HSM 202Program Planning

A. DEFINITION

1. Health program is an organized response to reduce or eliminate health/safety hazards or risk in the work environment and /or meet the health/safety needs of workers/employees.

Name

Situationer• status of disease problem• program status

Objectives

Targets• health status• service

External Cooperation

Program Budget• operational• capital

Linkages

Approach• Manner of implementation• Strategies• Responsible units• Changes/ developments

Evaluation Indicators

Key Elements of a Health Program

A. DEFINITION

2. Program planning is the process of• defining the problem• formulating the objectives• identifying activities to achieve objectives• determining ways of evaluating extent to

which objectives are attained

B. Reasons for Planning

1. Condition exist which require the most suitable and affordable solutions.

2. Conflicting values/views on problems to be solved requires systematic and participative approach using analytical tools.

3. Rapid growth in knowledge and technology 4. Strong desire for more rationality in decision making

in order to: - offset uncertainty and change- be accountable- be more efficient and effective

C. Basic Elements of Planning

1. Criteria of decision-making- efficiency- value or equity

2. Approaches to planning- evolution- base of plan - concern

C. Basic Elements of Planning

3. Scope of Plan- Comprehensive- Partial

4. Time Span- Long term- Medium term- Short term

C. Basic Elements of Planning

5. Authoritativeness• Indicative• Prescriptive

6. Levels• Top• Middle• technical

C. Basic Elements of Planning

7. Components• Objective• Strategy• finances

Steps in planning:

1. Defining the core problem• Statement of the problem in terms of:

– health/ safety hazards/ risks– Health deficits– Foreseeable crisis

• Identifying the causes or factors contributing to the problem– conditions of work & work environment – Management’s attitude towards safety services/workers– Workers/employees knowledge/attitudes

Steps in planning:

• Interpret problem/ needs based on:– appraisal of the potential hazards & needs of workers– Comparison of present condition with recommended

standards– Health policies & standards established by the company

Steps in planning:

2. Specify the program objectives in terms of• General objectives• Specific objectives

Characteristics of a well stated objectives:– consistent with the problem– tied in with the over-all philosophy & purpose of the

agency in relation to health/ safety of workers– S.M.A.R.T.

In planning a program, use SMART

S – specific M – measurable A – attainable R – realistic T – time bound

Steps in planning:

3. Identifying activities needed to achieve objectives• factors to consider:

– alternative activities & selection of the most appropriate means to attain objectives

– available resources & costs

Steps in planning:

4. Determining resources necessary to support activities in terms of:• personnel involved• supplies & materials• funds required

Steps in planning:

5. Planning for the evaluation to include :• what ?• how ?• by whom ?• when ?

Preparation forPlanning a Health Program

Scope

Read the following Chapters: • Preparation for Health Planning- Chap 13• Analysis of the Health Situation –Chap 14• Problem Identification & Explanation- Chap 15• Priority Setting – Chapter 17• Program Planning Overview – Chap 19• Project Planning – Chap. 24

Analysis & Promotion of Planning Conditions

• Officials commissioned in the health planning must know that:– Planning is a time-consuming event– Not an “all-out solution”– Planning models vary from place to place, country to

country due to various differences– A sound plan must be judged by its contents and the way it

is formulated– Planning may address to maintain the “status quo” or

meet a “developmental demand”– It is a continuous event

Consider this Issue

Withdrawal of toys made in

China

AdverseHealth Effects

Loss of Income&

Productivity

Plans to decrease

the burden of theproblem

Requisites…

• The need for political will– The government must be prepared to accept and

implement major changes– A political will to “plan”– Evidenced by political statements, directives or

legislation– Necessary for the holistic approach for health

development (wide-based participation)

Requisites…

• Review the organization and skills for planning– Be familiar with the structure, functions, sectoral

composition, and procedures of the national overall planning body

– Necessary to know how the proposals “fit in” the national socio-economic development plan

– Know the interrelationship of other planning bodies

Planning for the Planning Exercise

1.) Know how the country/ LGU is organized for planning

The Planners Advisers ofThe Planners

Also known asThe Technical Secretariat

Also known asNational Advisory HealthPlanning body

Planning for the Planning Exercise

2.) Determine the planning method to be followed.

Basic elements:

1.) Situational Analysis2.) Formulation3.) Implementation4.) Evaluation

The Planning Method

• Logical and systematic approach• Total and flexible• Useful to both the central, intermediate and local

levels of planning• Capable of permitting formulation of the health plan

in the context of overall development planning• Incorporate provisions for the improvement of

planning information

Other Issues

• Levels of planning and manner of evolving the plan

• Monitoring the planning exercise• Terms of reference of the planning exercise

Terms of Reference (TOR) of the Planning Exercise

• Minimum contents– Policies only ? Policies and administrative

requirements ? Operational?– The degree of involvement of the health sector

(partial or comprehensive)– Special problems to which the plan will adress

itself– Priorities and strategies– Time span of the plan

When needed, acceptance of external assistance should not infringe or compromise national sovereignty or diminish

national respect

Situational Analysis

• Diagnosis of the community’s health situation• Entails

– Describing the current health situation– Forecasting of the future status– Identifying the problems – Seeking explanations for such problems

Levels of Analysis

• Geographical Planning– National– Regional– Provincial– District– Municipal– Barangay

Analysis of the Population

• Total population and demography• Age and sex distribution• Selected vital events• Population estimation

Combined Analysis of Age and Sex Composition

• Population pyramid– a graphical representation of the age and sex

composition of the population– one can describe and explain the demographic

trends of the population in the past

Types of Population Pyramid

1 2 3 4 5

Population Pyramids

Type 1 Pyramid• Broad base with

gently sloping sides• High rates of death

and birth• Low median age• High dependency

ratio

Percent 0 2 4 6 88 6 4 2 0

0-4

5-9

10-14

15-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980+

Type 2 Pyramid• Broader base• Slanting from 0-4 years

old to the top• Beginning to grow rapidly

because of reduction in infant mortality but are NOT yet reducing fertility

• Rapid increase in population

• Median age is increasing

Percent 0 2 4 6 88 6 4 2 0

0-4

5-9

10-14

15-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980+

Type 3 Pyramid• Old fashioned

“beehive”• Low birth rate• Median age is highest• Dependency ratio is

lowest • Dependents mostly

elderly

Percent 0 2 4 6 88 6 4 2 0

0-4

5-9

10-14

15-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980+

Type 4 Pyramid• Transitional type• Represents a

population after 100 years with declining birth and death rates, has reversed the trend in fertility while maintaining the death rate at low models

Percent 0 2 4 6 88 6 4 2 0

0-4

5-9

10-14

15-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980+

Type 5 Pyramid• Rapid decline in

fertility• Low death rate• Reduced its birth rate

very rapidly

Percent 0 2 4 6 88 6 4 2 0

0-4

5-9

10-14

15-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980+

Analysis of the Health Status

• Describing the health status – leading causes of mortality– leading causes of morbidity– leading causes of infant mortality– leading causes of maternal mortality– leading causes of hospital admission– leading causes of consultation

Indices

• Economic indices• Social indices

– Education– Communication and transportation– Housing– Electrification

• Environmental indices– Safe water supply

Indices

• Environmental– Human waste disposal– Industrial waste disposal– Food establishments

• Nutritional status

Analysis of the Health Sector

• Components of the health sector• Intersectoral relationships

– Present government policy towards the health sector, training of manpower and manufacture of equipments

– Roles of medical insurance– Structure of authority and degree of responsibility

for health services

ANALYSIS OF HEALTH FACILITIES

• HOSPITALS– Inventory and distribution– Status of facilities– Selected attributes

• HEALTH UNITS

ANALYSIS OF HEALTH MANPOWER

• Current stock of health manpower• Projection• Review of technique of health manpower

development• Review of health manpower policies

ANALYSIS OF HEALTH EXPENDITURES

• Analysis of the DOH budget• Analysis of other government agencies of

institutions• Analysis of NGO expenditures on health

Problem Identification

1. Identification of the Problem a) Population b) Health status c) Health resources

Problem Identification

2. Explanation of the causes• Problem of health status• Socio- economic Factors• Problem with health resources

Problem Identification

3. Indication of areas of Change• Nature• Magnitude• Extent• Attitude of health authority• Degree of removability

Problem Identification

3. Indication of areas of Change: Criteria• Those that can be acted upon by the health sector and those

falling under the areas of concern of other health sector.• Those which maybe solved immediately and those which will

require medium or long term solutions• Those which can be acted upon locally and those which needs

action at intermediate & central level.• Those which will require additional commitment and those

which do not• Those which will require legislation

Example of Obstacle Matrix and Areas of Change

Gen. Deficiencies Technology Staff Facilities Procedures Organization Policy Environment

SickAwareMotivatedContacteda)RHU underutilizedb) Provincial

hospital overloaded

DiagnosedTreatedA) Incorrect RXB) Incorrect TxRecovered /

ProtectedHigh relapseNo ff upProtection not

achieved

Objectives & Targets

Priority setting : Criteria

1. Vulnerability of the problem to technologya) Existence of the technologyb) Feasibility of implementing the technologyc) Degree to which it can be applied by

geography, by costd) Multiplicity of the effect

Objectives & Targets

2. Magnitude of the problem 3. Social Concern : a) Explicit expressed as important to the

community b) Problem affected certain age groups,

geographical areas , social strata

4. Existing health policies

Country X

Three Kinds of People

• The ACTIVISTS: Those who make things happen.

• The UNINVOLVED: Those who watch things happen.

• The UNCARING: Those who wonder what happened.

The Challenge is . . .

“Plan your work and work your plan!”