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PLANNING, MONITORING & EVALUATION OF HEALTH

CARE PROGRAMS

Presented by-

Dr. Arijit Kundu

PG Student

IMS & SUM Hospital

Moderator -

Dr. Najnin Khanam

Assistant Professor

Dept. of Community Medicine

IMS & SUM Hospital

2 OUTLINE OF PRESENTATION

Definitions Planning cycle Steps of planning Monitoring Evaluation

3 PLANNINGPlanning has been defined as “the orderly process of

defining community health problems, identifying unmet needs and surveying the resources to meet them, establishing priority goals that are realistic and feasible and projecting administrative action to accomplish the purpose of the proposed programme”

Plan – Blue print for taking action

The purpose of planning is

(1) to match the limited resources with many problems

(2) to eliminate wasteful expenditure or duplication of expenditure

(3) to develop the best course of action to accomplish defined objective

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Planning cycle

5 Elements of plan-I. Objectives - Planned end-point of all activities related to alleviate a

problem.

II. Policies - It is the guiding principle with clear directives stated as an

expectation. It has to be translated into

legislation by parliament to become effective.

III.Programs - Sequence of activities designed to implement policies and

accomplish objectives.

IV.Schedules - Time sequence for the work to be done

V. Budget - An estimate of income and expenditure for a set period of time.

6 Monitoring

Day-to-day follow-up of activities done

To ensure programs are proceeding as planned and are on schedule

Continuous process of observing, recording & reporting

Keeping track of the course of activities

Identifying deviations & taking corrective actions if excessive deviations occur

7 Evaluation

Measures the degree to which objectives & targets are fulfilled and the quality of the results obtained.

Assesses how much output or cost-effectiveness is achieved

Assesses the adequacy & efficiency of the program

Assesses the acceptance by all parties involved

Enables reallocation of priorities and of resources on the changing health needs.

8 Steps in Planning and Evaluation of HealthPrograms :

Step 1 - Laying down the premises (scope) :

This defines the general perimeters or “boundaries”

This is done in terms of place,

time,

population

and disease condition,

within which the health

program being planned

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Step 2 - Situational analysis :

Relevant Demographic

Socio-economic

Disease data

Step 3 - Resource analysis :

Data on available resources (health

manpower, money and material) is obtained and analysed.

10Step 4 - SWOT Analysis :

The Strengths (S), Weaknesses (W), Opportunities

(O) and Threats (T) are identified in context of the proposed programme.

S and W are permanent phenomena that exist within

the organization or community.

O and T are temporary, that exist in the external

environment.

Step 5 - Ensure Community participation :

Identify the community leaders, peers and voluntary groups

and involve them fully in the planning process.

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Step 6 - Enunciation of the “COMMUNITY NEEDS” :

The major issues which need to be addressed and which

can be feasibly addressed are decided.

‘normative’ or ‘professionally assessed needs’ are what

we, as Doctors or public health care managers, feel that the community

requires

‘felt needs’ of the community are what the community

members feel is their need).

work out an optimum trade-off between these two needs.

12Step 7 - Setting the Priorities :

Work out the “priority” areas within the proposed

programme, which are the most important requirements on given our

available (and expected) resources, can feasibly address them.

An epidemiological method for according priorities is to

consider the following three headings and give marks accordingly:

●● Importance of disease : 3 if high importance

2 if moderate

importance

1 if low

importance.

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●● Effectiveness of Interventions :

3 if interventions

known to be very effective,

2 if moderately

effective,

1 if low or non

effective.

●● Cost of interventions : 3 marks if cost is low,

2 if moderate

cost,

1 if cost is high

.

Step 7 (contd…)

14Step 8 - Identify the “High Risk” Groups :

High Risk groups are those who have a much higher

chance of being affected by the disease or it’s adverse consequences.

It is important, at this stage, to identify the high risk

persons, based on our situational analysis and identification of community

needs, so that extra efforts may be directed towards them.

It depends on the disease or condition being

addressed.

Consequently, large amount of benefit will occur

from the programme if these groups are addressed.

15Step 9 - Enunciate the Goal (Aim), Objectives, Indicators and Targets of the

Programme :

Aim or the Goal is ultimate desired state towards which

objectives & resources are directed

Objectives are specific statements, through which the overall

goal would be achieved. Objectives are thus specific, quantifiable and usually

relate to a time-plan.

Indicators are parameters and Targets are discrete activity to

measure the degree of achievement.

16Step 9 (contd…)

This step is one of the most crucial steps in planning process is to

intelligently enunciate the goal, objectives, indicators and targets.

A lot of thought process and expert evaluation should go in at this

stage.

They should be realistically set

should be do-able

neither too ambitious nor too under-

achieving.

17Step 10 - Choose a Strategy and Draw an Action Plan :

The overall strategy what will be used in the proposed

programme is selected.

For eg.

Now, having decided the strategy, a detailed action plan as

to how the programme will be executed is written down.

To ensure that a “time-line” has been given for each

objective, target and indicator, the date of each end point is given.

18Step 11 - Address the Issues of Accessibility and Coverage :

Detailed spot maps of the concerned areas and work

out the aspects of population distribution, roads, communications and

transportation.

Many times it has been observed that the beneficiaries

of a prog live in areas which are not accessible easily, so the purpose of the

prog is defeated.

Hence at this point, work out where are your high risk

persons located and how they are covered adequately.

19 Step 12 - Organise the manpower, material, and finances :

Place the required manpower, equipment, material

and other logistics at the required places.

If some more resources are expected, make a plan

as to where they will be relocated and how.

Make out detailed, written “operations manual”

including the operative procedures for each activity, i.e. “who will do

what to whom and in what manner”.

Ensure that your personnel have been centrally

trained and tested for undertaking the procedures.

20 Step 13 - Undertake a “Pilot Run” :

This is another very important step.

A small scale trial of your procedures

is run and rectify if any defects are observed.

Step 14 - Conduct the Programme :

Launch the programme in a full

fledged manner.

Ensure that all the deputies are there

always at the sites where the services are being delivered.

Regularly obtain and analyse data on

various aspects as the programme progresses, making changes if required.

21 EvaluationStep 15 - Evaluate the programme :

Evaluation is the process of assessing the extent to which our

results are commensurate with our pre-decided objectives.

It should be a continuous process as the programme progresses

(concurrent evaluation) and not simply an exercise to be undertaken at the end of the

programme (terminal evaluation).

For evaluation, we again need valid and reliable data in the same

way that we obtained in the planning stage.

22Broadly, evaluation is undertaken for six different facets, as follows:

●● Evaluation of Relevance :

Concurrent evaluation evaluates whether we

need to continue it as such or in some modified manner.

Terminal evaluation evaluates whether the

programme was required at all or not.

This requires obtaining and reviewing the

data / intelligence about situational analysis, resources and community

needs.

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●● Evaluation of Adequacy :

Whether the required amount of

manpower, equipment, logistics, other type of material and finances

have been provided adequately

& whether they have been suitably

placed.

24●● Evaluation of Process :

How are / were the services/ activities undertaken?

What has been the quality of services?

Were the services accessible to or provided to all the

beneficiaries or only few segments?

For example, are the targeted number

of children being vaccinated, have some areas been left out, the scheduled

number of patients being seen and the planned number of health education

sessions being taken.

25 ●● Evaluation of Efficacy, Effectiveness and Efficiency:

EffectivenessEffectiveness is the extent to which planned outcomes,

goals, or objectives are achieved as a result of an activity, strategy, intervention or initiative intended to achieve the desired effect, under ordinary circumstances (not controlled circumstances such as in laboratory).

EfficiencyEfficiency is the ratio of the output to the inputs of any

system. An efficient system achieves higher levels of performance (outcome, output) relative to the inputs (resources, time, money) consumed.

26●● Evaluation of Efficacy, Effectiveness and Efficiency(contd…)

EfficacyEfficacy is the extent to which a specific intervention,

procedure, or service produces the desired effect, under ideal conditions (controlled environment, lab circumstances).

Efficacy answers the question “can the

programme or procedure work” (maybe in ideal or controlled situations)

Effectiveness addresses the question “Does it

work” (i.e., in the real life situations)

Efficiency answers the issue “Is it the most

economical way (in terms of time or money)”.

27 Example

The conventional combination regime of Streptomycin,

INH and Thioacetazone may still give good results for curing pulmonary TB if

we were to treat patients admitted in sanitoria for 18 months (i.e., is

efficacious),

But in the real domiciliary settings, it bring about only

about 30% cure (is not effective), while MDT would cure 70 to 80% patients in

real life domiciliary settings (is effective).

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Finally, comparison between the total costs of the two

regimen (drugs, duration of treatment, requirement of doctors,

paramedics and hospital buildings, commuted cost of reduction in

human suffering due to earlier cure, etc.) the overall cure rate may

finally indicate that short term MDT may be more “efficient”.

29 REFERENCES

Park’s Text Book of Preventive and Social Medicine 23rd edition Text book of Public Health & Community Medicine - WHO AFMC

Book Disease Control Priorities in Developing Countries 2nd edition Encyclopaedia of public health oxford textbook of public health 4th edition

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Thank you