Vision, Mission and Planning Cycle

Introduction to Planning
Hari Prasad Kaphle

Assistant Professor (Public Health)
Pokhara University
Introduction 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.
10
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.
11
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.
12
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.
13
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.
14
Planning is flexible.
Planning is done for the future. Since future is
unpredictable, planning must provide enough room

to cope with the changes in customers demand,
competition, government policies etc.
Under changed circumstances, the original plan of
action must be revised and updated to make it more
practical
15
Elements of Planning
16
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).
17
Vision Statement
Mission Statement
Goal
Objectives
Targets
Policies
Strategies
Activities
Programme
Project
Procedure/SOP
Rules
Schedule/Work plan
Budget
18
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.
19
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 firms
operation in product and market terms. It addresses

the basic question that feels all strategists. What is
our business?
20
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.
21
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.
22
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
23
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.
24
Nepal Health Sector Programme II
Mission: Promote the health of Nepals 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.
25
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.
26
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.
27
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
28
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).
29
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.
30
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.
31
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.
32
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
Introduction
Prasad
Kaphle
33
70% by 1996 and
to 50%to Planning
by theHari
year
2000.
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.
34
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
35
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.
36
Scope of Objectives
Target
37
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.
38
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
39
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
40
National Blood Policy 2050 (1993 AD)
The following guiding principles govern Nepals blood services:
The collection of blood is based on voluntary non-remunerated
blood donation,
The provision for blood and blood products must be on nonprofit 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,
41
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.
42
National Health Policy 2071
1 National Health Policy 2071.pdf
43
44
45
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?
Its 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.
46
1 National Health Policy 2071.pdf
47
48
CBIMCI: strategies
1. Improving knowledge and case management skills of health
service providers
CBIMCI 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 CBIMCI focal persons of the
districts
Inclusion of CBIMCI component in the curriculum of preservice
medical and paramedical
schools
Introduction to Planning
Hari Prasad Kaphle
49
CBIMCI: Strategies
2. Improving overall health systems
Carry out CBIMCI 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 mothers 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.
50
CBIMCI: 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 hardtoreach 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
51
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.
52
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.
53
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.
54
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.
55
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.
56
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
57
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.
58
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.
59
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 .
60
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
61
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 MothertoChild Transmission)
of HIV/AIDS
62
Some more examples of projects
BPCR (Birth Preparedness and Complication Readiness)
CMAM (Communitybased 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
63
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.
64
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.
65
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
66
Types of Planning
67
Types of Planning
Breadth
Time
frame
Specificit Frequenc Approac Degree of

y
y of use h
formalizati
adopted on
Strategic
Long term Direction Single

al
use
Operation
al
Short
term
Specific
Proactiv
e
Formal
Standing Reactive Informal
68
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
organizations overall objectives, and seeks to position the
organization in terms of its environment.
Top-level managers, formulate long-term strategic
planning to reinforce the firms mission (the mission
clarifies organizational purpose).
Strategic plans are specified for five years period or more;
but circumstances dictate the planning horizon
69
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.
70
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.
71
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.
72
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
73
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.
74
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.
75
Formal and Informal Planning:

In informal planning, planning is based on managers
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.
76
Process/Cycle of Planning
77
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
78
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
79
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
80
Problem identification & prioritization

SN Problem
identified
1
2
3
4
5
6
Malaria
HIV/AIDS
Tuberculosi
s
Diarrhoea
ARI
PEM
Score for each criterion

Magnitu Severi Feasibi Govt.
de
ty
lity
concer
n
4
3
3
5
5
5
5
3
5
4
4
4
Comm
unity
concer
n
3
3
3
5
5
4
5
5
4
5
5
5
5
5
5
5
4
4
Tota Priori
l
ty
scor rank
e
21
18
20
4
6
5
25
24
22
1
2
3
81
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.
82
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.
83
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.
84
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.
85
Preparation of Detail Action Plan

(Programming & Budgeting):
Objectiv
es
Propose
d
Activities
Approach Responsi
ble
(strategy)
person
Resources Cost Time

line
Performanc
e
Indicator
Objectiv
e 1:
Objectiv
e 2:
86
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.
87
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.
88
Monitoring and Evaluation:

S
N
Activity
Key indicator
Base
line
Target
ANC
service
1st ANC Coverage

4th ANC Coverage
IFA coverage
TT2 coverage
40 %
25%
41%
55%
80%
50%
90%
95%
INC
service
Institutional delivery
Skill birth Attendance
16%
31%
PNC
service
PNC coverage
Postnatal Vitamin
coverage
New
Born
Care
Birth weight
BCG Coverage
19%
A NA
NA
85%
Means
of
verificati
on
Clinic
report
Frequency Important
of
Data assumption
Collection
Monthly
and
Quarterly
Community
support
Coordination
with SHP/HP
70%
85%
Clinic
report
Monthly
and
Quarterly
50%
100%
Clinic
report
Monthly
and
Quarterly
85%
95%
Clinic
report
Monthly
and
Quarterly
89
Planning Cycle
90
Components of (Operational) a Plan

Executive summary
Introduction
Problem Statement
Objectives and targets
Strategies and activities
Budget
Work Plan
Monitoring and Evaluation
References
Annex
91
Strategic Planning
92
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 organizations capabilities and
environment, and leads to priority-based resource
allocation and other decisions.
93
Strategic Planning
A strategic plan develops a clear statement of the
organizations 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.
94
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
95
Strategic Planning
Desired Status
Gap
Sta
tus
Present
Status
Time
Planning Required
T1
T2
96
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
97
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.
98
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.
99
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.
100
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.
101
Strengths
Opportunities
SWOT
Analysis
Weakness
Threats
SWOT analysis
Strengths
Highly skilled manpower
Latest technology
Sufficient investment
Global presence
Well defined distribution mechanism
Weaknesses
Non experienced managers
Old technology
Lack of investment
Low position in business
Conflict b/n management and employees
Alternative products or services
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
103
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.
104
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.
105
Determination of organizational goal

and objectives
An organizations goal states the intentions behind the
organizations 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.
106
Determination of organizational goal

and objectives
An organizations goal states the intentions behind the
organizations 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
107
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.
108
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.
109
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.
110
Generation, Evaluation and Decision

on Strategic Options
Growth strategies take advantage of the organizations internal
strengths and the environments 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 organizations internal strengths to
respond to and address the environments threats (S, T).
Withdrawal strategies ensure survival when faced with internal
weaknesses and the environments threats, the organization
withdraws to seek the most favorable conditions (W, T).
111
WOST Matrix
Op
po
rtu
nit
ies
Th
re
at
s
Strengths
Growth Strategies
Expansion
Maintenance
Development and
Innovation
Diversification
Response Strategies
Market segmentation
Differentiation
Diversification
Leadership development
Strategic alliances
Political actions
Weaknesses
Reinforcement Strategies
Reorientation
Approach
Specialization
Withdrawal Strategies
Reorientation
Approach
Specialization
Segmentation
Differentiation
Leadership
Alliances
Political actions
112
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.
113
Sample strategies of a hospital

By the end of 2020 the institution must:
To position its institutional image in the minds of the countrys
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-ofthe-art technology, prioritizing the areas with the highest demand;
To strengthen the staffs 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.
114
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.
115
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.
116
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.
117
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.
118
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
119
Scope and Applicationof

Planning in (Public) Health
Hari Prasad Kaphle
Pokhara University
120
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.
121

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
122

Its scope also includes planning for public sector as
well as planning for private sectors (both private for

profit and private for non profit)
Its scope also include planning in other sector to
provide health related service: education, nutrition,

environment, agriculture, social development etc.
123
Public sector
planning
Interdisciplinary planning
Planning for population
development
Planning for agriculture &
veterinary
Planning for forestry
Financial & mgt planning
Private sector
planning
Development sector
planning
Planning for education
Planning for infrastructure
development
Planning for land reform
Health sector Planning

Planning for public health
& PHC
Planning for medical
education & service
Planning for indigenous
system
Planning for health
research and politics
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-fornonprofit

Planning for international
nongovernmental
organizations
Planning for national
nongovernmental
organizations
Planning for religious
organizations and charitable
trusts
124
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.
125
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.
126
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.
127
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.
128

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.
129

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.
130

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.
131
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.
132
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.
133
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 healthcare still
today.
134
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.
135
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.
136
Scope and Application of

Planning in Nursing
Hari Prasad Kaphle
Pokhara University
137
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.
138
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
139

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
140

Planning to provide nursing care
Short term care
Out patient care
Long term care
Inpatient care
Intensive care
Home care
Emergency care
Individual care
Institutional care
141

Planning for effective management of different
department regarding nursing care

Emergency
Labor
OPD
Post partum
ICU
Pediatric
NICU
Medical
CCU
Surgical
OT
Orthopedic
Laundry etc.
142

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
143
Benefits and limitations of

Planning
Hari Prasad Kaphle
Pokhara University
144
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.
145
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
146
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.
147
Barriers in effective planning

1.
2.
3.
Difficulty of accurate premising

Problem of rapid change
Internal barriers
a. Capital investment
b. Psychological factors
c. Policy and procedure
148
Barriers in effective planning

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
4.
149
Introduction to Policy
150
Introduction to Policy
Definition
Types
Benefits
Limitations
151
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.
152
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.
153
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.
154
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
155
Distributive policies
Distributive policies involve allocation of services
or benefits to particular segments of the population

(individuals, groups, corporations, and
communities).
156
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.
157
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.
158
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.
159
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.
160
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.
161
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.
162
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.
163
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.
164
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.
165
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
166
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.
167
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.
168
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.
169
Vertical and horizontal policies

Vertical policy (sometimes called corporate or
framework policy) is developed within an

organization that has authority and resources for
implementation.
170

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.
171

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.
172
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
173
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,
thatcharacterize the distribution of resources,

services, and political influences that impact on the
health of the population" -Miller (1987)
174
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)
175
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
179
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
180
Thank You
Establishing the
Objectives of Planning
Hari Prasad Kaphle
Pokhara University
182
Approaches of Planning
1.
2.
3.
4.
Top- Down approach

Bottom up approach
Participatory approach
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.
Management by
Objectives
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.
Management by Objectives
Organizational
Objectives
Divisional
Objectives
Departmental
Objectives
Individual
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
Procedure
Hari Prasad Kaphle
Pokhara University
205
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.
206
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.
207
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.
208
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.
209

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.
210

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

followed in a chronological sequence.
211
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
212
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
213
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
214
Winners do not do different things,

they just do same thing differently.
Work smart not hard to be a

successful manager !!!

Vision, Mission and Planning Cycle

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Vision, Mission and Planning Cycle

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Introduction to Planning

Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

action i.e. what action, why an action, how to take action,

aspects of planning process.

goal/objective/target and choosing the best way to achieve

objectives, determination of project and programme,

appropriate way to go from the current situation to the

Introduction to Planning Hari Prasad Kaphle

the future should be better than the present, what changes

executive action that embodies the skill of anticipating,

making and using of assumptions regarding the future

action considered necessary or desirable to achieve

defining community health problems, identifying

Introduction to Planning Hari Prasad Kaphle

thinking, sound judgment and imagination.

dynamic business environment.

Introduction to Planning Hari Prasad Kaphle

the minimum possible cost.

unpredictable, planning must provide enough room

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

become in future (e.g. in next 5yerars, 10 years, 20

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

Global excellence in health care, Getting to zero: Zero

Introduction to Planning Hari Prasad Kaphle

operation in product and market terms. It addresses

Introduction to Planning Hari Prasad Kaphle

International standards within the reach of every

Introduction to Planning Hari Prasad Kaphle

preventable disease, disability, and death

citizens by preventing disease, disability, and death

Introduction to Planning Hari Prasad Kaphle

the Nepalese population and provide an equal

Introduction to Planning Hari Prasad Kaphle

facilitating access to and utilization of essential health

demonstrate that the objective has been achieved),

permits the concept of degree of achievement.

in a problem where as objective are directly concerned

health care facilities.

1996 and to 400 by the year 2000.

from 54% to 76% by 1996 and to 100% by the year 2000.

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

1 National Health Policy 2071.pdf

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

1 National Health Policy 2071.pdf

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle

recommendations made by IMCI technical working group

outreach clinics and health facilities to individuals, families

procedure) is a sequence of steps for completing a

Introduction to Planning Hari Prasad Kaphle

For example, a Purchasing policy of an enterprise

may states purchasing from lowest bidding party.

Introduction to Planning Hari Prasad Kaphle

Introduction to Planning Hari Prasad Kaphle