Health Planning in Developing Countries: An Overview

1. Health Planning in Developing Countries: An Overview Regional Consultative Meeting on Strategic Planning in Health Damascus, Syria November 21-24, 2004

2. Presentation Outline Principles and rationale for strategic planning Strategic Planning: Process and product Planning for human resources Issues and challenges for strategic planning in EMR Conclusions

3. Four Fundamental Questions of the Planning Process

4. What is Strategic Planning? Strategic planning is a process of setting agreed priorities and direction for the health sector in the light of given resource constraints Source: Andrew Green (2003)

5. Why Strategic Planning? Means of giving content to the leadership function of the Ministries of Health; Process for developing intersectoral collaboration for health development; Means for constructive public-private partnership; Means for streamlining donor assistance; and Means for bringing about institutional change

6. Rationale for strategic planning “Wants and needs outstrip resources” Scarcity and Choice – The Basis for Planning Prioritizing decisions Appraisal of alternatives Rationing of resources Introducing discipline and minimizing external influences

7. Strategic choices facing the Public Health Sector

8. The Planning Cycle

9. Process for Developing a Strategic Plan

10. Strategic Planning Process: Values and Contextual Factors Values and Principles Equity, Efficiency Community participation, Privatization Transparency, Accountability Others Analysis of the contextual factors Social and economic policies Political and administrative setup Donor influence and assistance Stakeholder analysis State of the health system

11. Strategic Plan: Product General statement of health sector priorities with no set period – Health Sector Strategy, Health Policy ‘Organic’ document with inbuilt process for updating according to circumstances, information, analysis and resource availability – Rolling plans ‘Finished’ product with set periods of implementation of 5-15 years, objectives, targets, strategies, risks and assumptions, and allocated resources

12. Is Strategic Planning a Technical or a Political Activity? Technical – Planning tools and techniques essential to develop a plan document Political – Planning is about introducing a systematic change, views and perceptions of stakeholders Both

13. Major Types of Plans Strategic vs. Operational Plan Project vs. Program Plan Investment vs. Operational Plan Physical vs. Human Resource vs. Financial Plan Macro- vs. Micro-plan

14. Links between strategic and operational plans Strategic plan- Outlines the direction an organization is intending to follow, with broad guidance as to implications for service action – WHAT? Operational plan - Activity plan detailing precise timing, methods and modes of implementation – HOW?

15. Characteristics of Strategic and Operational Plans

16. Strategic Planning Tools Planning guidelines and frameworks Planning manuals Logframe, ZOPP, others Analytical tools Burden of Disease National health accounts Cost-effectiveness analysis Resource allocation formulae Population, BOD, income poverty Certificate of Needs

17. Planning for Human Resources Almost 2/3rd of the regular health budget of the government is spent on human resources; Are there right number of personnel, with the right skills, at right place and at the right time? Inadequate no. of trained and/or available personnel Over trained and unemployed Inappropriate skills Distributional difficulties Inappropriate use of trained personnel Migration of personnel Unproductive and demoralized staff

18. Why is Planning for Human Resources deficient? HR planning require medium to long term strategies; HR planning is attached the same status as planning for any other activity; Lack of unit or body for planning for HR within or outside the MOH Lack of accurate data on HR Lack of consideration of the HR needs of the private health sector

19. Health Planning: Issues and Challenges in the EMR Technical Lack of capacity – individual, institutional Weak or absent planning units Inadequate contextual analysis Weak health information system Poor operationalization of plans Insufficient monitoring and evaluation

20. Health Planning: Issues and Challenges in the EMR Political and Administrative Lack of political commitment Priorities set by political agenda Donor driven initiative Planning outside MOH Planning only for the public sector

21. Criteria for Assessing the Planning System Purpose and role of the planning system clear and appropriate Planning system based on explicit values Decision making structures of planning system Open and transparent Balance between central & local decision making Balance between technical and political decision making Planning for health instead of health care only

22. Criteria for Assessing the Planning System …contd. Balance between long-term direction with short term flexibility Adequate information base for planning Standard planning tools available and used Planning unit adequately resourced, technically sustainable Donor assistance program managed well

23. Conclusions or Questions? What do we know of the current status of health planning in countries of the EMR? strengths and weaknesses; What experiences can we share in the EMR on aspects of health planning and its tools? How can we give momentum to improved human resource planning in countries of the EMR? What will it take for the national governments and WHO to strengthen strategic planning in the Region?

24. Thank you for your attention!