Introduction to Planning for nursing/Public Health Students

Hari Prasad Kaphle
Assistant Professor (Public Health)
Pokhara University
1Introduction to Planning Hari Prasad Kaphle

Introduction
 Planning is the process of determining the future course
of action i.e. what action, why an action, how to take
action, when to take action, who is responsible for that
action.
 These why, what, how and when are related with
different aspects of planning process.
 Planning is a future oriented process of setting
goal/objective/target and choosing the best way to
achieve these goals

Introduction
 Planning includes the determination of specific
objectives, determination of project and programme,
setting policies and strategies, rules and procedures
and preparing budget.
 Planning also can be viewed as looking for the most
appropriate way to go from the current situation to the
desired situation.

Definition
 Planning can be defined as the process of deciding how
the future should be better than the present, what changes
are necessary to make these improvements and how these
changes should be implemented. – Brotherston (1974)
 Planning may be broadly defined as a concept of
executive action that embodies the skill of anticipating,
influencing, and controlling the nature and direction of
change. - Mc Farland (1974)

Definition
 Planning is the selection and relating of facts and
making and using of assumptions regarding the future
in the visualization of proposed activities believed
necessary to achieve desired result. - George R Terry
(1998)
 A plan is a commitment to a particular course of
action considered necessary or desirable to achieve
specific results.

Health Planning
 Health planning is defined as the orderly process of
defining community health problems, identifying
unmet needs of people and surveying the resources to
meet the established priority goals that are realistic
and feasible and projecting administrative actions to
accomplish the purpose of the proposed programs.

Characteristics/features of planning
 Planning is goal-oriented.
 Planning is made to achieve desired objective of
business.
 The goals established should general acceptance
otherwise individual efforts & energies will go
misguided and misdirected.
 Planning identifies the action that would lead to
desired goals quickly & economically.
 It provides sense of direction to various activities.

 Planning is an intellectual process.
 Planning is a mental exercise involving creative
thinking, sound judgment and imagination.
 It is not a mere guesswork but a rotational thinking.
 A manager can prepare sound plans only if he has
sound judgment, foresight and imagination.
 Planning is always based on goals, facts and
considered estimates.

 Planning is looking ahead (futuristic).
 Planning is concerned with looking into the future.
 It contains something that is going to do in future.
 It requires peeping in future, analyzing it and
predicting it.
 Thus planning is based on forecasting.
 A plan is a synthesis of forecast.
 It is a mental predisposition for things to happen in
future.

 Planning involves choice & decision making.
 Planning essentially involves choice among various
alternatives.
 Therefore, if there is only one possible course of
action, there is no need planning because there is no
choice. Thus, decision making is an integral part of
planning.
 A manager is surrounded by number of alternatives.
He has to pick the best depending upon
requirements & resources of the enterprises.

 Planning is the primary function of management (primacy
of planning).
 Planning lays foundation for other functions of
management.
 It serves as a guide for organizing, staffing, directing and
controlling.
 All the functions of management are performed within the
framework of plans laid out by planning.
 Therefore planning is the basic or fundamental function of
management.

 Planning is a continuous process of management.
 Planning is a never ending function due to the
dynamic business environment.
 Plans are also prepared for specific period of time
and at the end of that period, plans are subjected to
reevaluation and review in the light of new
requirements and changing conditions for further
planning.

 Planning is all pervasive.
 It is required at all levels of management and in all
departments of an enterprise.
 But, the scope of planning may differ from one
level to another.
 The top level may be more concerned about
planning the organization as a whole whereas the
middle level may be more specific in departmental
plans and the lower level plans implementation of
the same.

 Planning is designed for efficiency.
 Planning leads to accomplishment of objectives at
the minimum possible cost.
 It avoids wastage of resources and ensures adequate
and optimum utilization of resources.
 A plan is worthless or useless if it does not value
the cost incurred on it. Therefore planning must
lead to saving of time, effort and money.
 Planning leads to proper utilization of men, money,
materials, methods and machines.

 Planning is flexible.
 Planning is done for the future. Since future is
unpredictable, planning must provide enough room
to cope with the changes in customer’s demand,
competition, government policies etc.
 Under changed circumstances, the original plan of
action must be revised and updated to make it more
practical

Elements of Planning
Vision Statement:
 Vision represents the imagination of future events and
prepares the organization for it. It is a mental
perception of a kind of environment a
person/organization desires to create in future.
 A Vision Statement states that “What do we want to
become in future (e.g. in next 5yerars, 10 years, 20
years and so on)”.

 Vision Statement
 Mission Statement
 Goal
 Objectives
 Targets
 Policies
 Strategies
 Activities
 Programme
 Project
 Procedure/SOP
 Rules
 Schedule/Work plan
 Budget

Vision Statement:
 Developing a vision statement is the first step in
strategic planning. Most of the vision statements are
written in single sentence.
 A world Free of TB, Feed the hungry serve the nation,
Global excellence in health care, Getting to zero: Zero
infection, zero transmission etc.

Mission Statement:
 Mission is the purpose or reason of existence of an
organization. It tells what an organization providing to
society- a product or service?
 A mission statement identifies the scope of a firm’s
operation in product and market terms. It addresses
the basic question that feels all strategists. “What is
our business?”

Mission Statement:
 A clear mission Statement discusses the values and
priorities of an organization.
 A mission statement broadly charts the future
directions of an organization.
 The mission statements are quite longer than vision
statement . It should not be too long and too short.
 It should be long enough to cover everything, but
short enough to be attractive.

Apollo Hospital
 Vision: 'Touch a Billion Lives'.
 Mission: Our mission is to bring healthcare of
International standards within the reach of every
individual. We are committed to the achievement and
maintenance of excellence in education, research and
healthcare for the benefit of humanity.

CDC: Global Immunization Division
 Vision Statement: A world without vaccine-
preventable disease, disability, and death
 Mission Statement: To protect the health of global
citizens by preventing disease, disability, and death
through immunization

Nepal Health Sector Programme II
 Vision: Improve the health and nutritional status of
the Nepalese population and provide an equal
opportunity for all to receive quality health care
services affordably or free of charge, thereby
contributing to poverty alleviation.

Nepal Health Sector Programme II
 Mission: Promote the health of Nepal’s people by
facilitating access to and utilization of essential health
care and other health services, emphasizing services to
women, children, the poor and excluded, and
changing the dangerous lifestyles and behavior of the
Most-at-risk Populations (MARPs) through Behaviour
Change Communication (BCC) interventions.

Goal:
 Goal is an ultimate desired state towards which objectives
and resources are aimed.
 Goal is broad and generalized, is not time constrained or
bounded. It is formulated at high level and is described in
terms of:
 What is to be attained?
 Extent to which it should be attained?
 What to be achieved?
 Population or section or environment concerned
 Geographical area of concerned one, the length of time
to achieve goals.

National policy on skilled birth attendants, 2006
 Goal: To reduce maternal and neonatal morbidity and
mortality by ensuring availability, access and
utilization of skilled care at every birth.
Safe motherhood policy, 1998
 Goal: To reduce mortality and morbidity among
women during pregnancy, childbirth and the postnatal
period through the adoption of a combination of
health and health related measures.

National Immunization Programme
 Goal: To reduce child mortality, morbidity and
disability associated with vaccine preventable diseases.
Adolescent sexual and reproductive health
 Goal: to promote the sexual and reproductive health
status of adolescents.
National Tuberculosis Programme
 Goal: To reduce mortality, morbidity and transmission
of tuberculosis until it is no longer a public health
problem

Objectives:
 It is a planned end point of activities. Objectives are
the statements of what one hopes to achieve or
accomplish over a period of time.
 Objectives can be defined as specific results that an
organization seeks to achieve in perusing its basic
mission.
 Objective is the precisely stated end to which efforts
are directed, specifying the population outcome,
variable to be measured. – John M. Last (1995).

 All objectives should be SMART
 S=Specific (concerned with specific area or activity),
 M=Measurable (the outcomes can be measured to
demonstrate that the objective has been achieved),
 A=Attainable (the outcome is possible to achieve),
 R=Realistic (achievable with available resources),
 T=Time-framed (achievable within the time).
 We need to constantly review our objectives by
measuring the outcomes, so that we can change the way
that we are working, if necessary.

Targets:
 Targets are the desired end- results of specific
activities to be achieved in finite period of time.
 A target often refers to a discrete activity which
permits the concept of degree of achievement.
 Targets are thus concerned with the factors involved
in a problem where as objective are directly concerned
with problems itself.

 Specific objectives
 To increase the accessibility, availability and utilization of
maternal health care facilities.
 To strengthen the technical capacity of maternal health care
providers at all levels of the health care system.
 To strengthen referral services for maternity care, particularly
at the district level and with specific emphasis on appropriate
referral of high-risk cases.
 To increase the availability and use of contraceptives for child
spacing and family planning purposes.
 To raise public awareness about the importance of the health
care of women and in particular, maternal health care and safe
motherhood.
 To improve the legal and socio-economic status of women.

 Targets
 Reduce maternal mortality rate from 850 per 100,000 live birth to
750 by 1996 and to 400 by the year 2000.
 Increase contraceptive prevalence rate (CPR), with particular
focus on spacing methods, from 24% to 30% by 1996 and to 38%
by the year 2000.
 Increase the coverage of antenatal care services from 18% to 25%
by 1996 and to 50% by the year 2000.
 Ensure that at least 25% of all deliveries are attended by trained
health workers by 50% by the year 2000.
 Increase the number of first level referral hospitals with capacity
to provide essential obstetric functions from the present number of
14 to 24 by 1996.
 Reduce anaemia (i.e., Hb <11gm%) in pregnant women from 78%
to 70% by 1996 and to 50% by the year 2000. 33Introduction to Planning Hari Prasad Kaphle

 Targets
 Increase the enrollment of female students in primary school from
54% to 76% by 1996 and to 100% by the year 2000.
 Ensure the completion of primary education by girl children from
the present estimate of 27% to 55% by 1996 and to 70% by the
year 2000.
 Increase the female literacy from the present rate of 21% to 38%
by 1996 and to 61% by the year 2000.
 Initiate policy development on legal and programmatic aspects of
abortion and work toward the legalization of abortion.
 Introduce (mother and encourage) the enforcement of the legal age
of marriage in the coordination with the relevant government
entities.

Objective of the health policy 1991
 To upgrade the health standards of the majority of the
rural population by extending Basic Primary Health
Services up to the village level and to provide the
opportunity to the rural people to enable them to obtain
the benefits of modern medical facilities by making the
facilities accessible to them

Targets of the National Health Policy 1991
By the year 2000 AD., the following targets will be attained:
 The infant mortality rate will be reduced to 50 per thousand
from the present 107 per thousand.
 The mortality rate of children below 5 years will be reduced to
70 per thousand from the present 197 per thousand.
 The total fertility rate will be reduced to 4 from the present 5.8
children per women of child bearing age.
 The maternal mortality rate will be reduced to'4 per thousand
from the present 8.5 per thousand live births.
 The average life expectancy will be raised to 65 years from the
present 53 years.

Scope of Objectives
Target
Objective
Goal
Mission
Vision

Policies:
 These are the guiding principles stated as an
expectation, not as command.
 Policies are also plans (standing plan) in that they are
general statements or understandings which guide or
channel in decision making.
 Policy is a consistent guide to be followed under a
given set of circumstances.

Policies:
 Policies define an area within which a decision is to
be made and ensure that the decision will be
consistent with, and contribute to, an objective.
 Policies help to decide the issues before it becoming
problems.
 It also allows deciding for the same problem which
occurs again and again

National Blood Policy 2050 (1993 AD)
The following guiding principles govern Nepal’s blood services:
 The collection of blood is based on voluntary non-remunerated
blood donation,
 The provision for blood and blood products must be on non-
profit basis,
 No harm should be caused to the blood donor and recipients of
blood and blood products
 Every citizen of Nepal or any other country who needs blood
and blood products as recommended by the treating physician
in any health facilities in Nepal should have equal, prompt and
affordable access to blood and blood products,

National Blood Policy 2005
 Partnership between Ministry of Health and Nepal Red Cross for blood
donor recruitment, collection, processing, storage, supply and overall
management for provision of safe blood is vital and therefore must be
strengthened at all levels central, regional, districts and below by
formation of joint committees as guided by regulatory body.
 National blood services standards must ensure that services and products
conform to high quality standards,
 Blood transfusion is a medical intervention that should be indicated and
prescribed by medical practitioners registered with Nepal Medical
Council.
 The rights and duties of blood donors, staffs of the blood program
patients and physicians should be observed.
 Minimum wastage of blood should be ensured through effective supply
and demand management.
 NBA shall develop appropriate legal framework for enforcement of
provisions of the National Blood Policy.

 National Health Policy 2071
1 National Health Policy 2071.pdf

Strategy:
 In its most basic form, a strategy is simply a
declaration of intent. How we are going to perform
certain activities? What will our approach in
performing certain activities?
 It’s purpose is to provide the framework for guiding
decisions and actions towards a predefined goal.
 Strategy is a plan to achieve the mission and objective
of an organization.
 Strategy of an organization is a comprehensive master
plan stating how the organization will achieve its
mission and objective.

1 National Health Policy 2071.pdf

CB‐IMCI: strategies
1. Improving knowledge and case management skills of health
service providers
CB‐IMCI aims to improve the knowledge and skills of health
service providers through
 Training on integrated management of childhood illnesses
including follow up and onsite coaching for improved
performance;
 Regular integrated review and refresher trainings to health
service providers emphasizing on recent updates in CBIMCI
protocols;
 Technical support visit from higher levels to respective
institutions; central to regional to district to HFs to FCHVs
 Capacity building training to the CB‐IMCI focal persons of the
districts
 Inclusion of CB‐IMCI component in the curriculum of
pre‐service medical and paramedical schools

CB‐IMCI: Strategies
2. Improving overall health systems
 Carry out CB‐IMCI program maintenance activities as per the
recommendations made by IMCI technical working group
 Improve logistic supply of key commodities.
 Ensure transferred and new health workers are skilled in
CBIMCI program
 Regularize community based activities of FCHV and outreach
clinics including reactivating health mother’s group meeting.
 Strengthen supervision and monitoring of the program within
regular integrated supervision.
 Strengthen recording and reporting system of the CBIMCI
program at all levels.

CB‐IMCI: Strategies
3. Improving family and community practices
 Disseminate key behavioral message through FCHVs,
outreach clinics and health facilities to individuals, families
and communities using localized IEC materials.
 Reach the disadvantaged and hard‐to‐reach communities
through reactivated and socially inclusive health mothers’
group and planned outreach clinics.
 Create an enabling environment for practicing key
individual and family behaviors through continuous
advocacy and social mobilization for child health promotion
at national, district and community level

Procedure:
 A procedure (sometimes called as standard operating
procedure) is a sequence of steps for completing a
given activity.
 Formal procedures provide specific and detailed
instructions for the execution of plans.
 It is a standing plan that outlines a series of related
actions that must be taken to accomplish a particular
task.

Procedure:
 Procedures and policies are linked to each other.
 For example, a Purchasing policy of an enterprise may
states purchasing from lowest bidding party.
 To implement this policy an enterprise should
establish a procedure containing sequence of activities
how it will purchase from lowest bidding party.

Procedure:
 Policy: Recruitment of employee through open
competition
 Procedure: advertisement, collecting application,
screening, knowledge test, interview, verification of
certificates, reference checking, selection, placement
of selected employees etc.

Programme:
 A programme a combination of regular ongoing
activities which contributes to achieve specific goals.
 A programme provides base to carryout interrelated
activities
 Programme is a sequence of activities desired to
implement activities to achieve objectives
 programme is step-by-step approach to guide the
action necessary to reach a predetermined goals.

Programme:
 Programs are a complex of goals, policies,
procedures, rules, tasks, and assignments, steps to be
taken, resources to be employed and other elements
necessary to carry out a given course of action, and
ordinarily supported by budgets.
 A program is a group of related projects managed in a
coordinated way.

Programme:
 National Immunization Programme
 National Nutrition Programme
 National Programme for STI and AIDS Control
 National Tuberculosis Programme
 National Malaria Control Programme
 Adolescent Reproductive and Sexual Health
Programme
 Family Health Programme

Project:
 A Project is a group of milestones or phases, activities
or tasks that support an effort to accomplish
something.
 A project is a temporary endeavor (attempt)
undertaken to produce a unique product or service or
result.

Project:
 A project is a temporary attempt to produce/provide
unique service or product.
 A project has a clearly defined starting point and end
point.
 It has clearly defined scope.
 Project activities are elaborated in detail so that their
no room for misinterpretation.

Project
 Project especially work in unusual field or provides
unusual service and hence involves maximum risk
and uncertainty.
 Project utilizes the fund from unusual sources.
 After accomplishment of per determined objective or
after completing defined periods project automatically
terminated .

What are not Projects?
 Past activities that are repeated in exactly the same
way on the periodic basis,
 Activities with no clearly defined goals,
 Activities which can be repeated or translated
anywhere at any moment and
 Regular ongoing organizational activities

Project examples on HIV/AIDS
 Western highway project in HIV/AIDS for transport
worker and their partners.
 Increasing access to care and treatment in HIV/AIDS
among Migrant in Kaski.
 Prevention of HIV/AIDS among injecting drug users in
Kaski.
 Prevention of HIV/AIDS among Commercial Sex
Workers in Pokhara Valley.
 PMTCT (Prevention of Mother‐to‐Child Transmission)
of HIV/AIDS

Some more examples of projects
 BPCR (Birth Preparedness and Complication
Readiness)
 CMAM (Community‐based Management of Acute
Malnutrition)
 IMNMP (Intensification of Maternal and Neonatal
Micronutrient Program)
 RBM (Roll Back Malaria) Initiatives
 WASH Water, Sanitation and Hygiene
 Suaahara: An integrated Nutrition Program in Nepal
 School Health and Nutrition
 ODF Campaign

Schedule:
 It is a time sequence for work to be done. Schedule is
a commitment of resources and labor to tasks with
specific time frames.

Budget:
 Budget is a single use financial plan that covers a
specified length of time.
 Budget refers to the cost of programme usually in
terms of monetary value usually in US$.
 It describes in numerical terms resources allocated to
organizational activities.
 By budgeting, managers identify resources such as
money, material and human resource. It also
communicates performance expectations.

Budget:
 A budget is a financial statement of expected results in
numerical terms.
 For examples Government Annual Budget, Annual
Health Budget, Annual budget for HIV/AIDS
programme, Tuberculosis control programme etc.
MoHP Budget-Prog 2068-69.pdf

Introduction to Planning Hari Prasad Kaphle 67

Types of Planning
Breadth Time frame Specificity Frequency
of use
Approach
adopted
Degree of
formalization
Strategic Long term Directional Single use Proactive Formal
Operational Short term Specific Standing Reactive Informal

Strategic and Operational Planning:
 Strategic planning sets the long term direction of the
organization in which it wants to proceed in future. It is
applied to the entire organization and establishes the
organization’s overall objectives, and seeks to position the
organization in terms of its environment.
 Top-level managers, formulate long-term strategic
planning to reinforce the firm’s mission (the mission
clarifies organizational purpose).
 Strategic plans are specified for five years period or more;
but circumstances dictate the planning horizon

Strategic and Operational Planning:
 Operational plans specify the details of how the overall
objectives are to be achieved.
 Operational planning is accomplished by fist-line
managers.
 Operational planning is most concerned with budgets,
quotas and schedules.
 Time horizon for operational planning is very short.
 Most plans at this level reflect one operational cycles.
 Operational objective are narrow in scope, short-lived and
subject to sadden change.

Short-term and Long-term Planning:
 Short-term planning also known as operational or tactical
planning usually covers one year or less than one year.
These are aimed at sustaining organization in its
production and distribution of current product and services
to the existing markets.
 The long term planning involves the analysis of
environmental factors (external and internal) to set its
direction for future. Long term plans are strategic in nature
and usually cover 5 year or more.

Standing and Single-use Plans:
 Standing plans are ongoing, and provide guidance for
repeatedly performed actions in an organization. Standing
use plans- are those that are used on a continuous basis to
achieve consistently repeated objectives. Standing plans
take the form of policies, procedures and rules.
 Single-use plans are used to meet the needs of particular
or unique situation. Single use plans are those that are
used once to achieve unique objectives or objectives those
are seldom repeated. They are communicated through
programs, budget and schedule.

Specific and Directional Planning:
 In specific planning all the objectives and activities
are clearly defined and leave no room for
misinterpretation.
 In directional Planning only general guidelines are
expressed in plan so that these plans are flexible and
the way of implementation of this plan depends upon
the situation

Proactive and Reactive Planning:
 Proactive planning involves designing suitable course
of action in anticipation of likely changes in the
relevant environment.
 In reactive planning, organizations response comes
after the environmental changes have taken place.
After the change takes place, the organization starts
planning.
 For example disaster preparedness and prevention
plan is a proactive plan while disaster relief plan is a
reactive plan.

Formal and Informal Planning:
 Formal planning is in the form of well-structured
process involving different steps. At the end of
planning process, the organization has well structured
and documented plan with clear objective and
activities.
 In this types of planning all level of management are
involved in planning process and carried out all steps
of planning in an organizations.

Formal and Informal Planning:
 In informal planning, planning is based on manager’s
memory of events, institutions and got-feeling rather
than based on systematic evaluation of environmental
happenings.
 In fact informal plan are not true plans. These types of
planning are generally undertaken by smaller
organizations.

Process/Cycle of Planning
 Stage 1: Situational analysis
 Stage 2: Problem identification and prioritization
 Stage 3: Identify resources
 Stage 4:Setting objectives
 Stage 5: Preparation of action plan
 Stage 6: Plan Implementation
 Stage 7: Monitoring and Evaluation

Situational analysis
 Population characteristics – population size, age and sex
composition, vital statistics
 Socio economic characteristics of population –income,
education, occupation, cultural practices
 Morbidity and mortality profile of major health problems
 Epidemiology and geographic distribution of the disease under
consideration
 Availability healthcare facilities – type, infrastructure structure
and available health services
 Availability technical manpower – number, category and
knowledge and skill level
 Awareness level of the community regarding health and
diseases etc

Problem identification & prioritization
Health problems Health service
problems
Community health
problems
Malaria
Diarrhea
Malnutrition
Lack of supervision
Insufficient drugs
Lack of trained
personnel
Lack of safe water
supply

Problem identification & prioritization
SN Problem
identified
Score for each criterion Total
scor
e
Priori
ty
rank
Magnitud
e
Severity Feasibil
ity
Govt.
concern
Commu
nity
concern
1 Malaria 4 5 5 4 3 21 4
2 HIV/AIDS 3 5 3 4 3 18 6
3 Tuberculosis 3 5 5 4 3 20 5
4 Diarrhoea 5 5 5 5 5 25 1
5 ARI 5 5 5 5 4 24 2
6 PEM 4 4 5 5 4 22 3

Assessment of Resources:
 This involves identifying and quantifying the shortfalls (if
any) between what is and what ought to be. Analysis of
external and internal environment provides potential
shortfalls.
 This may include assessment of available internal and
external resources to fulfill the goal and objectives.
Resources are Man, Money, Materials, skill, techniques,
knowledge which are utilized to carryout health activities.

Setting Directions:
 This step involves setting the goals and objectives
towards which the performance of health system is
compared. This step is meant to identify the desirable
future state (expressed as outcomes) for the issue
under consideration.
 At the central level, the objectives would be more
general and with each successive level, the objectives
will become more specific.

Setting Directions:
Goal To improve the health status of community A
Objective To provide safe drinking water to community A
To improve environmental condition of community A
Target To supply safe drinking water to the 90% of households of
community A by the year 2018.
To support to 95% of households of community A for
constructing sanitary latrine by the year 2018.

Preparation of Detail Action Plan
(Programming & Budgeting):
 This step involves the preparation of detail action plan
to fulfill the established goals and objectives based on
available resources.
 An action plan describes the sequences of activities,
timeline to conduct each and every activity,
responsible person for each and every activity and
resources (financial and non financial) required for
each and every activity and indicators to monitor the
performance.

Preparation of Detail Action Plan
(Programming & Budgeting):
Objectives Proposed
Activities
Approach
(strategy)
Responsibl
e person
Resources Cost Time line Performance
Indicator
Objective
1:
Objective
2:

Program Implementation:
 This step involves implementation of the chosen solutions.
It requires detail description (write up) of formulated plan
or action plan for carrying out activities.
 It may include development of hiring land/buildings,
infrastructures, purchasing equipments, medicines,
logistics, selection and recruitment of health professionals
and initiation and continuation of services/clinics.
Implementation of plan should be accordingly detail
action plan.

Monitoring and Evaluation:
 This step may begin with development of an evaluation
plan well before evaluation actually takes place. It may
also involve development of ongoing monitoring
methods to be used to continuously identify and assess
the intended and unintended consequences of
implementation actions.
 Monitoring refers to the assessment of the day to day
functioning of the program. Evaluation refers to the
assessment of the final outcome of the plan.

Monitoring and Evaluation:
S
N
Activity Key indicator Base
line
Target Means of
verificatio
n
Frequency
of Data
Collection
Important
assumption
1 ANC
service
1st ANC Coverage
4th ANC Coverage
IFA coverage
TT2 coverage
40 %
25%
41%
55%
80%
50%
90%
95%
Clinic
report
Monthly
and
Quarterly
Community
support
Coordination
with SHP/HP
2 INC
service
Institutional delivery
Skill birth Attendance
16%
31%
70%
85%
Clinic
report
Monthly
and
Quarterly
”
3 PNC
service
PNC coverage
Postnatal Vitamin A
coverage
19%
NA
50%
100%
Clinic
report
Monthly
and
Quarterly
”
4 New Born
Care
Birth weight
BCG Coverage
NA
85%
85%
95%
Clinic
report
Monthly
and
Quarterly
”

Planning Cycle
Situational
analysis
Problem identification and
prioritization
Resources
Assessment
Setting objectives
Preparation of
action plan
Plan
Implementation
Monitoring and
Evaluation
Feedback

Components of (Operational) a Plan
 Executive summary
 Introduction
 Problem Statement
 Objectives and targets
 Strategies and activities
 Budget
 Work Plan
 Monitoring and Evaluation
 References
 Annex

Strategic Planning
 Strategic Planning is a long-term, future-oriented
process of assessment, goal-setting, and strategy
building that maps an explicit path between the
present and a vision of the future, that relies on careful
consideration of an organization’s capabilities and
environment, and leads to priority-based resource
allocation and other decisions.

Strategic Planning
 A strategic plan develops a clear statement of the
organization’s mission and vision, identifies a set of
goals and objectives and formulates key strategies that
address those factors that are essential to the its
success.
 Strategic plan is prepared by the comprehensive
scanning of internal (strengths and weaknesses) and
external (opportunities and threats) environment.

Strategic Planning
Strategic Planning answers the following questions
 Where are we now?
 Current status
 Where do we want to be?
 Desired status
 How do we get there?
 Strategies
 How do we insure we will be there?
 Monitor and control system

Strategic Planning
T1 T2
Gap
Desired Status
Present
Status Planning Required
Time
Stat
us

Strategic Planning
Steps
I. Environmental scanning
II. Determination of the organizational vision and mission
III. Determination of organizational goal and objectives
IV. Determination of performance objectives
V. Generation, evaluation and decision on strategic
options
VI. Preparing action plan
VII. Developing monitoring and control System
VIII. Strategy implementation

Environmental Scanning
External Appraisal:
 External appraisal involves analyzing the external
environment in which an organization operates in
terms of the risks and uncertainties it faces, its current
competitive position, and opportunities or threats
which it needs to address.

External Appraisal
 In the case of a private organization this would
include considering the change in technology, the
demand from consumers and the actions of
competitors.
 In the case of public service bodies political, social
and economic trends are of major importance.

Internal Appraisal:
 Internal appraisal entails examining the resources
(employees: number, level, knowledge and skill;
finance: capacity to collect and invest; material:
equipments, machine, producing capacity and its
technology) to find out its strengths and weaknesses
that an organization possesses in order to assess its
strategic capability so that choices of future strategies
can be made.

Internal Appraisal:
 This will enable management to decide what
resources and skill bases are required for each
potential activity and which ones the organization
currently possesses.

SWOT
Analysis
Opportunities
Weakness
Threats
Strengths

SWOT analysis
Strengths
• Highly skilled manpower
• Latest technology
• Sufficient investment
• Global presence
• Well defined distribution mechanism
• Alternative products or services
Weaknesses
• Non experienced managers
• Old technology
• Lack of investment
• Low position in business
• Conflict b/n management and employees
Opportunities
• Favorable government policy
• Availability of raw materials
• Availability of raw materials at low
costs
• Availability of latest technology
(PID, e-business,
telecommunication)
• Stable government
Threats
• Liberal government policy
• Threats of new entrance
• Hyper competition
• Threat of substitute products
• Bargaining powers of buyers
• Strict environmental laws

Determination of the organizational
vision and mission statement
 We should have to assess our current mission and
objectives and determine future vision and mission
based on circumstances identified by environmental
scanning
 Examples of vision statement may be “Healthy people
in health community”; “A world free of vaccine
preventable diseases”; “A world free of TB”; “Global
excellence in providing health and medical services”.

Determination of the organizational
vision and mission statement
 An example for the mission statement for privately run
hospital may be “As a leading private hospital in Nepal,
we are committed to the provision of comprehensive
healthcare services in all medical and surgical specialties
in a safe, modern, and patient-centered environment; for
the well-being of the whole community. We strive to
achieve excellence in serving our patients, regardless of
their cultural, ethnic, or social differences”.

Determination of organizational goal
and objectives
 An organization’s goal states the intentions behind the
organization’s actions. An organizational goal is the
general ends toward which it directs its efforts. A goal
addresses issues by stating policy intention. It may be both
qualitative and quantifiable, but not usually quantified.

Determination of organizational goal
and objectives
 An organization’s goal states the intentions behind the
organization’s actions. An organizational goal is the
general ends toward which it directs its efforts. A goal
addresses issues by stating policy intention. It may be both
qualitative and quantifiable, but not usually quantified

Determination of performance
objectives
 These will be quantified long term and short term
performance targets which the organization wishes to
achieve.
 These unit objectives relate to the specific objectives of
individual services or business units within an
organization.
 These should be SMART – Specific, Measurable,
Attainable, Relevant and Time Bound.

Second Long Term Health Plan
(1997-2017)
Objectives
 To improve the health status of the population of the most vulnerable groups,
particularly those whose health needs often are not met-women and children,
the rural population, the poor, the underprivileged, and the marginalized
population.
 To extend to all districts cost-effective public health measures and essential
curative services for the appropriate treatment of common diseases and injuries.
 To provide the appropriate numbers, distribution and types of technically
competent and socially responsible health personnel for quality healthcare
throughout the country, particularly in under-served areas
 To improve the management and organization of the public health sector and to
increase the efficiency and effectiveness of the healthcare system
 To develop appropriate roles for NGOs, and the public and private sectors in
providing and financing health services.
 To improve inter-and intra-sectoral co-ordination and to provide the necessary
conditions and support for effective decentralization with full community
participation.

Second Long Term Health Plan
(1997-2017)
Targets
 To reduce the infant mortality rate to 34.4 per thousand live births;
 To reduce the under-five mortality rate to 62.5 per thousand;
 To reduce the total fertility rate to 3.05;
 To increase life expectancy to 68.7 years;
 To reduce the crude birth rate to 26.6 per thousand;
 To reduce the crude death rate to 6 per thousand;
 To reduce the maternal mortality rate to 250 per hundred thousand births;
 To increase the contraceptive prevalence rate to 58.2 percent;
 To increase the percentage of deliveries attended by trained personnel to 95%;
 To increase the % of pregnant women attending 4 antenatal visits to 80%;
 To reduce the % of iron-deficiency anaemia among pregnant women to 15%;
 To increase the % of women of child-bearing age (15-44) who receive TT2to 90%;
 To decrease the percentage of newborns weighing less than 2500 grams to 12%;
 To have essential healthcare services (EHCS) in the districts available to 90% of the population
living within 30 minutes' travel time of facilities;
 To have essential drugs available at 100% of facilities;
 To equip 100% of facilities with full staff to deliver essential health care services;
 To increase total health expenditures to 10% of total government expenditures.

Generation, Evaluation and Decision
on Strategic Options
 Growth strategies take advantage of the organization’s internal
strengths and the environment’s opportunities to grow (S, O).
 Reinforcement strategies force the organization to overcome its
internal weaknesses in order to take advantage of the
opportunities the environment offers (W, O).
 Response strategies use the organization’s internal strengths to
respond to and address the environment’s threats (S, T).
 Withdrawal strategies ensure survival when faced with internal
weaknesses and the environment’s threats, the organization
withdraws to seek the most favorable conditions (W, T).

WOST Matrix
Opportunities
Strengths Weaknesses
Growth Strategies
 Expansion
 Maintenance
 Development and Innovation
 Diversification
Reinforcement Strategies
 Reorientation
 Approach
 Specialization
Threats
Response Strategies
 Market segmentation
 Differentiation
 Diversification
 Leadership development
 Strategic alliances
 Political actions
Withdrawal Strategies
 Reorientation
 Approach
 Specialization
 Segmentation
 Differentiation
 Leadership
 Alliances
 Political actions

Generation, Evaluation and Decision
on Strategic Options
 Examples of strategies include in health care setting may
be improve employee retention and recruitment, establish
new services that promote the continuum of care, improve
the profitability from payers (e.g., by reviewing contracts
and utilization patterns), develop distinctive tertiary
services that position the hospital as the preeminent
regional referral center, generating funds from unusual
sources (e.g. renting spaces within the premises of the
hospital for cafes and restaurants), achieve a culture of
quality that produces superior patient care outcomes and
customer satisfaction levels etc.

Sample strategies of a hospital
By the end of 2020 the institution must:
 To position its institutional image in the minds of the country’s
population as the best option to care for their health problems,
through its excellent quality of care and the implementation of
innovate market strategies;
 To have the most comfortable facilities available, equipped with
state-of-the-art technology, prioritizing the areas with the highest
demand;
 To strengthen the staff’s development and foster a harmonious
working environment, offering the best working conditions and
incentives in accordance with staff performance and the delivery of
quality services;
 To maintain client satisfaction levels above 95% at all institutional
facilities, especially those that come in direct contact with clients.

Preparing action plan
 Action Plan is a detailed description of the strategies used
to implement an objective.
 Action plans break strategies into manageable parts for
coordinated implementation of goals and objectives.
 Task specification includes staff assignments, material
resource allocations, and schedules for completion.
 Action plans specify detailed cost and expenditure
information and are often referred to as the step of
“operational plans” or “implementation plans”.

Developing Monitoring and
Control System
 An organization should plan for monitoring and tracking
performance which is a description of the methods the
organization is using to determine if the strategic plan is
being accomplished.
 Emphasis should be placed on describing how progress to
achieve the objective is currently being monitored by
using performance measures, as well as describing the
projected plan for each of the other future fiscal years.
 The description should evaluate the results of past actions
implemented.

Strategy Implementation
 Strategy implementation includes long term and short
term resource planning and budgeting. Plans for
developing new services, methods of delivery and
alternative locations for delivery need to be established.
 These long term plans should then be coordinated and
translated into financial terms by projecting the financial
impact of current and future activities for several years.

Strategy Implementation
 They provide a statement of the key initial targets and
actions required by an organization to achieve its strategic
plans.
 Capital expenditure plans will also normally originate
from the long term planning process.
 Once completed the long term plan should be continually
reviewed and revised to ensure its continued relevance.

Contents of Strategic Plans
1. Executive Summary
2. Table of Contents
3. Internal/External Assessment Summary
4. Vision Statement
5. Mission Statement
6. Principles and core values
7. Goals
8. Objectives
9. Targets (Performance Measures)
10.Resource Assumptions
11.Action Plans
12.Plan for Monitoring and Tracking Performance
13.References
14.Annex

Hari Prasad Kaphle
Pokhara University

Scope of Planning in Public Health
 Health is worldwide social goal.
 It is multi-sectoral and its goal cannot be achieved by
health system alone.
 It is the responsibility of all public as well as private
sectors.
 So the scope of health planning cannot be viewed as
health services planning by the state.
 But it includes all comprehensive, interdisciplinary and
disjointed & fragmented planning by state and private
sector which affects health of populations directly and
indirectly.

 The scope of health planning includes planning for
preventive, promotive, curative and rehabilitative
care.
 The scope of health planning also includes planning
for all level of health system: primary, secondary,
tertery

 It’s scope also includes planning for public sector as
well as planning for private sectors (both private for
profit and private for non profit)
 It’s scope also include planning in other sector to
provide health related service: education, nutrition,
environment, agriculture, social development etc.

Planning for private-for-profit
•Planning for health care
industries, pharmaceuticals,
private nursing homes and
hospitals
•Planning for other business
sectors e.g. food industries,
planning for occupation health
and safety
Planning for private-for-
nonprofit
•Planning for international
nongovernmental organizations
•Planning for national
nongovernmental organizations
•Planning for religious
organizations and charitable trusts
Development sector planning
•Planning for education
•Planning for infrastructure
development
•Planning for land reform
Interdisciplinary planning
•Planning for population
development
•Planning for agriculture &
veterinary
•Planning for forestry
•Financial & mgt planning
Health sector Planning
•Planning for public health &
PHC
•Planning for medical education
& service
•Planning for indigenous system
•Planning for health research
and politics
Publicsectorplanning
Privatesectorplanning

Education sector
 Sound education sector planning is essential for
production of health manpower of all cadre
insufficient number to provide health services
throughout the country.

Development Sector
 Appropriate design and construction of trade apartments,
industrial estate, public buildings and residential area
becoming challenging works now a day.
 Appropriate design and construction of roads, sewage
system, water supply system is of great public health
importance.
 This discipline of public health is also regarded as public
health engineering.
 Planned development helps in reduction of exposure from
many hazards and hence reducing public health problems.

Planning for land reform
 It is core element in all aspects of life and livelihood.
The production of farm depends on how well the
resources are mobilized.
 Redistribution and reuse and management plan for
unused land is of great importance in public health for
reducing food insecurity in populations.

Health Sector Planning:
 Planning for public health and primary health care:
Water and sanitation, control of communicable
diseases, endemic and epidemics of diseases,
reproductive health and family planning, maternal and
child health, immunization and health promotion and
behavior changes actions fall under the domain of
public health and primary health care planning.

 Planning for medical education and service: It
includes the planning and development health
manpower and appropriate management of all
categories of health manpower. Health services may
range from preventive to promotive, curative and
rehabilitative ones. Similarly it deals with the
management of health institutions and provision of
health services.

 Planning for indigenous systems of medicine: Various
systems of medicines have been growing with their
particular importance. For example ayurveda, unani,
naturopathy and others. Planning is essential to
establish their scope, coverage and efficacy.

 Planning for health research and politics: Research is
one that strives to establish new facts or verify old
facts. It needs appropriate planning which guides for
action. Planning for research work, data management,
dissemination and implication plan have been given
due importance. Similarly health sector development
requires political commitment and implementation
work schedule.

Interdisciplinary Planning:
 The Interdisciplinary planning is the integrated planning with
disciplines which had close relationship with public health.
 Such disciplines are demography and population studies,
management and finance, veterinary sciences and animal
husbandry, agriculture and forestry, environment science etc.
 Interdisciplinary planning helps to achieve the goal of both
public health as well as goal of concerned sector.
 Planning is essential for these sectors to support others also.
 Coordination and joint planning of department of health
services and department of animal health for the control of
avian influenza and zoonotic diseases is an example of
interdisciplinary planning.

Planning for Private for Nonprofit:
 Various multilateral organizations (e.g. UN agencies:
WHO, UNDP, UNFPA, CDC, UNICEF etc.) bilateral
organizations (e.g. GTZ, KFW, DFID, JICA, SDC etc.)
and unilateral organizations (FHI, PSI, OXFAM, CARE,
Save the children Fund etc.) working in the field of public
have important role in health planning and policy
development. These organizations provide technical as
well as financial support for planning, implementation and
evaluation of health services.

Planning for Private for Nonprofit:
 Similarly community based organization (CBOs), national
nongovernmental organizations (NNGOs) working for
particular geographical area and for particular segment of
population also plans separately or in coordination with
local government agencies to provide health service to that
segment of population.
 In many countries some religious organization and
charitable trusts also influencing health planning process
since they are providing faith-based health–care still
today.

Planning for Private for Profit:
 Private for Profit includes two types of enterprise:
first that directly provides health care services (e.g.
private hospital, nursing homes, medical colleges etc.)
and pharmaceuticals industries those produce medical
products and second other business sectors (e.g. food
industries) that do not provide health care service but
may influence the health of public with great
importance.

Planning for Private for Profit:
 The role of government is to monitor these enterprises
constantly to protect the health of the public.
Similarly business industries (public or private)
should plan for occupation health and safety for their
employees.

Hari Prasad Kaphle
Pokhara University

Nursing Philosophy
 Nursing is the protection, promotion, and optimization
of health and abilities, prevention of illness and injury,
alleviation of suffering through the diagnosis and
treatment of human response, and advocacy in the
care of individuals, families, communities, and
populations.

Scope and Application of planning in Nursing
 Planning for different field (specialty) of nursing
 Public health nursing
 Community nursing
 Maternal child health nursing
 Pediatric nursing
 Obstetric and gynecological/Midwifery nursing
 School health nursing
 Oral health nursing
 Hospital nursing/clinical nursing

 Planning for different field (specialty) of nursing
 Cancer nursing (Oncology)
 Cardiac care nursing
 Ophthalmology nursing
 Mental health nursing
 Emergency nursing
 Adult health nursing
 Family health nursing
 Gerentological nursing

 Planning to provide nursing care
 Short term care
 Long term care
 Intensive care
 Emergency care
 Out patient care
 Inpatient care
 Home care
 Individual care
 Institutional care

 Planning for effective management of different
department regarding nursing care
 Emergency
 OPD
 ICU
 NICU
 CCU
 OT
 Labor
 Post partum
 Pediatric
 Medical
 Surgical
 Orthopedic
 Laundry etc.

 Planning for production of Nursing professional
 Universities, colleges
 Professional council
 Planning to provide nursing leadership
 Development of various rules, regulations, ethics,
SOPs, protocols to provide nursing service
 Regulation of nursing employees
 Research to establish the evidence based practice

Hari Prasad Kaphle
Pokhara University

Benefits of Planning
 Planning provides the direction to an organization.
 Planning helps to carryout all other managerial function.
 Planning helps focus organizational attention on
objectives.
 Planning minimizes the risk and uncertainty.
 Planning helps to grasp the opportunity available in
external environment.
 Planning provides the direction to all employees to
carryout their responsibilities.

Benefits of Planning
 Planning provides the bases for control.
 Planning helps in coordination and communication
 Planning helps to increase organizational effectiveness
 Planning helps to increase efficiency
 Planning encourages motivation and creativity
 Provides the status to a manager and organization
 Planning help to adopt the change
 Planning helps to adopt the technology

Limitations of planning
 It depends up on facts and information. To get reliable
information may not possible always.
 To prepare an effective plan it needs highly experienced
managers.
 Planning needs team efforts.
 Planning may lead to internal inflexibilities and
procedural rigidities.
 Planning is an elaborative process needs more paper work.
 It is a time consuming and expensive process.
 Planning is rigid and may discourage innovation.

Barriers in effective planning
1. Difficulty of accurate premising
2. Problem of rapid change
3. Internal barriers
a. Capital investment
b. Psychological factors
c. Policy and procedure

Barriers in effective planning
4. External Barriers
a. Government policy
b. Political climate
c. Trade union
5. Lack of sufficient time for planning
6. Lack of sufficient cost for planning

Introduction to Policy
 Definition
 Types
 Benefits
 Limitations

Definition
 A policy is a statement of principle made by those in
authority (usually government) to be used as guide for
all subordinate action.
 A policy is a guiding principle or a plan of action
agreed to by a group of people with power to carry it
out and enforce it.

Definition
 Policy represents the way in which an organization
(usually government) seeks to achieve the objectives
it has set.
 Bridgman and Davis (1988) defined as “Policy is a
shorthand description for everything from an analysis
of past decisions to the imposition of current
thinking.”

Definition
 Daneke and Steiss (1978) defined it as “A broad guide
to present and future decisions, selected in light of
given conditions from a number of alternatives; the
actual decision or set of decisions designed to carry
out the chosen course of actions; a projected program
consisting of desired objectives (goals) and the means
of achieving them”.

Types of policies
 Policies can be categorized into distributive,
regulatory, self-regulatory, and redistributive policies
 Policies can also be categorized into macro policies
and micro policies

Distributive policies
 Distributive policies involve allocation of services or
benefits to particular segments of the population
(individuals, groups, corporations, and
communities).

Distributive policies
 Some distributive policies may provide benefits to one or
a few beneficiaries; others may provide benefits for vast
numbers of persons such as free education policy,
agricultural income-support policy, tax deductions policy
for home mortgage interest payments.
 Distributive policies typically involve using public funds
to assist particular groups, communities, or industries.

Regulatory policies
 Regulatory policies impose restrictions or limitations on
the behavior of individuals and groups.
 That is, they reduce the freedom or discretion to act of
those regulated.
 In this sense they clearly differ from distributive policies,
which increase the freedom or discretion of the persons or
groups affected.

Regulatory policies
 Some examples of regulatory policies are
environmental protection act; regulations for the
control of criminal offence, pornography, abortion,
personal behavior (restrictions of alcohol
consumption, smoking in public place; driving limit
etc.); consumer protection act; food act; policies for
media/television broadcasting etc.

Regulatory policies
 Some regulatory policies, those restrict entry into a
business known competitive regulatory policies.
 They limit the number of providers of specific goods
and services.
 They also may regulate the quality of services that can
be provided to consumers.
 For example television broadcasting regulation; of the
several applicants for a television broadcast license
for a city only one or few can be propitiated.

Self-regulatory policies
 Self-regulatory policies are similar to regulatory, except
that the persons or groups regulated possess considerable
authority and discretion to formulate and police the
regulations governing them.
 Public health workers, nurses, physicians, dentists,
medical technicians, optometrists, pharmacists,
psychologists, sanitarians, social workers and other
professions, for example, receive authority from
government to license practitioners, thus determining who
may and who may not practice the profession.

Self-regulatory policies
 Such groups often also develop and administer their
own codes of ethics, enforce discipline, and help to
govern the schools that produce the professionals.
 Self-regulatory policies are usually more controlled
by the regulated group as a means of protecting or
promoting the interests of its members.

Redistributive policies
 Redistributive policies involve deliberate efforts by the
government to shift the allocation of wealth, income,
property, or rights among broad classes or groups of the
population.
 Redistribution involves not only the allocation of benefits
or services to certain parts/groups of the population, but
the taxing of other parts/groups of the population to
generate the funds.
 These involve taxing relatively more affluent members of
society in order to provide income assistance, food,
housing, or health insurance to the less affluent.

Redistributive policies
 Redistributive policies are difficult to enact because they
involve the reallocation of money, rights, or power.
 Because money and power are good coinage in the
political realm, those who possess them have ample means
to resist their diminution.
 Such as health insurance package for poorer, agricultural
subsidies, income taxes based on ability to pay are
examples of redistributive polices.

Macro policies
 Some policies have boarder scope and have
implication across the most or areas such as health,
education, agriculture, economic and social
development sector, whose actors have limited
influence over them.
 Fiscal policies, civil service policies etc. are falls
under this category and termed as macro policies.

Macro policies
 These policies have solely political character and their
implication is influenced politically.
 Such policies are influenced by political system,
stability of government, economic trend, population
growth, technology advancement and external
pressure

Macro policies
 Within the health sector such policies are various
sectoral policies such as primary health care, essential
health service, basic health care package,
decentralization, health sector reform, sector wide
approaches in health and alternative financing
mechanisms etc. which affect most aspects of health
service delivery and applicable for all or most levels
or services or populations.

Micro policies
 Other policies, of strictly technical nature, address narrower
issues, of public concerns.
 Such micro policies having technical character have
implication for certain issues of particular sector.
 As for examples communicable disease (tuberculosis,
malaria, and HIV/AIDS etc.) control strategy, non
communicable disease (diabetes, cancer, coronary heart
disease etc.) control strategy, drug quality control etc have
narrower implications and the sectoral actors have sufficient
influence over them.

Micro policies
 Other examples of these categories of policies are
pesticides control in agriculture, food standard and food
safeties in nutrition have narrower implication with respect
to macro policies.
 These micro policies with technical implications are
influenced by narrower issues such as epidemic of cholera,
increase in HIV/AIDS in general population, resistance of
anti-tubercular drugs, increasing in suicidal rates among
adolescents, out breaks of poliomyelitis etc. provides
special attention to authorities of health sector.

Vertical and horizontal policies
 Vertical policy (sometimes called corporate or
framework policy) is developed within an
organization that has authority and resources for
implementation.

 Horizontal policy, sometimes referred to as integrated
policy, is developed by two or more organizations and
or departments of same organization having same
level, each of which has authority or ability to deal
with only a part of the situation. The distinction
reflects how clearly a mandate rests with one
department, unit or agency, and its capacity to address
the root cause of the issue with existing resources.

 Horizontal policy can itself be divided into three categories.
 Policy developed within a sector is referred to as sectoral
policy.
 When more than one sector is involved, the policy becomes
multi-sectoral.
 When the groups developing the policy are able to
determine a shared, super-ordinate goal and to work
collaboratively to achieve policy that addresses root causes
as well as symptoms, the policy is said to be integrated
policy.

Health policy
 “A formal statement or procedure within institutions (notably
government) which defines priorities and the parameters for
action in response to health needs available resources and
other political pressures.” – World Health Organization
(1998)
 “The decisions, usually developed by government
policymakers, for determining present and future objectives
pertaining to the health care system.” - Encyclopedia of
Medical Concept

Health policy
 “A set of statements and decisions defining health
priorities and main directions for attaining health
goals.” -Dictionary of Public Health (2007)
 "The aggregate of principles, stated or unstated,
that…characterize the distribution of resources,
services, and political influences that impact on the
health of the population" -Miller (1987)

Health policy
 “...courses of action (and inaction) that affect the sets of
institutions, organizations, services and funding
arrangements of the health system. It includes policy made
in the public sector (by government) as well as policies in
the private sector. But because health is influenced by
many determinants outside the health system, health
policy analysts are also interested in the actions and
intended actions of organizations external to the health
system which has an impact on health (for example, food,
tobacco or pharmaceutical industries).” - Buse, Mays &
Walt (2005)

Health policies of Nepal
 National Population policy 2070
 National Health Policy1991
 Tenth Plan Poverty Reduction Strategic Paper (2002-07)
 Free Health Care policy 2007
 National Ayurveda Health Policy 2052(1996)

 National Drug Policy 1995
 National Medicines Policy 2007
 Safe Motherhood Policy
 National Policy on Safe birth Attendance
 National Safe Abortion Policy 2003
 Vital Registration Act 2033
 National Oral Health Policy
 Mental Health (Treatment and Protection) Act 2006
 Policy on Quality Assurance in Health Care Services
2064

 Health Care Technology Policy 2006
 Water Resource act 2049
 Nepal National Policy on Sanitation
 National Policy on Rural Water Supply and Sanitation
2004
 Policy on NGO participation in WATSAN Program1996
 Natural Disaster Management Act
 Natural Calamity (relief) act 1982
 National Blood Policy 2050(1993)
 National Health Research Policy

Benefits of policy
 Outlines the working principles
 Provide the framework for providing public services
 Provide base for decision making
 Provide the roadmaps for the concerned sector
 Outline the government/organizational priorities
 Specify the strategies to achieve the goal and objectives
 Regulate governmental/organizational actives
 Distribute/redistribute resources to public

Limitations of Policy
 Leave room for misinterpretation
 Restrict certain behavior e.g. Environmental protection
act, regulation regarding health care waste management,
regulation regarding housing
 Some service/program/population may get less priority
 Collection and distribution of resources may not be fair
always
 sometime may outline political priorities and real
problems may not get priority
 May be difficulty to translate policy into programmatic
language

Hari Prasad Kaphle
Pokhara University

Approaches of Planning
1. Top- Down approach
2. Bottom – up approach
3. Participatory approach
4. Team approach

Top – down Approach
 Top level management formulation plans and goals
and plans are communicated to middle and lower level
management for implementation and control.
 It is generally used in highly centralized organizations
 Only top level managers have a role in planning
 Those who are responsible for implementation are not
involved in the planning process.
 It may not be sensitive to local conditions

Bottom –up Approach
 The plans are formulated at the operational level
 They travel bottom to top level
 It is decentralized approach of planning

Participatory Approach
 This methods is a blend of top down and bottom-up
methods of planning.
 The top management provides broad premises,
parameters and guidelines for planning to operational
level management
 Then operational level formulates the plans and
forwards to the top level which reviews and finalizes
the plans

Team Method of planning
 The job of planning is entrusted to a team
 The members of the team possess multiple skills in
planning.
 The team prepares draft plans which are forwarded to
the top management, which are reviewed and finalized
by top management

Setting Objectives
 Virtually, all organizations have a formal, explicitly
recognized, legally specified organ for setting the
initial objectives.
 Generally, top management determines the overall
objectives which the members of the organization
unite to achieve.
 In large corporate entities, such bodies as board of
directors, governing board, or executive committee
may set the objectives.

Setting Objectives
 Setting of organizational objectives depends upon
various factors such as
 value system of mangers particularly at the top
level,
 organizational strengths and weaknesses, and
 external environment.

Guidelines for setting objectives
 Objectives must be clearly specified.
 Objectives must be set taking into account the various
factors affecting their achievement.
 Objectives should be consistent with organizational
mission.
 Objectives should be rational and realistic rather than
idealistic.
 Objectives should be achievable but must provide
challenge to those responsible for achievement.

Guidelines for setting objectives
 Objectives should yield specific results when
achieved.
 Objectives should be desirable for those who are
responsible for the achievement.
 Objectives should start with the word 'to' and be
followed by an action verb.
 Objectives should be consistent over the period of
time.
 Objectives should be periodically reviewed.

Hari Prasad Kaphle
Pokhara University

Management by objectives
 Management by objectives is defined as “a process by
which supervisors and subordinate managers jointly
identify their common objectives, set the result that
should be achieved by the subordinates, assess the
contribution of each individual, and integrate
individuals with the organization so as to make best use
of organizational resources”.

 Management by Objectives (MBO) is a process of
agreeing upon objectives within an organization so
that management and employees agree to the
objectives and understand what they are in the
organization.

 Management by objectives (MBO) is a system of
allowing employees to work with their supervisors in
setting performance objectives in an effort to achieve
organizational outcomes.

 MBO is a comprehensive managerial system that
integrates many key managerial activities in a systematic
manner and that is consciously directed towards the
effective and efficient achievement of organizational and
individual objectives.
 The term "management by objectives" was first
popularized by Peter Drucker in his 1954 book 'The
Practice of Management'.

 The value of MBO is that it communicates the mission,
goals and objectives of the organization to the lower
levels.
 The lower level managers work out their plans and
targets in consultation with their subordinates, then sent
to higher levels for consideration.
 MBO allows employees to participate in planning and
control of their own work.

 This involvement of employees increases their
motivation and commitment to their work.
 MBO includes continuous tracking of the processes and
providing feedback to reach the objectives.

Organizational
Objectives
Divisional
Objectives
Departmental
Objectives
Individual
Objectives
Management by Objectives

Process of MBO
 Setting the preliminary objectives at the top,
 Clarifying Organizational role,
 Setting subordinates role,
 Recycling objectives.

MBO Advantages
 MBO programs continually emphasize what should be
done in an organization to achieve organizational
goals.
 Improvement in managing
 Clarification of organizational roles and structure
 Clarification of individuals roles within the
organization
 Encouragement in personal commitment (encourages
people to commit themselves to their goals)
 Development of effective controls

MBO Disadvantages
 The development of objectives can be time
consuming, leaving both managers and employees
less time in which to do their actual work.
 The elaborate written goals, careful communication of
goals, and detailed performance evaluation required in
an MBO program increase the volume of paperwork
in an organization.
 Failure to teach philosophy of MBO

MBO Disadvantages
 Failure to give guidance to goal setters
 Difficulty of setting goals: time consuming and
complex
 Emphysis on short run goals
 Danger of inflexibility
 Based on quantity rather than quality

Hari Prasad Kaphle
Pokhara University

Procedure
 A procedure (sometimes called as standard operating
procedure) is a sequence of steps for completing a
given activity.
 Formal procedures provide specific and detailed
instructions for the execution of plans.
 It is a standing plan that outlines a series of related
actions that must be taken to accomplish a particular
task.

Procedure
 Procedures and policies are linked to each other.
 For example, a Purchasing policy of an enterprise may
states purchasing from lowest bidding party.
 To implement this policy an enterprise should
establish a procedure containing sequence of activities
how it will purchase from lowest bidding party.

Procedure
 Policy: Recruitment of employee through open
competition
 Procedure: advertisement, collecting application,
screening, knowledge test, interview, verification of
certificates, reference checking, selection, placement
of selected employees etc.

Relationship b/n Policy and Procedure
 Policies are board guidelines to both thinking and
action where as procedures are definite and specific
guide to action.
 Policies are board therefore are subject to
interpretation, where as procedures are more fixed to
follow through a defined area of policy.

 Policies mostly guide to thinking and action of people
working at a higher level, where as procedures
generally guide the actions of people at the lower
level.
 Policies indicate the principles to be followed in
achieving the organizational objectives, where as
procedures guide us how to implement the policies.

 Policies are not followed in any chronological
order/sequence, where as procedures are always
followed in a chronological sequence.

Benefit of Procedures
 Procedures helps the workers to perform a task in a
standardized way.
 Procedures simplify the work by eliminating unnecessary
and overlapping steps.
 Procedures specifies the certain steps to perform certain
task
 Procedure provide specific and detailed instructions by
outlying a series of related actions

Benefit of Procedures
 Procedures help to perform activity repeatedly in a same
way
 Procedure help in implementing policies
 Procedure help in increasing staff performance
 Procedure helps in increasing organizational effectiveness
and efficiency
 Procedure provides the basis for managerial control

Limitation of Procedures
 May hider creativity
 Rigid and inflexible
 May not practical in all conditions
 May lead to decrease motivation to employees
 May provide lengthy process to perform certain task

Winners do not do different things, they just do
same thing differently.
Work smart not hard to be a successful manager !!!

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