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Problem Identification, Prioritization, Analysis

Prof. Richard Javier, MBA

Problem identification Problem prioritization - decision matrix Problem analysis - problem tree Objectives analysis - objectives tree Alternatives analysis - alternative tree

Outline Outline

Questions to Ask When Selecting Problems for Management Action

Which problem situation is causing the most difficulty? How soon must a solution be found to be the problem situation Is the problem situation in questions really the one to be solved, or it is simply part of a still larger problem, which requires study? What is the status of the job in question? Is it temporary in nature? If not, what will be the future demands?

Basic Considerations in Selecting and Prioritizing Health Problems

First and foremost, no health problem should be left unattended and unanswered Health problems of similar nature and population at risk should be grouped together as a specific type of problem. Eg. Immunizable diseases, lifestyle- related diseases, degenerative diseases, trauma, etc. Specific health problems considered specially important should not be grouped with other problems.

Basic Considerations in Selecting and Prioritizing Health Problems

Health problems are prioritized for the purpose of developing a special program specific to the health problem and for allocation of resources For management problems, selection and prioritization is done to determine what to include (and exclude) into the plan for the future actions

Problem Identification
Population Compare growth rate with desired rate as specified by the population program Which areas of the country are growing faster than others Relate age structure of the population to leading causes of illness Geographical distribution related to the ff: - access to health services - programs to improve transport and communication - urban growth and slums and their implications in terms of overcrowding, housing and sanitation, drugs/alcohol

Health Status Compare vital statistics with national rates, or with neighboring countries Note which areas are least healthy Age/sex patterns of death; also with other population subgroups Major causes of death and illness and geographic differences

Problem Identification

Problem Identification
Health Resources Problems of intersectoral relationships Problems of intrasectoral relationships Distribution of health facilities - number which need repair/rehabilitation - number which have inadequate staff - presence/absence of facilities in remote areas and for special population groups Performance of health facilities - efficiency of use of resources - coverage of services - methodologies used in the activities

Problem Identification
Health Resources Manpower - adequacy - geographical distribution - manpower development Health expenditure - total government per capita expenditure - % of total health expenses to GNP - budget distribution - % out-of-pocket expenses to total - % covered by SHI

Criteria in problem selection

Problem Prioritization

Magnitude of the problem deaths caused by the disease as well as prevalence and/or incidence of the disease in the locality as measured by morbidity and mortality rates higher rates gain higher scores Vulnerability to change presence or absence of the technology that will control the disease. This is measured by the effectiveness of an intervention to address the disease the more effective the intervention, the higher the score.

Problem Prioritization
Criteria in problem selection Impact to society scope of the population that is affected by the disease directly or indirectly. Conditions that will receive a higher score include high communicability, high degree of disability, bigger amount of money lost when afflicted with the disease. Administrative support extent of local executives endorsement of the project. The presence of personal motivation to support programs or health in general gain higher scores. Financial requirement amount of money needed to carry out the program/project. A larger amount will get a lower score.

Problem Analysis
Involves identifying what the main problems are and establishing cause and effect relationships between these problems The key purpose of analysis is to ensure that root causes are identified and subsequently addressed in the project design, not just the symptoms A clear and comprehensive analysis provides a good foundation on which to develop a set of relevant and focused objectives

Problem analysis should be undertaken as a group learning activity involving different stakeholders who can contribute relevant technical and local knowledge The process is as important as the product. The activity should be taken as a learning experience for all those involved, and as an opportunity for different views and interests to be presented and discussed One main tool used in problem analysis is the problem tree

Problem Analysis

Problem Tree
Preparatory steps Clarify the scope of the investigation or analysis Inform yourself further Identify relevant stakeholders Participants need to be informed to be useful and productive Conduct the analysis

Problem Tree
Steps in conducting problem tree analysis 1. Identifying and listing the main problems - Using contributions from the group, list all negative statements about the situation being analyzed (brainstorm) - Print each problem statement in clear language on a card and display on the wall or some suitable space

Problem Tree
Steps in conducting problem tree analysis 2. Identifying core problems - through discussions, identify a consensus core problem (the one which appears to be linked to most negative statements) - print a precise definition of the core problem on a card - display the card on the wall so the whole group can clearly see it

Problem Tree
Steps in conducting problem tree analysis 3. Identifying cause and effect - distribute the negative statement cards according to whether they are causes (leading to the core problem) or effects (resulting form the core problem). Place all causes below the core problem and the effects above the core problem (problems that are clear but very general in nature and which affect not only the issue at hand but almost any health problem can be treated as general constraints and placed at the side of the problem tree. This keeps the core problem tree focused and manageable.)

Problem Tree
Steps in conducting problem tree analysis 4. Identifying cause and effect - further structure the statements in the problem tree by selecting one of the statements and asking what leads to this? Then select from the other cards the most likely cause and place it below the chosen statement. Do the same for the other cards. - if there are 2 or more causes combining to produce an effect, place them side by side below the resulting effect - similarly, ask if there are any more effects resulting from that cause - if there are multiple effects resulting from a cause, place them side by side above the cause

Problem Tree
Steps in conducting problem tree analysis 5. Checking the logic - pick out one card from the top of the problem tree and work back through the diagram according to the guide question: what leads to, or causes, that? to check the logic and completeness of the diagram

- connect the cards with arrows to show causeeffect relationships

No policy/guidelines on TPR recording

ER/OPD emergency relievers not oriented TPR not recorded upon admission
Lack of skills in time management

Poor work planning Busy staff TPR not recorded in the logbook

58% of charts among pediatric patients have incomplete recording of vital signs(TPR)

Thermometers not included in the work & financial plan

No procurements of thermometers

Inadequate supply of thermometer No thermometer

No policy/guidelines on proper safekeeping of thermometers in the ward

No proper inventory of thermometers

Lack of thermometer in the wards No TPR recording in some shift

58% of charts among pediatric patients have incomplete recording of vital signs (TPR)

High Mortality 20 PTB Non-Adherence to WHO TB control strategy Poor treatment compliance Interrupted supply of quality Anti-TB Meds

Inadequate Supervision

Lack of training for community volunteers as treatment partners

No Social marketing

Unorganized drug logistic cycle

No LGU policy re buffer stocks

Poor income generation

Late submission of reports

No PhilHealth Accreditation

No Sponsorship

Inadequate information, education and communication Poor record management

Lack of political commitment

Objectives Analysis
Done by preparing an objective tree Problem statements (negatives) transformed into objective statements (positives) Shows the means-end relationship between objectives Leads directly into developing the projects narrative description in the Logical Framework matrix

Objectives Analysis
Once the negative statements in the problem tree have been reworded into positives, check: Are the statements clear and unambiguous? Are the links between each statement logical and reasonable? Are the positive actions at one level sufficient to lead to the results above? Will the achievement of one help support the attainment of another above it? Is there a need to add any other positive statements/actions? Is the overall structure simple and clear?

Decreased Mortality 20 PTB Non-Adherence to WHO TB control strategy Good treatment compliance Strict supervision by treatment partner Continuous supply of quality Anti-TB Meds

Community volunteers trained as treatment partners

Social marketing established

Drug logistic cycle in place

Established LGU policy re buffer stocks

Additional funds generated

PhilHealth Accreditation

Strengthen information, education and communication

Timely submission of reports


Excellent record management

Strong political commitment

Done by preparing an alternative tree

Alternatives Analysis

Questions to ask could include: Should all of the identified problems and/or objectives be tackled or just a few? What is the combination of interventions that are most likely to bring about desired results and promote sustainability of benefits? What are the likely capital and recurrent costs implications of different interventions? What can be realistically afforded? Which strategy will best support participation by both women and men? Which strategy will most effectively support institutional strengthening objectives?

Alternatives Analysis
Criteria that may be used to assess different intervention options Benefits to target groups equity and participation Sustainability of benefits Ability to repair and maintain assets post-project Total and recurrent cost implications Financial and economic viability Technical feasibility Contribution to institutional strengthening and management capacity building Environmental impact Compatibility of project with sector or program priorities

A project/program design should demonstrate that the main alternative options have been considered and assessed. There is always more than one way to solve a problem. The aim is to find the best way, subject to some criteria.

Planning is not a linear process. One does not move mechanically from one step to the next, always in a forward direction, and arrive automatically at the best solution. Planning is an iterative process.

Thank You!