Community Assessment / Community Health Project Planning,

Implementation, Monitoring and Evaluation

The General Picture of Planning in a Health Organization
Overview of Health Program Planning
• Three phases of the planning process
– Preparatory Phase
– Planning Phase
– Output
• Two objects of the planning process
– Planning for the programs and services
– Planning for projects
• One single output
– A consolidated health program plan
 COMMUNITY ASSESSMENT
A community assessment is an exercise by which
a collaborative partnership gathers information on
the current strengths, concerns, and conditions of
children, families, and the community.
The information comes from many sources-
especially parents and family members- and is
elicited by many techniques, including interviews,
focus groups, and scanning demographic data
collected by local agencies.
• Community assessments focus on local assets,
resources, and activities as well as gaps,
barriers, or emerging needs. The process of
identifying and appraising this information will
help your collaborative partnership.
 Clearly understand the context in which families live
and the issues families want to address; locate hidden
strengths or underutilized resources that could be
developed.
 Determine which resources could contribute to
comprehensive strategies, and in what way;
 Design effective, collaborative strategies that engage
children and families because they respond to real
and important conditions; and
 Empower families and community members by
giving them a role in designing and implementing the
strategies.
 The process of conducting a community
assessment involves :

(1) scanning the community to locate existing

information,
(2) developing a family focus,
(3) identifying community assets and the degree
to which they are accessible to the people who
can benefit from them, and
(4) analyzing the information obtained through
the first three steps.
 Program vs project
• Program a series of • Has an established and
coordinated related specific objective
multiple projects that
continue over extended • Has a defined life span with
time intended to achieve a a beginning and an end
goal • Usually the involvement of
several departments and
• is comprised of multiple professionals
projects and is created to
obtain broad organizational • Has specific time ,cost
or technical objectives performance requirements

OBJECTIVE . BENEFIT. TIME

 Major steps in planning, sustaining and
evaluating a health promotion project
1. Identify the issues or health problems in the community.
2. Prioritize the issues or health problems to identify the
one that the project will address.
3. Identify risk factors and set the goal for the project
4. Determine contributing factors and state objectives for
the project
5. Determine what strategies will be
6. Develop the action plan for the project. DO IT!
7. Sustain the project or keep the project (or some parts of
it) going
8. Evaluate the project
 Step 1: Identify the issues or health
problems in the community
NEEDS ASSESSMENT

• Clarifying need is an essential part of deciding what

issue or problem the project will address. The term
‘needs assessment’ is used to describe a process of
collecting information that will give a good indication
of the priority needs of a community.
• It provides an opportunity for the community to
become involved in the planning from the beginning.
• It helps with allocating resources and making decisions
about where to start with health promotion work.
CLASSIFYING NEEDS

When undertaking a needs assessment, it is

important to consider that needs will be thought
of differently, depending on whom you consult.
Needs are sometimes classified as:

– Normative needs
– Felt needs
– Expressed needs
– Comparative needs
 Sharing information from the needs
assessment
• Sharing the results of the needs assessment with
the community is a key part of the planning
process. This process will:

– Raise community awareness about the issues and

possible underlying causes
– Stimulate discussion about ways to address the issues
– Allows the community to be involved in planning and
decision-making about the project
 
Consider baseline data

• Some of the information gathered during the

needs assessment may be able to be uses as
‘baseline data’.
• Baseline data describe the situation or condition
at the time the project or intervention starts.
• Data collected later during the evaluation is then
compared against the baseline data to see the
effect of the project.
 Step 2: prioritize the issues or health
problems
• At the end of Step 1, the project team will have a list of
major issues and potential target groups for the project.
• There are always competing needs or issues in any
community.
• Limitations such as time and resources mean that not
everything can get addressed.
• Issues will need to be prioritized. Needs and priorities vary
from individual to individual, family to family, group to
group.
• It is important to work out criteria to sort out which issue
the project will address.
 DECISION MATRIX SAMPLE
Perceived Existing
Magnitude Feasibility
Problem 35% 30% Value Policies Total Rank
15% 20%

Delay in the delivery of

4 2 3 3
antigens for vaccination 3.05
(Low FIC coverage) (1.4) (0.6) (0.45) (0.6)

Birthing Facility not

Philhealth Accredited 4 3 4 2 3.3
(Low Maternal Health- (1.40 (0.9) (0.6) (0.4)
Facility Based Delivery)

Irregular supplies of 5 2 1 5
3.5
vaccines for FIC (1.75) (0.6) (0.15) (1.0)
Methods of Health Problem Analysis
• Qualitative Method
– Analysis of those who participated in the
circumstances that surround the problem through
focus group discussion (Participant’s Analysis)

• Quantitative Method
– Construct a problem tree illustrating the direct
and the underlying causes of the problem
– Provide estimates (evidence-based) on the nature
and extent of each cause through the use of
indicators.
 Methods to analyze causes

• Ishikawa diagram

• Vector Diagram

• Cause and effect tree

What is a Root Cause Analysis?
A root cause analysis is a class of problem
solving methods aimed at identifying the root
causes of the problems or events instead of
simply addressing the obvious symptoms.
The aim is to improve the quality of the
products by using systematic ways in order to be
effective (Bowen, 2011).

Techniques in Root Cause Analysis

Root cause analysis is among the core building
blocks in the continuous improvementHIS
efforts of
the organization.
1. ASK WHY 5 TIMES

This might sound like the technique of a five-year-

old wanting to get out of going to bed, but the five
whys analysis can be quite useful for getting to the
underlying causes of a problem. By identifying the
problem, and then asking "why" five times - getting
progressively deeper into the problem, the root
cause can be strategically identified and tackled.

HIS
2. Failure Mode and Effects Analysis (FMEA)
The failure mode and effects analysis (FMEA) is a technique
which is aimed to find various modes for failure within a
system. FMEA requires several steps for execution:
1. All failure modes (the way in which an observed failure
occurs) must be determined.
2. How many times does a cause of failure occur?
3. What actions are implemented to prevent this cause from
occurring again?
4. Are the actions effective and efficient?

FMEA is often performed and updated any time a new

product or process is generated, when changes are made to
current conditions, or to the design, when new regulations
HIS
occur, or when there is a problem determined through
customer feedback.
3. Fault Tree Analysis (FTA)
Uses boolean logic to determine the root causes of an undesirable
event. This technique is usually used in risk analysis and safety
analysis. At the top of the fault tree, the undesirable result is
listed. From this event, all potential causes tree down from it.
Each potential cause is listed on the diagram in the shape of an
upside down tree.

HIS
4. Current Reality Tree (CRT)

The current reality tree analyzes a system at once. It would

be used when many problems exist and you want to get to
the root causes of all the problems.
The first step in creating a current reality tree is listing all of
the undesirables or, problems. Then begin a chart starting
with each of those problems using causal language
(if...and...then). The tree will depict each potential cause for
a problem.
Eventually, the tree will show one cause that is linked to
all four problems.

HIS
5. Fishbone or Ishikawa or Cause-and-Effect Diagrams

No matter what term you use for the fishbone diagram,

the truth is, that it is a useful technique that will help you
in your root cause analysis. A fishbone diagram will group
causes into categories including:
• People
• Measurements
• Methods
• Materials
• Environment
• Machines
HIS
Fishbone or Ishikawa or Cause-and-Effect Diagrams

HIS
6. Kepner-Tregoe Technique
The Kepner-Tregoe technique, also known as rational
process is intended to break a problem down to its root
cause. This process begins with an
1. Appraisal of the situation - what are the priorities and
orders for concerns for specific issues?
2. The problem analysis is undertaken to get to the
cause of undesired events.
3. A decision analysis is tackled, outlining various
decisions that must be made.
4. A potential problem analysis is made to ensure that
the actions decided upon in step three are
sustainable.
HIS
7. RPR Problem Diagnosis
One final technique used in root cause analyses is the RPR
Problem diagnosis. RPR stands for "Rapid Problem
Resolution" and it deals with diagnosing the causes of
recurrent problems.

This process has three phases:

• Discover - team members gather data and analyze their
findings
• Investigate - a diagnostic plan is created and the root cause
is identified through careful analysis of the diagnostic data
• Fix - the problem is fixed and monitored to ensure that the
proper root cause was identified.

  HIS
The Problem Tree – The What and the How-
to

• A methodology to systematically identify the

possible contributory factors that led to the
formation of a health problem
 A Problem Tree Example
-The Roots of the Problem-
Deaths 2° TB

Deaths Deaths w/ Deaths in spite

w/o Tx Incomplete Tx of Tx

Drop-out
from Tx Inadequate
Refuse
supply of
Tx
Tx not drugs
available
Depleted
Stigma
Adverse Budget
Drug Rx
 A Problem Tree Example
-The Branches (or Effects) of the Problem-
Retardation of Social Progress

Decrease Social Productivity

Loss of Opportunities

Displacement of
Family Life

Deaths 2° TB
 Step 3. Identify risk factors and set the goal
for the project
Risk factors- are any aspect of behavior, society or the environment
that are directly linked to the health problem. Risk factors lead to
or directly cause the problem. Note that some risk factors can be
charged, while others are not able to be modified, for example,
family history of a condition.

• Example of risk factors:

 
– Eating high fat food (behavioral) and having a family history of heart
disease (biological) are both risk factors for heart disease, People can
change their food choices (modifiable) but not their genetics (non-
modifiable)
– Direct exposure to bacteria to bacteria and germs (environmental) may
be a risk factor for diarrhea
• Addressing a problem successfully will require the
project to focus on the underlying causes or issues
that led to the problem in the first place.
• In other words, the goal and objectives of a
project need to relate to the underlying causes or
issues.
• Developing a clear and organized goal and
objectives that relate to each other requires some
critical analysis of the problem.
 
 Step 4: Determine contributing factors and
state objectives for the project
Contributing factors- are any aspects of behavior, society or the
environment that leads to the risk factors developing.
Contributing factors enable or reinforce the risk factors. They can relate to
individual, financial, political, educational, environmental, or other issues.

• Examples of contributing factors:

– Lack of knowledge about low fat diets (educational) and high cost of low-fat
foods in the store (financial) are both contributing factors to the risk factor
‘eating a high fat diet’

– Poor housing condition (environmental) and lack of home hygiene (behavioral)

are both contributing factors to the risk factor’ exposure to bacteria and
germs’ 
Developing the project goal and objectives

• The Goal and Objectives:

– Make plan clear and focus that energies of the

project team
– Let people know what they can expect to happen
as a result of the project
– Are the basis for planning the evaluation of the
project
Goal

• The goal is about making changes to the risk

factors addressed by project
• The goal indicates what the planned, longer
term outcome of the project is
• It is also intended to inspire, motivate and
focus people and encourage team
cooperation.
Objectives

• Objectives state what changes the project will make to the

contributing factors.
 
• The objectives indicate what the impact will be on the
contributing factors during the time frame of the project.
 
• The objectives are about what has to change in the short term
to get closer to achieving the project goal.
 
• A well written ‘goal and objectives’ state who will achieve how
much of what by when. Developing a clear, achievable goal and
objectives requires good baseline data.
Step 5: Determine what strategies will be
• After the objectives are developed, the strategies are
determined. Strategies describe what it is that the project
team will do to try and make the changes required to
achieve the objectives.

• Relationship between the goal, objectives and strategies

– The process for planning a project begins with the big picture
(issue of problem). It is an analysis of the big picture issue that
gives the framework for developing the plan- from the longer
term goal, to more specific objectives, down to the actual
strategies, and finally the detail of individual actions.
 Step 6: develop the action plan
• Once the strategies of the project are
determined, the project team can write the
action plan. The action plan includes all the
specific activities, large and small, that will
need to be done to implement each of these
activities, when they will be completed and
how they will be evaluated.
• The more detail that is worked out for
strategies, the easier it will be to accurately
identify all the activities to be done.
• If the project is large, with many stages, it may
not be possible to detail all the specific
activities at the beginning of the project.
• Detailed documentation is also important for
maintaining accountability within the team
and between the team and the community or
funding agency.
• The action plan will also list the resources
required to do the project successfully.
Resources will be required throughout the
whole project, from needs assessment
through putting strategies into action to final
report writing.
•  Resources can include human resources,
financial resources, materials, equipment and
venues.
 Step 7: Sustain the project
• Planning for sustainability means thinking of ways
to keep the project (or important parts of it) going
after its official end. It then becomes an ongoing
part of community activity.

• Many factors can threaten sustainability of the

project. Project teams need to be on the lookout for
these factors and have a plan for dealing with them.
Sustainability needs to be considered from the
initial planning stages of a project.
 Step 8: Evaluate the project
Evaluating a project is about looking critically at
what is happening in the project and making a
judgment about its value, worth or benefit (see
the word value in evaluate). Evaluation is
important because it can tell us:
 
– How the project is going
– What effect it is having
– What changes we need to make to improve it 
 Outline in Developing a Management Project
Plan
• Project Title
• Rationale of the Project
• Objective of the Project
– Pertains to the resolution of the main problem as
identified in the Obstacles Analysis Matrix
• Specific Objectives of the Project
– Pertains to the completion of the selected solutions
– The written format is as follows:
“At the end of the project, the following should have
been achieved: (followed by a list of end-of-project
milestones)
Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Outline in Developing a Management Project
Plan
• Project Components
– A project component is comprised of a set of
interrelated activities that contributes to the
attainment of at least one specific objective.
– Often, a person can be assigned to be responsible in
ensuring the attainment of the specific objective.
• Project Milestones
– Intervening events within each component to serve
as reference to the progress each component has
achieved as it moves closer to its completion.

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Outline in Developing a Management Project
Plan
• Project Activities
– These are activities that are critical to reaching
the milestones.
• Project Flowchart
– This depicts the flow of activities when
implemented from the start to the end of the
project as they pass through the different
milestones

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Outline in Developing a Management Project
Plan
• Project Activity-Resource Matrix
– A table showing all the critical requirements to
implement each activity
– In its minimum form, the matrix should contain
the following:
• In the first column, it shall contain the project activities
arranged and grouped together under each project
component
• Succeeding components should contain the duration of
the activity, human resource requirements and
financial requirements

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Outline in Developing a Management Project
Plan
• Project Monitoring Worksheet (PMW)
– This worksheet allocates the time, human
resource requirements and budget requirements
for each activity
• Project Budgeting Worksheet
– With a list of pre-determined budget expenditure
items, each activity is assessed on the amount it
needs for each of the expenditure item.

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Project Management Development Plan

• Title: Strengthening of the Dengue Control

Program in Municipality X
• Background:
– With the rise in the incidence of Dengue in
Municipality X, the local health service program
find itself unable to arrest its rise. Obstacles that
hindered its effectiveness and efficiency have
been identified. This project aims to minimize, if
not eliminate the obstacles.

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
 Project Management Development Plan
• Project Objective
– To strengthen STOP DENGUE Package of Services within 6 months.
• Specific Objectives
At the end of the project, the following conditions will be achieved:
1) All identified high risk families will be using bed nets when
sleeping.
2) Recruited health volunteers are distributing and advising families
on how to use the bed nets
3) The DOH and the NGO’s are actively engaged with the RHU in
promoting preventive measures
4) A MOA with the nearby military hospital has been signed to absorb
dengue patients that cannot be accomodated in public hospitals
5) Basic facts and list of preventive measures are broadcast in radio,
television and included in local newspaper
Project Management Development Plan
• Project Components and Milestones
– Procurement and distribution of bednets
• Approved allocation from disaster fund for purchasing
bednets
• Purchase order released
• Delivery of bednets accepted
• High risk families receive bednets
– Recruitment and orientation of health volunteers
• Health volunteers are recruited
• Health volunteers are oriented and given assigned barangays
• Health volunteers have distributed bednets and conducted
family preventive education
Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Project Management Development Plan
• Project Components and Milestones
– Establishing a joint dengue control task force consisting of the
RHU, DOH and NGO’s
• MOA establishing a Joint Dengue Control Task Force signed by LGU, DOH
and NGO’s
• Action plan for the next six months are agreed
– Linkage with local military hospitals
• MOA that will allow admission of Dengue cases is signed with the local
military hospital
– Tri-media dengue prevention campaign
• MOA with tri-media organizations to allow free time slots to broadcast
public messages and to publish in local newspapers on dengue prevention
• Press releases and broadcast clips are developed and disseminated

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
 Project Management Development Plan
• Project Milestones and Activities
– Approved allocation from disaster fund for purchasing bednets
• Request for allocation to come from the disaster fund
– Purchase order released
• Announcement and selection of bids for bednets
– Delivery of bednets accepted
• Delivery and inspection of the delivery of bednets
– High risk families receive bednets
• Identification, mapping and distribution of families considered with high risk of
acquiring dengue
– Health volunteers are recruited
• Announcement and recruitment of health volunteers
– Health volunteers are oriented and given assigned barangays
• Orientation and assigning of barangays to health volunteers
– Health volunteers have distributed bednets and conducted family
preventive education
• Deployment of health volunteers
Lifted from and Notes
Mr. R. Javier’s delivery of health
“Planning services
for Health to communities
Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
 Project Management Development
Plan
• Project Milestones and Activities (con’t)
– MOA establishing a Joint Dengue Control Task Force signed by LGU, DOH and NGO’s
• Request and conduct preliminary meetings with DOH and NGO’s
• Signing of MOA
– Action plan for the next six months are agreed and signed
• Formulate a single plan of action for the next 6 months
– MOA that will allow admission of Dengue cases is signed with the local military
hospital
• Request and conduct preliminary meetings with the local military hospitals
• Signing of MOA
– MOA with tri-media organizations to allow free time slots to broadcast public
messages and to publish in local newspapers on dengue prevention
• Request and conduct preliminary meetings with local tri-media organizations
• Signing of MOA
– Press releases and broadcast clips are developed and disseminated
• Develop broadcast clips and press releases

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Project Management Development Plan

Project Activity and Resources Worksheet

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Project Management Development Plan
Project Activity

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Project Monitoring Worksheet

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013
Proposed Project Budget

Lifted from Mr. R. Javier’s Notes “Planning for Health Programs and Projects”, HPAD 202,
UPM, SY 2012-2013