4. REVIEW OF RESOURCE AVAILABILITY Objective: To enable the planner to stay within the frame of realism and limits of available resources in the development of intervention packages. Check for current and future situations with respect to three “M’s. Inventories need to be prepared. –Compare staffing and equipment with national standards/yardsticks –What is actually required for program System review need to be done once a year.

For services to be functional requires: Trained staff, essential buildings, furniture, equipment, drugs, support services and money. Depth and extent of effort required to unravel these resources allocated to health problems is important. Assessing adequacy of existing manpower in terms of: Availability: (ratio of health cadre to population, supervisory staff to health care providers, no of staff available per facility per hour and on holidays)

Distribution: ( Proportion of staff engaged in supervision, basic and in service training, outreach activities, preventive services(immunization, mobile clinics),clinical services. Source and use of information –Official documents on policy, implementation plan –Financial documents on costing, cost objectives, budget and financial description.

Functional capacity: (In terms of level of training ,staff knowledge and skills, output and physical presence. Assessing adequacy of existing material goods in terms of availability, distribution and functional capacity. Availability: (No and type of facilities, facility to population ratio, presence of drugs and equipment.) Adequacy of existing finance needs following indicators to be applied: Budget needed for (clinical and preventive services, surpervision, in service training, facility maintainence, recurring preventive and clinical services cost, investment in clinical and preventive services)

2. Sources and Use of information on Resource allocation: Two major sources. 1. Official documents stating goals, policies, objectives and implementation plans and technical descriptions. 2. Financial reports describing methods of costing, cost objectives and programs, approved budget, expenditure and accounting reports.

3. Resource Planning –Future resources are to be reduced by cutting out non essential activities and improving the effectiveness and efficiency of essential ones through re-deployment and re shuffling of available resources. System review will help identify problem areas. –Resource base remains as it is by maintaining the existing status and making it more effective and efficient. System review helps identify programs requiring special efforts and the ones which need reduction in input and cost/activity sharing.

–Additional resources become available for specific use, these are made available by external donors who wish to de novo implement a program or project.e.g.family planning,diarrhoeal disease control etc. –Additional resources become available for non specified use, usually in a donor-sponsored project. The rule is health improvement of specific population group rather than general population

RESOURCE AVAILABILITY (Cont.) 4. Sources of resources: Identify the programs and external resources that have been made available for and to plan their deployment for only specified purpose. 5. Accounting Procedures: Important management function to use the resources for specified purpose and be able to account for their use. Most common misuses are: use of official vehicles for private use, program equipment and drugs for personal use.

6. Care of resources: –Setting drug rotating systems ,maintaining cold chains –Pilferage of drugs/ resources, Transport system –M & R Systems, planning vehicle routes and staff transportation, rational therapies, using equipment without being familiar.

5. DEVELOPING INTERVENTIONS Process of identifying, short listing and developing interventions from a variety of potential interventions. Objective: To identify and develop most appropriate interventions and packages(strategies)for health needs. Identify existing services that need to be modified Identify additional components/activities required to bring about desired change. Identify potential constraints and limitations in ecological environment, assess feasibility of proposed intervention.

Plan how to address constraints(additional resources, integrating services, use community resources, modify job responsibilities, shift available resources from one program to other) Plan for the improvement of management and administration(community involvement, coordination with other agencies active in health and development.

1. Improving the existing systems by finding gaps and weaknesses in the system by a system review,(need tree) 1.1 Service Inputs – necessary rather than political considerations (Program/MMM ,infrastructure, transport, communication, record system, M&R) 1.2 Management and Organization (CRAQ) 1.3 Health Service Distribution (Geographic/ Equity) 1.4 Community Participation Verbalization Contribution Utilization

DEVELOPING INTERVENTIONS (Cont) 2. Identifying newly required interventions, components, or strategies for high priority health needs and weaknesses in situation analysis. To carry out community based and organized services and programs through CHW’s e.g. distributing ORS packs and can be combined with clinic organized outreach services run by nurses e.g. distribution of pills and health advice on family planning methods e.g. injections, sterilization carried out in health facility.

To set up joint programs between ministries to implement HE, community obs. services ,food security programs and FP services for reducing maternal mortality. 2.1 Examining suitability and feasibility of strategies for integration with existing resources: look for any geographical, cultural and political constraints, is it according to the needs, does it require additional resources, is M&O working ,cost of intervention in relation to budget •Some programs e.g. AIDS, EPI,TB come pre packaged.

2.2 Development of a referral system: sending patients to a higher level care center for better diagnostic and curative facilities and providing feedback and advice on follow up to lower level facility. Referral system is obligatory if clinical skills and treatment facilities of lower level care provider are insufficient to look after immediate curative needs, long term curative needs, or have inadequate diagnostic facilities. • Health preventive and promotive services are not available at lower level facility and require referral e.g. contraceptive care.

2.3 Assessment of interventions for effects up and beyond expectations: Examine both existing and newly introduced service packages for their potential effects on routine services. 3. Health Care Financing: Methods and means of financing health services(curative and preventive) for a given community or country. The cost of health care comprise of service cost, operational cost, investment cost, and resources for emergency care services.

DEVELOPING INTERVENTIONS (Cont) Major sources are: –Government subsidy –Fee for services ,user charges –Insurance and risk sharing –Loans and grants, Contribution in kind –Community Financing – revolving drug funds, health cards, community funded services, contribution in kind, resource generation through small scale activities. Efficient use of resources

6. SETTING PLAN OBJECTIVES AND TARGETS Process of defining what one wants to achieve in the period within given constraints. Objectives: To highlight aims planners wish to achieve, quantify these and selection of most appropriate inputs and activities. 1.Determining plan objectives: Planners need to have clear objectives in areas of health status, service activities & O, support systems, community involvement and multisectoral integration.

What is required level of effectiveness Resources available to translate objectives into activities How efficient is the system in translating objectives into outcomes Political considerations, hindrances, effects that prevail Objectives must be SMART. Short term and long term objectives 2. SETTING TARGETS: Targets are the number and quality of specific activities that have to be carried before objectives are achieved.e.g no of TBA’s to be trained ,no of training sessions to be given, no and frequency of ante natal visits.

Developing intervention matrix can help in making an implementation plan. It includes aim, program strategy, short term objectives, planned targets and activities. 3.Matching targets to performance standards Planned targets should be matched against potential performance that can be delivered, otherwise objectives need to be modified.