. NEED FOR TECHNICAL COOPERATION FROM NEED FOR TECHNICAL COOPERATION FROM

EXTERNAL AGENCIES EXTERNAL AGENCIES - specify nature of needed cooperation- specify nature of needed cooperation10. 10. EVALUATION INDICATOR(S)EVALUATION INDICATOR(S) = this is decided upon considering the health policy = this is decided upon considering the health policy

objectives, the health status targets and the service objectives, the health status targets and the service targetstargets

PROGRAMME OBJECTIVES / TARGETPROGRAMME OBJECTIVES / TARGET

OBJECTIVESOBJECTIVES::

= Program Objective:= Program Objective:

- Essentially the same as the health policy - Essentially the same as the health policy

objective objective

- the most important consideration is that - the most important consideration is that

whatever objective formulation should state whatever objective formulation should state

: : what is to be done by the programwhat is to be done by the program with with

regards to a priority health problem identified regards to a priority health problem identified

at the stage of situational analysis .at the stage of situational analysis .

= = Target:Target:

- quantified objectives with a time factor- quantified objectives with a time factor

- may be expressed as reduction of maternal - may be expressed as reduction of maternal

mortality to a specific level, reduction of mortality to a specific level, reduction of

cholera or TB levels to zero cases, etc.cholera or TB levels to zero cases, etc.

- define quantity and quality of activities to - define quantity and quality of activities to

be accomplished by disease reduction be accomplished by disease reduction

targets or health status targets / health targets or health status targets / health

impact objectives.impact objectives.

2 types2 types:: 1. 1. Service Targets / input targetsService Targets / input targets - act directly to reduce the disease / - act directly to reduce the disease /

condition level condition level 2. 2. Developmental activities / Developmental activities /

resource targetsresource targets : : - aim to remove the obstacles to the - aim to remove the obstacles to the

appropriate delivery of service targets appropriate delivery of service targets or strengthen the capability to such or strengthen the capability to such deliverydelivery

EXAMPLES OF TARGETSEXAMPLES OF TARGETS:: Health statusHealth status – reduction to zero levels of tetanus – reduction to zero levels of tetanus neonatorumneonatorum Service Service – full immunization of all pregnant women – full immunization of all pregnant women

with tetanus toxoid within three yrs. with tetanus toxoid within three yrs. DEVELOPMENTAL ACTIVITIESDEVELOPMENTAL ACTIVITIES Staff Staff = assignment of a complete rural health = assignment of a complete rural health

unit for each municipality within 3 unit for each municipality within 3 yearsyears FacilitiesFacilities = construction of 50 health centers in 3 = construction of 50 health centers in 3

yrs yrs Expenditures Expenditures = jt js necessary to determine how = jt js necessary to determine how much can be done to reduce the problems within much can be done to reduce the problems within a specified period of timea specified period of time

TargetsTargets cont’d: cont’d: = target statements are guided by removability of corresponding = target statements are guided by removability of corresponding

constraintsconstraints = target statements must be very clear free from double interpretation= target statements must be very clear free from double interpretation = plans are periodically reviewed and adjusted and careful projection = plans are periodically reviewed and adjusted and careful projection

should take careshould take care Service TargetsService Targets = are discussed 1= are discussed 1stst before the disease/ condition before the disease/ condition reduction targets because the latter depends reduction targets because the latter depends on the degree of achievement of the former. on the degree of achievement of the former. = However in the writing of programmes ‘ = However in the writing of programmes ‘ disease/condition targets are presented first.disease/condition targets are presented first. = Balancing act between what is epidemiologically = Balancing act between what is epidemiologically desirable and what is administratively feasible desirable and what is administratively feasible

Operational standards to be observed for Operational standards to be observed for activities:activities:

1. Duration of activity (e.g. length of 1. Duration of activity (e.g. length of hospitalization)hospitalization)

2. Frequency of application of activity per case/2. Frequency of application of activity per case/

person/ establishment number of times OPTperson/ establishment number of times OPT

will be given per child will be given per child

3. Staff performance ( e g : consultation per 3. Staff performance ( e g : consultation per hour, per vaccination )hour, per vaccination )

4. Facility performance (e.g. bed occupancy 4. Facility performance (e.g. bed occupancy rate) rate)

Activities will be carried out by trained staff Activities will be carried out by trained staff provided with appropriate equipments and provided with appropriate equipments and medical supplies and with adequate medical supplies and with adequate supervision. supervision.

Productivity and efficiency are assumed.Productivity and efficiency are assumed.

HEALTH SERVICE DESIGN:- what are the HEALTH SERVICE DESIGN:- what are the systems involved systems involved

IDENTIFICATION OF NEEDS FOR IDENTIFICATION OF NEEDS FOR PROJECTSPROJECTS

BUDGET ESTIMATESBUDGET ESTIMATES

3. Establishing Program Goals3. Establishing Program Goals - first step is - first step is

= = to to identify goals for health identify goals for health

education education

=identify the =identify the resourcesresources and and

constraintsconstraints

FORMATIVE EVALUATION:FORMATIVE EVALUATION:

= RELEVANCE and ADEQUACY of a = RELEVANCE and ADEQUACY of a plan /program is decided; plan /program is decided;

= It is done during the stage of program = It is done during the stage of program formulationformulation

4. PLANNING FOR IMPLEMENTATION: 4. PLANNING FOR IMPLEMENTATION: Two (2) activities included here are:Two (2) activities included here are: 1. The planning of preparation and 1. The planning of preparation and 2. Developmental activities:2. Developmental activities: = allocation of resources= allocation of resources = securing legal authorization to start = securing legal authorization to start implementation implementation = promotional activities planning= promotional activities planning = preparation for the institution of minor changes= preparation for the institution of minor changes = refer to the institution of major changes = refer to the institution of major changes including the introduction of new including the introduction of new developmental activitiesdevelopmental activities

EVALUATION:EVALUATION:

SUMMATIVE EVALUATIONSUMMATIVE EVALUATION

= Evaluation of effectiveness and impact = Evaluation of effectiveness and impact

= done at the end of implementation= done at the end of implementation

5. DESIGNING PROGRAM EVALUATION5. DESIGNING PROGRAM EVALUATION = must be included in the planning process= must be included in the planning process = must have evaluation criteria or standards by which = must have evaluation criteria or standards by which

the program achievements can be assessedthe program achievements can be assessed = are assessed in terms of their accomplishment= are assessed in terms of their accomplishment = ease in drafting this depends on the way the health = ease in drafting this depends on the way the health

plan has been formulatedplan has been formulated = a good plan should have evaluation guides= a good plan should have evaluation guides = the overriding concern of evaluation is to determine = the overriding concern of evaluation is to determine

the impact on the health condition of the country.the impact on the health condition of the country. : endpoint of plan but also the start of another : endpoint of plan but also the start of another planplan : checks if the plan is successful or not: checks if the plan is successful or not : do monitoring first, revise, and evaluate : do monitoring first, revise, and evaluate

PROCESS OR OUTCOME EVALUATION:PROCESS OR OUTCOME EVALUATION:

= determines the extent to which the = determines the extent to which the objectives contained in policies, objectives contained in policies, programs and projects have been programs and projects have been achievedachieved

STEPS IN THE PLANNING PROCESS: (cont’d)STEPS IN THE PLANNING PROCESS: (cont’d)2. Defining and Verifying the Problem (cont’d2. Defining and Verifying the Problem (cont’d)) Establishing program goalsEstablishing program goals - First important process - First important process - Once needs are verified can be translated into - Once needs are verified can be translated into

program goals. All subsequent activities should focus program goals. All subsequent activities should focus on designing program that will address and identified on designing program that will address and identified need in particular populationneed in particular population

Defining and assessing behaviorDefining and assessing behavior -must define behaviors related to the problem.-must define behaviors related to the problem. “ “ The essence of health education is planned The essence of health education is planned

behavior change, “ planned changes in behaviors that behavior change, “ planned changes in behaviors that are related to maintenance and improvement of are related to maintenance and improvement of health. health.

3. PLAN FORMULATION / DEVELOPING A 3. PLAN FORMULATION / DEVELOPING A PROGRAM PLAN: Objective Setting and PROGRAM PLAN: Objective Setting and Strategy FormulationStrategy Formulation

Planning For ImplementationPlanning For Implementation Establishing Program GoalsEstablishing Program Goals the first step is to identify goals for health the first step is to identify goals for health educationeducation identify resources and constraintsidentify resources and constraints SETTING THE OBJECTIVES/ SETTING THE OBJECTIVES/ FORMULATION OF OBJECTIVES FORMULATION OF OBJECTIVES The following steps are followed:The following steps are followed: ( 1.)setting the overall health policy which ( 1.)setting the overall health policy which

(2.) Includes the ff: (2.) Includes the ff:

a. main objectivesa. main objectives

b. priority settingb. priority setting

c. general (or basic) strategyc. general (or basic) strategy

(3.) planning of programmes(3.) planning of programmes

(4.) health service design(4.) health service design

(5.) identification of needs for projects(5.) identification of needs for projects

(6.) budget estimates (6.) budget estimates

planning group must select educational planning group must select educational methods (chosen alternative of proven merit methods (chosen alternative of proven merit and review of literature is imp’t.and review of literature is imp’t.

Formative evaluation= relevance and Formative evaluation= relevance and adequacy of a plan/program is decided; it is adequacy of a plan/program is decided; it is done during the stage of program formulation.done during the stage of program formulation.

Planning for Implementation:Planning for Implementation:Two ActivitiesTwo Activities1. The planning for preparation and developmental 1. The planning for preparation and developmental

activitiesactivities Preparatory activities:Preparatory activities: ♥♥ allocation of resourcesallocation of resources ♥♥ securing legal authorization to start securing legal authorization to start implementation implementation ♥ ♥ promotional activities planningpromotional activities planning preparation for the institution of minor preparation for the institution of minor changeschanges Developmental activitiesDevelopmental activities ♥ ♥ refer to the institution of major changes including refer to the institution of major changes including

the introduction of new developmental activitiesthe introduction of new developmental activities2. Actual delivery of health services2. Actual delivery of health services

EVALUATION:EVALUATION:

Summative Evaluation= evaluation of Summative Evaluation= evaluation of effectiveness and impact; done at the end of effectiveness and impact; done at the end of implementation.implementation.

DESIGNING PROGRAM EVALUATION:DESIGNING PROGRAM EVALUATION: must be included in the planning processmust be included in the planning process must have evaluation criteria or standardsmust have evaluation criteria or standards

by which the program achievements can by which the program achievements can

be assessedbe assessed process or outcome evaluation = determine the process or outcome evaluation = determine the

extent to which the program achievements can extent to which the program achievements can

be assessedbe assessed

Are assessed in terms of their accomplishment Are assessed in terms of their accomplishment Ease in drafting this depends on the way the health plan has Ease in drafting this depends on the way the health plan has

been formulatedbeen formulated A good plan should have evaluation guidesA good plan should have evaluation guides The overriding concern of evaluation is to determine the The overriding concern of evaluation is to determine the

plan impact on the health condition of the countryplan impact on the health condition of the country

♥ ♥ endpoint of plan but also start of endpoint of plan but also start of

another plananother plan

♥ ♥ checks if the plan is successful or notchecks if the plan is successful or not

♥ ♥ do monitoring first, revise and evaluatedo monitoring first, revise and evaluate Involves synthesizing all collected data and determine gaps Involves synthesizing all collected data and determine gaps

between health problems and services. between health problems and services.

♥ ♥ the gaps– indications of need within the community that the gaps– indications of need within the community that may be particularly affected by health problemsmay be particularly affected by health problems

♥ ♥ the group– becomes the target populationthe group– becomes the target population

THANK YOU!THANK YOU!