Health Planning & Managment

1. Health Planning & Managment

2. Planning: • To match the limited resources with many problems. • To eliminate wasteful expenditure or duplication of expenditure. • To develop the best course of action to accomplish a defined objective.

3. Planning includes three steps : • Plan formulation • Execution • Evaluation

4. Development Planning: Continuous ,systematic, coordinated, planning for the investment of the resources of a country in programmes aimed at most rapid economic and social development possible.

5. Health Planning: 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.

6. Resources: Implies the manpower , money , materials, skills knowledge , techniques and time needed or available for the performance or support of action directed towards specified objectives.

7. Objective : It is precise , concerned directly with the problem. Planned end point of all activities Target : It permits concept of degree of achievement ; concerned with factors involved in a problem. Goal : The ultimate desired state towards which objectives and resources are directed.

8. Plan: • Blue print for taking action • It has five major elements: • Objectives, policies, programmes, schedule & budget • Policies : Guiding principles stated as an expectation , not as a commandment. • Programmes : Sequence of activities designed to implement policies and accomplish objectives.

9. Schedule : Time sequence for the work to be done. • Procedures : Set of rules for carrying out work which , when observed by all help to ensure the maximum use of the resources and efforts.

10. Pre –planning: • Preparation for planning. • Important preconditions are: • Government interest • Legislation • Organization for planning – Planning commission of India • Administrative capacity – Central & State Ministries of Health

11. PLANNING CYCLE: • Defined as a process of analyzing a system or defining a problem, assessing the extent to which the problem exist as a need , formulating goals and objectives to alleviate or ameliorate those identified needs , examining and choosing from among alternative intervention strategies , initiating the necessary action for its implementation of the plan and evaluating the results of intervention in the light of stated objectives.

12. Steps: Analysis of health situation: involves the collection , assessment and interpretation of information in such a way as to provide a clear picture of the health situation. Establishment of objectives and goals Assessment of resources Fixing priorities

13. 5. Write up of formulated plan 6. Programming and implementation 7. Monitoring 8. Evaluation

14. MANAGEMENT • purposeful and effective use of resources – manpower , materials and finances – for fulfilling a pre-determined objective. • Consists of four basic activities: • Planning • Organizing • Communicating • Monitoring

15. Management methods and techniques • Based on behavioral sciences Quantitative methods • 1. Organizational design 1.Cost Benefit Analysis • 2.Personnel management 2.Cost Effective Analysis • 3.Communication 3.Cost Accounting • 4.Information Systems 4.Input Output Analysis • 5.Management by objectives 5.Model • 6.System Analysis • 7.Network Analysis • 8.PPBS • 9.Work Sampling • 10.Decision Making

16. 1) Cost –Benefit Analysis: • Economic benefits of any programme are compared with cost of that programme. • Benefits are expressed in monetary terms to determine whether a given programme is economically sound and to select best out of several alternate programmes.

17. 2) Cost –Effective Analysis: • Similar to cost benefit analysis except that benefit instead of being expressed in monetary terms is expressed in terms of results achieved. • 3) Cost Accounting: • Provides basic data on cost structure of any programme. • Has 3 important purpose in health services: Cost control , planning and allocation of people & pricing of cost reimbursement.

18. 4) Input –Output Analysis: • Input refers to all health service activities which consume resources. • Output refers to such useful outcomes as cases treated and lives saved. • An input –output table shows how much of each input is needed to produce a unit amount of each output. • Enables calculations to be made of the effects of changing the inputs.

19. 5) Model: • An aid to understand how the factors in a situation affect one another. • Is an abstraction of the reality. • 6) Systems Analysis: • To help the decision maker to choose an appropriate course of action by investigating his problem, searching out objectives, finding out alternative solutions, evaluation of alternatives in terms ,re-examination of objectives if necessary & finding the most cost effective alternative.

20. 7) Network Analysis: • Network is a graphic plan of all events and activities to be completed in order to reach an end objective. • Two common types of network technique: • PERT(Programme Evaluation and Review Technique) • CPM ( Critical Path Method)

21. PERT(Programme Evaluation and Review Technique): • Technique which makes possible more detailed planning & more comprehensive supervision • Essence of PERT is to construct an Arrow diagram, which represents the logical sequence in which events must take place • Time taken to complete each activity can be calculated • Can identify paths which are critical CPM ( Critical Path Method): • It the longest path of the network • If any activity along the critical path is delayed, the entire project will be delayed

22. 2 months Staff recruited Staff Trained 4 months START Plan Service 1 month 2 months Start providing Service Equipment ordered Equipment installed 10 months 1 month TERMINAL EVENT

23. 8) Planning Programming Budgeting System(PPBS): • A system to help decision makers to allocate resources so that the available resources of an organization are used in the most effective way in achieving its objectives. • It calls for grouping of activities into programmes related to each objective. • Another approach is Zero Budget Approach i.e all budget starts at zero & no one gets any budget that he cannot specifically justify on a year to year basis

24. 9)Work Sampling: • Is a systematic observation and recording of activities of one or more individuals, carried out at predetermined or random intervals • It provides quantitative measurement of the various activities. • It helps in standardizing the method of performing jobs and determining the manpower needs in any organization.

25. 10) Decision Making: • It does not follow that the best decisions are always made at the top of an organization • An adage that decisions should be made at the level where the best decisions can be made • Decisions should not be made with incomplete data.

26. Health planning in India • Integral part of national socio economic planning • Government of India appoints different committees from time to time to review existing health situations and recommend measures for further actions • Hence guidelines for national health planning were provided by number of committees

27. Bhore committee,1946 • ‘Health survey & development committee’ • Integration of preventive & curative services at all administrative levels • PHC cater to 40,000 population with a 2* health centre to serve as supervisory, coordinating & referral institution • 3 million plan- • 3 months training in PSM to prepare “social physicians”

28. Mudaliar committee,1962 • ‘Health survey and planning committee’ • Strengthening of existing PHCs before new centers were established • Strengthening of District hospitals with specialist services • Each PHCs not to serve more than 40000 population • Consolidations of advances made in first two five year plans • Constitution of an All India Health Service on the pattern of Indian Administrative service

29. Chadah committee, 1963 • National malaria eradication programme responsibility of general health services, i.e., PHC at block level • Monthly home visits by basic health worker for vigilance operations of Malaria • One basic health worker/ 10000 population • Basic health worker also called multipurpose worker, entrusted to look after duties like vital statistics, family planning etc

30. Mukherji committee, 1965 & 1966 1965: • Delinked malaria and family planning programmes • Separate staffs for both programmes 1966: • Worked out Basic Health Service which should be provided at block level

31. Jungalwalla committee, 1967 • ‘Committee on Integration of Health Services’ • Integration from the highest to the lowest level in the services, organization & personnel • Unified cadre • Common seniority • Recognition of extra qualifications • Equal pay for equal work • Special pay for specialized work • No private practice

32. Kartar Singh committee, 1973 • ‘The committee on Multipurpose Workers under Health & Family Planning’ • ANM to be replaced by ‘Female Health Worker’ & Basic health workers, Malaria surveillance workers, vaccinators etc to be replaced by ‘Male Health Worker’ • One PHC for 50000 population • Each PHC should be divided into 16 sub centers which caters to 3000 – 3500 population • Each sub centre to be staffed by a team of one male and one female health worker • Doctors in charge of PHC should have overall charge of all supervisors and health workers in his area

33. Shrivastav committee, 1975 • ‘Group on Medical Education & Support Manpower’ • Creation of bands of Para & semi professional health workers from within the community itself • Development of a ‘Referral Services Complex’ • Establishment of a Medical & Health Education Commission for planning & implementing the reforms needed in health & medical education • Recommends one male & female health worker for 5000 population • Health assistant should be located at the sub centre, not at the PHC

34. Rural Health Scheme, 1977 • Steps were initiated for involvement of medical colleges in the total health care of selected PHCs with the objective of reorienting medical education to the needs of rural people • Reorienting training of MPWs engaged in the control of various communicable disease programmes into Unipurpose workers

35. Health for all by 2000 AD • Report of working group, 1981

36. National Health Policy - 2002 • Eradicate Polio & Yaws - 2005 • Eliminate leprosy - 2005 • Eliminate Kala- Azar - 2010 • Eliminate Lymphatic Filariasis - 2015 • Achieve zero level growth of HIV/AIDS - 2007 • Reduce mortality by 50% on account of TB, Malaria & other vector & water borne disease - 2010 • Reduce the prevalence of blindness to 0.5% - 2010 • Reduce IMR to 30/1000 & MMR to 100/ Lakh - 2010 • Increase state sector health spending from 5.5% to 7 & of the budget - 2005

37. Eleventh Five Year Plan (2007-2012) • Reducing MMR to 1 per 1000 live births • Reducing IMR to 28 per 1000 live births • Reducing TFR to 2.1 • Providing clean drinking water for all by 2009 • Reducing malnourishment among children of age group 0-3 to half its present level • Reducing anemia among women & girls by 50% • Raising the sex ratio for age group 0-6 years to 935 by 2011-12 & 950 by 2016-17 • Twelfth Five Year Plan (2012-2017)

38. Health System In India Central Level: • Union Ministry of Health & Family Welfare • Directorate General of Health Services • Central Council of Health State Level: • State Ministry of Health • State Health Directorate

39. Health System In India contd.. District Level: • The Collector Administrative areas under district: • Sub divisions • Tahsils (Talukas) • Community Development Blocks • Municipalities & corporations • Villages • Panchayats

40. PANCHAYATI RAJ: • Three tier structure of rural local self government in India • All developmental programmes are channeled through these bodies • Links the village to the district • The three institutions are • Panchayat – at village level • Panchayat Samiti – at block level • Zilla parishad – at district level

41. Evaluation of Health Services General steps of evaluation: • Determine what is to be evaluated • Establish standards and criteria • Plan the methodology to be applied • Gather information • Analyze the results • Take action • Re-evaluate