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Dr. M. Logaraj
Professor of Community medicine
Chettinad hospital & Research Institute
Concept of health planning, monitoring and evaluation
1. What is health planning?
2. Purpose of health planning
3. What are health needs and demands?
4. What are objectives, targets and goals?
5. Steps in planning cycle
6. What is monitoring?
7. What is evaluation? And basic steps in evaluation.
8. Elements of evaluation
9. National health policy
“The orderly process of defining community health
problems, identifying unmet needs and surveying the
resources to meet them, establishing priority goals that
are realistic and feasible and projecting administrative
action to accomplish the purpose of the proposed
The increasing demand for medical and health care services, in
the face of limited resources, has brought out the need for
careful planning and management of health services
The purpose of planning:
1. To match the limited resources with many problems
2. To eliminate wasteful expenditure and avoid duplication
3. To develop the best course of action to accomplish a defined
Health needs and demands
The purpose of health planning is to meet the health needs and
demands of the people.
Health needs is defined as the ‘deficiencies in health that call for
preventive, curative, control and eradication measures’.
The needs for safe water supply and sanitation, control of
communicable diseases, medical care including hospitals, dispensaries
and primary health centres, public health services, family planning,
adequate nutrition, immunization are all community health needs.
In democratic country/ developing country people’s needs may be
presented as demands.
Objectives, targets and goals
An important element of planning is the setting of clear cut objectives,
targets and goals.
Objective: It is a planned end point of all activities. It is stated in term of
measured amount of progress towards goal.
Targets: When the objective is split into discrete activity it becomes target
like number of sputum smear collected or Tubectomy done.
Goal: An ultimate desired state towards which the objectives and resources
are directed. Goal is not constrained by time, resources nor are they
necessarily attainable. They are formulated at top level and they are
generally broad for example ‘Health for all.
Planning for health involves 3 types of activities
1. Assessment of the current status
2. Identification of the desired state in the future
3. Specification of interventions and other activities
to achieve the new desired state.
Planning is a dynamic process it involves three steps.
If no favourable outcome, change the plan,
implement and re-evaluate. Evaluation is an
ongoing process repeats itself in a cyclic manner is
called planning cycle
Planning involves following steps
Analysis of health situation
Establishment of objectives
Assessment of resources
Write up of formulate plan
Analysis of health situation:
The minimum essential requirement of health planning includes
1. The population its age and sex structure
2. Mortality and morbidity statistics
3. The Epidemiology and geographical distributions of diseases
4. Medical care facilities available such as hospitals, health centres and other
private and public health agencies.
5. The man power available
6. Training facilities available
7. Beliefs and attitude of people towards health, disease, its cure and
.The analysis of the above data brings out health problems, needs and
demands of the population.
Establishment of goals and objectives
Objectives are the guide for action.
Objectives needed for economical and better performance
Objectives should be established at all levels at upper level
it is more general and lower level it is more detail and
Objectives may be long term and short term. In setting up
these objectives time and resources are important factors
Objectives shout be - SMART
Assessment of resources:
Knowledge and techniques needed or available for the
implementation of the health programmes.
Establish the priorities in the order of magnitude of health
Prioritisation is based on financial constraint, mortality
and morbidity data, diseases which can be prevented at low
cost, political and community interest.
Once priorities are established alternative plans are
formulated and assessed to determine whether they are
Alternate plan with greater effectiveness are chosen.
Write-up formulated plan
The plan should be complete in all aspect.
The input required for the health programme and the
Cost and time needed for each stage of
implementation of the health programme.
Working guidance for all those involved in the
implementation of the health programme.
It must contain a’ built in’ system of evaluation
Programming and implementation:
Once the plan is approved by policy making authorities
programme and implementation are begun.
The effective implantation of the programme depends upon the
existence of effective organization.
The main consideration at implementation stage include
1. Defining of the role and task
2. Selection, training, motivation and supervision of the
3. Organization and communication
4. The efficiency of the implementing institution
It is the final step of planning cycle. It should be both concurrent
The purpose of evolution is to assess the achievements of stated
objectives, its adequacy, efficiency and its acceptance by the people.
Evaluation measures the degree to which objectives and targets are
fulfilled and the quality of the results obtained.
It measures the productivity of the available resource in achieving
Evaluation makes it possible the reallocation of priorities and of
resources on the basis of changing health needs.
Components of the evaluation process:
Relevance: Relevance relates to the rationale for
adopting health policies in terms of their response to
social and economic policy; and to having
programmes, activities, or services, in terms of their
response to essential human needs. For example
vaccination against small pox is now irrelevant
because the disease is eradicated.
Adequacy: Adequacy implies that sufficient attention has
been paid to certain previously determined course of action,
such as the various issues to be considered during broad
Progress; Progress is concerned with the comparison of
actual with schedule activities, the identification of reason for
achievements or shortcomings and indications for remedies
for any shortcomings. Progress evaluation track of ongoing
activities, milestones achieved, personnel matters, supplies
and equipment, money spent in relation to budgets allocated.
Efficiency: Efficiency is an expression of the relationship
between the results obtained from a health programme or
activity and the efforts expended in terms of human, financial
and other resources, health processes and technology and time.
Effectiveness; effectiveness is an expression of the desired
effect of a programme, services, institution or support activity in
reducing a health problem or improving an unsatisfactory
health situation. Thus effectiveness measures the degree of
attainment of the predetermined objectives and targets of the
programme, services or institution.
Impact: Impact is an expression of overall effect of a
programme, service or institution on health and
related socioeconomic development.
Aimed at identifying any necessary change in the
direction of health programmes so as to increase their
contribution to overall health and socioeconomic
Basic steps of evaluation
Determine what is to be evaluated
Establish standards and criteria
Plan the methodology
Analysis and interpretation of the results
Determine what is to be evaluated:
There are types of evaluation
Structure evaluation- evaluation of the resources used in the
programme like personnel, money, materials or buildings etc.
Process evaluation- the way in various activities of the
programme is carried out is evaluated by comparing with the
predetermined standard. How the inputs are utilized to
produce an output of a service.
Outcome evaluation – this is concerned with the end result of
the programme. The types and quantities of goals and services
produced by the programme.
Evaluation can also be classified as a) terminal
evaluation b) continuous evaluation c) periodic
evaluation based whether evaluation is planned at the
end of the programme or along with the programme
continuously or periodically.
Establishment of standards and criteria: Establishment of
standards and criteria are necessary to determine how well
objectives have to be attained.
Structure criteria: physical facilities, personnel and
Process criteria: no. of antenatal visits to be made, no. of
blood smear to be collected.
Outcome criteria: no. of death to be prevented no of patients
Methodology: methodology of evaluation should be
based on the purpose of evaluation.
Gathering information: evaluation requires
collection of data or information. The amount of data
required will depend on the purpose and the use of
Analysis of results: analysis of the data and interpretation
of data and feedback to all individuals concerned should
take place which will provide opportunity for discussing the
Taking action: Based on the evolution results actions are
taken to strengthen or modify the programme, which may
call for shifting priorities, revising the objectives etc.
Re-evaluation: Evaluation is an ongoing process which is
needed to make health programmes more relevant, efficient
National Health Policy
Policy: A policy may be thought of as a system which provides
the logical framework and rationality of decision – making for
achievement of intended objectives.
Health policy: Policy related to health aim to satisfy basic
human needs and therefore influence other social, economic,
human and developmental goals.
National health policy: Is an expression of goals for
improving the health situation, the priorities among those
goals, and the main directions for attaining them.
The National health policy adopted by the
Government of India in 1983 covers almost all systems
and subsystems required for health development and
for moving towards health for all by 2000AD. Since
then there has been significant changes in the
determinants factors relating to the health sector,
necessitating revision of policy, and a new national
health policy 2002 was evolved.
National Health Policy 2002
Objective: The main objective of this policy is to
achieve an acceptable standard of good health
amongst the general population of the country.
The approach would be to increase access to decentralized public health system by establishing
new infrastructure in the existing institutions.
Overriding importance would be given to ensure a more equitable access to health services
across the social and geographical expanse of the country.
Primacy will be given to prevent and first line curative initiatives at primary health level.
The policy is focused on those diseases which are principally contributing to disease burden
such as tuberculosis, malaria, blindness and HIV/AIDS.
Emphasis will be laid on rational use of drugs within the allopathic system.
To translate above objectives into reality the health policy has laid down specific goals to be
achieved by year 2005, 2007, 2110 and 2015.
National health policy 2002: Goals to be achieved by 2015
Eradicate Polio and Yaws 2005
Eliminate Leprosy 2005
Eliminate Kala-azar 2010
Eliminate Lymphatic Filariasis 2015
Achieve zero level growth in HIV/AIDS 2007
Reduce mortality by 50% on account of TB,
Malaria and other vector and water borne diseases 2010
Reduce prevalence of blindness to 0.5% 2010
Reduce IMR to 30/1000 and MMR to 100/lakhs 2010
Increase utilization of public health facilities from
current level of 20% to > 75% 2010
Establish an integrated system of surveillance
National health accounts and health statistics 2005
Increase health expenditure by government
From existing 0.9% of GDP to 2.0% of GDP 2010
Increase share of central grants to constitute at least
25% of total health spending 2010
Increase state sector health spending from 5.5%
to 7% of the budget 2005
Further increase to 8% of the budget 201