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Situation analysis

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Situation analysis

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Situation analysis

  1. 1. Situation Analysis & Priority Setting
  2. 2. Functions of Management 2 Planning Implementatio n Evaluation
  3. 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) 3
  4. 4. Planning Cycle / Spiral 4 Situation Analysis Implementation and Monitoring Evaluation Option appraisal Priority, goal, and objective setting Programming
  5. 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 5
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  7. 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 7
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  10. 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 10
  11. 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 11
  12. 12.  Current situation on  baseline information  morbidity, mortality, service utilization  for service provision  for young or elderly health 12
  13. 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 13
  14. 14. Area characteristics and infrastructure  Geographical situation  Infrastructure Transport modes & routes Communications Water supply & sanitation facilities Utilities - distribution of main electricity 14
  15. 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 15
  16. 16. Policy and political environment  Overall national policies  Existing health policies National Health Policy  Political environment In order to recognize potential opponents or supporters 16
  17. 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 17
  18. 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 18
  19. 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 19
  20. 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 20
  21. 21. Resources  Financial resources capital & recurrent budget, constraints, source, projected inflation rate  Personnel staff employed, training, losses  Buildings, land, equipment and vehicles  Times  Information 21
  22. 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) 22
  23. 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 23
  24. 24. SWOT Analysis  Internal Analysis Strengths Weaknesses  External Analysis Opportunities Threats 24
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  26. 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 26
  27. 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 27
  28. 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 28
  29. 29. Who should carried out?  Health professionals & service manager  Representatives of other sectors related to health sector  Community representatives 29
  30. 30. Setting Priorities 30
  31. 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 31
  32. 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. 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 33
  34. 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 34
  35. 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 35
  36. 36. Criteria for priorities  maximum feasible health gain within available resources ( efficiency )  effects on equity  level of public demand 36
  37. 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 37
  38. 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 38
  39. 39. Priority assessment of Health problems and needs  Prevalence / Incidence  Severity of problem  Effective Intervention  Acceptability / Feasibility  Community involvement  Cost and Resources 39
  40. 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 40
  41. 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 41
  42. 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. 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 43
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