Health Programme Planning-PHS303 PDF

Health Programme Planning- PHS303 NAME-DR JOHNSON ADEGBOYEGA OYENIYI MBBS,MPH ,FWACP,Cert.Health Plan & Mang.  Background The course intend to prepare public health and student of health science to organise health programme that meet specific identified com...

Health Programme Planning- PHS303 NAME-DR JOHNSON ADEGBOYEGA OYENIYI MBBS,MPH ,FWACP,Cert.Health Plan & Mang.  Background The course intend to prepare public health and student of health science to organise health programme that meet specific identified community needs. The course also highlights the critical issues and logical questions in health planning, the main function of management , the implementation function, the support systems to implement health care programmes , the evaluation processes and health information format.  Background Skills include setting goals and objectives, setting strategies , assessing and mobilizing internal and external resources. linking implementation and evaluating results.  Meaning of Planning Planning is one of the activity of manager and the students need to familiarize themselves with planning concepts. They need to know the various types of the of planning been used at the different managerial level to keep the system running. Knowing planning cycle will help them. The importance of setting objectives that are “SMART” (specific,measurable,achievable,realistic &Time bound).  Planning continue Student should understand the importance of monitoring and evaluation in assessing programme or project. They also need to know some of the pre-plan activities they need to take into consideration before the commence planning.  Health Planning Presentation outline: Definition Types of planning Reason for planning. Limitation of planning Planning cycle. What factors they need to take into consideration when they are implementing programme.  Meaning of planning Planning: is the function of management that involves setting objectives and determining a course of action for achieving those objectives. Planning is the process of selecting a future course of action. Planning and decision-making, organizing, leading and controlling all interrelated There are external factors that affect your goal/objectives.  Meaning of planning Planning is ascertaining what to do and how to do. Before doing something, the manager must form an opinion on how to work on a specific job. planning involve creativity thinking. But the manager would first have to set goals. Planning is an essential steps for all managers at all levels of management. It requires making decisions since it includes selecting a choice from alternative ways of performing a task.  Meaning of planning Planning is building a bridges when there is a gap between where we are (present) and where we want to be (future). In simple words, foreseeing the future contingencies and plan for it to accomplish an objective.  Importance of planning Planning provides directions: Planning assures that the objectives are certainly asserted so that they serve as a model for determining what action should be taken and in which direction. If objects are well established, employees are informed of what the company has to do and what they need do to accomplish those purposes. Planning decreases the chances of risk: Planning is an activity which permits a manager to look forward and predict changes. By determining in prior the tasks to be completed, planning notes the way to deal with changes and unpredictable effects.  Importance of planning Planning decreases overlapping and wasteful activities: Planning works as the foundation of organizing the activities and purposes of distinct branches, departments, and people. It assists in avoiding chaos and confusion. Since planning guarantees precision in understanding and action, work is conducted on easily without delays. Planning encourages innovative ideas: Since it is the primary function of management, new approaches can take the form of actual plans. It is the most challenging project for the management as it leads all planned actions pointing to growth of the business.  Importance of planning Planning aids decision making: It encourages the manager to look into the future and make a decision from amongst several alternative plans of action. The manager has to assess each option and pick the most viable plan.  Planning process planning process? The planning process is a process used to develop objectives, develop tasks to meet objectives, determine needed resources, create a timeline, determine tracking and assessment, finalize the plan, and distribute the plan to the team  The four types of planning : Strategic Planning. Tactical Planning. Operational Planning. Contingency Planning.  Types of planning the scope of planning differs. 1)Top-level management plans for the organizational as a whole. They think from the perspective of the whole organization. 2)Middle-level management thinks from the perspective of their departments and are involved in departmental planning. 3)Lower level management plans for the day-to- day operations of the concern 4)Contigency plan. Plan B is prepare for an organization to respond effectively in case of emergency.  LIMITATION OF PLANNING (1) Planning Leads to Rigidity The plans are rigid in nature and have to be complied with throughout the organisation. Such rigidity of plans may be internal as well as external. Internal rigidity relates to plans, policies, programs, rules, and methods, etc. External rigidity relates to political, industrial, technological, legal and economic changes, etc. Example: A super specialist hospital has fine branches in a city. Whatever the top management of the hospital decides the head of the branch of the hospital and their subordinates have to follow. 2. Planning May Not Work in Dynamic Environment The environment in which a business survives is dynamic as it keeps on changing to situation. It is difficult for an organization to assess future trends, the taste of customers, natural calamity, competitors’ policies and effects of changes in the different components of the environment. The organization has to constantly adapt itself to changes because it is difficult to forecast the future changes with absolute accuracy  3.Planning Reduces Creativity Planning is mostly done by the top management and other members Middle and lower levels of management have to follow these plans. They can’t deviate or change the plans made by their seniors  4) Planning Involves Huge Cost Formulation of plans can be too much costly because there is a lot of time and money is involved. Some costs are incidental in nature like- expenses on boardroom meetings, discussions with professional experts and preliminary investigations to find out the feasibility of the plan. (5) Planning is a Time-consuming Process Planning is a very lengthy process as it consumes a lot of time for collection, analysis, and interpretation of data. Due to such a lengthy process, sometimes decisions get delayed, opportunities are lost and there is not much time left for the implementation of plans  5) Decision Making – Decision making means choosing the best alternative among the alternatives available. – Planning cannot be imagined in the absence of alternatives. – If there is no alternative available then there is no need for planning.  6) Planning is mental exercise Planning is the outcome of a mental process rather than wishful thinking and guesswork. Planning is a thinking process and it is separate from organisational activities. It is based on logical reasoning, facts, foresight, vision, intelligent imagination, and sound judgment.  PLANNING STEP It include: 1)Plan formulation 2) Execution 3) Evaluation Planning is a team work and require consultation. It involve specialist with in the field of medicine and others field : economic, sociology , statistics, management etc  National Development Planning Every country has its own plan for National Development Plan. The purpose of national development is to achieve rapid, balanced, economic and social development of the country as a whole. It is combination of sectorial plan: health, agriculture, education, industry , power and transportation & communication. National Development plan All these sector compete for national resources. National Development Plan has be define as continuous, systematic, coordinated planning for the investment of the resources of country in programme aimed at achieving the most rapid economic and social development possible.  HEALTH PLANNING It is part of national development plan. Health plan is necessary for economic use of scares material resources ( 5M). It is to improve the health services. National health planning : has been defined as the orderly process of defining community health problems, identifying unmet needs and surveying the resource to meet them, establishing priority goals that are realistic and feasible and projecting administrative action to accomplish the purpose of the proposed programme.  Module 2 Outline of presentation: Planning cycle What is planning Planning for planning  STEPS IN PLANNING 1) Health need assessment- identify deficiency in preventive, curative and institute control measure. Assess water, nutrition , immunization, family planning which are community health need. 2) Resources-man power , money, material, skill , knowledge , technique and time needed for the performance.  Note the following useful term 3)Goal, objective & target- These are the end result of planning. Objective-it is planned end of all activities. Target-discrete activity eg No. of blood film collected. Goal-what is to be obtained. The extent to which it can be attained and the population involved  Note the following useful term Procedure- are a set of rule set up to carry out work. Policies- are the guiding principles stated as expectation and not commandment  PLAN- a blue print for taking action. It consist of 5 major elements: objective , policy , programme , schedules and budget. A Programme -is a sequence of activities to implement policy and to achieve objective. It must be closely integrated to objectives. A Schedule- is a time sequence for the work to be done.  Pre-Planning/preparation for planning/ Planning for planning. Precondition are: 1) Government interest with strong political will. 2) Legislation- approve by the house in the budget. 3) Organization for planning. Ministry of planning must plan for it. It is capture in government plan & budgeted for. 4)Administrative capacity- ministry of health is given opportunity to implement health plan.  Planning health services for a community Planning for planning: 1. Assembling the team including member of community whose is opinion leader & can take decision for the community. Training of all the members for effective participation & sustainability. Develop the instruments/questionnaires for  PLANNING CYCLE 1) Analysis of health situations 2) Establish objective & goal 3) Assessment of resources 4) Fixing priorities 5) Write up formulated plan 6) Programming and implementation 7) Monitoring 8) Evaluation Diagramme of planning cycle  Analysis of the situation The first step in health planning is the analysis of the current situation. The different aspects to be studied are: – Population – age and sex structure, religion, Sex ratio etc. – Morbidity and mortality rates – Morbidity and mortality rates due to the disease condition. Analysis of the situation Epidemiology and geographic distribution of the disease under consideration – Existing healthcare facilities – Technical manpower available – Facilities for training healthcare staff – Awareness and attitude of the community regarding the disease Establishment of objectives and goals This step is to identify the desirable future state for the issue under consideration.The program has to work for achieving this through goals and objectives. Establish the standards against which current disease will be compared for assessing the performance of program if there are no clear objectives and goals, a plan cannot be implemented efficiently. Then haphazard wasteful activity will result  Establishment of objectives and goals At the central level ,the objectives would be more general and with each successive level ,the objectives will become more specific. Management techniques are usually used to determine objectives eg cost-benefit analysis These analysis will assess the feasibility of attaining the desired results in optimum cost and time the objective can be defined like: "To reduce the prevalence of a health condition to 0.5%"  Assessment of resources The available : Manpower ,Money, Material ,skills, knowledge and Techniques should be accessed A balance is to be struck between the available resources and the attainment of the objectives  Fix priorities The resources are usually not enough to attain all the objectives so priority goals should be listed out and resources should be allocated to these various considerations in fixing priorities can be :- – in order of magnitude – lower costs needed to achieve the objectives – saving the lives of younger people – political commitments and pressure etc  Fixing priority Once the priority objectives have been decided: Alternative ways of achieving them should be assessed E.g. Whether vaccination is more cost effective or treatment of the cases? e.g. the disease itself may be mild and requiring inexpensive treatment whereas vaccine may need to be imported and very expensive for mass application. Hence a program for early diagnosis and treatment may be preferred over vaccination for achieving the target prevalence rate. Management techniques for comparing the efficiency of alternative plans may be useful for deciding priority  Write up formulated plan once priorities are laid out , a systematic plan should be made to attain them All the major steps should be included with the – resources(input) required for each step – the expected outcome(output) and – time period specified for each step – also include are precise guidelines for procedures Fixation of responsibility (identify individual responsible for the execution of each step) Programming and implementation once the plan has been approved it has to be implemented Implementation requires an effective organization to run the routine procedures and referrals The real shortcomings or impracticabilities of the program may be revealed at this stage  Programming and implementation Main consideration at this stage are – definition of roles and tasks – selection and training of personnel – organization and communication so that all workers are aware of their responsibility and remain motivated – the involved institutions should work efficiently  Monitoring Monitoring refers to the day to day follow up of functioning of program It is to be ensured that the activities are : proceeding as planned and are on schedule Immediate corrective action is to be taken in case of deviations Monitoring is thus defined as "the continuous process of observing ,recording and reporting on the activities of the organization or project  Evaluation Evaluation refers to the assessing the final outcome of the plan Evaluation is in terms of : – Degree to which objectives are achieved – How efficiently has the resources been utilized(output-input , cost-benefit analysis etc.) in achieving these – What were the factors responsible for shortfalls – Factors responsible for better performance if any  Evaluation – Difficulties faced during the implementation of and possible solutions for them Based on the results of the evaluation, one of the following decisions may be taken: – To continue running the program as the results are satisfactory – To make a few changes to overcome inefficiencies and let the program continue – To change the objectives as the disease profile has changed due to the effect of the program  Evaluation – To change the objectives as the disease profile has changed due to the effect of the program – To abandon the approach and analyze alternative approaches The program failed to achieve the objectives or A new and much more effective technology has been developed for controlling the disease and needs to be incorporated in the program or A new and more dangerous health problem has emerged and the priority needs a change  Questions Q.1 What Would Happen if Objectives Are Not Set in the Planning Process? Answer: In the absence of objectives, employees working at different levels of management would be working in different directions and the goals of the organizations cannot be achieved  Questions Q.2 What is Primacy of Planning? Answer: Planning precedes all other functions of management like Organizing, staffing, directing and controlling. So, planning becomes a primary function of management. Q.3 What is the Role of Lower Level Manager in the Process of Planning. Answer: Lower level management plans for day-to-day operations of the organization  questions Mention three level of planning in health institution for the delivery of health care services. What is National Health Development plan What is health plan. What advantages do we derived from planning. Draw a health planning cycle.  question Explain the following term as it apply in a health planning cycle: 1)Situation analysis in health planning 2) programme implementation in health planning. 3)Monitoring & evaluation in health planning 4) priority setting in Health planning.  questions What are the factor you will take in to consideration when you are planning for health programme in your establishment as a director in ministry of health.  References. 1. Park k. Text book of preventive and social medicine. 2.Lucas & Gilles. Short text book of public health , medicine for public health, 3)  Module 3-planning for health services PLANNING HEALTH SERVICES FOR A COMMUNIT (A)Planning for planning: 1. Assembling the team including member of community whose is opinion leader & can take decision for the community. Training of all the members for effective participation & sustainability. Develop the instruments/questionnaires for survey & train team in their use  (b)Analysis of the situation The first step in health planning is the analysis of the current situation. The different aspects to be studied are: – Population – age and sex structure, religion, SES etc. – Morbidity and mortality rates – Morbidity and mortality rates due to the disease under consideration  Situation analysis Epidemiology and geographic distribution of the disease under consideration – Existing healthcare facilities – Technical manpower available – Facilities for training healthcare staff – Awareness and attitude of the community regarding the disease etc. Establishment of objectives and goals This step is to identify the desirable future state for the issue under consideration.The program has to work for achieving this. Hence,goals and objectives , establish the standards against which current disease will be compared for assessing the performance of program  if there are no clear objectives and goals, a plan cannot be implemented efficiently and haphazard wasteful activity will result. At the central level ,the objectives would be more general and with each successive level ,the objectives will become more specific. Management techniques are usually used to determine objectives ex : cost-benefit analysis These analysis will assess the feasibility of attaining the desired results in optimum cost and time the objective can be defined like: "To reduce the prevalence to the level of 0.5%"  ( D)Assessment of resources The available : Manpower , Money, Material , skills, knowledge and Techniques should be accessed A balance is to be struck between the available resources and the attainment of the objectives  Fix priorities The resources are usually not enough to attain all the objectives so priority goals should be listed out and resources should be allocated to these various considerations in fixing priorities can be :- – in order of magnitude – lower costs needed to achieve the objectives – saving the lives of younger people – political commitments and pressure etc Once the priority objectives have been decided:  Alternative ways of achieving them should be assessed E.g. Whether vaccination is more cost effective or treatment of the cases? e.g. the disease itself may be mild and requiring inexpensive treatment whereas vaccine may need to be imported and very expensive for mass application. Hence a program for early diagnosis and treatment may be preferred over vaccination for achieving the target prevalence rate. Management techniques for comparing the efficiency of alternative plans may be useful for deciding priority ( E)Write up formulated plan once priorities are laid out , a systematic plan should be made to attain them All the major steps should be included with the – resources(input) required for each step – the expected outcome(output) and – time period specified for each step – also include are precise guidelines for procedures Fixation of responsibility (identify individual responsible for the execution of each step)  ( F)Programming and implementation once the plan has been approved it has to be implemented Implementation requires an effective organization to run the routine procedures and referrals The real shortcomings or impracticalities of the program may be revealed at this stage Main consideration at this stage are – definition of roles and tasks – selection and training of personnel – organization and communication so that all workers are aware of their responsibility and remain motivated – the involved institutions should work efficiently  (G )Monitoring Monitoring refers to the day to day follow up of functioning of program It is to be ensured that the activities are : proceeding as planned and are on schedule Immediate corrective action is to be taken in case of deviations Monitoring is thus defined as "the continuous process of observing ,recording and reporting on the activities of the organization or project  ( H)Evaluation Evaluation refers to the assessing the final outcome of the plan Evaluation is in terms of : – Degree to which objectives are achieved – How efficiently have the resources been utilized(output-input,cost-benefit analysis etc.) in achieving these – What were the factors responsible for shortfalls – Factors responsible for better performance if any  EVALUATION – Difficulties faced during the implementation of and possible solutions for them Based on the results of the evaluation, one of the following decisions may be taken:  EVALUATION – To continue running the program as the results are satisfactory – To make a few changes to overcome inefficiencies and let the program continue – To change the objectives as the disease profile has changed due to the effect of the program – To abandon the approach and analyze alternative approaches  Evaluation – To abandon the approach and analyze alternative approaches The program failed to achieve the objectives or A new and much more effective technology has been developed for controlling the disease and needs to be incorporated in the program or A new and more dangerous health problem has emerged and the priority needs a change Module 4 –decision making Planning is the process of selecting a future course of action. Planning and decision-making, organizing, leading and controlling all interrelated/external factors that affect your goal/objectives. Thus if you are planning for a health programme, best decision will help you to achieving your objectives and goal  Decision making Decision making is the core of management. Indeed, a manager competence as a decision maker determines weather he is a good manager or a bad one. For we expect a good manager to make best decisions most of the times. Does a good decision always result in a good outcome.  How many of the factors in the managers environment are actually beyond his control? What does manager do when he is pressed for time, when he has incomplete information, when there are conflicting objective and future is so uncertain? Managerial decision making is a complex one. LEVEL OF DECISION MAKING There are three level of decision making: 1) Short-time operational decisions- which are typically routine , frequently recurring ,and amenable to the development and implementation of straight forward decision rule. Eg: Examples of such decisions are management of the inventory of drugs, scheduling of  2)Periodic control decision- These are made less frequently and are concern essentially with monitoring the effectiveness of monitoring of organisation allocation of resources.eg: includes: Problem associated with advertising. Deployment of staff of various categories. Pricing and re-pricing of hospital services.  Responding to relatively changes in the economic ,Legal, technology and competitive environments.  3) Strategic decision=which has high cost and significance for the long=term development and welfare of the organization. Such decisions normally require a highly detailed analysis. And substantial element of judgment by the person or group of persons faced with the problem of international donor agencies.  Example occur in the area of introduction of new products development, competitive bidding for a large contract , investment in new health centers, and so on. NB-The difference between these decision types have several implications for the way in which organisation need to structure its decision making process.  Perhaps the most obvious implication is that management need to ensure that routine decisions are treated as such in order to avoid wasting valuable time and money. It is important that non-routine are given time and depth analysis that is required if there structure is to be fully understood, and for improvement in the quality of  Its therefore clear that an organization needs to develop a proper procedure for handling its various managerial decisions if resources are to be utilized effectively and efficiently. It now lead to this questions. At what levels in the organisation hierarchy should various decisions be made?  In general, short-time operation decision and periodic decisions should be made by junior and middle level management who are involved in day-to-day administration of the organisation and not by organization senior management. The business of senior management is to concentrate upon non-routine, non-recurring,  Strategic decisions in which , as observed earlier, there is a high degree of uncertainty regarding the outcome and of which, of consequently, a far greater element of judgment and creativity is required. Those organisation where senior management involves itself in day-to-day, straight-forward operation decisions, the effectiveness and motivation of lower level management would suffer.  In addition , because of pre- occupation of senior management on routine or short-time decisions, less time will be available for long-range issues, with the result that managerial focus will shift from long- range strategic development to short-range control.  Module 5-Controlling Controlling-is the process of ensuring that objective are accomplished as planned. It is a continuous process , but it could be broken into three steps. 1) Establish standarg- eg reduce absenteeism in a class to 3% per year. In establishing a standards , one should avoid as much as possible ,standard that are stated in qualitative terms.eg develop a more efficient work schedule.  2) Compared measured performance with standards. Effective manager will not wait till the end of the project/performance to determine if standard are being met. They monitor regularly the intermediate performance indicators. They could monitor on weekly or monthly basis.  3) Reinforcing success and correcting short coming. The manager should correct the most serious error first ,determining the nature and extent the problem or issue identified and quickly fix the problem. By acting quickly , the manager can influence the result/outcome.  Methods of control Policies/procedure/rules External/internal auditor Budget Performance appraisal report Personal observation Project control-Gantt Chart, quality control chart.  Why is decision making so important in management. Mention three level of decision making in kwara State University , Malate. Mention with examples three level of decision making in University of Ilorin Teaching Hospital. What is control and why is control important during the delivery of health services. EVALUATION OF HEALTH SERVICES There has been a growing concern about the functioning both in developing and developed countries. People are concern about the quality, of medical care , ultilization , coverage, benefit to the community in term of morbidity and mortality reduction and improvement in the health status of the recipients of care. There is a need for evaluation to address these issues.  General steps of evaluation The following steps are involved: 1) Determine what to be evaluated 2) Establish standard and criteria 3) Plan the methodology to be applied. 4) Gather the information. 5) Analyze the information. 6) Take action. 7) Re-evaluation.  1) Determine what is to be evaluated There are 3 types of evaluation. (a) Evaluation of structure-This is evaluation of facilities ,equipment ,manpower , and organization meet a standard accepted by experts as good. (b) Evaluation of process: The process of medical care includes the problem of recognition, diagnostic procedures, treatment ,management , care and prevention. The way in which the process is carried out is evaluated by comparing with the predetermined standard. An objective and systematic way of evaluating a medical officer or a nurse is called medical or nurse audit.  ©Evaluation of outcome This is concern with the end result. Whether the person using the health services experience measurable benefit such as improve survival or reduced disability. 2) Establishment of standard and criteria: standard and criteria must be established to determine whether the objective have been attained. Example on process-every ANC must have attended ANC 6 times before delivery. 3)Planning the methodology A format in keeping with the purpose of evaluation must be prepare for gathering information desired. Standard and the criteria must be included at the planning stage. 4)Gathering information. It require collection of information or data. The type of information required may include : political, economic, enviromental , cultural and administrative factors that influence health situation.  5)Analysis of results Analysis and interpretation of result should be done at short possible time and the result must be made available to every that is concern. In addition , opportunity must be provided for discussion of the evaluation results.  6) Taking action For evaluation to be truly productive , emphasis should be placed on actions. Actions designed to support, strenghten, or other wise modify the service involved. This may also call for shift priorities, revising objectives or development of new programme or services to meet previously unidentify needs.  Re-evaluation Evaluation is an ongoing process aimed mainly at rendering health services/activities more relevant, more effective and more efficiently  ELEMENT OF EVALUATION Evaluation is perhaps the most difficult task in the whole area of health services. The components of the evaluation process are: A) Relevance: Relevance or requisiteness relates to service appropriateness of the service. Whether it is needed at all. If there is no need , the service can be of no value.eg vaccination against small pox is irrelevant because small pox has been eradicated.  b) Adequacy It implies that sufficient attention has been paid to certain previously determined course of an action. For example , the staff allocated to a certain programme may be describe as inadequate if sufficient attention is not paid to the quantum of work-load and the target to be achieved  c)Accessibility: Is the proportion of the population that is expected to use the facility. The barrier may be physical- distance , time, travel; economical- travel cost fees charged; social $ cultural-taste or language barrier. D) Acceptability-The service may be accessible but not acceptable by people eg male sterilisation , screening for rectal cancer.  E) Efficiency: It is a measure of hoe resources-money manpower , materials and time are used to achieved a given effectiveness. F) Effectiveness: It is the extent to which underlying problem are prevented or alleviated. It measure the degree to which a pre- determined objectives and target of the programme , service, or institution expressed if possible , in term of health benefit , problem reduction , or improvement in an unsatisfactory health situation.  g) Impact: It is an expression of the over all effect of the programme , service or institution on health status and socio-economic development. For example as a result of malaria control programme , in addition to reduction in malaria incidence , but all aspect of life-agriculture , industrial and social showed an improvement.  Planning and evaluating must be viewed as a continuous interactive process, leading to continual modification both of objectives and plans. Successful evaluation may also depend on upon wether the means of evaluation were built in to the design of the programme before it was implemented.  Management Administration: mean getting things done. Management: Purposeful and effective use of resources-manpower, materials and finances for fulfilling a pre-determined objective. Management consist of four basic activities: 1) Planning-determine what to do 2)Organising:setting up the frame work or apparatus and making it possible for people to work together. 3) Communicating-motivating people to do the work. 4)Monitorin(controlling) checking to make sure the work is progressing satisifactorily.  Management method and Technics Method based on behavioural sciences: 1)Organizational design-Poor organization result in waste of resources. Organisation must be suited to its current situation and in the way it should serve. The organisation of health service should be designed so as to meet  Organisation design should be review every few years because of changing concept or purpose ,changing problem and changing technology. Efficient delivery of health service depend upon the existence of an effective organization/  2) Personnel management This is skillful use of human resources. Proper method of selection , training, and motivation, division of responsibility, distribution of role; elimination of square pegs in round hole (professional not suited to administration either through training, selection or natural inclination, should not be entrusted  Incentive for better work, opportunities for promotion and professional advancement ; effective design of health team are all fundamental techniques of personnel management which could contribute to the efficiency of health service delivery.  Communication Better communication contributes to effective functioning of an organization. Communication road block exist at various levels. Between doctor and the patient; between doctor and the nurse,between senior officer and junior; between the directorate and the ministry; between health ministry and other ministries and rest of the government. Communication delay are responsible for delay in regular reporting and notification; delay in compilation of statistics; delay in the release of supplies and salaries;  Delays in the institution of remedial measures. One the task of health management is to solve the communication problem by establishing suitable vertical and horizontal communication channels.  4) Information system Information is needed for the day to day management of health system. Information come from many sources- formal and informal sources. The information must be tailored according to the management need of individual health facility. The function of information system consist of: collection, classification, transmission , storage , retrieval, transformation and display of information.  A Good information system provide data for monitoring health programme and give requisite feed back to health administrator and planner at all levels. Computer can play a role in improving the health information system.  MANAGEMENT BY OBJECTIVES Objectives are set for different Units and Subunits. Each of the unit prepare their own action on a short- term basis. This helps in achieving the result more effectively and smoothly. QUANTITATIVE METHOD- Quantitative methods are derived from field of economics , operation research and budgeting. Some of these techniques play a greater role in the management of health services  Cost benefit analysis. The economic benefit of any programme is compared with the cost of the programme. The benefits are express in monetary terms to determine wether a given programme is economically sound and to select out of the alternative programme. The main drawback of this technique is that benefit in the health field can not be expressed in monetary terms. Health benefit is generally expressed in term of births or death prevented , or illness avoided or overcome.  Cost effective analysis It is similar to cost benefit analysis except that the benefits instead of been expressed in monetary term is expressed in terms of result achieved , eg number of live saved or the number of days free from disease.  Cost Accounting It provides basic data on cost structure of any programme. Financial records are kept in a manner permitting cost to be associated with the purpose for which they are incurred. It has three important purpose in health services: 1)cost control 2)planning and allocation of people and financial resources. 3) Pricing of cost reimbursement.  INPUT-OUTPUT ANALYSIS Input-output analysis is an economic technique. In the health field , input refer to all health services activities that consume resources(manpower ,money , materials & time). And output refer to such useful outcomes as cases treated, live save or inoculations performed.  Model Model is a basic concept of management science. It is an aid to understand how the factors in a situation affect one another. It is an abstraction of the reality, not the reality itself. The decision process includes the use of model.  6) System analysis The purpose of system analysis is to help the decision maker to choose an appropriate course of action by investigating his problem , searching out objectives, finding out alternative solutions, evaluation of alternatives in term of cost- effectiveness, evaluation of the alternatives in term of cost effectiveness , re-examination of the objectives if necessary and finding the cost effectiveness alternative of all the available alternatives. The system can be hospital supply system, an information system, an out patient clinic or any other system with problem of management.  NETWORKANALYSIS A network is graphical plan of all events and activities to be completed in order to reach an end objectives. It bring greater discipline in planning. The two common types of network technique are:( a) PERT and( b) CPM PERT-(Programme Evaluation Review Technique:) is a management technique which make detail planning possible and more comprehensive supervision. The essence of PERT is to construct an arrow diagram The diagramme represent the logical sequence in which events must take place.  It is possible with such a diagramme to calculate the time by which each activities must be completed and to identify those activities that are critical. This simple technique provides a basic discipline by which all concerned in a project can know what is expected of them and to minimize any delays or crises in the implementation of the plan.  It aids in planning , schedule , monitoring the project. It allow better communication between various level of management. It identify potential problem. It furnishes continuous and timely progress report. CRITICAL PATH METHOD (CPM)-CRITICAL The longest part of the network. If any activities along the critical path is delay, the entire project will be delayed.  PLANNING –PROGRAMMING BUDGETTING SYSTEM(PPBS) The planning-programming –budgeting system is primarily a system to help decision makers to allocate resources so that the available resources of an organization are use in the most effective way to achieve the objective. It calls for grouping of activities in to programme related to each objectives. Zero budget Approach: All budget start at zero. And no one get a budget that he can not specifically justify on a year to year basis  Work sampling It is systematic observation and recording activities of one or more individuals carried out at pre- determine or random interval. It provide quantitative measurement of the various activities. The major parameter that are analysed are the type of activities performed and the time needed to do specified job.  Work sampling studies have been done on doctor , nurse , pharmacist and laboratory technicians. It permit judgment to the appropriateness of current staff, job description and training. It help in standardizing the method of performing job and determine the man power needs in any organization.  Decision making Decision must be made with complete information /data. It is better that decision are made at appropriate level where the best decisions can be made. In the health sector , decision should made about development of resources , optimum work load for doctor ,and Para- medical, strategies for providing health care etc.  QUESTIONS-PHS-303 1a What is planning in health system management. 1b What is importance of planing fo health programme/community intervention 2 What are the different level of planning in health system management with examples. 3 What are the steps involve in planning a health programme during a community posting.  4 What are pre-planning condition that you need to take in to consideration if you want State Government to support your health programme. 5 During your rural community posting and you conducted situation analysis what are those factors or variable you assessed to know health problem of such community.  6) Write short note on the elements/variables use for evaluation of health system. What are the reason why health system are evaluated. 7) Explain the following with respect to health evaluation. (a) Cost Benefit Analysis ( b) Cost Effective Analysis. 8) Explain NET-WORK ANALYSIS in health programme management( PATH &CPM) 9) What are the resources needed for health programme in a rural community. (b) what will determine your community intervention during the posting i.e priority setting.