Health Planning

1. Concept and Approaches to Planning:

Planning is needed everywhere. Everyone makes plan for their daily life. It is fundamental. Planning is one of five major processes of management.

1. Planning
2. Organizing
3. Leading
4. Staffing
5. Controlling

Therefore being a health care manager one must have clear understanding of planning especially health care planning. Health is a state of complete mental, physical and social well-being not merely the absence of disease or infirmity. Therefore there are basically three components of health and while planning health care one should have to consider all these things. Health care planning can be disintegrated into two:

Health care services provided to individuals or community by agents of the health services or professionals for the purpose of promoting, maintaining and restoring health.

Planning – process of making decision in the present to bring about an outcome in the future. It involves determining appropriate goals and means to achieve them stating assumptions, developing premises and reviewing alternative course of action.

Health care Planning: making decisions and choosing alternative course of action in the present for effective and efficient health care services to be provided in the future. Health care planning is a fundamental management function which includes decision making and commitment. It is cyclic or continuous process. Health care planning basically consists of following elements:

• What (resources)
• How (to do)
• Who (will do)
• When (it should be done)

Characteristics of effective health care planning:

• Flexibility
• Tine table and sequence
• Not too vague
• Adaptability
• Neither too idealistic nor too limited

Health care planning is a part of national Development Plan

Need of health care planning

Scenario in health care:

• Limited health resources to meet unlimited health needs and demands
• High wasteful expenditure
• Quality is major consideration

Why health care planning?

• To match the limited resources with many problems
• To eliminate wasteful expenditure in health sector
• To avoid duplication of work
• To develop best course of action to accomplish predetermined objectives

1.1 Planning Models

Planning models are those models that are used for doing planning for any of the works in advance for the future purpose. There are different types of planning models in management

1.1 Planning model:

Planning models are the planning practice that is practiced by any organization for the planning purpose to fulfill their needs and demands for the fulfillment of the organizational goals and objectives through the optimum utilization or the available resources in an effective and efficient way.

Different planning models are used in a planning process by the organization. They are:

• Comprehensive rationalism
• Mixed scanning
• Incrementalism

Comprehensive rationalism:

An explicit activity that attempts to determine how resources are used to further the specific goals of an organization. Common sense might suggest that any such decisions about the future required a sequence of broad logical steps such as those set which includes; what is the situation?, where do we want to go?, which possible alternatives are there for action?, which alternative is best?, take action. Such series of steps is often depicted as a continuous cycle. The first stage analyses the current position or problem to be solved. Next the aims (where we want to be) are decided. All the possible alternative courses of action are listed, and assessed as to their feasibility and capability to achieving the aims. Lastly, having decided on the most appropriate alternative, action is taken to implement it. The cycle then starts again with a reassessment or evaluation of the situation.

Mixed scanning:

The difficulties of operating such comprehensive system are recognized by proponents of mixed scanning. Here a deliberate decision is taken to narrow down the area of maneuverability by focusing planning attention on selected areas of interest. An early stage in the modified cycle involves determining the priority or problem areas for planning, and it is within these that the examination of options occurs. Mixed scanning is so called because it advocates a broad sweep or scan of the whole health sector, which then forms the basis for the more detailed examination of selected areas for planning action. Such an approach is less costly in terms of time and information resources. Its selection of priority areas for alternatives certainly reflects the reality of much planning. However, it raises a fundamental question: on what basis is such screening to occur?

Increamentalism:

The third approach to planning, incrementalism, recognizes the political nature of planning in a far more overt manner than either of the previous approaches. The term ‘political’ is used here in a wide sense, and , through inclusive of ideology and party politics, is by no means confined to these. It is used to cover analysis and action that recognizes the nature and effect of different interest groups in society, whether based on class, employment or business, area of residence, professional or trade union association, religion, ethnicity, gender, or any of the other variables which determine an individual’s values, loyalties, and actions.

Planning, as it is seen in this third approach, has been described as a process of ‘muddling through’ or as a series of ‘disjointed steps’ moving in an incremental manner towards the set goal, the degree of movement at any time being determined by the political context

1.2 Realistic Rational Planning:

It is perhaps more accurate to describe the realistic rational planning as a planning spiral, with the end-point of each cycle forming the start of the next cycle, but at a higher plane.

Situation Analysis:

The first step in such a process involves an assessment of the present situation. This is often referred to as a situation analysis. This analyses the present situation from various perspectives:

• It examines the current and projected characteristics of the population including its demography
• It looks at the physical and socio-economic characteristics of the area and its infrastructure
• It analyses the policy and political environment including existing health policies
• As essential part is the analysis of the health needs of the population
• It would also look at the services provided both by the non-health sector and by the health sector itself. The latter would focus on facilities provided, their utilization and service gaps, together with organizational arrangements
• The situation analysis would also examine the resources used in the provision of services and their current efficiency, effectiveness, equity and quality of services.

Priority setting:

The second stage of the planning spiral involves the determination of hierarchy of goals, objectives and targets of an organization- in other words, what it wants to achieve. This will be influenced by the situational analysis, especially the health needs, and by the broad policy objectives of the organization or state. Any realistic planning system must ensure that the priorities set are feasible within the social and political climate, and within the context of available resources. In practice this is likely to mean that within any one planning period only some problems are addressed. Clear criteria for the selection of these priority problems are needed. Such criteria should include political feasibility.

Option appraisal:

The third stage involves the generation and assessment (often called option appraisal) of the various options for achieving the set objectives and targets. For any target there may be a number of ways of achieving it. Although it is often worth while and productive at this stage to allow a wide variety of creative ideas to emerge, it is important that this set of option is quickly reduced, without too sophisticated analysis, to a reasonable shortlist. Such preliminary criteria are in practice often applied subconsciously.

Each of remaining options on the shortlist is looked at in turn, and is assessed in three ways:

• The impact of each is examined to see its effects on the health target set.
• The resources implications will ne examined, both to look at the efficiency with which each alternative could meet the targets (known as its cost-effectiveness) and to determine whether overall option can be afforded, given resource constraints.
• The feasibility of each approach will be examined to see whether there are other barriers to its success.

Programming and budgeting:

The option appraisal stage will result in preferred option, which will then form part of the plan. This process will be carried out for each priority areas and its associated set of targets. The programming stage translates the results of the earlier decision into a series of programmes, each with a budget. The result of this is the plan document, which is a statement of intent concerning the activities over the plan period.

Implementation and Monitoring:

The penultimate stage involves the implementation of the plan, a neglected yet essential part of planning. This involves transforming the broad programmes into more specific timed and budgeted sets of task and activities, and involves the drawing up of a more operational plan or a work plan. This is the type of planning that we have described earlier as activity planning. An essential part of this process is the monitoring of the implementation of these activities.

Evaluation:

Lastly, a process of evaluation of the plan provides the basis for the next situational analysis, and hence afresh leads in to the planning spiral just described. Evaluation shares many of the characteristics of appraisal.

1.3 Public and Private Sector Planning:

The preceding sections described general approaches to allocative planning. The general principles and stages of planning outlined above are as valid for a private health-care provider as for a public sector provider. Planning for institutions within the private sector requires a similar combination of technical skills and political analysis. The parameters and values judgments which form the planning framework are however, bound to be different contents for their plans.

Comparison between the business and public sector planning

Private(Business) sector planning	Public sector planning
Determination of mission statement	Setting of goals
Analysis of strengths, weakness, opportunities, and threats (SWOT analysis) (including marketing)	Situation analysis (including needs assessment)
Determination of strategy	Option appraisal and monitoring
Operational plans	Operational plans
Implementation	Implementation
Feedback	Evaluation and monitoring

· The situational analysis needs to be far broader than that of a pure service provider, such as the private sector organization. It needs to look at the sector as a whole, rather than just at the ministry’s own activities and resources. It also needs to assess the broad causes of ill health, so as to allow the possibility for wider intersectoral strategies to be developed.

· The option appraisal must include the potential contribution that other sector can be encouraged or required to make to the state’s overall health goals. Thus options for health promotion must not be restricted to health service activities, but can include regulatory activity, legislation, and collaboration with other non-health agencies.

1.4 Level of planning: With in three groups of organizations – public, private-for-profit, and NGO – there are likely also to be different levels of planning within the organization. Although the principles and broad processes will be similar at each level, as one moves down to the lower levels plans will be more specific with the central plans providing the broad strategies envelope into which they are placed. Each level therefore needs to take account of plans being developed both in other organizations working at the same horizontal level and also plans of both higher and lower levels in the system the vertical dimension.