Healthcare Planning

and Management

Prof.HSC

Planning is for tomorrow

Purpose of planning :

• To match limited resources with many problems.

• To eliminate wasteful expenditure.

• To develop best course of action to accomplish an objective.

Planning includes 3 steps:

1. Plan formulation

2. Execution

3. evaluation

• Health planning: It is the process of defining community health problems, identifying unmet needs, surveying the resources to meet them, establishing priority goals that are feasible and projecting administrative action to accomplish the purpose of proposed programme.

• Resources : manpower, money, material, time, skills

• Objective :It is planned end point of all activities and is concerned with the problem itself.

• Target : is discreet activity. It is degree of achievement .Ex. No. of blood films, no. of vasectomies.

• Goal : ultimate desired state towards which objectives and resources are directed.

Goal is described in terms of

• What is to be attained

• Extent to which it is to be obtained

• Population involved

• Geographical area

• Length of time required for attaining the goal

• Plan: is a blue print for taking action.

It has 5 elements

1. Objective

2. Policy : guiding principles stated as an expectation.

3. Programme: sequence of activities

4. Schedule : is time sequence for work to be done.

5. budget

Planning cycleAnalysis of

health situation

Objectives and goals

Assessment of resources

priorities

Formulate plan

Programming and implementation

Monitoring

Evaluation

• Planning cycle

1. Analysis of health situation

2. Establishment of objectives and goals

3. Assessment of resources

4. Fixing priorities – meet unmet needs

5. Write up formulated plan – each stage is defined, costed ,time needed to implement is specified ,working guidance for all staff and built in system of evaluation.

6. Programming and implementation –selection,training,and supervision of manpower.

7. Monitoring

8. Evaluation

Tools for planningSituation Analysis

– Epidemiological analysis (time, place & person)

– Stakeholders analysis

– SWOT analysis

– Problem Tree Analysis- Fish Bone Analysis

– Bottle neck analysis

– Critical Path Analysis

Objectives, Target setting and indicators

Gantt Chart preparation

Budgeting

Until 1983 India adopted a formal or official National Health Policy. Before that health activities were formulated through 5 year plan and Committees.

Health Planning In India

Health planning in India is an integral part of nationalsocioeconomic planning .the guidelines for national healthplanning were provided by various committees appointed byGovernment of India .

Bhore committee ,1946

• Integration of preventive and curative services at all administrative level.

• Development of primary health centers in rural area.

• Major change in medical education- 3 months training in PSM to make social physicians

Mudaliar committee also called as Health Survey and Planning Committee, 1962

• Strengthening of PHC (for 40,000 population) , sub divisional and district hospitals .

• To improve the quality of health services.• Constitution of All India Health Service on the pattern of Indian

administrative services.

Chadah committee ,1963: to study the arrangements for maintenance phase of National Malaria Eradication Programme.

• Vigilance operations in National Malaria Eradication Programmeshould be the responsibility of PHC.

• Basic health workers OR Multipurpose health workers for 10000 population has to carry out monthly home visits.

• The family planning health assistants were to supervise 3 or 4 basic health workers .

MUKERJI COMMITTEE,1965• Separate staff for family planning programme• To delink the malaria activities from family planning

MUKERJI COMMITTEE,1966• Worked out details of Basic health services at the block level

JUNGALWALLA COMMITTEE,1967• Integrated health services • Unified cadre ,common seniority ,recognition of extra qualification ,equal pay for

equal work, no private practice .

KARTAR SINGH COMMITTEE,1973• Multipurpose health workers for all the programmes.• One PHC to cover 50,000 population.• Each sub centre for 3000-3500 population and staffed by one male and female

health worker• Health supervisors to supervise 3-4 health workers.

SHRIVASTAV COMMITTEE,1975

• Creation of bands of paraprofessional and semiprofessional health workers (Community participation)

• referral services

RURAL HEALTH SCHEME,1977

• Involving medical colleges for ROME SCHEME

The National Health Plan ,1983

• One PHC for 30,000 population in rural plains and for 20,000 population in hilly ,tribal and backward areas

Health Infrastructure Development in India 1951-2000

Health Care in India

India has 1700 patients per doctor Wide urban-rural gap in the availability of medical services: Inequity Poor facilities even in large Government institutions compared to corporate hospitals

National Rural Health Mission 2005-2012

To provide effective health care to rural population throughout country with special focus on states with weak infrastructure.

To raise public spending on health from 0.9% of GDP to 2-3% of GDP.

Provision of Accredited Social Female Health Activist (ASHA) in each village.

To undertake architectural correction of health system.

Decentralization of programmes.

To improve access to rural people .

To revitalize local health traditions (AYUSH)

Goals • Reduction of IMR to 30 per 1000 live births.

• Reduction of MMR to 100 per 100,000 live births by 2012.

• Reduction of total fertility to 2.1.

• Universal access to public health services.

• Prevention and control of communicable and non communicable diseases.

• Access to integrated comprehensive PHC.

• Population stabilization ,gender and demographic balance.

• Revitalize local health traditions.

• Promotion of healthy life style.

PLAN OF ACTIONComponent (A) : ASHA• Every village will have ASHA chosen by and

accountable to village panchayat to act as the interface between the community and the public health system.

• She will be trained honorary volunteer receiving performance based compensation.

• She will be given training for 23 days, on the job training would continue for 1 year.

• She will prepare and implement village health plan along with AWW,ANM and other functionaries under the leadership of village panchayat.

• She is given drug kit for common ailments.

Component (B) :strengthening of subcentre

• Each subcentre will have fund Rs. 10000 per annum. This is deposited in joint bank account of ANM and sarpanch.

• Supply of essential drugs.

• Posting additional health workers and upgrading existing subcentres.

Component (C) :strengthening of PHCs

• Provision of 24 hour services

• Adequate supply of essential quality drugs and equipments like auto disable syringes.

• Provision of second doctor in case of additional outlays.

Component (D): strengthening of CHCs

• 30 -40 beds in It and making it 24 hours first referral unit with posting of anesthetist.

• To upgrade quality of services.

Component (E) :District Health Plan

Component (F) :Total Sanitation Campaign

Component (G) :Strengthening disease control programmes

• Strengthening of disease surveillance system

• Provision of mobile medical unit at district level.

Component (H) : Public –private partnership for public health goals

• Component (I) : New health finance mechanism

• Component (J) : Reorienting medical education to support rural health issues

A day in hospital