District Health Planning for PIP

8/14/2019 District Health Planning for PIP

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District Health Planning for PIP

State Institute of Health & Family Welfare, Jaipur


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SIHFW: an ISO 9001: 2008 Certified Institution 2

Sources of Data

DLHS NFHS

SRS NSSO UNICEF

Special surveys bymedical collegesetc

CBHI

District data Household surveys

Facility surveys Eligible couple register State annual reports

Disease surveillancesystem Routine reports


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Planning & Plan

Planning -an act or process of choosingbetween alternatives to accomplish preset

goals

Plan denotes a blue print of action


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Planning Steps

Situational analysis Deciding objectives Defining strategies

Laying an operational plan Implementation Evaluation Criteria Frequency Process


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Planning in Health Sector Measurement or assessment of burden of illness Identification of cause of illness Measurement of effectiveness of different

community interventions Assessment of efficiency of interventions interms of resources used

Implementation of interventions Monitoring of activities Reassessment of burden of Disease to see if

there is any change


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The Planning Process in HealthThe essentials of planning in health lie in answering thefollowing key questions:

1 Where are we now? (Situational analysis)

2 Where do we want toreach?

(Goals, objectives, priorities,targets and strategic decisions)

3 How will we get there? (Organizational constraints,resources and organisationalstructure, functions andmanagement)

4 How well we havedone?

(Monitoring, evaluation andfeedback)

5 What new problems dowe have?

(Replanning)


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Why District Action Plans?

Mechanism to partner with community Planning based on local evidence and

needs

Area specific strategies to achieve NRHMgoals Cost effective and practical solutions Move from budget based plans to

outcome oriented plans Requirement of GOI no funds if no plans


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Participatory Planning Promote community ownership Greater ownership of health functionaries Harness benefits of community action Bring accountability of health functionaries to

community members Draw together elements that are determinants

of health Share resources and opportunities with

partnering departments convergent action


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What a District Plan Should Have

Background Planning Process Priorities as per the

background and planningprocess

Annual Plan for each of theHealth Institutions basedon facility surveys

Community Action Plan Financing of Health Care

Management

Structure to deliver theprogram Partnerships for convergent

action Capacity Building Plan

Human Resource Plan Procurement and Logistics Plan Non-governmental Partnerships Community Monitoring and

evaluation Framework

Action Plan for Demandgeneration Sector specific plan for maternal

health, child health, adolescenthealth, disease control,

Geriatric care disease,Surveillance, family welfare Program Management Structure Budget


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The Levels of Planning

Goals

Objectives

Strategies Activities/Processes

Inputs

Impact indicators

Outcome indicators

Output indicators Process indicators

Input indicators


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Planning Steps Objectives (what is being planned?) Approach or strategies for reaching the

objectives (how shall the objectives beachieved?)

Activities required to achieve the objectives(which?)

The obstacles that may hamper the activities(why?)

Resources to be used (who?) Cost of activities (money?) Detailed scheduling


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District Plan Components

Introduction

Situational Analysis

Goals and Objectives

Strategies Activities

Work Plan/Schedule

Monitoring and Evaluation

Budget


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Setting Goals

Societal in Nature Not necessarily measurable Flows from vision document and societal goals-

as well as from situation analysis Responsive to people needs and demands-as

articulated through their representatives-the political process- and

directly by different sections-this is the basis of democratic functioning Example: Goals in RCH (purpose)


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What is being Planned Looking at the situation

Information from the community Information from records

Morbidity and mortalityprofile

Health care institutions(PPP)

ICDS Social and cultural

background PRI structure


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District Planning: Situation Analysis

Identify the problems Identify the causes Do resource analysis to handle the

causes- man, money, material & time Map the problem geographically, groups

& vulnerability and the resources

Identify the strategies to improve


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Situation Analysis

District Profile Public Health Infrastructure in the District

(Government Building or Rented) Human Resources in the District Functionality of District Hospitals, CHCs, PHCs

and Sub-centres District:- Availability of Staff needed

for service Guarantees CHC:- specialists, at FRUs. Indicate

blocks where more than 20 %posts are vacant


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PHC:- Availability of an ANM at sub-

centre Indicate PHCs with morethan 10% vacant Sub-Centre:- Availability of an ANM

at sub-centre Status of Logistics

Availability of a dedicated Districtwarehouse for health department

Stock outs of any vital supplies in lastyear

Indenting Systems (from peripheralfacilities of districts)


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Status of Logistics Existence of a functional system for

assessing Quality of Vaccine Physical Infrastructures

Indicate the trainings conducted for all categories of health personnel Training load Personnel trained each training or

topic wise BCC Infrastructure in the district


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Private Health Facilities Nursing Homes Practitioners AYUSH Private Sector RMPs Nursing Homes with facilities for

comprehensive emergencyobstetric care

Centres for Sterilization Services Centres for IUD Services

ICDS Program Elected Representatives of PRIs


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NGOs & CBOs

Examine the performance of theMaternal Health indicators Examine the performance of the

Family Planning indicators Examine the performance of the

Child Health indicators Examine the performance of the

National Disease Control Programindicators

Locally Endemic Diseases in theDistrict

New Interventions under NRHM


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District Planning: Desk Review Compare District with State average and NRHM

objectives Mapping- facilities / services /staffing, infrastructure,

population served /Patient load & utilization(PHCs &CHCs

Review performance of National Programs in thelast year

Map performance of ANM/ MPW Mapping of TBA- AWW-ANM- LHV Listing of NGOs reach and focus of work CBOs in the district block and activity- wise Last years budget and expenditure analysis


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District Planning: CommunityAssessment

Resource Mapping Understanding health

problems Assess BOD Health expenditure Problems- referral/

transport/FP Role of PRI Understanding health

seeking behavior andpractices Pregnancy/illnesses

Understanding CommunityParticipation andOwnership: MeetingVHSC

Perception and the role of PRI Additional Information Studies

NGOs-activities/achievementand willingness

Other CBOs / SHGsfederation


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Distt. Planning: Recognize Problems

Health problems Health service problems Community problems


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Distt. Planning: Setting Objectives Expected outcomes Relevance(related to the problem or

policy)

Feasibility (it can be achieved) Observable (its achievement can be

clearly seen) Measurable (outcome can be stated in

number)


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Objectives: SMART

S Specific: Everyone should interpret it thesame way

M Measurable: An objective as different froma goal is clearly measurable

A Appropriate: It should directly relate to theprogram

R Realistic: It should be possible to achieve

this objective TTime: It should be possible to achieve this

within the stated time-frame


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S.No.

Objectives to be achieved by the district Currentyear

Nextyear

1. Universal coverage of all pregnant women withpackage of quality ANC services as per nationalguidelines

2. Increase in deliveries with skilled attendance atbirth including institutional deliveries

3. FRUs (including DHs, CHCs/PHCs) madefunctional as defined in the National RCH 2 PIP

4. Universal coverage of all eligible pregnantwomen under JSY scheme5. Increase in percentage of new born babies

given colostrums

Setting Objectives of the D.H.A.P.

SIHFW: an ISO 9001: 2008 Certified Institution


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s.No.

Objectives to be achieved by thedistrict

Currentyear

Nextyear

6. Increase in prevalence of exclusive breastfeeding

7. Increase in percentage of fully protectedchildren in 12-23 months as per nationalimmunization schedule

8. Universal coverage with Vitamin Aprophylaxis in 9-36 months children

9.Percentage of severely malnourishedchildren below 6 yrs referred to medicalinstitutions



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s.No.

Objectives to be achieved by thedistrict

Currentyear

Nextyear 10. Unmet demand for contraception

-Spacing

-LimitingA. Number of Govt. Health Institutions providing:i) Female sterilization services DH/ SDH / CHC /PHCii) Male sterilization servicesiii) IUD insertion services --------- CHC / PHC /

SCB. Number of accredited private institutionsproviding:i) Female sterilization servicesii) Male sterilization servicesiii) IUD insertion services


S Objectives to be achieved by the district Current Next


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S.No


Nextyear

11. Number of health institutions in PHCs/CHCs offeringARSH services

12. Number of health institutions providing services for management of STIs and RTIs

13. Performance indicator for NVBDCP-API for MP-Annual blood examination rate for MP increased (over 10 % of all OPD cases)-Slide Positivity Rate-Number of deaths due to malaria

14. Performance indicator for RNTCP

-Percentage of TB suspects examined out of the totaloutpatients-Annualized New Smear Positive (NSP) case detectionrate per 100,000 populations


b b h d b h d


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S. No. Objectives to be achieved by the district Current Next

-Annualized Total Case detection rate per 100,000populations-Treatment success rate15. Percentage (as planned) of ASHAs functional in thedistrict (received induction training )

16. Number of RKS registered /established

17. Number of Health care delivery institutions upgradedSHCsPHCs- CHCs to FRUs fulfilling the 4 basic criteria in FRUguidelines Upgrading to IPHS will come later ( these institutions should be in conformity with IPHS)

18. Village health and sanitation committees Constituted- Grants given



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S.No.


Nextyear

19. Number of SCs strengthened- Additional ANMs hired- Annual maintenance grants given

20. of PHCs strengthened to provide 24x7- 3 staff Nurses hired- Annual maintenance grants given21. National Blindness Control Program- C ataract surgery rate (450/100,000 population)-% surgery with IOL- School Eye Screening in the age group of 10-14years should be screened for refractive errors- Oral Health Screening for:CommunitySchool Children



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S.No.


Nextyear

22. National Leprosy Eradication Programme

- PR Leprosy cases per 10,000 population- ANCDR New leprosy cases per 1,00,000 population- Proportion of MB, Female, Child, ST, SC cases amongthe new cases detected- Proportion of Patients completed treatment (RFT)

23. Integrated Disease Surveillance programme- Number of labs to be upgraded ( L1 and L2)- Number of staff to be trained in surveillance activities

24. Staff for mobile medical units in place25. Number of facilities to be covered for facility survey

- SHCs- PHCs- CHCs



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S.No.


Nextyear

26. No. of villages to be covered for HH survey

27. No. of Community hearings planned

28. District training plan developed andimplemented

29. District BCCC plan developed andimplemented

30. District procurement and Logistics plandeveloped

31. No. of PHC/CHCs where AYUSH physiciansposted



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Distt. Planning: Review Punctuations Types:

Manpower Materials Money Minutes Environment Technical Social

Analyzing punctuations Removable Modifiable Stubborn



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Defining Strategies:

How do we aim to achieve objectives? The choice of strategies Are these strategies

Technically sound? Capability and manpower wise feasible? Budget-wise feasible? Does it have capacity to manage the

identified constraints?



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Distt. Planning: Choosing Alternatives

Technically sound Feasible

Manpower Finances Manageability of

constraints



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Distt. Planning: Scheduling Activities

Consider the alternativestrategies

List out the resources Select the best strategy Mobilize the community

resources Detail activities Log frame approach



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Indicators

Observable measure of how well we aredoing with respect to a specific criterionsuch as quality, effectiveness of theprogram against the expected objective

Essential for monitoring and evaluation andtherefore for planning too.

Can indicators be achieved without achievingobjectives?



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Monitoring

Efficiency tells you that the inputinto the work is appropriate in

terms of the output; in terms of money, time, staff, equipment.



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Evaluation

Impact tell you whether or not thespecific objectives you addressedmade any difference to the maingoals you were trying to address. Inother words, was your strategyuseful?



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PIP

Essentially a statement of intent A description of implementation with

estimation of cost

If implemented are likely to lead todesired results The MOU between C&S should include

plans, budget and log frames



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A.RCH

B.Add. - NRHM

C.Immun.

D.NDCPs

FMG/NRHM-Finance

Div., GOI

State level

expenses

SPMU

State Health Society

District Health Society

DPMU

RCH Add.-NRHM Imm. RNTCP VBDCP,others

Intersector convergence

Funds

FMRUCAudit

Report

Mission Flexible Pool

E.IntersectoralConvergence



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District Planning-Situation Analysis

Identify the problems Identify the causes Do resource analysis to

handle the causes---man, money, material &time

Map the problemgeographically, groups

& vulnerability and theresources Identify the strategies to

improve


H lth M g

NRHM ILLUSTRATIVE STRUCTURE


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BLOCKLEVEL

HOSPITAL

30-40 Villages

Strengthen Ambulance/transport ServicesIncrease availability of NursesProvide TelephonesEncourage fixed day clinics

AmbulanceTelephone

Obstetric/Surgical MedicalEmergencies 24 X 7

Round the Clock Services;

CHIEF BLOCK MEDICAL OFFICER / BLOCK LEVEL HEALTH OFFICE --------------- Accountant

CLUSTER OF GPs PHC LEVEL

3 Staff Nurses; 1 LHV for 4-5 SHCs;Ambulance/hired vehicle; Fixed Day MCH/Immunization

Clinics; Telephone; MO i/c; Ayush Doctor;Emergencies that can be handled by Nurses 24 X 7;

Round the Clock Services; Drugs; TB / Malaria etc. tests

GRAM PANCHAYAT SUB HEALTH CENTRE LEVEL

Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic1000

Population VILLAGE LEVEL ASHA, AWW, VH & SC

1 ASHA, AWWs in every village; Village Health DayDrug Kit, Referral chains

100,000

Population100 Villages

5-6 Villages

Accredit private

providers for publichealth goals

Health Manager

Store Keeper

NRHM ILLUSTRATIVE STRUCTURE


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Level of Planning and the Key

Functionaries

Village Level ASHA Anganwadi Panchayat Representative SHG Leader PTA/MTA Secretary Local CBO Representative Data Source

Village HealthRegister

Village Health

PlanSIHFW: an ISO 9001: 2008 Certified Institution


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Gram Panchayat Level The Gram Panchayat

Pradhan ANM MPW Village Health & SanitationCommittee



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Block/CHC Level The Adhyaksha of the Block Panchayat

Samiti Block Medical Officer Block Development Officer NGO /CBO Representative Head of the CHC level RKS/ RMRS The Block level Health Mission Team will

finalize the Block Health Plans



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District Level NGO Representatives Few professionals recruited to

meet planning andimplementation needs.

Zila Parishad Adhyaksh District Medical Officer

District Magistrate



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State PIP Structure

Summary Process of plan preparation

Time frame Background and current status

Demographic and socio economic features Administrative divisions RCH outcomes & service utilization in

Maternal Health, Child Health, FamilyPlanning, Adolescent Health (based on RHC/MICS/ NFHS/ State HMIS)

Public health infrastructure Private/ NGO health services/ infrastructure



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Donor assisted programs in State

including Institutional inputs &organizational development issues & gaps

Program finances No. of sub-centers

Urban family welfare centers District wise Training institutes Management positions in Directorate District Family Welfare Bureaus

Additional expenditure in state/ districtfamily welfare bureaus



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Additional expenditure onNational, Maternity, BenefitScheme (NMBS) renamed asJanani Suraksha Yojana

Inventory of Vehicles Commodity assistance (past 3

years)

Situational Analysis- identifies core issuesboth outcomes specific and cross cutting in

Maternal health Child health Family Planning Adolescent health District/ sub District Variations



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National Health Programmes HRD including training Inequities/ Gender Logistics HMIS Other (specify)

RCH-II/ NRHM, Objectives and Strategies Program management arrangements Budget Monitoring and evaluation Sustainability



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Annexure

Work plan Log frame Examples of District PIPs

Criteria for appraisal of SPIP:

Program managementarrangements Institutional strategies Technical strat4egies

Work plan Cost/ budget



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THANK YOU

Documents

District Health Planning for PIP