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  Basics of health planning / Class 2. Situational analysis

Objectives
By the end of this class the students will know

  • what is a situational analysis
  • why it needs to be done (the purpose)
  • how it can be done (the process)
  • what information is necessary for successful planning

    Situational analysis (also called "needs assessment, "community analysis", "environmental assessment") is one of the steps of the generic planning model we have discussed in Class 1

    A situational analysis is an analysis of the current situation. It includes collecting, analyzing assessing and documenting information regarding current health status. To plan (at any level - national, regional, district, or community), it is necessary to have a clear broad understanding of the background situation.

    Thus, the purpose of a situational analysis is to provide a wide basis for understanding the current situation. The analysis

    • provides a common reference point for the rest of the planning process
    • provides information that aids in the identification of the priority areas of concern of planning
    • produces a document of the current situation

    The following four steps form the process of situational analysis:

    1. Making decision on what information to collect
    2. Collection of the information
    3. Analysis of the collected information
    4. Production of the document/report

     

    1. What information to collect

    To make correct decisions in the planning process, information is needed. Some authors call it "the lifeblood of the planning process". You may have heard one more expression related to information - "information is power", meaning that access to and familiarity with different types of information puts one in a powerful position to influence the decision-making process. At the same time it is necessary to remember that only the information which is relevant and important for the planning process, needs to be collected. Otherwise it is easy to be trapped by the vast amounts of available information.

    The question arises - what information should be collected for planning? (first step of the situational analysis).

    It depends on several factors. The most important of them are listed below.

    1) Who are the planning players;
    2) What definition of health and health system (strict medical vs holistic) are accepted by them;
    3) Types of available information (feasibility, validity);
    4) Level of planning (national vs community-level planning), etc.

    In general, all the information necessary for the situational analysis relates to the next three broad areas:

    a) health status and needs
    b) health services and resources
    c) policy and political environment

    Let's discuss them in detail.

     

    A. Health status and needs

    Any situational analysis requires information about the population under analysis (people of the country or a particular area) as starting point, so health status includes descriptive information on the following broad themes:

    a) demographic information covering such points as

  • absolute size and distribution of population
  • vital rates - birth, death, and fertility rates
  • immigration and emigration rates
  • the overall population grow-rate
  • age and sex-structure

    b) epidemiological data including

  • morbidity rates - by disease and by category of group affected, for example, age, sex, class, ethnicity, location (rural/urban)
  • mortality rates (as for morbidity rates)
  • disability rates
  • risk factors, etc

    c) health conditions and practices describing

  • water supplies
  • sewerage and waste collection
  • housing
  • child feeding practices
  • vector control, etc br>

    Information on health needs should include the following:

    a) Medically perceived needs, which are based on medical indicators (epidemiological data) coming from community health surveys, medical records of the patients as well as from the perceptions of health professionals

    b) Community perceived needs, which are far harder to define, particularly at the national level, and often expressed in terms of services deficiencies rather than 'health' indicators. Community perceptions of needs are likely to be less easily available and less structured. This information usually comes from surveys of the attitudes and views of community members of their health needs and also may be derived through existing community structures such as village health , or indeed at the national level, through demographically representative structures.

    The next principal category of information in a situational analysis concerns the health services and resources available to the target population.

     

    B. Health services and resources

    Information on health services and resources includes data about the following subcategories:

    a) Human resources

  • number of personnel employed within the public sector
  • number of personnel employed in health fields outside the public sector
  • projected transfers between the public and private health sector
  • projected output from training
  • projected losses from the service
  • age and sex distribution
  • urban versus rural distribution
  • current and projected gaps in staff

    b) Physical resources (buildings, land, equipment, vehicles, and other supplies)

  • type
  • capacity
  • locations
  • ownership
  • state of repair
  • any particular constraints on the provision of other supplies, such as drugs

    c) Financial resources

  • health expenditures (% GDP)
  • health budget relative to total expenditures
  • private vs public expenditures
  • current and potential health funding resources
  • projected inflation rates

    d) Service utilization statistics

  • facility attendance rates, and numbers of preventive activities performed ( such as immunization rates, family planning accepters; drinking- water springs protected, pit latrines dug, etc.)
  • hospital occupancy rates, hospital discharges, duration of hospital stay

    e) Coverage

  • proportion of underweight children served by feeding centers
  • proportion of deliveries attended by trained personnel, etc

    f) Service gaps

  • known service gaps (areas not covered by basic facilities)
  • projected service gaps resulting from population changes, new health needs, changes in service standards, etc

    g) Costs and charges/sources of payment

  • cost per immunization
  • free-of charge, user fees

    h) Health services organizational arrangements

  • degree of centralization in decision-making
  • degree of and opportunities for links with other sectors and community participation

    i) Efficiency, Effectiveness, and Equity of current services

    Class 5 will cover questions related to those points, and introduce the concept of "cost effectiveness", "cost- benefit analysis", etc.

     

    C. Policy and Political Environment

    The third broad area of information needed in the situational analysis refers to the general environment. It includes information about:

  • political environment: national polices (health and non- health related); political environment; interest groups, etc
  • cultural characteristics
  • health- related knowledge, attitudes and practices of population
  • socio-economic situation
  • geographical/ topographical environment
  • religious characteristics
  • infrastructure: transport, communication, utilities, etc
  • non- health sector: services provided by and planned for in education, agriculture

     

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