Planning

Meaning of Planning

·         “Planning is deciding in advance about what to do, how to do it, when to do it, and who is to do it. It provide ends to be achieved”.  -   Stephen P. Robbins

·         “Planning is the process by which managers define goals and take necessary steps to ensure that goals are achieved   -   Richard Steers

·         “To some people, planning means specifying a plan of action; to others, determining the most efficient allocation of resources; still to others, identifying the future want”.-   Mary Arnold

·         A plan is defined as a road map, as preparation, as an arrangement. Planning defines where one wants to go, how to get there and the timetable for the journey. Complete planning sets out indicators for tracking progress and ways to measure if the trip was worth the investment.  Health System Intelligence Project – 2006   Ontario

Health Planning

·         Health planning  “The systematic process of defining community health problems; identifying unmet needs and surveying the resources to meet them; establishing the priority goals that are realistic and feasible and projecting administrative actions to accomplish the purpose of anticipated program”.  -   WHO

 

Planning answer the Question

·         Where are we now? ( assessment)

·         Where do we want to go? ( priorities, goal, objectives, targets, decisions)

·         How will we get there? (strategy, management)

·         How will we know where we arrive? (monitoring, evaluation)

 

Planning

 In summary “Planning is a systematic process of:

1.      defining health needs;

2.      prioritize the problems;

3.      setting goals, objectives and strategies;

4.      analyze and allocate resources;

5.      prepare details plan of action and

6.      setting monitoring and evaluation methods”

 

Why planning ? / Purpose of planning

To match limited resources with many problems

To eliminate wasteful expenditures or duplication of expenditures

To develop the best course of actions for achieving the defined objectives

The purpose of planning is to ensure that a program has the best possible likelihood of being successful defined in terms of being effective with the least possible resources (greater outcome with least resources).

Importance of planning

·         Control risk and uncertainty of the project

·         Allocate resources in the coordinated manner

·         Establish standards of performance of monitoring and evaluation

·         Provide a structured to execute the project

·         Establish procedure to make correction the project work

·         Achieve results in time in estimated cost and desired level of quality performance

·         Improve efficiency of project operation by minimizing waste

 

Characteristics of planning

·         Futuristic in nature

·         Systematic process

·         Change oriented

·         Continuous and dynamic

·         Goal-focused

·         Efficiency

·         Pervasiveness (concern in all level)

 

Types of Planning

Types of planning is vague. There is no any specific classification of planning, rather it is classified in different perspectives.

A. Types of planning – by duration

1.      Long term planning: long term planning usually covers several years of planning, deals with subject which needs long time to meet (e.g. HR, infrastructure)

2.      Medium term planning: usually 3-7 years period, more concerned achieving pre-defined goals and objectives

3.      Short term planning: mostly 1-2 year period, link with government’s budget period

 

B. Types of planning - by level

1.      Top level planning: focuses on setting directions and policies, known as health policy plan, guide and regulate health system

2.      Middle level planning: deals with translation of policy in to operation, known as health sector program planning

3.      Lower level planning: deals with necessary arrangement for implementation including formulation of projects, basically known as health project planning

 

C. Types of planning –  by function

1.      Strategic planning: Strategic planning involves determining the goals and gives general direction of healthcare delivery and the development of the overall framework and principles, which may require “engineering” an agreement between various stakeholders.

2.      Strategic planning is a process where top-level management sets long-term organizational goals and determines where an organization is going over a period  time, more -typically 3 to 5 years, although some extend their vision to 10 to 20 years.

1.      Operational planning (tactical): Operational planning refers to the translation of strategic objectives into action. includes concrete sequence of activities, involving the allocation of budgets and resources, the provision of facilities, equipment and staff and the organization of services. Operational plans that are short-term and deal with the day-to-day work of their team. Short-term goals are aligned with the long-term goals and can be achieved within a month, quarter or up to one year.

Culture

Meaning of Culture

Culture (from the Latin cultura stemming from colere, meaning "to cultivate"). When the concept first emerged in eighteenth- and nineteenth-century Europe, it connoted a process of cultivation or improvement, as in agriculture or horticulture. In the nineteenth century, it came to refer first to the betterment or refinement of the individual, especially through education, and then to the fulfillment of national aspirations or ideals. In the mid-nineteenth century, some scientists used the term "culture" to refer to a universal human capacity. For the German sociologist, George Simmel, culture referred to "the cultivation of individuals through the agency of external forms which have been objectified in the course of history".

Source. Wikipedia

Definition of culture

Culture is that complex whole which include knowledge, belief, art, morals, law customs and any other capabilities acquired by man as a member of society- Tylor

In an another definition he said; “Culture is an attribute of man, acquired by him in time, as a member of society”

Culture is sum total of human achievements materials as well as non-material, capable of transmission, sociologically i.e. by tradition and communication, vertically as well as horizontally- Maxumdar HT

Culture is the totality of the group ways of thought and action duly accepted and followed by the group of people – A F Walter Paul

Culture is socially transmitted system of idealized ways in knowledge, practice and belief along with the artifacts that knowledge and practice produce and maintain a they change in time – Green  

Culture is integrated system of learned behavior patterns which are characteristics of the member o society and which are not the biological inheritance

Culture is the particular way of life of the society 

Culture is genetically pre-determined: it is non instinctive

It is result of social invention and is transmitted and maintained solely through communication and learning.

In 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of "culture" in Culture: A Critical Review of Concepts and Definitions. However, the word "culture" is most commonly used in three basic senses:

•      Excellence of taste in the fine arts and humanities, also known as high culture 

•      An integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for symbolic thought and social learning

•      The set of shared attitudes, values, goals, and practices that characterizes an institution, organization or group

MANIFESTATIONS OF CULTURE

Cultural differences manifest themselves in different ways and differing levels of depth. Symbols represent the most superficial and values the deepest manifestations of culture, with heroes and rituals in between.

• Symbols are words, gestures, pictures, or objects that carry a particular meaning which is only recognized by those who share a particular culture. New symbols easily develop, old ones disappear. Symbols from one particular group are regularly copied by others. This is why symbols represent the outermost layer of a culture.
• Heroes are persons, past or present, real or fictitious, who possess characteristics that are highly prized in a culture. They also serve as models for behavior.
• Rituals are collective activities, sometimes superfluous in reaching desired objectives, but are considered as socially essential. They are therefore carried out most of the times for their own sake (ways of greetings, paying respect to others, religious and social ceremonies, etc.).
• The core of a culture is formed by values. They are broad tendencies for preferences of certain state of affairs to others (good-evil, right-wrong, natural-unnatural). Many values remain unconscious to those who hold them. Therefore they often cannot be discussed, nor they can be directly observed by others. Values can only be inferred from the way people act under different circumstances.
• Symbols, heroes, and rituals are the tangible or visual aspects of the practices of a culture. The true cultural meaning of the practices is intangible; this is revealed only when the practices are interpreted by the insiders.

Characteristics of Culture

•      Culture is an acquired quality

•      Culture is social not individual heritage of man

•      Culture is idealistic; it embodies the ideas and norms of a groups. It is some total of ideal patterns and norms of group of people

•      Culture is total social heritage

•      Culture fulfils some needs; Cultural fulfills those ethical and social needs of groups which are ends in themselves

•      Culture is an integrated system

•      Language is chief vehicle of culture

•      Culture evolves into more complex

•      Culture is changing

•      Culture is adaptive

Motivation

Motivation

•      Motivation is the driving force that causes the flux from desire to will in life. For example, hunger is a motivation that elicits a desire to eat.

•      Motivation is an inner drive to behave or act in a certain manner. These inner conditions such as wishes, desires and goals, activate to move in a particular direction in behavior.

 

Abraham Maslow’s Hierarchy of Motivation

           

                        Abraham Maslow’s Hierarchy of Motivation

           

 

Motivation in Health Problem Solution

•      Self-actualization: Problem solving Need at top, that is to be self-actualized by the person or people.

•      Esteem: Respect by others and achievement

•      Love/belonging: self, family, friendship

•      Safety and security of: body, health, family, life

•      Physiological: breathing, water, food, sleep, excretion, etc.

 

Types of Motivation

1.     Intrinsic (internal) motivation, and

2.     Extrinsic (external) motivation

•      Intrinsic motivation refers to motivation that is driven by an interest or enjoyment in the task itself, and exists within the individual rather than relying on external pressures or a desire for reward.

•      Extrinsic motivation refers to the performance of an activity in order to attain an outcome, whether or not that activity is also intrinsically motivated. Extrinsic motivation comes from outside of the individual. e.g., money, reward, upgrades, promotion, etc.

•      Role of Health Education and Counseling in Health

•      Knowledge (+ve) and understanding of the problem and solution

•      Positive attitude development

•      Motives and drives towardness

•      Motivational action

•      Behavior improvement

•      Long term impact/result as an improved behavioral culture established

Primary Health Care (PHC)

Concept of Primary Health Care (PHC)

Primary health care (PHC)

Jointly both World Health Organization (WHO) and United Nations International Children’s Fund (UNICEF) conference was held at Alma Ata in Almaty, Kazakhstan in 1978 A.D. and endorsed (declared and signed) on the WHO concept of Health for all by the year 2000 A.D. and suggested a new approach to health care that integrates at the community level all the factors required for improving the health status of people is known as primary health care(PHC).

Nepal had signed the HFA 2000 document at Alma-Ata in 2978 A.D. and had accepted Primary health care(PHC) as being an effective method by which essential health services were to be providing the community people.

 

Health for all 2000 (HFA 2000)

Health For All means that health is to be brought within reach of everyone in a given country.

And by "health" is meant a personal state of well being, not just the availability of health services – a state of health that enables a person to lead a socially and economically productive life. In other worlds, as a minimum, all people in all countries should have at least such a level of health that they are capable of working productively and of participating actively in the social life of the community in which they live.

 

Primary health care (PHC): Alma Ata Declaration

The Alma-Ata Declaration was adopted at the International Conference on Primary Health Care (PHC), at Almaty, Kazakhstan, 6-12 September 1978 ratified by 134 WHO member states. It expressed need of urgent action by all the government, all health and development workers, and the world community to protect and promote the health of all people. It highlighted the importance of Primary Health Care(PHC). The conference highlighted that the HFA by 2000 is a goal and Primary Health Care(PHC) is a strategy or approach to achieve that goal. It reaffirmed the health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

 

Primary health care (PHC)

Primary health care (PHC) refers to essential health care based on scientifically sound and socially acceptable methods and technology, made universally accessible to all individuals and families in a community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determination. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work and constitutes the first element of a continuing health care process.

 

Pillars/principles of Primary health care (PHC)

• Equitable distribution of health care – according to this principle, primary care and other services to meet the main health problems in a community must be provided equally to all individuals irrespective of their gender, age, caste, color, urban/rural location and social class.
• Community participation – in order to make the fullest use of local, national and other available resources. Community participation was considered sustainable due to its grass roots nature and emphasis on self-sufficiency, as opposed to targeted (or vertical) approaches dependent on international development assistance.
• Health work force development – comprehensive healthcare relies on adequate number and distribution of trained physicians, nurses, allied health professions, community workforce and others working as a health team and supported at the local and referrals levels.
• Use of appropriate technology - medical technology should be provided that is accessible, affordable, feasible and culturally acceptable to the community. Examples of appropriate technology include refrigerators for vaccine cold storage. Less appropriate could include, in many settings, body scanners or heart-lung machines, which benefit only a small minority concentrated in urban areas. They are generally not accessible to the poor, but draw a large share of resources.
• Multi-sectional approach – recognition that health cannot be improved by intervention within just the formal health sector; other sectors are equally important in promoting the health and self-reliance of communities. These sectors include, at least: agriculture (e.g. food security); education; communication (e.g. concerning prevailing health problems and the methods of preventing and controlling them); housing; public works (e.g. ensuring an adequate supply of safe water and basic sanitation); rural development; industry; community organizations (including Panchayats or local government etc.).

 

8 elements of Primary health care (PHC)

1.     E- Essential Drug Supply: By providing essential drugs to those who need them, such as antibiotics to those with infections, caregivers can help prevent disease from escalating. This makes the community safer, as there is less chance for diseases to be passed along.

2.     L- Local endemic Disease Control: Prevention and control of local diseases is critical to promoting primary health care in a population. Many diseases vary based on location. Taking these diseases into account and initiating measures to prevent them are key factors in efforts to reduce infection rates.

3.     E- Expanded Program on Immunization: By administering global immunizations, WHO works to wipe out major infectious diseases, greatly improving overall health globally.

4.     M- Maternal and Child Health Care and Family Planning: Ensuring comprehensive and adequate health care to children and to mothers, both expecting and otherwise, is another essential element of primary health care. By caring for those who are at the greatest risk of health problems, WHO helps future generations have a chance to thrive and contribute to globally. Sometimes, care for these individuals involve adequate counseling on family planning and safe sex.

5.     E-Education on Health: Public education is the first, and one of the most essential, component of primary health care. By educating the public on the prevention and control of health problems, and encouraging participation, the World Health Organization works to keep disease from spreading on a personal level.

6.     N-Nutrition: Nutrition is another essential component of health care. WHO works to prevent malnutrition and starvation and to prevent many diseases and afflictions.

7.     T-Treatment for minor illness: Another important component of primary health care is access to appropriate medical care for the treatment of diseases and injuries. By treating disease and injury right away, caregivers can help avoid complications and the expense of later, more extensive, medical treatment.

8.     S-Sanitation and safe drinking water supply: A supply of clean, safe drinking water, and basic sanitation measures regarding trash, sewage and water cleanliness can significantly improve the health of a population, reducing and even eliminating many preventable diseases.