it describes various planning tools and its implementation in health sector

1. PLANNING TOOLS IN
IMPLEMENTATION OF HEALTH
PROGRAMS
Bikram Chand
MPH 2nd Year
Nitte University

2. PLANNING
The process of setting goals, developing strategies and
outlining tasks and schedules to accomplish the goals.
Planning is deciding in advance what to do, how to do
and who is to do it.
Planning bridges the gap between where we are to,
where we want to go.
It makes possible things to occur which would not
otherwise occur.

3. HEALTH CARE PLANNING
Orderly process of:
Defining community health problems,
Identifying unmet needs,
Surveying resources to meet them,
Establishing priority goals, that are realistic and feasible
and
Projecting administrative action to accomplish the purpose
of proposed programs.

4. ELEMENTS
Objectives
Policies
Programs
Schedules
Budget

5. PLANNING CYCLE
Analysis of
health situation
Objectives and
goals
Assessment of
resources
priorities
Formulate
plan
Programming and
implementation
Monitoring
Evaluation

6. INTRODUCTION
Formal research on the seven new quality tools began in
1972 as part of the Japanese Society of QC technique
development meetings.
It took several years of research before the seven new tools
were formalized.
The original seven tools of quality (scatter diagram, flow
charts, histogram, etc.) were adequate for data collection
and analysis.
However, the new tools allow for more
identification, planning, and coordination in finding a
problem solution.
The seven new tools are written by Japanese authors
Mizuno Shigeru (1988) and Asaka Tetsuichi and
Ozeki Kazuo (Tetsuichi, 1990).

7. BASIC 7 TOOLS
Flow Charts
Run Charts
Histograms
Pareto Diagrams
Cause and Effect Diagrams
Scatter Diagrams
Control Charts

8. PLANNING TOOLS
Affinity diagram
Tree diagram
Interrelationship diagram
Process decision program chart (PDPC)
Matrix diagram
Prioritization matrix
Activity network diagram

9. AFFINITY DIAGRAM
It was created in the 1960s by Japanese anthropologist
Jiro Kawakita (KJ method).
The affinity diagram is a technique that an individual
or team can use for problem solving.
Is a way to organize a large set of ideas.
Very helpful for any team with a brainstorming
session, when analyzing information.
Modification of traditional Brainstorming method.
Technique to generate ideas and linkup with other
ideas to form common ideas.
Encourages the participation of all in the group.

10. WHEN TO USE???
Many facts or ideas.
Too large and complex issue to handle.
Group agreement is necessary.

11. STEPS
Problem is written on the center of the board.
Each team/member generates ideas to find the causes of the
problem.
Each team/member is encouraged to give more and more
ideas.
Ideas are written on a small piece of paper (normally 3” x
5”).
Each paper is placed on the board around the problem.
Team study and categories the similar ideas by agreement.
Ideas are reduced to a workable number of ideas and a
border line is drawn around these ideas.

12. AFFINITY DIAGRAM
What are the Barriers to on-time
delivery of medication
Telephone med
requests
New
pharmacists
Cannot find
procedures
Wrong quantity
delivered
Order cannot be
read
Physicians revises
medications
Nurses
unfamiliar with
generic name
Procedure
unclear
Interruption in
pharmacyNot enough
pharmacists

13. AFFINITY DIAGRAM
Staff issues
New
pharmacists
Not enough
pharmacists
Nurses unfamiliar
with generic name
Process interruptions
Wrong quantity
delivered
Physicians revises
medications
Interruption in
pharmacy
Telephone med
requests
Problem with procedures
Order cannot be
read
Procedure
unclear
Cannot find
procedures
What are the Barriers to on-time
delivery of medication

14. TREE DIAGRAMS
Also known as Systematic
Diagram.
Partition a big idea or problem
into its smaller components.
Drawn to develop a series of
strategies/ means for
achieving an objective (target,
goal or result) systematically
and logically.
Starts with one item that
branches into two or more
branches, each of which
branches into two or more,
and so on.
Strategy-development or component
development diagrams.

15. WHEN TO USE???
logical steps to achieve an objective.
Processes in detail.
To explain details to others.

16. STEPS
Identify a high priority problem that need to be solved
earliest.
Choose form: Tree or Cascade?
Identify primary means.
Identify secondary means for primary means.
Tertiary means.
Continue the process till the group feels that the end of
the line has been reached.

17. TREE DIAGRAMS
To
Accomplish
3rd means
3rd means
Primary means
3rd means
3rd means
Primary means
Secondary means
Secondary means
Secondary means
Secondary means
3rd means
3rd means
3rd means
3rd means
4th means
4th means
4th means
4th means
4th means
4th means
4th means
4th means
4th means
4th means
4th means
4th means

18. TREE DIAGRAMS
High IMR
High rate of
Infection
Poor nutritional
status of infant
Improper
supplementary
feeding
Low attendance at
clinic
Shortage of
vaccine
Low education
Poverty
Diagnosed at late
stage
Low attendance at
clinicBirth complication
Low vaccination
Poor Hygiene of
infant
Low breast
feeding

19. INTERRELATIONSHIP DIAGRAM
The Interrelationship Diagrams are used for finding appropriate
solution strategies by clarifying the causes of the problem using
why, why technique.
Also known as Relationship Diagraphs.
Technique for clarifying the complex issues by considering the
numerous possible causes .
Useful tools for finding appropriate strategies by relating different
causes of a problem.
Enables to identify the root causes of the problem.

20. WHEN TO USE???
Area of greatest impact for improvement.
Complex solution is being implemented.
More completely explore the relations.

21. STEPS
Agree on the problem or question.
Place the problem in the center.
Write primary causes of the problem round it.
Determine the secondary, tertiary, 4th & 5th level causes
by repeating why, why about 5-times.
Review the whole diagram and systematically explore the
relationships among these causes.
Many causes at 4th & 5th stage may have the common
reasons.
Combine such reasons to reach the root cause of the
problem.

23. PROCESS DECISION PROGRAM CHARTS
(PDPC)
Used to chart the course of events that will take us from
a start point to our final complex goal.
Designed to help prepare contingency plans.
The emphasis of PDPC is the impact of the “failures”
(problems) on project schedules.
Helps the user to select the best processes to be used to
accomplish a desired task.
Used for getting activities back on track.
Finds feasible counter measures to overcome problems.

24. WHEN TO USE???
The task is new, unique.
The task is complex.
The implementation must keep to a tight schedule.
There are problems with a reasonable chance of happening.

25. STEPS
Prepare a normal flowchart with all expected events in
the chart.
Consider the possible occurrences that will affect the
process and demonstrate through branching at
appropriate locations.
Consider how the abnormal occurrences will influence
the process and find ways to counter them.
Show the counter measures connecting to the
abnormal occurrences on one side and the process of
the goal on the other.

26. PROCESS DECISION PROGRAM CHARTS
(PDPC)

27. MATRIX DIAGRAM
Is used to show the relationship between objectives and
methods, results and causes, tasks and people, etc.
Used to determine strength of relationships between a grid
of rows and columns.
Sets of data are compared in rows and columns.
Can identify key aspects based on relationships.

28. STEPS
Determine 2 sets of factors for which the relations are needed
to be established.
Select appropriate format.
In the main body of the matrix, use the symbols to represent
the degree of connections.
Analyse each cell by inserting the appropriate symbol.

29. MATRIX DIAGRAM
Affinity Diagram
Interrelationship
Tree Diagram
Prioritisation
Matrix Diagram
PDPC
Activity network
Tool
Use
CreativityTool Analysis Consensus Action
Always Frequently Occasionally

30. PRIORITIZATION MATRIX
Matrix in which same attributes/strategies/tasks are
written both horizontally and vertically.
Then instead of finding relationship among two different
attributes, the importance of horizontally placed attributes
is compared with the vertically placed attribute.
In this way the importance of each task when compared to
all other tasks become visible.
This type of matrix is drawn when there are many tasks
but there are not enough resources.
So instead of just thinking which tasks are more important,
the Priority Matrix is drawn.

31. WHEN TO USE???
There are more tasks than available resources.
Numerous possibilities/multiple choices exists.
Selection criteria is complicated.
Prioritizing between several viable options.

32. PRIORITIZATION IN TERMS OF
MAGNITUDE OF PROBLEM
Disease/health
problem
ARI Diarrhea Malaria Typhoid COPD
ARI Diarrhea ARI Typhoid ARI
Diarrhea Diarrhea Diarrhea Diarrhea Diarrhea
Malaria ARI Diarrhea Typhoid Malaria
Typhoid Typhoid Diarrhea Typhoid Typhoid
COPD ARI Diarrhea Malaria Typhoid
ARI = 4 Diarrhea = 8
Typhoid = 6 Malaria = 2
COPD = 0

33. FINAL SCORE
Criteria
Magnitude
of problem
Administrative
feasibility
Available
technology
Cost
effectiveness
Total
ARI 4 3 5 6 18
Diarrhea 8 4 4 7 23
Typhoid 6 4 2 5 17
Malaria 2 5 2 3 12
COPD 0 2 3 2 7

34. ACTIVITY NETWORK DIAGRAM
Activity network diagram, network diagram, activity chart,
node diagram, CPM (critical path method) chart.
Graphic project time-line.
Identifies critical tasks to be monitored.
Team can identify resources, bottlenecks and timetables.
Shows relationships among tasks needed to implement a plan.
Network technique using nodes for events and arrows for
activities.
Used in PERT (Program Evaluation and Review Technique) and
CPM (Critical Path Method).

35. WHEN TO USE???
When scheduling and monitoring tasks within a complex
project or process with interrelated tasks and resources.
When you know the steps of the project or process, their
sequence and how long each step takes, and.
When project schedule is critical, with serious consequences
for completing the project late or significant advantage to
completing the project early.

36. SUMMARY
The Affinity Diagram is a useful brainstorming tool and
will energize the team.
The Interrelationship Digraph comes in handy when the
team needs to agree on the most likely cause(s) and
effect(s) contributors.
The Prioritization, Matrix, PDPC, Tree and Activity
Network Diagrams are effective planning tools as they
help the team build consensus on priorities, relationships
and identify the elements required for effective
execution of a given plan.

37. SUMMARY
TOOL QUESTION
Affinity diagram WHAT
Interrelationship diagram WHY
Tree diagram HOW
Matrix diagram WHICH
PDPC IF...THEN
Activity network diagram WHEN