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District Health Planning for PIP
State Institute of Health & Family Welfare, Jaipur
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SIHFW: an ISO 9001: 2008 Certified Institution 2
Sources of Data
DLHS NFHS
SRS NSSO UNICEF
Special surveys bymedical collegesetc
CBHI
District data Household surveys
Facility surveys Eligible couple register State annual reports
Disease surveillancesystem Routine reports
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Planning & Plan
Planning -an act or process of choosingbetween alternatives to accomplish preset
goals
Plan denotes a blue print of action
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Planning Steps
Situational analysis Deciding objectives Defining strategies
Laying an operational plan Implementation Evaluation Criteria Frequency Process
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Planning in Health Sector Measurement or assessment of burden of illness Identification of cause of illness Measurement of effectiveness of different
community interventions Assessment of efficiency of interventions interms of resources used
Implementation of interventions Monitoring of activities Reassessment of burden of Disease to see if
there is any change
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SIHFW: an ISO 9001: 2008 Certified Institution 6
The Planning Process in HealthThe essentials of planning in health lie in answering thefollowing key questions:
1 Where are we now? (Situational analysis)
2 Where do we want toreach?
(Goals, objectives, priorities,targets and strategic decisions)
3 How will we get there? (Organizational constraints,resources and organisationalstructure, functions andmanagement)
4 How well we havedone?
(Monitoring, evaluation andfeedback)
5 What new problems dowe have?
(Replanning)
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Why District Action Plans?
Mechanism to partner with community Planning based on local evidence and
needs
Area specific strategies to achieve NRHMgoals Cost effective and practical solutions Move from budget based plans to
outcome oriented plans Requirement of GOI no funds if no plans
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Participatory Planning Promote community ownership Greater ownership of health functionaries Harness benefits of community action Bring accountability of health functionaries to
community members Draw together elements that are determinants
of health Share resources and opportunities with
partnering departments convergent action
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What a District Plan Should Have
Background Planning Process Priorities as per the
background and planningprocess
Annual Plan for each of theHealth Institutions basedon facility surveys
Community Action Plan Financing of Health Care
Management
Structure to deliver theprogram Partnerships for convergent
action Capacity Building Plan
Human Resource Plan Procurement and Logistics Plan Non-governmental Partnerships Community Monitoring and
evaluation Framework
Action Plan for Demandgeneration Sector specific plan for maternal
health, child health, adolescenthealth, disease control,
Geriatric care disease,Surveillance, family welfare Program Management Structure Budget
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The Levels of Planning
Goals
Objectives
Strategies Activities/Processes
Inputs
Impact indicators
Outcome indicators
Output indicators Process indicators
Input indicators
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Planning Steps Objectives (what is being planned?) Approach or strategies for reaching the
objectives (how shall the objectives beachieved?)
Activities required to achieve the objectives(which?)
The obstacles that may hamper the activities(why?)
Resources to be used (who?) Cost of activities (money?) Detailed scheduling
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District Plan Components
Introduction
Situational Analysis
Goals and Objectives
Strategies Activities
Work Plan/Schedule
Monitoring and Evaluation
Budget
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Setting Goals
Societal in Nature Not necessarily measurable Flows from vision document and societal goals-
as well as from situation analysis Responsive to people needs and demands-as
articulated through their representatives-the political process- and
directly by different sections-this is the basis of democratic functioning Example: Goals in RCH (purpose)
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What is being Planned Looking at the situation
Information from the community Information from records
Morbidity and mortalityprofile
Health care institutions(PPP)
ICDS Social and cultural
background PRI structure
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District Planning: Situation Analysis
Identify the problems Identify the causes Do resource analysis to handle the
causes- man, money, material & time Map the problem geographically, groups
& vulnerability and the resources
Identify the strategies to improve
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Situation Analysis
District Profile Public Health Infrastructure in the District
(Government Building or Rented) Human Resources in the District Functionality of District Hospitals, CHCs, PHCs
and Sub-centres District:- Availability of Staff needed
for service Guarantees CHC:- specialists, at FRUs. Indicate
blocks where more than 20 %posts are vacant
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PHC:- Availability of an ANM at sub-
centre Indicate PHCs with morethan 10% vacant Sub-Centre:- Availability of an ANM
at sub-centre Status of Logistics
Availability of a dedicated Districtwarehouse for health department
Stock outs of any vital supplies in lastyear
Indenting Systems (from peripheralfacilities of districts)
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Status of Logistics Existence of a functional system for
assessing Quality of Vaccine Physical Infrastructures
Indicate the trainings conducted for all categories of health personnel Training load Personnel trained each training or
topic wise BCC Infrastructure in the district
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Private Health Facilities Nursing Homes Practitioners AYUSH Private Sector RMPs Nursing Homes with facilities for
comprehensive emergencyobstetric care
Centres for Sterilization Services Centres for IUD Services
ICDS Program Elected Representatives of PRIs
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NGOs & CBOs
Examine the performance of theMaternal Health indicators Examine the performance of the
Family Planning indicators Examine the performance of the
Child Health indicators Examine the performance of the
National Disease Control Programindicators
Locally Endemic Diseases in theDistrict
New Interventions under NRHM
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District Planning: Desk Review Compare District with State average and NRHM
objectives Mapping- facilities / services /staffing, infrastructure,
population served /Patient load & utilization(PHCs &CHCs
Review performance of National Programs in thelast year
Map performance of ANM/ MPW Mapping of TBA- AWW-ANM- LHV Listing of NGOs reach and focus of work CBOs in the district block and activity- wise Last years budget and expenditure analysis
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District Planning: CommunityAssessment
Resource Mapping Understanding health
problems Assess BOD Health expenditure Problems- referral/
transport/FP Role of PRI Understanding health
seeking behavior andpractices Pregnancy/illnesses
Understanding CommunityParticipation andOwnership: MeetingVHSC
Perception and the role of PRI Additional Information Studies
NGOs-activities/achievementand willingness
Other CBOs / SHGsfederation
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Distt. Planning: Recognize Problems
Health problems Health service problems Community problems
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Distt. Planning: Setting Objectives Expected outcomes Relevance(related to the problem or
policy)
Feasibility (it can be achieved) Observable (its achievement can be
clearly seen) Measurable (outcome can be stated in
number)
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Objectives: SMART
S Specific: Everyone should interpret it thesame way
M Measurable: An objective as different froma goal is clearly measurable
A Appropriate: It should directly relate to theprogram
R Realistic: It should be possible to achieve
this objective TTime: It should be possible to achieve this
within the stated time-frame
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S.No.
Objectives to be achieved by the district Currentyear
Nextyear
1. Universal coverage of all pregnant women withpackage of quality ANC services as per nationalguidelines
2. Increase in deliveries with skilled attendance atbirth including institutional deliveries
3. FRUs (including DHs, CHCs/PHCs) madefunctional as defined in the National RCH 2 PIP
4. Universal coverage of all eligible pregnantwomen under JSY scheme5. Increase in percentage of new born babies
given colostrums
Setting Objectives of the D.H.A.P.
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s.No.
Objectives to be achieved by thedistrict
Currentyear
Nextyear
6. Increase in prevalence of exclusive breastfeeding
7. Increase in percentage of fully protectedchildren in 12-23 months as per nationalimmunization schedule
8. Universal coverage with Vitamin Aprophylaxis in 9-36 months children
9.Percentage of severely malnourishedchildren below 6 yrs referred to medicalinstitutions
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s.No.
Objectives to be achieved by thedistrict
Currentyear
Nextyear 10. Unmet demand for contraception
-Spacing
-LimitingA. Number of Govt. Health Institutions providing:i) Female sterilization services DH/ SDH / CHC /PHCii) Male sterilization servicesiii) IUD insertion services --------- CHC / PHC /
SCB. Number of accredited private institutionsproviding:i) Female sterilization servicesii) Male sterilization servicesiii) IUD insertion services
SIHFW: an ISO 9001: 2008 Certified Institution
S Objectives to be achieved by the district Current Next
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S.No
Objectives to be achieved by the district Currentyear
Nextyear
11. Number of health institutions in PHCs/CHCs offeringARSH services
12. Number of health institutions providing services for management of STIs and RTIs
13. Performance indicator for NVBDCP-API for MP-Annual blood examination rate for MP increased (over 10 % of all OPD cases)-Slide Positivity Rate-Number of deaths due to malaria
14. Performance indicator for RNTCP
-Percentage of TB suspects examined out of the totaloutpatients-Annualized New Smear Positive (NSP) case detectionrate per 100,000 populations
SIHFW: an ISO 9001: 2008 Certified Institution
b b h d b h d
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S. No. Objectives to be achieved by the district Current Next
-Annualized Total Case detection rate per 100,000populations-Treatment success rate15. Percentage (as planned) of ASHAs functional in thedistrict (received induction training )
16. Number of RKS registered /established
17. Number of Health care delivery institutions upgradedSHCsPHCs- CHCs to FRUs fulfilling the 4 basic criteria in FRUguidelines Upgrading to IPHS will come later ( these institutions should be in conformity with IPHS)
18. Village health and sanitation committees Constituted- Grants given
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S.No.
Objectives to be achieved by the district Currentyear
Nextyear
19. Number of SCs strengthened- Additional ANMs hired- Annual maintenance grants given
20. of PHCs strengthened to provide 24x7- 3 staff Nurses hired- Annual maintenance grants given21. National Blindness Control Program- C ataract surgery rate (450/100,000 population)-% surgery with IOL- School Eye Screening in the age group of 10-14years should be screened for refractive errors- Oral Health Screening for:CommunitySchool Children
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S.No.
Objectives to be achieved by the district Currentyear
Nextyear
22. National Leprosy Eradication Programme
- PR Leprosy cases per 10,000 population- ANCDR New leprosy cases per 1,00,000 population- Proportion of MB, Female, Child, ST, SC cases amongthe new cases detected- Proportion of Patients completed treatment (RFT)
23. Integrated Disease Surveillance programme- Number of labs to be upgraded ( L1 and L2)- Number of staff to be trained in surveillance activities
24. Staff for mobile medical units in place25. Number of facilities to be covered for facility survey
- SHCs- PHCs- CHCs
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S.No.
Objectives to be achieved by the district Currentyear
Nextyear
26. No. of villages to be covered for HH survey
27. No. of Community hearings planned
28. District training plan developed andimplemented
29. District BCCC plan developed andimplemented
30. District procurement and Logistics plandeveloped
31. No. of PHC/CHCs where AYUSH physiciansposted
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Distt. Planning: Review Punctuations Types:
Manpower Materials Money Minutes Environment Technical Social
Analyzing punctuations Removable Modifiable Stubborn
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Defining Strategies:
How do we aim to achieve objectives? The choice of strategies Are these strategies
Technically sound? Capability and manpower wise feasible? Budget-wise feasible? Does it have capacity to manage the
identified constraints?
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Distt. Planning: Choosing Alternatives
Technically sound Feasible
Manpower Finances Manageability of
constraints
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Distt. Planning: Scheduling Activities
Consider the alternativestrategies
List out the resources Select the best strategy Mobilize the community
resources Detail activities Log frame approach
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Indicators
Observable measure of how well we aredoing with respect to a specific criterionsuch as quality, effectiveness of theprogram against the expected objective
Essential for monitoring and evaluation andtherefore for planning too.
Can indicators be achieved without achievingobjectives?
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Monitoring
Efficiency tells you that the inputinto the work is appropriate in
terms of the output; in terms of money, time, staff, equipment.
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Evaluation
Impact tell you whether or not thespecific objectives you addressedmade any difference to the maingoals you were trying to address. Inother words, was your strategyuseful?
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PIP
Essentially a statement of intent A description of implementation with
estimation of cost
If implemented are likely to lead todesired results The MOU between C&S should include
plans, budget and log frames
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A.RCH
B.Add. - NRHM
C.Immun.
D.NDCPs
FMG/NRHM-Finance
Div., GOI
State level
expenses
SPMU
State Health Society
District Health Society
DPMU
RCH Add.-NRHM Imm. RNTCP VBDCP,others
Intersector convergence
Funds
FMRUCAudit
Report
Mission Flexible Pool
E.IntersectoralConvergence
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District Planning-Situation Analysis
Identify the problems Identify the causes Do resource analysis to
handle the causes---man, money, material &time
Map the problemgeographically, groups
& vulnerability and theresources Identify the strategies to
improve
SIHFW: an ISO 9001: 2008 Certified Institution
H lth M g
NRHM ILLUSTRATIVE STRUCTURE
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BLOCKLEVEL
HOSPITAL
30-40 Villages
Strengthen Ambulance/transport ServicesIncrease availability of NursesProvide TelephonesEncourage fixed day clinics
AmbulanceTelephone
Obstetric/Surgical MedicalEmergencies 24 X 7
Round the Clock Services;
CHIEF BLOCK MEDICAL OFFICER / BLOCK LEVEL HEALTH OFFICE --------------- Accountant
CLUSTER OF GPs PHC LEVEL
3 Staff Nurses; 1 LHV for 4-5 SHCs;Ambulance/hired vehicle; Fixed Day MCH/Immunization
Clinics; Telephone; MO i/c; Ayush Doctor;Emergencies that can be handled by Nurses 24 X 7;
Round the Clock Services; Drugs; TB / Malaria etc. tests
GRAM PANCHAYAT SUB HEALTH CENTRE LEVEL
Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic1000
Population VILLAGE LEVEL ASHA, AWW, VH & SC
1 ASHA, AWWs in every village; Village Health DayDrug Kit, Referral chains
100,000
Population100 Villages
5-6 Villages
Accredit private
providers for publichealth goals
Health Manager
Store Keeper
NRHM ILLUSTRATIVE STRUCTURE
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Level of Planning and the Key
Functionaries
Village Level ASHA Anganwadi Panchayat Representative SHG Leader PTA/MTA Secretary Local CBO Representative Data Source
Village HealthRegister
Village Health
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Gram Panchayat Level The Gram Panchayat
Pradhan ANM MPW Village Health & SanitationCommittee
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Block/CHC Level The Adhyaksha of the Block Panchayat
Samiti Block Medical Officer Block Development Officer NGO /CBO Representative Head of the CHC level RKS/ RMRS The Block level Health Mission Team will
finalize the Block Health Plans
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District Level NGO Representatives Few professionals recruited to
meet planning andimplementation needs.
Zila Parishad Adhyaksh District Medical Officer
District Magistrate
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State PIP Structure
Summary Process of plan preparation
Time frame Background and current status
Demographic and socio economic features Administrative divisions RCH outcomes & service utilization in
Maternal Health, Child Health, FamilyPlanning, Adolescent Health (based on RHC/MICS/ NFHS/ State HMIS)
Public health infrastructure Private/ NGO health services/ infrastructure
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Donor assisted programs in State
including Institutional inputs &organizational development issues & gaps
Program finances No. of sub-centers
Urban family welfare centers District wise Training institutes Management positions in Directorate District Family Welfare Bureaus
Additional expenditure in state/ districtfamily welfare bureaus
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Additional expenditure onNational, Maternity, BenefitScheme (NMBS) renamed asJanani Suraksha Yojana
Inventory of Vehicles Commodity assistance (past 3
years)
Situational Analysis- identifies core issuesboth outcomes specific and cross cutting in
Maternal health Child health Family Planning Adolescent health District/ sub District Variations
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National Health Programmes HRD including training Inequities/ Gender Logistics HMIS Other (specify)
RCH-II/ NRHM, Objectives and Strategies Program management arrangements Budget Monitoring and evaluation Sustainability
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Annexure
Work plan Log frame Examples of District PIPs
Criteria for appraisal of SPIP:
Program managementarrangements Institutional strategies Technical strat4egies
Work plan Cost/ budget
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THANK YOU