National Health Policy and Plan
Unit II
Kunwar LB
Concept of Health Policy
• Health policy refers to decisions, plans, and actions that are
undertaken to achieve specific h...
Health Policy
• Health policy is a formal statement or
procedure within institutions (notably
government) which defines pr...
Health Policy
• Health policy is often considered in a narrow
sense, referring specifically to medical care issues
and the...
Health Policy
• The modern health policy in its broader sense
is striving towards a continual process of
improving the pop...
Evidence-based health policy
• Evidence-based health policy attempts to
maximize the use of empirical research,
evaluation...
Component of Health Policy
1. Policy content,
2. Policy process,
3. Policy context and
4. Policy actors.
Policy content
• Systemic – structure of the health system.
• Programmatic – set for interventions and
operational guideli...
Policy process
• Rational model : that the process of policy
formulation is rational & based on correct
information.
• Inc...
Policy context
1. Quality of technical analysis;
2. Amount of political stability and support;
3. Capacity, motivation and...
Policy Process
• Policy Formulation
• Policy Implementation
• Policy monitoring
Policy Actors
• The role of actors and their power
relationships, as policy-making often depends
more on political comprom...
Policy Cycle
Agenda
Setting
Policy
Formulation
Policy
Legitimation
Policy
Implementation
Policy
Evaluation
Policy
Terminat...
Health policies of Nepal
• First Long Term Health Plan 1975
• National Health Policy1991
• Second Long Term Health Plan, 1...
Health policies of Nepal
National Drug Policy 1995
National Medicines Policy 2007
Safe Motherhood Policy
National Poli...
Health policies of Nepal
• Health Care Technology Policy 2006
• Water Resource act 2049
• Nepal National Policy on Sanitat...
National Health Policy
National Health Policy
• The national health policy was adopted in 1991 ( FY 2048 BS)
to bring about improvement in the he...
The National Health policy addresses the following
areas.
• Preventive Health services
• Promotive Health Services
• Basic...
Current Five Year Plan in Health
Services
Five year plans of Nepal
• Documented and systematic planning is not available
before 1956 in Nepal. After Rana regime, th...
Plan Period (in AD)
The Pre plan period 1951 - 1956
First 5 year plan 1956 - 1961
Second 3 year plan 1962 - 1965
Third 5 y...
First 5 year plan (1956 – 1961)
• Establishment of Malaria eradication program 1958
• Establishment of MoH in 1956
• Const...
Second 3 year plan (1962 – 1965)
• Small fox survey in 1962
• Leprosy control 1964
• TB control in 1965
• 450 people were ...
Third 5 year Plan (1965 – 1970)
• Stress on establishment of vertical projects, i.e
Leprosy eradication projects, smallpox...
Fourth 5 year plan (1970 – 1970)
• Integrated Basic Health service was started in 1971
• Contemplation of First Long Term ...
Fifth 5 year plan (1975 – 1980)
The primary health objectives of the fifth plan was to raise life
expectancy through reduc...
Sixth 5 year plan (1980 – 1985)
Primary objectives of the sixth five year plan
incorporated similar health objectives of t...
Seventh 5 year Plan (1985 – 1990)
• The primary health objectives of the seventh five year
plan was to promote, physical, ...
Cont..
• Increased number of hospitals, hospital beds, health centers,
health posts and Ayurvedic Dispensaries.
• Give emp...
Eighth 5 year plan (1992 – 1997)
The primary health objective of the eighth plan was to
increase rural access to basic pri...
Cont..
• Target of establishing SHP, PHCC, Ayurvedic dispensaries,
reducing TFR, leprosy were set
• Launched polio drop se...
Ninth 5 year Plan (1997 – 2002)
The primary objectives of the ninth five year plan was
to ensure preventive, promotional, ...
Cont..
• Increased number of SHP and PHCC
• Essential Drug Lists were prepared for SHP, HP,
PHCC AND District hospitals.
•...
Tenth 5 year plan (2002 – 2007)
The primary objectives of tenth plan was to increase
services for poor and backward and ma...
Cont…
• Developed national capacity to produce human
resource in health sectors
• Started bottom – up planning
• Set the t...
Interim plan (2007 – 2010)
Bridge between 10th and 11th plan maximize
effort to attainment MDGs
• Provision of free servic...
12th third Year Plan (2010 -2013)
• Emphasis on quality health care service.
• Increase on access of quality health servic...
Overview of Health Planning process in
Nepal
Introduction
• National Planning Commission (NPC) is the apex body for
formulating development plans and policies of the c...
Cont..
1. The Cabinet
2. The National Development Council which is sometimes
referred to as "Development Parliament" (NDC)...
Development plans are prepared for fix period
1. Long term plan (10-20 years)
• based on longer-term growth prospects with...
3. Annual Plan
• Operational/ strategic plan
• Effective guides to action, output and expenditures
must be determined for ...
National Planning Commission
(Final recommendation for budgetary allocation)
Line agencies/ministries
Recommendation for b...
• DOHS get the budget from MOHP and goes in NPC in first
Kartika than goes to lower health organization.
• current plannin...
Macro level Planning process of central level
planning
• National Planning Commission (NPC) is the apex body for
formulati...
Cont..
• Sectorial chapters lay the basic foundation of the
plan’s objectives and sectorial targets
• A draft Approach Pap...
Micro level planning process of central level
planning
• Basic sectorial planning process is undertaken by the
respective ...
Types of Health Planning
Health Planning
• Health planning is process of deciding in advance
what health services are to be delivered in order to
a...
Characteristics of Planning
• Planning is a process
• Planning is future oriented
• Planning is pervasive. It is a functio...
TYPES OF HEALTH PLANNING
Health planning includes several specific, often connected,
types of planning:
1. Health services...
1. Health Service Planning
• Health services planning relates to the planning in a
specific type of service or sector- mat...
Cont..
• The Task Forces’ work is a strategic planning
exercise that produced several options for
system design and implem...
2. Health System Planning
• In every nation, a recognized goal of government will
form an efficient and well-organized hea...
Cont..
• A well-organized and functioning system of health
services is like the connectivity of the human body
system. Bot...
Cont..
• A health system cannot be achieved via a one-time
organization of providers. It is necessary to establish
mechani...
3. Health Goals Planning
• National government is responsible for identifying
the goal of the health sector of a country.
...
4. Population Health Planning
• The World Health Organization’s definition of
health is relevant to all health planning, b...
Steps In Health planning
1. Analysis of Health Situation.
2. Establishment of objectives and goals
3. Assessment of resour...
1. Analysis of health situation
• It involves the collection, assessment and
interpretation of information in such a way a...
Cont…
V. Technical manpower of various categories
VI. Attitude and beliefs of the population towards
diseases.
2. Establishment of objectives and goals
• Objectives and goals are guide the effort, with out
objectives established, the...
• The term resources implies the manpower,
money, materials, skills, knowledge and
techniques needed or available for the
...
4. Fixing Priorities
• Community and political interest
• Financial constraints
• Mortality and morbidity data, diseases w...
5. Write – up formulated plan
• The next major step in the planning process is
the preparation of the detailed plan or pla...
6. Programming and Implementation
• Once the health plan has been selected and approved
by the policy making authorities, ...
Cont..
• The main considerations at the implementation stage
include:
a) Definition of roles and tasks
b) The selection, t...
7. Monitoring
• Monitoring is the day to day follow up activities during
their implementation to insure that they are proc...
8. Evaluation
• The purpose of evaluation is to assess the achievement of the stated
objectives of a programme, its adequa...
Program Planning
Introduction
• Program planning is a multi-step process that
generally begins with the definition of the problem and
devel...
Terminology in Health Planning
1. Objective: Is planned end point of all activities
 Is precise
 Is concerned with the p...
3. Goal: Ultimate desired state towards which objectives and
resources are directed
 Is constrained by time or existing r...
Planning in Health Sector
• Planning is a future oriented process of setting
goals/objectives/target and choosing the best...
Types of Planning
There are various type of plans the types of plan depend on
the complexity of operations and nature of o...
Pre Planning
Pre planning is preparation for planning, the important
preconditions are:
1. Government Interest
2. Legislat...
1. Government Interest:
Any plan for the health and welfare of a country must
be based on a strong “political will” as man...
3. Organization for Planning:
There should be an organizational structure for the
preparation of the various parts of the ...
Importance and Purpose of Health Planning
• Planning provides a roadmap to achieve the goal or to
reach destination.
• Pla...
Purpose of Planning is :
• To match the limited resources with many problems
• To eliminate wasteful expenditure or duplic...
STEPS IN PLANNING PROCESS
1. Stating the mission, or purpose of the
organization/programme,
2. Analyzing the external envi...
Problem Solving
What is problem solving
• Problem solving is a mental process and is part of the
larger problem process that includes prob...
Characteristics of difficult problems
Difficult problems have some typical characteristics that
can be summarized as follo...
Cont..
3. Complexity (large numbers of items, interrelations
and decisions)
• Innumerability
• Connectivity (hierarchy rel...
Basic Guidelines to Problem solving and Decision
Making
There are many approaches to problem solving on the
nature of the ...
1. Define the problem
• Defining the problem means writing down a short
description of the problem in terms “of the follow...
2. Look at potential causes for the problem
• Find out the potential cause of problem
through talk with the those people w...
3. Identify alternatives for approaches to resolve the
problem
• Brainstrom for solutions to the problem
• Through brainst...
4. Select an approach to resolve the problem
When selecting the best approach, consider:
• Which approach is the most like...
5. Plan the Implementation of the best alternative
(This is your action plan)
• Carefully consider “ what will the situati...
Cont..
• What resources will you need in terms of people,
money and facilities?
• How much time will you need to implement...
6. Monitor implementation of the plan
Monitor the indicators of success:
• Are you seeing what you would expect from the
i...
7. Verify if the problem has been resolved or not
One of the best way to verify if a problem has been
solved or not is to ...
Cont…
• Lastly consider “what did you learn from this
problem solving ?” consider new knowledge,
understanding and/or skil...
Decentralization Policy
Basic concepts and Difinations
WHO
Decentralization is transfer of authority or dispersal
of public planning, management ...
Cont..
World Bank
Transfer of authority and responsibility for public
functions from the central government to subordinat...
Cont..
• Decentralizations restructuring of authority so that
there is a system of co-responsibility between
institutions ...
Rational
Improve efficiency? allocative and production
efficiency
Improve equity?
Improve quality of care?
Improve fin...
Types of decentralization
1. Political
2. Fiscal
3. Market
4. Administrative
 De-concentration  Delegation
 Devolution ...
Administrative Decentralization
• “is the transfer of responsibility for planning,
financing, and managing certain public
...
Deconcentration - shifting power from the central
offices to peripheral offices of the same administrative
structure e.g....
Delegation - shifts responsibility and
authority to semi-autonomous
organizations;
Salient features
o Functions are shif...
Administrative Decentralization
Devolution – transfer of functions or decision making authority
to legally incorporated l...
Decentralization in Nepal
• Decentralization and local self-governance have been made
operational in Nepal since the 1960s...
Cont…
• This Act recognized the role of local self governance and
devolution of authority and responsibility to make local...
National Health Policy and Plan
National Health Policy and Plan
National Health Policy and Plan
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National Health Policy and Plan

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  • 1. National Health Policy and Plan Unit II Kunwar LB
  • 2. Concept of Health Policy • Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. • An explicit health policy can achieve several things: it defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. • It outlines priorities and the expected roles of different groups; and it builds consensus and informs people.
  • 3. Health Policy • Health policy is a formal statement or procedure within institutions (notably government) which defines priorities and the parameters for action in response to health needs, available resources and other political pressures. • One of the key functions of public health professionals is to influence and shape policy decision at all levels for the benefit of the population.
  • 4. Health Policy • Health policy is often considered in a narrow sense, referring specifically to medical care issues and the organization of health care services. • However, health is influenced by a broad range of policy decisions, not just those in the medical or health field. • A true health policy should therefore provide a framework for health-promoting actions covering the social, economic, and environmental determinants of health.
  • 5. Health Policy • The modern health policy in its broader sense is striving towards a continual process of improving the population health. • It represents the formal statements or procedures within the government and institutions by which the priorities and action parameters are defined as response to health needs, available resources, and various political pressures.
  • 6. Evidence-based health policy • Evidence-based health policy attempts to maximize the use of empirical research, evaluation, and structured analysis as key inputs into the policymaking process.
  • 7. Component of Health Policy 1. Policy content, 2. Policy process, 3. Policy context and 4. Policy actors.
  • 8. Policy content • Systemic – structure of the health system. • Programmatic – set for interventions and operational guidelines for service delivery • Organizational - structure of institutions responsible for policy implementation. • Instrumental - generating information to enhance the functioning of the health system.
  • 9. Policy process • Rational model : that the process of policy formulation is rational & based on correct information. • Incrementalist model : that the policy process is more incremental, consists of slow bargaining between different interest groups to select priorities • Mixed scanning model: broad review of the policy field without engaging in the detailed exploration of options as suggested by the rational model. • Punctuated equilibria model: which has recently been applied to priority setting in the international health policy arena.
  • 10. Policy context 1. Quality of technical analysis; 2. Amount of political stability and support; 3. Capacity, motivation and support of the bureaucracy; 4. the nature of culture and civil society 5. And the influence of international actors.
  • 11. Policy Process • Policy Formulation • Policy Implementation • Policy monitoring
  • 12. Policy Actors • The role of actors and their power relationships, as policy-making often depends more on political compromise than on rational debate (stakeholder or political mapping can be useful in detailing these power structures, and helps illuminate actors’ agendas).
  • 13. Policy Cycle Agenda Setting Policy Formulation Policy Legitimation Policy Implementation Policy Evaluation Policy Terminate or Change
  • 14. Health policies of Nepal • First Long Term Health Plan 1975 • National Health Policy1991 • Second Long Term Health Plan, 1997-2017 • Strategic Analysis to Operationalize SLTHP (2000) • Local Self-Governance Act, 2055 (1999) • Tenth Plan Poverty Reduction Strategic Paper (2002-07) • Three Year Interim Plan (2064/65-2066/67) • Free Health Care policy 2007 • National Ayurveda Health Policy 2052(1996)
  • 15. Health policies of Nepal National Drug Policy 1995 National Medicines Policy 2007 Safe Motherhood Policy National Policy on Safe birth Attendance National Safe Abortion Policy 2003 Vital Registration Act 2033 National Oral Health Policy Mental Health (Treatment and Protection) Act 2006 Policy on Quality Assurance in Health Care Services 2064
  • 16. Health policies of Nepal • Health Care Technology Policy 2006 • Water Resource act 2049 • Nepal National Policy on Sanitation • National Policy on Rural Water Supply and Sanitation 2004 • Policy on NGO participation in WATSAN Program1996 • Natural Disaster Management Act • Natural Calamity (relief) act 1982 • National Blood Policy 2050(1993) • National Health Research Policy
  • 17. National Health Policy
  • 18. National Health Policy • The national health policy was adopted in 1991 ( FY 2048 BS) to bring about improvement in the health status of the people of Nepal. • The primary objective of the National Health Policy id to extend the primary health care system to the rural population so that the people get benefited from modern medical facilities and trained health care providers
  • 19. The National Health policy addresses the following areas. • Preventive Health services • Promotive Health Services • Basic Primary Health Services • Ayurvedic and Traditional Health Service • Organization and Management • Community Participation in Health service • Human resource for Health development • Resource Mobilization in Health service • Private Non Government Health services and Intersectoral Coordination • Decentralization and Regionalization • Blood Transfusion Services • Drug Supply
  • 20. Current Five Year Plan in Health Services
  • 21. Five year plans of Nepal • Documented and systematic planning is not available before 1956 in Nepal. After Rana regime, the democratic government started to develop and implement medium term plan obviously for 5 year duration.
  • 22. Plan Period (in AD) The Pre plan period 1951 - 1956 First 5 year plan 1956 - 1961 Second 3 year plan 1962 - 1965 Third 5 year plan period 1965 - 1970 Fourth 5 year plan 1970 - 1975 Fifth 5 year plan 1975 - 1980 Sixth 5 year plan 1980 - 1985 Seventh 5 year plan 1985 - 1990 Eight 5 year plan 1992 - 1997 Ninth 5 year plan 1997 - 2002 Tenth 5 year plan 2002 - 2007 Eleventh 3 year interim Plan 2007 - 2010 Twelfth 3 year Interim Plan 2010 -2013 Thirteenth 3 year Interim plan 2013 - 2016
  • 23. First 5 year plan (1956 – 1961) • Establishment of Malaria eradication program 1958 • Establishment of MoH in 1956 • Construction of first maternal hospital in 1959 • Production of nurses.
  • 24. Second 3 year plan (1962 – 1965) • Small fox survey in 1962 • Leprosy control 1964 • TB control in 1965 • 450 people were vaccinated against smallpox in Kathmandu • 3 hospitals and 8 health centers were added.
  • 25. Third 5 year Plan (1965 – 1970) • Stress on establishment of vertical projects, i.e Leprosy eradication projects, smallpox eradication project 1967, FP/MCH project1968 • Establishment of Central Health Laboratory in 1967.
  • 26. Fourth 5 year plan (1970 – 1970) • Integrated Basic Health service was started in 1971 • Contemplation of First Long Term Health Plan • Community Health and Integrated Division under MoH was set up • Maternal Child Health Programme was initiated around fiscal year 1973/74
  • 27. Fifth 5 year plan (1975 – 1980) The primary health objectives of the fifth plan was to raise life expectancy through reduction in death rates, maintain regional balance in the provision of health services and control population. • Integration of Vertical programmes in to health infrastructure • Nepal Signed the Alma – Ata declaration in 1978 • Adopted PHC strategy for achieving Health for All 2000
  • 28. Sixth 5 year plan (1980 – 1985) Primary objectives of the sixth five year plan incorporated similar health objectives of the fifth plan, including for the reduction of people suffering malnutrition and creation of healthy environment through promotion of clean drinking water and sanitation. • COMBINA (Child spacing, Oral rehydration, Maternal health, Breast feeding, Immunization, Nutrition) was mooted • Stressed on increasing food supply and provision of clear drinking water.
  • 29. Seventh 5 year Plan (1985 – 1990) • The primary health objectives of the seventh five year plan was to promote, physical, mental and community health of general public and to prepare healthy manpower to provide maximum number of people with basic health services and to reduce the death rate, increase longevity through promotional, preventive and curative health services, population control and extending maternity and child services.
  • 30. Cont.. • Increased number of hospitals, hospital beds, health centers, health posts and Ayurvedic Dispensaries. • Give emphasis on Basic Minimum Health Need to achieve HFA by 2000 • National Health Information System has been functioning 1988 • Guidelines was formulated for established Health Post (walking distance, population, accessibility) • Five regional health directorates of health services were established .
  • 31. Eighth 5 year plan (1992 – 1997) The primary health objective of the eighth plan was to increase rural access to basic primary health and doctor’s service to rural population, effective implementation of population control through mother child health and family planning service and development of specialized services within the country.
  • 32. Cont.. • Target of establishing SHP, PHCC, Ayurvedic dispensaries, reducing TFR, leprosy were set • Launched polio drop services since 1996/97 for 0-5 years children • Implemented DOTS strategy in 10 districts to reduce morbidity and mortality of TB • Leprosy Control Programme was expanded nationwide while target was to expand in 71 districts from 56 districts • Integration of DPHO and District hospital under DHO
  • 33. Ninth 5 year Plan (1997 – 2002) The primary objectives of the ninth five year plan was to ensure preventive, promotional, curative and rehabilitating health and family planning services as a part of human right to bring about a perceivable improvement in health status
  • 34. Cont.. • Increased number of SHP and PHCC • Essential Drug Lists were prepared for SHP, HP, PHCC AND District hospitals. • Reproductive Health Clinical Protocol was prepared • Concept of PPP (Public private partnership) was emphasized • Human Organ Transplantation Act 1998 was prepared.
  • 35. Tenth 5 year plan (2002 – 2007) The primary objectives of tenth plan was to increase services for poor and backward and marginalized community and people • It is Nepal’s poverty Reduction Strategy Paper(PRSP) • Following the Local self government Act 1999, started to handover SHP, HP AND PHCC to local budies
  • 36. Cont… • Developed national capacity to produce human resource in health sectors • Started bottom – up planning • Set the targets and meet most of the targets
  • 37. Interim plan (2007 – 2010) Bridge between 10th and 11th plan maximize effort to attainment MDGs • Provision of free services in peripheral levels • Provision of free obstetrical services.. • Aama Surkshya Program
  • 38. 12th third Year Plan (2010 -2013) • Emphasis on quality health care service. • Increase on access of quality health service. Strategy • Strengthening the human resource, construction and reconstruction of health infrastructure. • For control of Malnutrition, multisectoral nutritional policy has been launched. For detail follow the page no. 193 to onwards
  • 39. Overview of Health Planning process in Nepal
  • 40. Introduction • National Planning Commission (NPC) is the apex body for formulating development plans and policies of the country under the directives of the National Development Council (NDC) • Planning functions at the central level are widely scattered over a number of institutions. At least, five institutions/agencies are directly involved in the planning process
  • 41. Cont.. 1. The Cabinet 2. The National Development Council which is sometimes referred to as "Development Parliament" (NDC) 3. The National Planning Commission (NPC) 4. Development Ministries, and 5. Departments and the Regional/Zonal Offices of Ministries Each of these institutions does play a varying role at different stages of the planning process.
  • 42. Development plans are prepared for fix period 1. Long term plan (10-20 years) • based on longer-term growth prospects with general targets based on only rough approximations of the likely supply of, and the demand for, resources 2. Medium term plans • A medium term plan-a five-year plan in the context of Nepal indicates total investment and investment by sectors for the entire plan period and the targets to be achieved at the end of the plan period
  • 43. 3. Annual Plan • Operational/ strategic plan • Effective guides to action, output and expenditures must be determined for each year. • Based on medium-term plan objectives and programs for implementation
  • 44. National Planning Commission (Final recommendation for budgetary allocation) Line agencies/ministries Recommendation for budget District Council Prioritization coordination, integration, fund allocation, forwarding Ilika Planning workshop Coordination between projects, integration, and prioritization Settlement Need Collection VDC Council VDC Plans, prioritized project, resource allocation Top- down Process Ministry of Finance Resource allocation INGOs/Donor agencies Resource allocation Fig: Health Planning Process of Nepal
  • 45. • DOHS get the budget from MOHP and goes in NPC in first Kartika than goes to lower health organization. • current planning system of Nepal is started from SHP by organizing VDC meeting and detect the required material then send to PHC/HP and it conduct the same meeting and make annual plan send to include HP plan and send to the district level and make annual plans • This plan has to be approved in the district community meeting before the plan is sent to region by the end of 30th Falgun. • Then region collect the report and make annual plan sent to center on 15th of Baishaka in the one way planning take place
  • 46. Macro level Planning process of central level planning • National Planning Commission (NPC) is the apex body for formulating development plans under the direction of the National development council • NPC prepares the draft of Approach Paper for the forthcoming development plan • Initially, the main objective and targets are determined for the plan period • Financial plan is prepared • Preparation of sector planning, the principal outputs of sector planning the sectorial chapter in the five year plan or may be Interim Plan
  • 47. Cont.. • Sectorial chapters lay the basic foundation of the plan’s objectives and sectorial targets • A draft Approach Paper prepared and presented to the NDC for suggestions. • NPC revise the Approach Paper according to the suggestions given by the NDC • The detailed plan document is prepared based on the Approach Paper
  • 48. Micro level planning process of central level planning • Basic sectorial planning process is undertaken by the respective development related ministry based on the plan document • NPC’s various sectorial taskforces review the plan and present sectorial report • After the preparation of the detailed plan document, it is put forward to the cabinet for its approval • The plan is executed after the Cabinet approval
  • 49. Types of Health Planning
  • 50. Health Planning • Health planning is process of deciding in advance what health services are to be delivered in order to achieve the greater health goals. • Planning in health sectors from DoHS to SHP
  • 51. Characteristics of Planning • Planning is a process • Planning is future oriented • Planning is pervasive. It is a function of every manager. Its nature and scope differ according to the level of managers • Goal – focused: Planning not only sets goals but also selects actions to achieve them. • Decision – oriented: planning involves decisions at all level, of management. Decisions in respect of objectives, activities and resources are prime concern of planning. • Efficiency – Oriented: Planning is directed toward efficiency at all level of management. Efficiency means greater output at lower cost, doing thing right.
  • 52. TYPES OF HEALTH PLANNING Health planning includes several specific, often connected, types of planning: 1. Health services planning 2. Health system planning 3. Health goals planning 4. Population health planning
  • 53. 1. Health Service Planning • Health services planning relates to the planning in a specific type of service or sector- maternal health service delivery for example. • This type of planning can be undertaken by government or devolved (delegated) to providers. • The Task Forces Groups formed by DoHS are a good example of taking a specific sectoral approach to service planning.
  • 54. Cont.. • The Task Forces’ work is a strategic planning exercise that produced several options for system design and implementation approaches. • This planning may be an output of the strategic directions of the organization, but is usually considered as program or operational planning.
  • 55. 2. Health System Planning • In every nation, a recognized goal of government will form an efficient and well-organized health system. • The system itself is usually planned at national government level, and by such Department of health services. Health “system” implies:  Client access to a range of appropriate, and appropriately connected/integrated, services  Operational efficiency and a sustainable operation.
  • 56. Cont.. • A well-organized and functioning system of health services is like the connectivity of the human body system. Both require:  Command centers  A supportive contextual infrastructure and  A series of linked and inter-supporting activities. There are two essential phases of health systems planning:  The design and system development phase  Implementation of the system management and operations components.
  • 57. Cont.. • A health system cannot be achieved via a one-time organization of providers. It is necessary to establish mechanisms for the ongoing running and adjustments of the system. • A health system planning has the most potential for payoff in improved health because it can include both health services and population health within its strategic directions.
  • 58. 3. Health Goals Planning • National government is responsible for identifying the goal of the health sector of a country. • The health sector goal of a country is based on the health status and existing health problems which a government wants to achieve through its long term plan.
  • 59. 4. Population Health Planning • The World Health Organization’s definition of health is relevant to all health planning, but particularly underlines the population health approach.
  • 60. Steps In Health planning 1. Analysis of Health Situation. 2. Establishment of objectives and goals 3. Assessment of resources 4. Fixing priorities 5. Write of formulated plan 6. Programming and implementation 7. Monitoring 8. Evaluation
  • 61. 1. Analysis of health situation • It involves the collection, assessment and interpretation of information in such a way as to provide clear picture of health situation. • In this step generally following items of data are analysis: i. Population, its age and 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
  • 62. Cont… V. Technical manpower of various categories VI. Attitude and beliefs of the population towards diseases.
  • 63. 2. Establishment of objectives and goals • Objectives and goals are guide the effort, with out objectives established, there is likely to be haphazard activity. • Objectives not only for the guide to action it also measure work after it is done. • Objectives should be established according to need of people.
  • 64. • The term resources implies the manpower, money, materials, skills, knowledge and techniques needed or available for the implementation of the health program. • Resources should be assessed and a balance is struck between what is required and what is available or likely to be available in terms of resources. 3. Assessment of resources
  • 65. 4. Fixing Priorities • Community and political interest • Financial constraints • Mortality and morbidity data, diseases which can be prevented at low cost.  Once priorities have been established ALTERNATIVE PLANS for achieving them are also formulated and assessed in order to determine whether they are practicable and fasible.
  • 66. 5. Write – up formulated plan • The next major step in the planning process is the preparation of the detailed plan or plans. • Plan must be complete in all respects for the execution of a project, the resource (inputs) required are related to the results (outputs) expected. • Each stage of plan is defined and costed and the time needed to implement is specified. • The plan must contain working guidance to all those responsible for execution.
  • 67. 6. Programming and Implementation • Once the health plan has been selected and approved by the policy making authorities, programming and implementation are begun. • Plan execution depends upon the existence of effective organization. • The organizational structure must incorporate well defined procedures to be followed and sufficient delegation of authority to and fixation of responsibility of different workers for achieving the predetermined goal, objectives.
  • 68. Cont.. • The main considerations at the implementation stage include: a) Definition of roles and tasks b) The selection, training, motivation and supervision of the manpower involved c) Organization and communication d) The efficiency of individual institution such as hospitals or health centers.
  • 69. 7. Monitoring • Monitoring is the day to day follow up activities during their implementation to insure that they are proceeding as planed 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 if excessive deviations occur.
  • 70. 8. Evaluation • 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. • Evaluation measures the degree to which objectives and targets are fulfilled and the quality of the results obtained . • It measures the productivity of available resources in achieving clearly – defined objectives. • It measures how much out put or cost effectiveness is achieved. • It makes possible the reallocation of priorities and of resources on the basis of changing health needs.
  • 71. Program Planning
  • 72. Introduction • Program planning is a multi-step process that generally begins with the definition of the problem and development of an evaluation plan. Although specific steps may vary, they usually include a feedback loop, with findings from program evaluation being used for program improvement.
  • 73. Terminology in Health Planning 1. Objective: Is planned end point of all activities  Is precise  Is concerned with the problem itself 2. Target: Permits the concept of degree of achievement, so it often refers to a discrete activity such as the number. 3. Goal: is defined as the ultimate desired state towards which objectives and resources are directed. • To known whether the goal is accomplished or not various objectives and targets are formulated and accomplishment of such objectives and targets signals accomplishment of the goal.
  • 74. 3. Goal: Ultimate desired state towards which objectives and resources are directed  Is constrained by time or existing resources  Is necessarily attainable 4. Mission: is a description of fundamental principle of existence of a programme  Is usually not time bound  Is a statement of purpose 5. Impact : is an expression of the positive effect of a program, service or institution on the overall health development and on related social and economic development
  • 75. Planning in Health Sector • Planning is a future oriented process of setting goals/objectives/target and choosing the best way to achieve these goals • In Planning we decide Objectives and then we decide the Activities to be executed and then resources which are used during execution to obtain the objectives.
  • 76. Types of Planning There are various type of plans the types of plan depend on the complexity of operations and nature of organizations According to managerial hierarchy: 1. Long term plans 2. Medium term plans 3. Short term Plans According to use: 1. Single use plans 2. Standing use plans
  • 77. Pre Planning Pre planning is preparation for planning, the important preconditions are: 1. Government Interest 2. Legislation 3. Organization for Planning 4. Administrative Capacity
  • 78. 1. Government Interest: Any plan for the health and welfare of a country must be based on a strong “political will” as manifested by clear directives or policies given the political authority. 2. Legislation: The social and health policies formulated may have to be translated in to legislation as an example may be cited the enactment of the medical termination.
  • 79. 3. Organization for Planning: There should be an organizational structure for the preparation of the various parts of the plan. 4. Administrative Capacity: One of the essential pre conditions of planning is administrative capacity for proper coordination of activities and implementation of the plan at all levels.
  • 80. Importance and Purpose of Health Planning • Planning provides a roadmap to achieve the goal or to reach destination. • Planning provides chronological orders of different activities, assigns different jobs and duties • Planning help us to spend resources efficiently. Resources are limited in nature in developing countries like Nepal, we have to achieve lots of objectives and on other hand we have scarcity of resource also.
  • 81. 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 accomplish a defined objectives.
  • 82. STEPS IN PLANNING PROCESS 1. Stating the mission, or purpose of the organization/programme, 2. Analyzing the external environment, 3. Assessing internal strengths and weaknesses and external opportunities and threats (SWOT analysis), 4. Establishing goals, 5. Selecting activities for each objective; developing detailed work plans, 6. Preparing a financial plan, 7. Introducing a monitoring and control system.
  • 83. Problem Solving
  • 84. What is problem solving • Problem solving is a mental process and is part of the larger problem process that includes problem finding and problem shaping. • Problem solving occurs when an organism or an artificial intelligence system needs to move from a given state to a desired goal state.
  • 85. Characteristics of difficult problems Difficult problems have some typical characteristics that can be summarized as follows: 1. Intransparency • Commencement opacity • Continuation opacity 2. Multiple goals • Opposition • Temporary
  • 86. Cont.. 3. Complexity (large numbers of items, interrelations and decisions) • Innumerability • Connectivity (hierarchy relation, communication relation, allocation relation) • Heterogeneity 4. Time considerations • Temporal constraints • Phase effects • Dynamics unpredictability
  • 87. Basic Guidelines to Problem solving and Decision Making There are many approaches to problem solving on the nature of the problem and the people involved in the problem. 1. Define the problem 2. Look at potential causes for the problem 3. Identify alternatives for approaches to resolve the problem 4. Select an approach to resolve the problem 5. Plan the implementation of the plan 6. Verify if the problem has been resolved or not
  • 88. 1. Define the problem • Defining the problem means writing down a short description of the problem in terms “of the following happening” writing such requires answers of some questions like: a. What can you see that causes you to think there’s a problem b. Where is it happening c. How is it happening d. With whom is it happening e. Why is it happening • Verifying your understanding of the problem • Prioritize the problems • Understand your role in the problem.
  • 89. 2. Look at potential causes for the problem • Find out the potential cause of problem through talk with the those people who are effected by it and who notice the problem closely. • Write down a description of the cause of the problem and in terms of what is happening, where, when, how, with, whom, and why.
  • 90. 3. Identify alternatives for approaches to resolve the problem • Brainstrom for solutions to the problem • Through brainstorming collect the ideas as much as possible. • Then Screening them to find the best idea.
  • 91. 4. Select an approach to resolve the problem When selecting the best approach, consider: • Which approach is the most likely to resolve the problem for the long term? • Which approach is the most realistic to accomplish for now ? Do you have resources? Are they affordable ? Do you have enough time to implement the approach? • What is the extent of risk associated with each alternative?
  • 92. 5. Plan the Implementation of the best alternative (This is your action plan) • Carefully consider “ what will the situation look like when the problem is solved ?” • What steps should be taken to implement the best alternative to solving the problem? What systems or process should be changed in your organization, e.g. a new policy or procedure? Don’t resort to solutions where someone is “just going to try harder”. • How will you know if the steps are being followed or not ? (these are your indicators of the success of your plan)
  • 93. Cont.. • What resources will you need in terms of people, money and facilities? • How much time will you need to implement the solution? Write a schedule that includes the start and stop times. • Who will primarily be responsible for ensuring implementation of the plan? • Communicate the plan to those who will be involved in implementing it and, at least, to your immediate supervisor. •
  • 94. 6. Monitor implementation of the plan Monitor the indicators of success: • Are you seeing what you would expect from the indicators • Will the plan be done according to schedule? • If the plan is not being followed as expected, then consider: Was the plan realistic? Are these plan sufficient resources to accomplish the plan on schedule? Should the plan be changed?
  • 95. 7. Verify if the problem has been resolved or not One of the best way to verify if a problem has been solved or not is to resume normal operations in the organizations. Still, following things should consider: • What changes should be made to avoid this type of problem in the future? Consider changes to polices and procedures, training, etc.
  • 96. Cont… • Lastly consider “what did you learn from this problem solving ?” consider new knowledge, understanding and/or skills. • Consider writing a brief memo that highlights the success of the problem solving effort, and what you learned as a result. Share it with your supervisor, peers and subordinates.
  • 97. Decentralization Policy
  • 98. Basic concepts and Difinations WHO Decentralization is transfer of authority or dispersal of public planning, management and decision making from the national level to sub-national levels [1990] Promotion of primary health care was seen as incompatible with centralized systems of health care
  • 99. Cont.. World Bank Transfer of authority and responsibility for public functions from the central government to subordinate or quasi-independent government organizations and/or the private sector
  • 100. Cont.. • Decentralizations restructuring of authority so that there is a system of co-responsibility between institutions of governance at the central, regional and local levels according to the principle of solidarity, thus increasing the overall quality and effectiveness of the systems of governance, while increasing the authority and capabilities of sub-national levels.“ UNDP
  • 101. Rational Improve efficiency? allocative and production efficiency Improve equity? Improve quality of care? Improve financial soundness? Improve local accountability
  • 102. Types of decentralization 1. Political 2. Fiscal 3. Market 4. Administrative  De-concentration  Delegation  Devolution  Privatization
  • 103. Administrative Decentralization • “is the transfer of responsibility for planning, financing, and managing certain public functions from the central government to lower levels” (Rondinelli 1999).
  • 104. Deconcentration - shifting power from the central offices to peripheral offices of the same administrative structure e.g. provincial department of health and its district offices o Functional: field officers are directly linked and controlled from centre; o Prefectoral: there is a layer [PREFECT] in between – commissioner or governor; Salient features  Shifting of power from the same structure;  Semi-autonomy to field officers in routine decision making;  Some planning functions according to central guidelines; Administrative Decentralization
  • 105. Delegation - shifts responsibility and authority to semi-autonomous organizations; Salient features o Functions are shifted to regions or functional bodies or special project units; o Independent from central government rules and regulations in personnel, recruitment, budgeting and procurement; o Examples: Social security institutions, separate regulatory commission or accreditation commissions; Administrative Decentralization
  • 106. Administrative Decentralization Devolution – transfer of functions or decision making authority to legally incorporated local governments such as states, provinces..etc ( Collins 1994); Shifts responsibility and authority from the central offices (MoH) to separate administrative structures still within public administration ( Bossert 1995) • Responsibilities for services to local government • Local governments elect their own representatives • Raise their own revenues and • Independent authority to make investment decisions
  • 107. Decentralization in Nepal • Decentralization and local self-governance have been made operational in Nepal since the 1960s. • In 1987, the centre (MoH) underwent change and as a result— Regional Health Directorates were established in five development regions in Nepal • In 1999, Nepal enacted a Local Self-Government Act (LSGA) • This Act, whose monitoring committee was chaired by the Prime Minister, laid the foundation for establishing a local self-governance system adopting a broad-based and cross- sectoral approach.
  • 108. Cont… • This Act recognized the role of local self governance and devolution of authority and responsibility to make local authorities more responsive and accountable to people. • The rationale for this Act was both philosophical and practical and involved legislation, institutional provision, resources (both financial and human) mobilization and considerations, i.e. autonomy and equality

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