Unit 2

Planning
 Contents
• Definition, types of public health planning
(Strategic/operational, short term/long term,
Single-use and Standing, proactive/reactive, formal/informal)
• Methods of planning, and its elements
• Importance of public health planning
• Setting objectives: definition of objectives, hierarchy of
objectives, guideline for setting
objectives, benefit of objective setting
• MBO: concept, process, characteristics, strength and weakness
• Approaches of planning: Need based Approach (NBA), Right
Based Approach (RBA)
 What is planning
• A plan is defined as a map, as preparation, as an
arrangement
• Planning defines where one wants to go, how to
get there and the timetable for the journey.
• Planning can also identify the journey’s
milestones.
• Complete planning sets out indicators for
tracking progress and ways to measure if the trip
was worth the investment.
 elements of planning
• Identifying a vision and goals
• Undertaking strategic planning
• and evaluation.
 What is Health planning?
• Health planning is a process to produce health
related issues and their solution.
• It does this by creating an actionable link
between needs and resources
Its nature and scope will depend upon:
• The time allowable
•The number of answerable questions to be
addressed within the process
Based Planning, for insights into approaches and
tools used in answering questions
• The resources available to support the
process??
• The broader political and social environment.
 Characteristics of Planning

1. Planning is a process
2. Planning is future oriented

3. Planning is universal. It is a function of every

manager. Its nature and scope differ according to
the level of managers.
4. Goal focused: Planning not only sets goals but also selects
actions to achieve them.
5. Decision - oriented: planning involves decisions at all level, of
management. Decisions in respect of objectives, activities and
resources are prime concern of planning.
6 Efficiency - oriented: Planning is directed toward efficiency at all
level of management. Efficiency means greater output at lower
cost, doing thing right.
 Types of planning
•Various types of plans. The types of plan depend on the complexity operations
and nature of organization.

1.According to managerial hierarchy

a. Long-term plans

b. Medium-term plans

C. Short-term (Operational)

2. According to use
a. Single use plans

b. standing use plans

•Long-term plans: these are long-term for five or more years. These are
also called corporate plans They are prepared by top level management.
They provide long - term direction. Long-term health plan, Millennium
Development Goals, Health policy are its examples.

•Medium-term plan: These are tactical(strategic) plans; they are prepared

for one to five years. It defines tactical goals for implementing corporate
plan. Three years interim five year plan of Nepal are its example. These are
based on long-term plan.

•Short-term plan: These are Operational plans, these are prepared by

management. They are for short term, generally annual, quarter, month.
Operational plans should be consistent with tactical plan.
•Single use plan: They are prepared for non-repetitive
activities. They are used only once, e.g., project, and budget.
•Standing plans: They are developed for ongoing repetitive
activities, goals, policies, strategies, procedures, rules. Such
plans are used over a long period time, They provide
guidance for repeatedly performed actions
 Types of health planning

1.Health system planning. . . . . . . . . . . . . . . . . . .

2.Health goals planning

3.Health services planning. . . . . . . . . . . . . . . . . .

4.Population health planning……………………
 Health System Planning
• Recognized goal of government is to fund an efficient and well-organized

health system. The system itself is usually planned at the provincial

government level, and by provincial agents such as regional health boards.

•A well-organized and functioning system of health services is like the
connectivity of the health issues.
 command centers
 a supportive contextual infrastructure
 and a series of linked and inter-supporting activities.
 Planning Cycle (PIE cycle)
l . Analysis of health situation
2. Establishment of objectives and goals
3. Assessment of resources
4. Fixing priorities
5. Write-up of formulated plan
6. Programming and implementation
7. Monitoring & Evaluation plan
 Analysis the
health
problems

Monitoring & Established

evaluation Objective

PIE Cycle

Programming Assessment
& Implement resources

Write up
Fixing
Formulation
Priorities
plan
 1. Analysis of health situation:
• It involves the collection, assessment &
interpretation of information in such a way as
to provide a clear picture of the health
situation.
The following items of data are the minimum essential requirement for
health planning:
i. Population, its age & sex structure

ii. Statistics of morbidity and mortality

iii. Epidemiological distribution of different diseases

iv. Medical care facilities and other health agencies, both public and
private
v. Technical manpower of various categories
vi. Training facilities available

vii. Attitudes and beliefs of the population towards disease, its cure and
prevention
 2. Established Objective

It is measurable goals to be achieved, and should be SMART

• Specific: identifies concrete events or actions that will take
place.
• Measurable: quantifies the amount of resources, activity, or
change to be expended and achieved.
• Achievable: Provides a realistic dimension that can be achieved
with the available resources and plans for implementation.
• Realistic: logically relates to the overall problem statement and
desired effects of the program.
• Time-based: specifies a time within which the objective will be
achieved.
 3. Assessment of resources:
• Resources implies man, money, materials, skills, knowledge,
techniques, tools, and time,
• Need to analyze:
 what is required, what is available, and what is likely to be available.
 Any possible source ( donors, CBOs, private organizations, community
 Locally available resources – manpower, materials, communication,
physical facilities, local technology, transportation, accommodation etc.
•Resources are assessed and a balance is hit between, what is required and
what is available, or likely to be available in terms or resources
 4. Fixing priorities:
• Once problems, resources and objectives have
been the next most important step in planning
is establishment of priorities in order
importance or magnitude, since the resources
always fall short of the total requirement In
fixing priorities
• In fixing priorities attention is paid to financial
constraints, morbidity and data, disease which
can be prevented at low cost, saving the lives
of younger people in whom there has been
considerable social investment; and also
political and interests and pressures.
 5. Write-up of formulated plan:
• The plan must be complete in all respects the
implementation of a project.
• For each proposed health programme, the
resources (inputs) required are related to the
results (outputs) expected.
• Each stage of plan is defined and the time
needed to implement is specified.
• "the plan must contain work in guidance to all
those responsible for implementation”.
It is a implementation framework. Should be in
details and able to answer the following question.
 What – activities
 Why – purpose
 How/Which – methods/procedures
 Who – task division
 When – activities schedules
 Where – geography/district/location
 6. Programming and implementation:

•The main considerations at the implementation stage

include:
 definition of roles and tasks

 the selection, training, motivation and supervision of

manpower involved organization and communication
 efficiency of individual institutions such as hospitals,
PHCC, HP
 7. Monitoring & evaluation plan:
• Monitoring is the day-to-day follow-up of activities
during their implementation to ensure that they are
proceeding as planned and are on schedule.
• It is a continuous process of observing, recording,
and reporting on the activities of the organization or
project.
• Monitoring, thus, consists of keeping track of the
course of activities and identifying deviations and
taking corrective action it excessive deviations occur
•The purpose of evaluation is to assess the
achievement of the stated objectives of a
programme, its adequacy, its efficiency and its
acceptance by all parties involved.
•Thus monitoring and evaluation are different
terms and these should be planned in advance
for effective and efficient execution.
Importance and Purpose of Health Planning

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The purpose of planning is:

 
 to match the limited resources with many problems
 to eliminate wasteful expenditure or duplication of
expenditure
 to develop the best course of action to achieve a
defined objective
 Methods of planning

1.Top-down method
2.Bottom - up method
3.Participatory method
4.Team method
•Top-down method of Planning: Top management
determines goals and formulates plans.
•The plans are communicated to middle and lower level
management implementation It is generally used in highly
centralized organizations.
•Top level managers have a role in planning. Those who
are responsible for implementation are not involved in the
planning process. It may not be sensitive to local
conditions.
•Bottom-up method of planning: The plans are
formulated at the operational. They travel up to
top level. It is decentralized approach of
planning.
Participatory approach of planning:
• This method is a mixture of top-down and
bottom-up methods of planning.
• The top management provides broad premises,
parameters and guidelines for planning to
operational level management.
• Then operational level formulates the plans and
forwards to the top level which reviews and
finalize' the plans
Team method of planning: The job of planning
is trusted to a team. The members of the team
possess multiple skills in planning. The team
prepares draft plans which are forwarded to the
top management, which are reviewed and
finalized by top management.
 Elements in planning methods and process
There are three broad elements in a planning process

1. Identifying the vision and goals,

2. Undertaking the strategic plan,
3. and Evaluation.
Health planning and budgeting Structure in
local level
 Strategic planning
• A process of setting agreed priorities and determining
future direction for the health sector in the light of
given resource constraints.
-Nuffield Institute for health
• Strategic planning is the process of determining what
an organization intends to be in the future and how it
will get there.
• It is finding the best future for your organization and
selecting the best path to reach that destination. -
Ethiopia public health initiative
• “the process for assessing a changing
environment to create a vision of the future;
determining how the organization fits into the
anticipated environment based on its
institutional mission, strengths, and
weaknesses; and then setting in motion a plan
of action to position the organization
accordingly.” - Evashwick (1988),
 Strategic Planning Process
Components
• Vision
• Mission
• Principles/values
• Strategies
• Objectives
• SWOT analysis
• Problem Statement
• Action plans/activities
• Evaluation framework
Values and principles of Strategic Planning

• Client –centered • Accessibility

• Efficiency • Equity
• Quality • Gender Sensitivity
• Affordability • Accountability
• Decentralization •Cost-effective
• Incorporation •Transparency
• Stakeholder Consultation
• Community Participation
• Sustainability
• Collaboration
 SWOT Analysis Matrix
Positive Strength Opportunities

Negative Weakness Threats

Strength
 availability of resources
 trained manpower
 Clear strategic direction
 Good leadership and management
 Clear purpose
 Strong network
 Good relationship to donors
 Strong financial resources management
 
Opportunity
 Clear and supportive government polices
 Presence of a functional health committee in the
communities
 Well-functioning community organization
 Support from donor agencies
 Under utilized health resources
 Community support
 Political support
 
Weakness
 lack of managerial talent
 obsolete facilities
 Inadequate internal communications
 Inadequate strategic direction
 Inadequate funding
 Poor coordination
 Low capacity of staff to perform
 Low capacity of technology use
 Poor information system
 Inappropriate organizational structure
Threats
 adverse cultural believes towards modern
medical practice
 Growing cost of essential drugs
 Low literacy rate
 Lack of political commitment
 Lack of community support
 Religious resist
 Poor economy
 Gender disparity in community
 Dysfunctional health system
 Areas for Strategic Planning
• leadership and governance for health
• health service delivery
• human resources for health
• health financing
• national health information system
• community participation and ownership
• partnerships for health
• Health Research
• Health infrastructure (physical facilities)
• Health logistic (procurement and distribution)
• Health sector implementation planning
• Health service decentralization
Basis for comparison Strategic planning Operational planning
Meaning The planning for achieving Operational Planning is a
the vision of the organization process of deciding in
is Strategic Planning. advance of what is to be
done to achieve the tactical
(planned) objectives of
organization?
Time Horizon Long term planning Short term planning
Approach Friendly Self-contained
Modifications Generally, the plan lasts The plan changes every year.
longer.
Performed by Top level management Middle level management
Scope Wide Narrow
Emphasis on Planning of vision, mission Planning the routine
and objectives. activities of the company.

Tactical planning is a type of planning that involves breaking down a long-term strategic
plan into smaller and more distinct short-term plans.
 APPLICATION OF PLANNING IN PUBLIC
HEALTH
• Building harmony around organizational goals, objectives,
and priorities.
• Providing the guideline for implementation of activities
• coordinates the actions of diverse and separate parts of
the organization into unified programs to accomplish
objectives.
• provides a road map, direction, and focus for the
organization’s future—where it wants to go and the routes
to get there.
• sets priorities for the crucial (Vital) strategic tasks,
including the complex, burning issues
• allocates resources available for growth and change to
the programs and activities with the highest potential.
• establishes measures of success
• gathers input and ideas from all parts of the
organization on what can be done to ensure future
success
• generates commitment to implement the plan by
involving all parts of the organization in its
development
 Setting Objectives

•A specific result that a person or system aims to achieve within a

time frame and with available resources.
In general, objectives are more specific and easier to measure than
goals. Objectives are basic tools that underlie all planning and
strategic activities. They serve as the basis for creating policy and
evaluating performance.
•Some examples of health planning objectives include minimizing
expenses, expanding internationally, or making a profit.
 “What are goals and objectives?”
• Goals are general guidelines that explain what you want to
achieve in your community. They are usually long-term and
represent global visions such as “protect public health and
safety.”
•Objectives define strategies or implementation steps to attain the
identified goals.
•Unlike goals, objectives are specific, measurable, and have a
defined achievement date.
•They are more specific and outline the “who, what, when, where,
and how” of reaching the goals.
• Objectives are the ends for the achievement of which
managerial activities are directed
• Objectives are a pre-requisite for planning.
• ‘No planning is possible without setting up of
objectives’
• Objectives are not only helpful in planning but also in
other managerial functions like organizing, directing
and controlling.
• Clear cut objectives help in proper decision-making
and in achieving better results.
 Features of Objectives
 Every organization has objectives rather it is started to achieve certain
objectives. All the members of an organization channelize their energies
to achieve the stated goals.

 The objectives of a business organization may be broad as well specific.

These may be set for the whole organization or different segments of it.

 The objectives may be for long term or short periods.

 The overall objectives of the organization are supported by the sub

objectives.
 Objectives have hierarchy. At organizational level
broad objectives are fixed by the top level
management.
 An organization tries to fulfill the needs and
aspirations of society.
 objectives may change as per the environmental
changes or change in social needs.
 All organizational objectives are inter-related. The
achievement of main objectives will require the
achievement of subordinate objectives
 Hierarchy of Objectives:

• Objectives form a hierarchy ranging from the broad aim

to specific individual objectives.
• At the top of it the main goals of the organization are set.
•The overall objectives of the organization are specified
at the top level management.
• The next in hierarchy comes the objectives of divisions
and departments and units and these are decided at
middle level management comprising Vice-president or
functional managers.
 A SMART objective
Why use SMART objectives?
 To provide a structured approach to developing and designing a
work plan.
 To systematically monitor progress towards a target
 To set the stage for measuring performance and identifying
opportunities for improvement
 To briefly communicate intended impact and current progress to
stakeholders
• To concretely describes how goals will be met
SMART objectives should:

 Include all components of SMART

 Relate to a single result
 Be clearly written
 How to Write SMART Objectives

Specific
• Objectives should be well-defined, and clear to
other team members and to stakeholders who
also understand the program or plan
Consider these prompts:

•What:
 What exactly will you do?
 What is the action?
 What do you mean to impact?
•Who:
 Who is responsible for carrying out the action?
 What are you intending to impact or who is your target
population?
Measurable

•This involves selecting what will be measured to show

improvement, impact or success. There may be existing measures
and targets that are required for a specific program or grant. Try to
pick a measure that is meaningful. The easiest things to measure
may not be the most meaningful.

•Consider these prompts:

 How much and in what direction will the change occur?

 What data will be used to prove the target is met?
 Where will this data come from?
Time-Bound

•Objectives should be achievable within a specific time frame

that isn't so soon as to prevent success, or so far away as to
encourage procrastination.

•Consider these prompts:

 When will this objective be achieved?

 Is this time-frame realistic?
 Should it be closer or further in the future?
Achievable

•Objectives should be within reach for your team or program,

considering available resources, knowledge and time.

•Consider these prompts:

 How can this objective be accomplished?

 Given the current time frame or environment, can this
objective be achieved? Should we scale it up or down?
 What resources will help us achieve this objective? What
limitations or constraints stand in our way?
Relevant

Objectives should align with a corresponding goal. Consider if

and how successfully completing an objective will be relevant to
achieving the goal. Consider if an objective relates to the larger
program, plan or organization's mission, vision and goals.

•Consider these prompts:

 Will this objective lead to achieving this organization's goals?

 Does it seem worthwhile to measure this objective? Does it
seem reasonable to measure this objective?
 Management By Objective(MBO)
• Management by objectives (MBO) is a strategic
management model that aims to improve the
performance of an organization by clearly
defining objectives that are agreed to by both
management and employees.
• Management by objectives (MBO) is the
establishment of a management information
system to compare actual performance and
achievements to the defined objectives.
 Features of Management by Objectives

• It is a technique and philosophy of management.

• Objective setting and performance review are made by the participation of
the concerned managers.
• Objectives are established for all levels of the organization.
• It is directed towards the effective and efficient achievement of
organizational objectives.
• It is concerned with converting an organizational objective into a personal
objective on the presumption that establishing personal objectives makes
an employee committed which leads to better performance.
• The basic emphasis of MBO is on objectives. Management by
Objectives tries to match objectives with resources.
• Objectives in MBO provide guidelines for appropriate systems and
procedures.
• Periodic review of performance is an important feature of MBO.
• MBO provides the means for integrating the organization with its
environment, its subsystems, and people.
• Employees are provided with feedback on actual performance as
compared to planned performance.
Process of MBO
1. Define Organizational Goals
•Goals are critical issues to organizational effectiveness, and
they serve a number of purposes. Organizations can also have
several different kinds of goals, all of which must be
appropriately managed.
•And a number of different kinds of managers must be
involved in setting goals. The 
goals set by the superiors are preliminary , based on an
analysis and judgment as to what can and what should be
accomplished by the organization within a certain period.
2. Define Employees Objectives
•After making sure that employees’ managers have informed
of pertinent general objectives, strategies and planning
premises, the manager can then proceed to work with
employees in setting their objectives.
•The manager asks what goals the employees believe they can
accomplish in what time period, and with what resources.
They will then discuss some preliminary thoughts about what
goals seem feasible for the company or department.
•3. Continuous Monitoring Performance and Progress
•MBO process is not only essential for making line managers in business
organizations more effective but also equally important for monitoring the
performance and progress of employees.
•For monitoring performance and progress the followings are required;
 Identifying ineffective programs by comparing performance with pre-established
objectives,

 Using zero-based budgeting, (budgets are started from a zero-

base, with a fresh decision on everything being made every year.)
 Applying MBO concepts for measuring individual and plans,
 Preparing long and short-range objectives and plans,
 Installing effective controls, and
 Designing a sound organizational structure with clear, responsibilities and decision-
making authority at the appropriate level.
4. Performance Evaluation
• Under this MBO process performance review
are made by the participation of the concerned
managers.
5. Providing Feedback
• The devoted elements in an MBO program are
continuous feedback on performance and goals that
allow individuals to monitor and correct their own
actions.
• This continuous feedback is supplemented by
periodic formal appraisal meetings which superiors
and subordinates can review progress toward goals,
which lead to further feedback.
6. Performance Appraisal
• Performance appraisals are a regular review
of employee performance within organizations.
It is done at the last stage of the MBO process.
 Benefits of Management by Objectives

• Improves Management
• Encourages Personal Commitment
• Clarifies Organization
• Device for Organizational Control and
Systematic Evaluation
• Develops Effective Control
• Improving Productivity
• Motivating the Subordinates
• Personal Satisfaction
 Weaknesses of Management by Objectives

1. Failure to teach the philosophy

2. Failure to give proper guidelines to goal setters
3. Difficulty in setting verifiable goals
5. The danger of inflexibility
 Approaches of Planning models:
• Need Based Planning
• Right Based Planning
 Need Based Planning
•A number of measures are used to determine the requirements for
health care resources in an area, including: demographics, socio-
economic status and health status.
•In particular, special attention is given to the age and gender of a
population, premature mortality and socio-economic indicators of
populations as measured by the Socio-Economic Risk Index (SERI).
• This also includes physician contact rates, and the characteristics of
local practicing physicians (eg. workload, closeness to retirement).
 Human rights-based approach (HRBA)
• Using a human rights-based approach (HRBA), development partners should
direct their programmes to promote and protect human rights- based on
agreed international human rights standards and principles.
• The approach seeks to identify groups and people whose rights are been
violated, understand why certain people are unable to enjoy their rights, and
redress unjust distributions of power that impede development progress.
• In this sense it identifies rights-holders and their entitlements and
corresponding duty-bearers and their obligations, and works to strengthen the
capacity of duty bearers to comply with their obligations and right holders to
claim and exercise their rights.
• In that respect, human rights are the goals and guiding principles in
development efforts: a human rights-based situation analysis is the basis for
identifying priorities and action.
Need Based Approach Right Based Approach

Focus on input not outcome Focus on process and outcome

Emphasizes meeting needs Emphasizes realizing rights

Recognizes needs as valid rights Recognizes individuals and group

rights as claims toward legal and
moral duty-beares

Individuals are objects of Individuals and groups are

development interventions empowered claim their rights

Individuals justify help Individuals are eligible to help

Focuses on immediate causes of Focuses on structural causes and

problems their manifestations