Health Planning Health Care Health Care Delivery Health Systems

1. HEALTH PLANNING
Professor Syed Amin Tabish
FRCP (London), FRCP (Edin.), FAMS, MD (AIIMS)
Postdoc Fellowship, Bristol University (England)
Doctorate in Educational Leadership (USA)

2. Responsibilities of a Doctor
 Patient Care: Disease
Prevention, Health Promotion,
Medical care with advanced
technology
 Some level of teaching
competence with
professionalism
 Research

3. Pressures of Changes
 Knowledge Explosion
 Technological Advances
 Information
Superhighway
(Internet/World Wide
Web)

4. Roles of Physician
 Medical Expert (clinical decision-
maker)
 Communicator / Educator
 Collaborator (team leader)
 Manager/Leader: managing resources
 Health advocate
 Scientist/Scholar
 Professional: to provide high quality
care with honesty & compassion

5. What are the responses
 A New Curriculum: Outcome-
based, community-based
 New Educational strategies: PBL,
SDL, Integrated learning, task-
based learning, Core curriculum
& student-selected components
 New Curriculum models:
Communication skills,
preparation for practice, team
work, EB practice

6. Health Planning
 During the 20th century, the
expectation of life in all parts
of the world has been
transformed
 Concerns for efficient use of
health resources
 Importance of health
planning widely recognized

7. Planning
 Deciding how resources
should be allocated
 Determining how to
implement these decisions
 Judicious health planning
is crucial

8. Planning
 A method of trying to
ensure that the
resources available
now and in future are
used in the most
efficient way to obtain
explicit objectives

9. Planning
 A system of making decisions
about how an organization
will use its resources in the
future
 It involves making of choices
 Requires possibility of real
alternatives
 Resources are limited

10. Important components
 Where are we going? –
Objectives
 With what? –
Resources
 How? - (efficient
implementation)
 When? – (future)

11. Health care
 Public Health Services
(environmental sanitation)
 Personal Preventive
Services (immunization)
 Personal Curative Services
(hospitals, health centres)

12. PLANNING SPIRAL
 Situational Analysis
 Priority Setting
 Option appraisal
 Programming & budgeting
 Implementation &
monitoring
 Evaluation

13. Situational Analysis
 Assessment of present
situation
 Examine the current &
projected health situation,
the demographic pattern,
and present & future
health needs

14. Situational Analysis
 Looks at the general
socioeconomic & provision
of non-health services &
infrastructure
 Analysis the infrastructure
of health sector & the
pattern of services
provided

15. Situational Analysis
 Examines the current &
future resources of the health
sector in terms of both
financial resources & real
resources (personnel,
equipment, buildings, etc.)
 Analysis the efficiency &
effectiveness within which
the health sector operates

16. Situational analysis
 General country
characteristics
 Health Status Needs
 Health Service availability
 Policy & political
environment

17. Demographic information
 Absolute size & distribution
of population
 Vital statistics (births,
deaths, fertility)
 Population growth rate
 Age & sex structure

18. Priority Setting
 Determination of goals,
objectives & targets of the
organization
 Ensuring that the
priorities are set are
feasible within the social
& political climate

19. Option Appraisal
 Generation and
assessment of various
options for achieving each
of the set objectives and
targets
 Appraisal info:
effectiveness, efficiency,
equity, acceptability,
feasibility, resource
availability

20. Programming & Budgeting
 Translate the results of
the earlier decision into a
series of programmes
each with a budget and
resources
 Option chosen
 Budgetary info
 Resources

21. Implementation & Monitoring
 Transforming the broad
programs into more specific
times and budgeted sets of
tasks and activities
 Involves the drawing up of a
more operational plan of a
work
 Monitoring of the
implementation of activities

22. Implementation
Management info at
service provision stage:
 Utilization of services
 Cost
 Constraints

23. Evaluation
Provides the basis for
the next situational
analysis

24. Primary Health Care
The Alma-Ata
Declaration (1978)
endorsed PHC as
the key to
achieving HFA goal
National Rural
Health Mission

25. Essential Components of PHC
 Education concerning
prevailing health problems
and methods of prevention &
control
 Promotion of food
supply/nutrition
 Safe water & basic sanitation
 MCH/RCH

26. Components of PHC (contd)
 Immunization
 Prevention & control of
locally endemic diseases
 Treatment of common
diseases
 Provision of essential
drugs

27. Equity
Emerging Issues in HC:
 Equal health
 Equal access to health care
 Equal access to HC according to
need
 Equal utilization of HC according
to need
 Planning requires identification
of disadvantaged groups and
address their needs

28. Approach to planning
 A clear definition of equity
 A clear process for involving
communities in decision
making about strategies to
improve their health
 A clear process for involving
other sectors in health-
promotive strategies

29. Approaches to planning
Management
structures consistent
with the principles of
PHC
Criteria for assessing
the appropriateness
of approaches chosen

30. Data Collection/Information
 Surveys
 Vital registration
 Treatment records
 Notifiable diseases return
 Management reports & return
 Informed opinion (meeting with
individuals/groups)
 Information from other
ministries, institutions, agencies

31. Information on Health Needs
Basic requisite for a plan
Medically perceived Health Needs:
 Morbidity rates
 Mortality rates
 Disability rates
 Antenatal care
Community perceived Health Needs:
 Service deficiencies

32. Information of Services/Resources
 Socioeconomic situation &
infrastructure
 Socioeconomic & cultural
characteristics
 Geographical & topographical
characteristics
 Infrastructure
 Services provided by other sectors
(education, water, sanitation,
agriculture, public works)

33. Information (contd.)
Health Services
 Service facilities (hospitals,
beds)
 Service utilization
(occupancy rates,
immunization)
 Service gaps (areas not
covered by basic facilities;
projected service gaps)

34. Health service organizational
arrangements
 The degree of
centralization of decision
making
 Opportunities for
community participation
in decision making
 Linkage between sectors

35. Resources
 The resources currently deployed
in the health sector
The resources likely to be available
in future
 Financial resources (budget)
 Personnel
 Building, land, equipment &
vehicles
 Efficiency, effectiveness, equity
of current services

36. Setting Priorities
First Stage:
 Involves the production of a
macro situational analysis
setting out the key information
at national level
Second stage:
 Discussion by a national-level
planning group, involving
representatives of major health
related sectors

37. Priority Setting (contd.)
Third stage:
 The development of local-
level situational analysis
by local level health &
other professionals &
community
representatives

38. Priority Setting (contd)
Fourth Stage:
The review of these
policies by National
Health Planning Unit
Priority setting involves
a combination of
technique & judgement

39. Human Resource Planning
 To ensure that there is the
right number of personnel
with the appropriate skills
available in the right place at
the right time
 Health facilities are highly
labour intensive
 50-70% of the health budget
spent on human resources

40. Human Resource Planning
 Supply of HR: available
personnel
 Demand for HR: funded
requirement for personnel
 An equilibrium (Balance)
situation is required: where
Demand & Supply are equal
for each set of staff for each
year

41. Human Resource Planning
 Estimating projections
of each side of the
supply & demand
equation
 Estimate demand for
each category (ideally
for a decade)

42. HR Planning (contd)
 Estimation of the present &
future supply of each
category of health
professionals
 Comparison of demand &
supply
 Establishment control
 Development of training plan

43. Human Resource Planning
 Demand should be based on
the plans for service implicit
in the broader sectoral plan
 Planning system should be
sustainable
 Ensure that the planning
function will continue despite
broader organizational
changes

44. HR Planning (contd.)
Disciples required in
planning include:
economics, sociology,
social epidemiology,
community
development,
operations research,
law

45. Creating a structure for success
A carefully organized
and well-defined
planning structure is
essential
Planning process for
success

46. Creating a structure for success
There are several options
for developing
steering committees,
advisory committees,
and other structures to
carry out planning work
and involve people in
the process.

47. SWOT Worksheet
 SWOT is an examination of a
group’s internal strengths
and weaknesses, as well as
the environment’s
opportunities and threats. It
should be used in the
beginning stages of decision
making and strategic
planning.

48. SWOT
 Strengths What are your state’s
particular strengths? Do you do
something particularly unique?
What could be an asset in
developing objectives for your
state plan?
 Weaknesses Where is your
state lacking? What do others
seem to accomplish that you
cannot? What could limit your
state planning efforts?

49. Identifying & securing
Resources
“It takes a village to raise a child
(or develop a state plan).”
 Identify resources needed to
develop state plan
 Identify existing internal
resources
 Develop budget # Identify
potential external resources,
including potential donated
resources

50. Resources (contd.)
 Plan to integrate the plan
into state planning,
budgeting, and programming
processes
 Develop staff and technical
support plan
 Secure identified resources
and develop alternative
resources if necessary

51. Ask the right questions early
 What is the scope of the state
planning process?
► What does the state want to
accomplish through this process?
► Why should taxpayers or others
fund the development of the
state plan?
► What will it take to support the
planning initiative?

52. Plan for the future
 Don’t forget to plan for the future—
it’s not over when the plan is released
► Identify resource needs to carry out
a ten-year plan to monitor progress,
publish periodic reviews, and sustain
activities
► Keep a wish list ready for future
funding (e.g., resources for a business
companion document, a special health
disparities consortium, or other ideas
generated planning)

53. Align the planning structure
with goals

54. THANK you
Very much

55. Health Service Providers(1)
 Ministry of Health (MOH)
 King Faisal Specialist Hospital &
Research Center (KFSH&RC)
 Ministry of Defense (MODA)
 Ministry of Interior (SFH)
 National Guard (NGHA)
 Universities Hospitals
 Private Sector

56. Current Status (1)
 Ministry of Health (MOH)
 195 hospitals
 1760 PHCC
20 are running different HIS & no connection
between them
40 has a connection to MOH WAN but does not
have HIS
A system has been developed in-house for
PHCC’s and applied in 9 of them which has
connectivity
The system can be accessed remotely by dialup

57. Current Status (2)
 King Faisal Specialist Hospital
 2 hospitals (1 in Riyadh & 1 in Jeddah)
The most advanced EMR in the country

58. Current Status (3)
 Ministry of Defense (MODA)
 25 hospitals
 150 clinics
(10 are running different HIS & not
connected to each other)
137 are connected to the nearest hospital

59. Current Status (3)
 Ministry of Defense (MODA)
 25 hospitals
 150 clinics
(10 are running different HIS & not
connected to each other)
137 are connected to the nearest hospital

60. Current Status (4)
 Ministry of Interior (SFH)
 1 hospital
 30 +- clinics
(hospital is running HIS)
Simple system in clinics & not connected
to the hospital

61. Current Status (5)
 National Guard (NGHA)
 4 hospitals
 60 clinics
( 4 hospitals are connected through ASP
model + 25 clinics)

62. 1/27/2023 The 4th Regional conference
on e-Health
62
Current Status (6)
 Universities Hospitals
 4 hospitals
2 are running the same HIS through
connectivity
Others are running different HIS

63. 1/27/2023 The 4th Regional conference
on e-Health
63
Current Status (6)
 Universities Hospitals
 4 hospitals
2 are running the same HIS through
connectivity
Others are running different HIS

64. Public Input