Situation analysis

1. Situation Analysis
&
Priority Setting

2. Functions of Management
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Planning Implementatio
n
Evaluation

3. PLANNING
 A systematic method of trying to attain
explicit objectives for the future through the
efficient and appropriate use of resources,
available now and in the future.
 (Green, 2007)
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4. Planning Cycle / Spiral
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Situation Analysis
Implementation and
Monitoring
Evaluation
Option appraisal
Priority, goal, and
objective setting
Programming

5. SITUATION ANALYSIS
 First stage – to improve the understanding
of the current situation
 Purpose
provide a common reference point for rest of planning
process
 provide the background for the selection of priority areas of
concern for planning
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7. SITUATION ANALYSIS is conducted to
 Describe the current status (What is?)
 Describe trends (past, present, future)
 Project (base future)
 Identify problem and reasons for their existence
 Prioritize problems
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10. Key content of a situation
analysis
 Population characteristics
 Area characteristics & Infrastructure
 Policy and political environment
 Health needs
 Health services
 Services provided by non-health sector
 Resources
 Efficiency, Effectiveness, Equity and Quality of current services
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11. Population characteristics
Demographic information
 Size & distribution of population
 age & sex structure
 vital rates - birth, death and fertility rates
 immigration & emigration rates
 over all population rates
 ethnicity, class & geographical distribution
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12.  Current situation on
 baseline information
 morbidity, mortality, service utilization
 for service provision
 for young or elderly health
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13. Population characteristics
(cont.)
Religious, educational and cultural characteristics
 Important impact on health
 Education level and literacy rate
eg. High literacy rate vs Low IMR
 Cultural or religious characteristics
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14. Area characteristics and
infrastructure
 Geographical situation
 Infrastructure
Transport modes & routes
Communications
Water supply & sanitation facilities
Utilities - distribution of main electricity
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15. Area characteristics and
infrastructure (cont.)
 Socio-economic situation
Linkage between economy & other sectors
pattern of economy & activities
 Public and private sector structure
Information & relationship
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16. Policy and political environment
 Overall national policies
 Existing health policies
National Health Policy
 Political environment
In order to recognize potential opponents or
supporters
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17. Health needs
 Medically perceived health needs
Come from community health survey
Records of health services
Morbidity rates - Incidence and Prevalence
Mortality rates - IMR, MMR, CFR
Disability rates
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18. Health needs (cont.)
Non-illness related needs
Antenatal care & Family Planning
Burden of disease – DALY
 Community perceived health needs
express in terms of service deficiencies from
community surveys of attitudes & views
existing community structure
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19. Health services
 Service facilities
 Type & number of services, facility capacity, location,
ownership of facilities
 Service utilization
 Hospital occupancy rate, attendance rates, immunization, family
planning, DOTS, water supply, Latrine
 Service gap
 Health service organizational arrangement
 degree of centralization of decision making
 community participation on decision making
 Linkage between sectors
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20. Services provided by and plans of
non-health sector health services
 Brief description of the main services and future plan
of sectors related to health
Education
Water & sanitation
Agriculture & forestry
Community development
Public works
Industrial and mining sectors
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21. Resources
 Financial resources
capital & recurrent budget, constraints, source,
projected inflation rate
 Personnel
staff employed, training, losses
 Buildings, land, equipment and vehicles
 Times
 Information
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22. Efficiency, Effectiveness, Equity,
Quality of current services
 Evaluate the current services as situation analysis
 look closely to option appraisal & economic techniques
 Planning future allocation
 Assess effectiveness and quality of service
 Compare among different facilities/ services
 Examine distribution of resources between different
population groups in compare with their needs (Equity)
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23. Techniques
 Participatory Rapid Appraisal (PRA)
to obtain information from community
 Health needs assessment
 to collect information about health needs using a variety of
epidemiological methods
 SWOT analysis
to get common understanding of issues facing a particular
organization
 Stakeholder analysis
to assess attitudes of particular issues
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24. SWOT Analysis
 Internal Analysis
Strengths
Weaknesses
 External Analysis
Opportunities
Threats
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26. Example of SWOT analysis of NGO hospital
Strengths (Internal) Weakness (Internal)
Committed staff
Access to external donations
Poor management
Lack of lab. Staff
Old building
Opportunities (External) Threats (External)
Decentralization
Contracting of services by
government
Rise of private sector likely to
poach “private bed” patients
essential for funding
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27. Typical issues in Situation Analysis
High population growth rates
High infant and child mortality
Changing burden of disease
Poor prospects for future growth in resources for
the health sector
Inappropriate organizational structures
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28. Lack of coordination between Public sector and other
health services
Inefficient allocation of resources between
levels of facilities
Shortage of health professionals and low morale
among health workers
Inequitable distribution of resources
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29. Who should carried out?
 Health professionals & service manager
 Representatives of other sectors related to
health sector
 Community representatives
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30. Setting Priorities
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31. Setting Priorities
 Fundamental rationale for planning - inevitable between
available resources and competing uses
 Limited resources best allocation approach
Demand based market mechanism
Need based planning approach
 Priorities are expressed in a hierarchy of objectives –
goals, aims, objective, targets
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32. Goals, aims, objective, targets
 Goal - broad statement, one goal for service
 eg. Health for All, MDG
 Aim - a number of aims relating to the goal
- specific to particular health problem
 eg.To raise the nutritional status of women and children
 Objective - a number of objectives relating to the aim
- specified in measurable terms
 eg.To ensure that 95% of children under 5 are adequately nourished
by the year 2010.
 Target - a number of targets which specify various points on the
way to the attainment of the objective
 eg.To ensure that 75% of children under five are adequately nourish
as pre-defined by the year 2008.32

33. Health needs
 General lack of something, relate directly to the
measurement of health
 Gradation of need - depending on observer
 Viewed predominantly from epidemiological perspective -
emphasis on mortality and morbidity
 Perceived need – needs that is neither a scientific judgment
nor the province of medical profession alone
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34. Underlying perceptions of health
 Groups in different positions within health system -
different perceptions
 Different health problems have varying combinations of
effects of ill health
Injury - pain and discomfort
polio - disability
cholera - death
alcoholism - social effects
 Setting priority – depend on attitudes towards the particular
effects of different health problems
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35. Who should set priorities
 Provision of information – health & other professionals
 Decision on needs
 National level - d/p on political structure
 Local level - community involvement
 Central - to ensure equity of resource availability, maintenance
of standards, provision of framework for determination of
local needs
 Relationship between political structures at the national level
and those at community level
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36. Criteria for priorities
 maximum feasible health gain within available
resources ( efficiency )
 effects on equity
 level of public demand
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37. Priority setting
 Determination of ‘what it wants to achieve’
(hierarchy of objectives)
 To ensure feasible within the social and political
climate, available resources
 Clear criteria for selection are needed
Allow broad view of health
Balance decision making at national and local
Transparent process
Needs to end up with objectives that are feasible
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38. Prioritize the problem
 effect on the majority of population
 effect mothers and children
 has high mortality
 has a solution & can be solved with available resources
 the community accept as a problem
 the community participate in solving it
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39. Priority assessment of
Health problems and needs
 Prevalence / Incidence
 Severity of problem
 Effective Intervention
 Acceptability / Feasibility
 Community involvement
 Cost and Resources
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40. Prioritization of health problems was based on
Objective criteria : morbidity, mortality, trend
Subjective criteria: Political concern, community concern,
availability of preventive technology, availability of
curative technology, socio economic impact
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41. Prioritization technique
Prioritization = MIV/C
M = magnitude of the health status effected by the
problem i.e., morbidity, mortality and disability
I = importance/ extent of problems, area, risk group,
impact of disease
V = Vulnerability
C = Cost
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42. Techniques for priority setting
 Economic appraisal
Combine consideration of health gain &
resources
Use cost per DALY
Applicability ?? Lack appropriate data in
developing countries
 Multivariable decision matrices
 Delphi technique42

43. Hypothetical example of a multi-variable
decision matrix
Weighting of
criteria
Criteria
Cost per DALY Public demand Mortality rates Disability rates
Allocated score
4 Measles AIDS AIDS Polio
3 TB Alcoholism TB Alcoholism
2 Malaria Malaria
1 Gastro-enteritis
Scoring
AIDS 8
TB 6 Measles 4
Alcoholism 6 Malaria 4
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