planning at the district level.

1. District health planningDistrict health planning
Dr. Vishal SoyamDr. Vishal Soyam
11

2. PLAN OF PRESENTATIONPLAN OF PRESENTATION
• Definition
• Brief history of planning
• Why District Health Planning
• District health Planning process
• Components of district health planning
• Steps of District Health Action Plan
• Example
• References
2

3. PLANNINGPLANNING
 DEFINITION : It is a process of identifying a
course of action systematically in an organized
manner to achieve the objectives by utilizing the
available resources skillfully in a cost – effective way.
 Purpose :
 To match the limited resources
 To eliminate the wasteful expenditure
 To develop the best course of action
3

4. HEALTHPLANNINGHEALTHPLANNING
 DEFINITION : It is the process of
 Defining community health problems,
 Identifying unmet needs & surveying the resources to
meet them,
 Establishing priority goals that are realistic & feasible &
 Projecting administrative action to accomplish the
purpose of the programme.
 Purpose :
 To improve health services 4

5. Brief history of decentralizedBrief history of decentralized
planningplanning
Decentralized planning started for the first time in the
First Five Year Plan (1951-56), when it was suggested
that the planning process be undertaken at the state and
district levels too.
73rd and 74th Amendments of the Constitution
mandating the establishment of Panchayats at the
district, intermediate and village levels. Reversal of the
centralised approach to district planning
Establishment of the District Planning Committee (DPC)
for consolidating plans
Little progress except in very few states
55

6. Brief history of decentralizedBrief history of decentralized
planningplanning
Decided that the ‘district plan process’ should be an
integral part of the process of preparation of state’s Five
Year Plan and the annual plan since 2005.
NRHM proposed the decentralisation of healthNRHM proposed the decentralisation of health
planning so that the state health plan representsplanning so that the state health plan represents
the needs and priorities of respective blocks andthe needs and priorities of respective blocks and
districts in the state.districts in the state.
Transforming a vertical planning process into aTransforming a vertical planning process into a
horizontal processhorizontal process
Village is envisaged as the primary unit for planning
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7. Relevance of District HealthRelevance of District Health
PlanningPlanning
Inter district variations – bridging disparityInter district variations – bridging disparity
Planning based on local evidence & needsPlanning based on local evidence & needs
To partner with CommunityTo partner with Community
Area specific strategies to achieve NRHMArea specific strategies to achieve NRHM
goalsgoals
Cost effective and practical solutionsCost effective and practical solutions
Move from budget based plans to outcomeMove from budget based plans to outcome
oriented plansoriented plans
Requirement of GoI – no funds if no plansRequirement of GoI – no funds if no plans
77

8. District Health PlanningDistrict Health Planning
District is the basic unit for dispensing of health services
Consistent with specific needs of the people, the growth
potential of the area & budgetary allocation available
District is the micro decision making unit, it can
implement innovation & experimentation to ameliorate
their own problems & satisfy the basic needs.
District have framework of the NHP, central five yr plan
, state plan and their priorities , keeping them in view
district make plan according to local specific needs. 88

9. Planning Process…Planning Process…
Participatory/Bottom Up Approach – under NRHMParticipatory/Bottom Up Approach – under NRHM
V V V VV V V V V V V 99

10. 1010
Contd…Contd…
 Planning process require setting up ofPlanning process require setting up of planningplanning
teams & committeesteams & committees at different level:at different level:
Village - VHSCVillage - VHSC
Gram Panchayat / Sub-centre –GP Pradhan,Gram Panchayat / Sub-centre –GP Pradhan,
ANM, MPW, few VHSCANM, MPW, few VHSC
PHC - PHC health planning & monitoringPHC - PHC health planning & monitoring
committeecommittee
CHC/Block level – Block planning & monitoringCHC/Block level – Block planning & monitoring
committeecommittee
District level – District health committeeDistrict level – District health committee

11. 1111
Institutional Framework forInstitutional Framework for
Convergent ActionConvergent Action
State Health Mission/Society
District Health Mission/Society
Block Health & Sanitation
Committee
Village Health & Sanitation
Committee
Partners and Members in above
mentioned Societies and Committees-
– DWCD; PRI/RD; Education;
PHED and AYUSH
District level organization chart
District health mission
Integrated District health
society
DPMU
Implementation of program

12. 1212
District Health MissionDistrict Health Mission
The DHM would get the district plan prepared coveringThe DHM would get the district plan prepared covering
health as well as the other determinants of health.health as well as the other determinants of health.
Chaired by dist. Magistrate/Collector/deputy commissionerChaired by dist. Magistrate/Collector/deputy commissioner
At the district level all existing societies have been mergedAt the district level all existing societies have been merged
into the District Health Society with its apex body performinginto the District Health Society with its apex body performing
the functions of the District Health Mission(DHM)the functions of the District Health Mission(DHM)
Roles and Responsibilities of District Health Mission includes:
– District health planning, implementation and monitoring
– Coordination across relevant Department
– Management of cash flows
– Financial accounting/ administration

13. Components of District PlanComponents of District Plan
BackgroundBackground
Planning processPlanning process
PrioritiesPriorities as per the background and planningas per the background and planning
processprocess
Annual planAnnual plan for each of the health institutionsfor each of the health institutions
based on facility surveysbased on facility surveys
Community action planCommunity action plan
Financing of health care managementFinancing of health care management
Structure to deliver the programStructure to deliver the program
Partnership for convergent actionPartnership for convergent action
1313

14. Components of District PlanComponents of District Plan
Capacity Building Plan
Human Resource Plan
Procurement and Logistics Plan
Non-governmental Partnerships
Community Monitoring Framework
Action Plan for Demand generation
Sector specific plan for maternal health, child health,
adolescent health, disease control, disease surveillance,
family welfare etc.
Budget
1414

15. District Health Action PlanDistrict Health Action Plan
 Preparation of annual plans for the district
called DHAP
 Suggests district specific interventions
 District health mission is responsible for
preparation of DHAP by constituting
planning team
 DHAPs contain inputs on the needs of the
districts in terms of programme
implementation and hence the funds
required for the same.
1515

16. District Health Action PlanDistrict Health Action Plan
 STEPSSTEPS
1.1. Introduction : The settingIntroduction : The setting
2.2. Situation analysisSituation analysis
3.3. Goals and ObjectivesGoals and Objectives
4.4. StrategiesStrategies
5.5. ActivitiesActivities
6.6. Work Plan/ ScheduleWork Plan/ Schedule
7.7. Monitoring and evaluationMonitoring and evaluation
8.8. BudgetBudget
1616

17. Example – RI Strengthening inExample – RI Strengthening in
migratory populationmigratory population
Gurgoan DHAPGurgoan DHAP
1717

18. 1. District Planning – Background1. District Planning – Background
LocationLocation
DemographyDemography
Socio-economicSocio-economic
Agro-economicAgro-economic
ResourcesResources
InfrastructureInfrastructure
SectoralSectoral
GeologicalGeological
Ground waterGround water
SoilSoil
ForestForest
Land utilizationLand utilization
1818

20. District Gurgaon At a Glance
Total Population : 1.8 Million
Urban and Peri-urban Population : 1.2 Million
Migratory Population : 0.8 Million
No. of Blocks : 04
No. of CHCs : 03
No. of PHCs : 13
No. of Sub-Centres : 76
No. of Anganwadi Centres : 265
No. of ASHA Workers : 393
Birth Rate : 31.1
IMR : 51.8
MMR : 286/lac
TFR : 2.6

21. Name of Block
Appox. No of
Household/
Families
Total
Population
Appox. No.
of 0-5 year
Children
Appox. No. of
<15 year
Children
Gurgaon (U) 49631 155463 22209 59224
Sohna 8804 29841 4263 11368
Pataudi 13169 43981 6283 16755
Farukhnagar 195337 573377 81911 218429
Total 266941 802662 114666 305776
Migratory Population of the District

22. 2. District Planning – Situation Analysis2. District Planning – Situation Analysis
Analysis of health situation:Analysis of health situation:
1.1. Assessment of present health situationAssessment of present health situation
2.2. Projection of the future health situationProjection of the future health situation
Situation analysis : By DataSituation analysis : By Data
– CollectionCollection
– Assessment/analyzeAssessment/analyze
– interpretationinterpretation
Use various data sources- district level dataUse various data sources- district level data
Interpreted in terms of characteristics of population,Interpreted in terms of characteristics of population,
data on health facilities, data on availabledata on health facilities, data on available
resources, data on training institutions etc.resources, data on training institutions etc. 2222

23. 2. District Planning – Situation Analysis2. District Planning – Situation Analysis
Compare district parameter with the state parameterCompare district parameter with the state parameter
Identify the problems, problems at various levelIdentify the problems, problems at various level
Identify the causesIdentify the causes
Do resource analysisDo resource analysis
Map the problem geographically, groups & vulnerabilityMap the problem geographically, groups & vulnerability
& the resources& the resources
2323

24. Migratory population is settled in Urban and Peri-urban areasMigratory population is settled in Urban and Peri-urban areas
of Gurgaon, they are from UP, Bihar, MP, Orissa andof Gurgaon, they are from UP, Bihar, MP, Orissa and
RajasthanRajasthan
Incidence of VPDs are much more in them, recently in 2008Incidence of VPDs are much more in them, recently in 2008
WPV (P3) detected in MigrantsWPV (P3) detected in Migrants
RI status in these population is around 30%RI status in these population is around 30%
No Anganwadi/ ASHAs in migratory coloniesNo Anganwadi/ ASHAs in migratory colonies
HealthHealth sub-centerssub-centers are overburdened, 30,000 population/are overburdened, 30,000 population/
sub-centresub-centre
Grossly inadequate health delivery systemGrossly inadequate health delivery system
Gurgoan Ex. – situation analysis

25. Areas of the concern are in the Migratory
Population
0
20
40
60
80
100
Yr 2005-06 Yr 2006-07 Yr 2007-08 Yr 2008-09
Haryana Gurgaon Migratory
% Fully Immunized Children

26. StrengthsStrengths ::
– Receptive District Health AdministrationReceptive District Health Administration
– Adequate budget for RI strengtheningAdequate budget for RI strengthening
– Well functioning cold chain system at the DistrictWell functioning cold chain system at the District
– Adequate supply of vaccines and logistics atAdequate supply of vaccines and logistics at
DistrictDistrict
– Excellent support staff for smooth data entry atExcellent support staff for smooth data entry at
District and Block level.District and Block level.
SWOT AnalysisSWOT Analysis

27. – Low capacity to devise, supervise, monitor andLow capacity to devise, supervise, monitor and
implementation of RI micro plansimplementation of RI micro plans
– Poor immunization infrastructure in Urban and Peri-urbanPoor immunization infrastructure in Urban and Peri-urban
areasareas
– Lack of adequate trained human resourceLack of adequate trained human resource
– Weak management of fund flow to the health facility levelWeak management of fund flow to the health facility level
– High drop outs – poor IEC and social issuesHigh drop outs – poor IEC and social issues
WeaknessesWeaknesses

28. – Capacity building of the staffCapacity building of the staff
– Inter-sectoral coordination between health and ICDS staffInter-sectoral coordination between health and ICDS staff
– Public-private partnership (Role of IAP/IMA and NGOs)Public-private partnership (Role of IAP/IMA and NGOs)
– Exploring immunization sites in the migratory campsExploring immunization sites in the migratory camps
– Innovative IEC in the migratory camps (Through schools)Innovative IEC in the migratory camps (Through schools)
OpportunitiesOpportunities

29. ThreatsThreats
– Sustainability of the programSustainability of the program
– Availability of motivated, trained manpowerAvailability of motivated, trained manpower
– Other competing priorities of the health systemOther competing priorities of the health system
– Fatigue factor and motivation of the staff working in theFatigue factor and motivation of the staff working in the
migratory camps ????migratory camps ????
– More immunization, more AEFI and community reactionMore immunization, more AEFI and community reaction
??

30. 3. District Planning – Goals & Objectives3. District Planning – Goals & Objectives
Goals:Goals:
– Societal in natureSocietal in nature
– Not necessarily attainableNot necessarily attainable
– Responsive to people needs & demandResponsive to people needs & demand
Objectives:Objectives:
– SMARTSMART
3030

31. ObjectivesObjectives
1.1. To increase immunization coverage in theTo increase immunization coverage in the
migratory camps from current level of 30% tomigratory camps from current level of 30% to
80% by 2010-1180% by 2010-11
2.2. To increase the demand generation of theTo increase the demand generation of the
community through innovative IECcommunity through innovative IEC
3.3. To reduce the VPDs and IMR in the HRAsTo reduce the VPDs and IMR in the HRAs
Goal
 Reduce child mortality
Example

32. 4. District Planning – Strategies4. District Planning – Strategies
How do we aim to achieve the objectives?How do we aim to achieve the objectives?
The choice of strategiesThe choice of strategies
Are these strategiesAre these strategies
– Technically soundTechnically sound
– Capability & manpower wise feasible?Capability & manpower wise feasible?
– Budget-wise feasible?Budget-wise feasible?
– Does it have capacity to manage the identifiedDoes it have capacity to manage the identified
constraints?constraints?
Choosing alternative strategiesChoosing alternative strategies 3232

33. StrategyStrategy
– Strengthening of RI micro plans in HRAs throughStrengthening of RI micro plans in HRAs through
identification, enlisting and mapping of HRAs sub-identification, enlisting and mapping of HRAs sub-
centre wisecentre wise
– Capacity building of the Health StaffCapacity building of the Health Staff
– BCC and IEC in the communityBCC and IEC in the community
– Bringing immunization sites closure to theBringing immunization sites closure to the
communitycommunity
Example

34. 5. District Planning – Activities5. District Planning – Activities
What are the activities needed to achieve theWhat are the activities needed to achieve the
objectives under specified strategy should beobjectives under specified strategy should be
stated.stated.
Who is responsible for the particular activity alsoWho is responsible for the particular activity also
specifiedspecified
Resources required for each activity estimatedResources required for each activity estimated
Sources of fund – from where expenditure incurredSources of fund – from where expenditure incurred
(eg. office expenditure, NRHM, DFW etc)(eg. office expenditure, NRHM, DFW etc)
Time frame for each activityTime frame for each activity
Any constraint for any activityAny constraint for any activity
3434

35. ActivitiesActivities
– Developing RI micro plans at district and health facility levelDeveloping RI micro plans at district and health facility level
– Preparation of micro plans for outreach camps
– Identification of fixed immunization sites in terms of time/place/personIdentification of fixed immunization sites in terms of time/place/person
– Availability of vaccine and logistics and its transport to the facility level.Availability of vaccine and logistics and its transport to the facility level.
– Outsourcing of human resources.Outsourcing of human resources.
– BCC and IEC activityBCC and IEC activity
– Training of the health staff for routine immunizationTraining of the health staff for routine immunization
– Interaction with RWAs /Builders association and stakeholdersInteraction with RWAs /Builders association and stakeholders
– Monitoring and evaluationMonitoring and evaluation
Example

36. 6. District Planning – Schedule6. District Planning – Schedule
In a matrix form and how activities will beIn a matrix form and how activities will be
conducted with special references to timeconducted with special references to time
frame and identify responsible officialframe and identify responsible official
/agency/agency
Preparation of Gantt chart to ensure thePreparation of Gantt chart to ensure the
activity going according to planactivity going according to plan
3636

37. Activity
No Name of the Activity July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar.
1 Identification of slum areas/
high risk areas
2 Preparation of micro plans for
outreach camps
3 Hiring or recruitment of
Health workers for these
sessions
4 Capacity Building of Health
Staff
5 Availability of Vaccine and
Logistics
6 Interaction with RWAs /
Builder and stakeholders
7 Availability of Budget
8 Preparation of Tracking bags
9 IEC activities
10 Monitoring and evaluations
Example Gantt chart

38. 7. District Planning – Monitoring &7. District Planning – Monitoring &
EvaluationEvaluation
Flow of data from different level i.e. serviceFlow of data from different level i.e. service
delivery, community monitoring and long scale datadelivery, community monitoring and long scale data
sets to be considered (RIMS) .sets to be considered (RIMS) .
Decide what is to be monitor ?, who will monitor ?Decide what is to be monitor ?, who will monitor ?
How to monitor? Process of monitoring etcHow to monitor? Process of monitoring etc
Set the indicator for monitoringSet the indicator for monitoring
Monitoring process finalised by training & clearMonitoring process finalised by training & clear
instructionsinstructions
Resources required for monitoring & evaluationResources required for monitoring & evaluation
3838

39.  Tickler bags has to be given for tracking dropoutsTickler bags has to be given for tracking dropouts
 Tickler bags are to be supplied for all the RITickler bags are to be supplied for all the RI
sites.sites.
 Self monitoring Immunization chart for DPT1 andSelf monitoring Immunization chart for DPT1 and
DPT3 at S/C, PHC and DHQDPT3 at S/C, PHC and DHQ
 Standard Monitoring format is to be used by allStandard Monitoring format is to be used by all
the Supervisors for RI sessions.the Supervisors for RI sessions.
 All field officers/Supervisors are supposed to doAll field officers/Supervisors are supposed to do
monitoring regularly and send the report monthlymonitoring regularly and send the report monthly
within the time frame.within the time frame.
Initiatives in Monitoring and Supervision
Example

40. Tickler bag being used in the State

41. EVALUATIONEVALUATION
 By internal agency Or by external agency:By internal agency Or by external agency:
 Are we going in a right direction?Are we going in a right direction?
 Is there any input lacking?Is there any input lacking?
 Are there any gaps found?Are there any gaps found?
 Have we achieved the goals and objectives preparedHave we achieved the goals and objectives prepared
for this action plan?for this action plan?
 Whether re-planning needed, if not heading towardsWhether re-planning needed, if not heading towards
the desired results?the desired results?
4141

42. 8. District Planning – Budget8. District Planning – Budget
Unit cost should be given for each costedUnit cost should be given for each costed
activity and source of funding also should beactivity and source of funding also should be
reflectedreflected
Costs should, as far as possible beCosts should, as far as possible be
estimated separately for each activity in theestimated separately for each activity in the
work planwork plan
4242

43. S.S.
No.No.
ActivityActivity ResponsibleResponsible
PersonPerson
Duration &Duration &
datedate
ItemItem
RequiredRequired
BudgetBudget
RequiredRequired
1 Identification of slum areas/ high risk
areas
MOIC, PPC Sohna,
Pataudi,
Farukhnagar with
DIO
July Govt. Vehicle-
4* 4 Days 400*4= 1600
2 Preparation of micro plans for
outreach camps
MOICs of each area
with DIO
August Stationery Required 500* 4= 2000
3 Hiring or recruitment of Health
workers for these sessions
DIO September,
October
Advertisement and
interviews
Approx.
3,50,000 per month
4 Capacity Building of Health Staff DIO October,
November
Training Material
and trainers
5000*4= 20000
5 Availability of Vaccine and Logistics DIO September,
October,
November
Vaccine and
Logistics
DGHS
6 Interaction with RWAs / Builder and
stakeholders
DIO/ MOICs December Venue, Tea and
Snacks
10000
7 Availability of Budget DIO October,
November,
December
- DGHS
8 Preparation of Tracking bags MOICs January 40 Tracking Bags 40*200= 8000
9 IEC activities DIO/MOICs October,
November,
December
Poster & Banners 40000
10 Monitoring and evaluations DIO/ District
Program
Officer/SMOs/ MOs
January,
February, March
Vehicle
8*400*12
8*400*12
38400 per month

44. THANK YOU
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