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  Basics of health planning / Class 7. Planning for Implementation and Evaluation

Objectives
At the end of this class the students will know

  • what is programming
  • what is the difference between a program and a project
  • some of the issues faced in programming (in particular the relationships between programs and projects and donors)
  • what documentation is required for a program
  • what is program implementation
  • what is the record regarding implementation
  • what are the techniques for providing the success rate in the implementation of the programs and projects

    After we have (1) analyzed the situation, (2) set priorities, (3) wrote objectives, (4) developed and appraised options, (5) decided on a strategy, and (6) allocated resources, it is time to begin programming - translating the results of the priority setting process and option appraisals into the set of workable programs of activity that forms the basis of a plan. The plan includes the budget (already discussed in previous class) and the staffing requirements (to be discussed in detail during the next class).

    1. Programs and projects
    Before starting the discussion, let's briefly outline the main differences between a program and a project. Programs and projects are the instruments of planning. Some people use these terms interchangeably, but they differ in terms of time, focus/topic, and location.
      Program Project
    Time Ongoing Limited duration
    Scope Broad, wide range of topics Specific focus
    Location Wider area Limited location

    Many donors still consider discrete project activities as the most desirable and monitorable, and the best forms of aid. The reason for this is that in addition to any presumed desire to support the health-promoting activities of a country; donors have other concerns about the way their funds are used. They usually are:

    1. interested to ensure that funds they provide are used in ways consistent with their own priorities
    2. due to political reasons, donors prefer to support activities which have identifiable results in the short to medium term
    3. concerned to ensure that proper financial control is exercised
    4. often anxious to ensure that the disbursement of the funds occurs within the agreed time-table
    It is true that the use of projects within defined program areas has many advantages, but the difficulties arise when a project is defined by a donor agency in a way which crosses over existing program boundaries, and essentially sets up new organizational structures within the health sector. The project may also adversely affect the ability of other programs to implement their projects. Examples of such projects, currently popular in Armenia, include Family Health Projects or Population projects (in Armenia it may be Family Planning projects, which are highly important, but there are too many of them and they are often overlapping). To avoid problems it is recommended to locate projects organizationally within the existing programs, rather than setting up new structures.

    2. Planning and implementation

    Now let's discuss how programs and projects are implemented. Unfortunately, often insufficient attention is given to this element of planning, and in many cases the record on the implementation of plans is generally poor.

    To avoid problems with implementation (delayed implementation, non-implementation, or implementation in a form different from what was planned), it is necessary to understand the root causes.

    Factors leading to poor implementation may include:

    • changes in priorities or policies from those originally agreed
    • resistance to the changes inherent in the plan, either from within the health service or from outside
    • lack of necessary resources (financial or real, for example, trained staff) required to implement the plan
    • imprecisely specified details of the project or program to be executed
    • lack of the appropriate organizational structure or the appropriate managerial skills necessary

    In real life all these factors are interdependent to some extent. It is also important to know that failures of implementation can frequently be traced to inadequate earlier planning, rather than to incompetence on the part of those charged with implementing the plan.

    Figure 6. Causes of failures of implementation (A. Green "Introduction to health planning in developing countries")

    All of the major reasons for poor implementation can be summarized into three types:
    I- unavoidable circumstances (genuine policy change, extraneous circumstances)
    II- poor planning during earlier parts of the planning cycle
    III- poor planning at the programming and implementation stages

    Let's look more closely at the type III poor planning.


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