Health Planning

Dr. Amos Oyoko

Maseno University School of
Medicine
 Management cycle

– Planning
– Implementation
– Evaluation

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 Health planning
“The orderly process of defining 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”.
WHO

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 What is a Planning Cycle/Spiral ?
A continuous and cyclical process passing iteratively
through the following stages:

• Situation analysis
• Priority, goal and objective setting
• Option appraisal
• Programming
• Implementation and Monitoring
• Evaluation

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 The Planning Cycle
Situation Analysis,
Identifying problems

Evaluation Priority, goal, and objective setting

Implementation and
Monitoring Option appraisal

Programming

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 Health Planning

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 The Four Fundamental Questions
of the Planning Process
Where are we? Situation Analysis & priority setting
 

Where do we want to be? Objectives/Targets

How do we get there? Strategies/ Intervention /Activities

How do we know that we have Indicators/Sources of Information

got there?

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 Why Planning ?
• Provides direction in context of change
(demographic, technological/demand,
epidemiological, resource changes, migration,
social & political change)
• Dissatisfaction with current health situation
and/or allocation of resources
• Condition for resource allocation: choosing
between competing uses of inevitable limited
resources
• Linking objectives with actions and available
resources
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 Approaches to Planning
1. Problem-solving approaches versus longer term
needs-assessment
2. Structured logical framework versus looser
strategic directional approaches
3. Geographically focused plans versus
organizational plans (ex. County versus a
hospital)
4. Health versus health care/health sector plans
5. Health plans versus program plans versus project
plans (sector wide approaches)

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 Planning Systems Vary
• For example:
– 3/5 year health plan
– 5 year sector programme/SWAp program of work
– 5 year national development plan
– Poverty Reduction Strategy Papers (PRSP)
– Medium Term Expenditure Frameworks (MTEF) and
budget projections
– Annual workplans and budgets

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 Types of Plans
– Strategic vs. Operational Plan
– Project vs. Program Plan
– Investment vs. Operational Plan
– Human Resource vs. Financial Plan
– Macro- vs. Micro-plan
– Sectoral vs. multisectoral plan
– Health sector vs. Public health sector plan

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 TYPE OF AIM / SCOPE DURATION WHO PLANS
PLANNING

Normative or Definition of the general > 5 years Government

Political planning direction, global objectives and Central
mission statement Ministries

Strategic, Determination of orientations to 2-5 years Central

development follow, priorities in relation to Ministries
planning possibilities and resources Counties
Organisations

Tactical or Distribution of resources and 6 months – Counties

Operational activities in order to reach 1 year Sub-Counties
planning objectives Local level
Action Plan   Projects
Time schedule, responsibilities

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 Strategic choices facing the Public Health
Sector
Government
Funding Allocation between sectors

Economic
Education Defence Health Others
development

Curative Preventive Allocation within

Care Care
health sector
Allocation
Allocation
primary vs. Personal Public
Hospital Clinic
preventive health personal vs.
secondary
public health

Road Traffic
Other Pediatric Obstetric TB HIV/AIDS Polio
Accidents

Allocation between specialties Allocation between programs

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 Strategic Planning Tools
– Stakeholder analysis
– Problem tree analysis
– Logframe analysis
– Health Needs assessment
– Institutional and organizational assessment
– MTEF,
– Resource Allocation formulae
– Lobbying/advocacy, requiring communication
and negotiation

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 • What will make a project work?

• Fits within the country strategy

• Has a clear objective
• Technically sound (e.g. malaria, TB, alternatives)
• Economically sound (cost-benefit, cost-effectiveness)
• Project design not too ambitious! Clear!
• Fiscal impact and recurrent cost

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 • What will make a project work (2)?

 Institutional capacity (Who? How? Motivation?)

 Risk analysis
 Can I measure progress and relate it to my objectives?
Logical framework, indicators, monitoring system
 Project management team, organization
 Regular and thorough supervision

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How do we get started?
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 • SITUATION ANALYSIS
• Situation Analysis and Analysis of Context.
• Stakeholder Analysis (target groups, broader
stakeholders)
• Problem Analysis / Problem tree.
• Objectives Analysis.
• Analysis of alternatives; option appraisal.

• PROJECT DESIGN
• Specific Planning of Activities, inputs and resources. 
• Preparation of a Detailed Logical Framework.
• Implementation, resource and cost schedules
• Risk Analysis and analysis of Assumptions

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 LOGICAL FRAMEWORK MATRIX
Narrative Verifiable Means of Important
Summary Indicators Verification Assumptions
(OVI) (MOV)

GOAL

PURPOSE

OUTPUTS

ACTIVITIES Inputs
Cause-effect relationship among objectives at
several levels

Goal

Purpose

Outputs

under full control of

Activities
project management

Inputs beyond control of

project management
 Analysis of health situation:
The minimum essential requirement of health planning
includes:
1. The population its age and sex structure
2. Mortality and morbidity statistics
3. The Epidemiology and geographical distributions of diseases
4. Medical care facilities available such as hospitals, health centres
and other private and public health agencies.
5. The man power available
6. Training facilities available
7. Beliefs and attitude of people towards health, disease, its cure
and prevention.
The analysis of the above data brings out health problems,
needs and demands of the population.

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 SWOT analysis
• Strength- the positive internal attributes of an
organization
• Weaknesses- the negative internal attributes
of an organization
• Opportunities- external factors that could
improve the organization prospect
• Threats- external factors that could
undermine the organization prospect

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 Stakeholders analysis
• All those with an interest (stake), e.g.
– Community groups
– Health managers, volunteers, workers and policy
makers at different levels
– NGOs and Government sectors
– Unions and other professional org.
– Politicians and other leaders
– Private firms
– Donor agencies

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 Problem Analysis
• A set of techniques to:

• analyse the existing situation of the project environment

• identify the major problems in this context

• define the core problem of a situation

• visualise the cause-effect relationship in a diagram (Problem

Tree)

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 Problem (tree) Analysis
Important characteristics:

• The problem tree is a hypothetical model about cause and effect

relationships.

• If it is well constructed it is a very useful instrument for planning

as it allows you to identify all those problems which can be
tackled in the County action plan.

• The more detailed your causal analysis the better the planning
afterwards.

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Problem Tree Analysis
• Identify major problems within a given situation (brainstorming)
• Select a starter problem
• Look for related problems to the starter problem
• Establish hierarchy of cause and effects
• Problems which are directly causing the starter problem are put
below
• Problems which are direct effects of the starter problem are put
above
• Connect the problems with cause-effect arrows
• Review the diagram and verify its validity and completeness

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 Criteria priority setting (examples)
– Magnitude
– Severity
– Population in greatest need (equity)
– Perceived needs communities
– Feasibility to address problem
– Cost effectiveness

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Establishment of objectives and goals

 The goal should be realistic.

 It should be specific.
 Acceptability
 Easily measurable

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 Objectives, targets and goals
• Objective: It is a planned end point of all activities. It is
stated in term of measured amount of progress
towards goal.
• Targets: When the objective is split into discrete
activity it becomes target like number of sputum
smear collected or skilled deliveries conducted.
• Goal: An ultimate desired state towards which the
objectives and resources are directed. Goal is not
constrained by time, resources nor are they necessarily
attainable. They are formulated at top level and they
are generally broad for example ‘Health for all.

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 Assessment of resources
 Manpower
 Money
 Materials
 Skills and knowledge
 Technical needs

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 Fixing of Priorities
• Establish the priorities in the order of magnitude
of health problems
• Prioritization is based on financial constraint,
mortality and morbidity data, diseases which can
be prevented at low cost, political and
community interest
• Once priorities are established alternative plans
are formulated and assessed to determine
whether they are practicable feasible
• Alternate plan with greater effectiveness are
chosen.
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 Write-up formulated plan
• The plan should be complete in all aspect.
• The input required for the health programme
and the output expected
• Cost and time needed for each stage of
implementation of the health programme.
• Working guidance for all those involved in the
implementation of the health programme.
• It must contain a’ built in’ system of
evaluation
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Programming and implementation
 Assign and fix responsibilities
 Define roles and tasks
 Selection, training, motivation and supervision
 Organization and communication
 Efficiency of health institutions

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 Monitoring
• Continuous process of observing, recording
and reporting on the activities of the
organization or project
• Daily, weekly, monthly…. reports

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 Evaluation
• It is the final step of planning cycle. It should be both
concurrent and terminal.
• The purpose of evaluation is to assess the achievements of
stated objectives, its adequacy, efficiency and its
acceptance by the people.
• Evaluation measures the degree to which objectives and
targets are fulfilled and the quality of the results obtained.
• It measures the productivity of the available resource in
achieving measured output.
• Evaluation makes it possible the reallocation of priorities
and of resources on the basis of changing health needs.

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 Dictated by
• International Health policies
• National policies
• Local health need (Health Need Assessment)
• County Integrated Development Plans (CIDP)
• Man power
• Pressure
– Local
– National
– Political
Kenya National Health policy Goals
• Kenya Health Policy 2014-2030
Towards attaining the highest standard of
health.

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