1. Step 2: System Diagnosis

2. Learning Objectives Define system and SWOT analysis Define system and SWOT analysis Participate in strategic planning teams Participate in strategic planning teams

3. Systems Components Environment InputsProcessOutput Information

4. Public RH Sector/System Environment Political climate Private sector Epidemiological profile Inputs OB/GYN RH budget FP centers Process Director, RH/FP Current strategy Management Output CPR MMR Unmet need Information Internal (MIS) External (private sector)

5. RH Sector & Its Environment Public Private Culture & religion EpidemiologicalprofileSocioeconomicfactorsPoliticalclimate

6. System Diagnosis Assessing environmental and internal components Assessing environmental and internal components Identifying factors responsible for the current situation Identifying factors responsible for the current situation Identifying critical factors Identifying critical factors System Diagnosis Model/SWOT Analysis Root-cause Analysis

7. SWOT Analysis Diagnosing the Current Situation System Diagnosis Model Goal Environment Input Information Process External Environment Opportunities Threats Internal Environment Strengths Weaknesses

8. Environment Defined Not under the direct control of the systemNot under the direct control of the system Hostile or friendly toward the systemHostile or friendly toward the system Example Political climatePolitical climate EconomyEconomy

9. RH Sector: Environment Environment Economy Political Climate Commercial Sector Epidemiological & Demographic Profile Legal & Regulatory Health Policy Sociocultural Technology International Donors

10. Environmental Analysis Integrates quantitative and qualitative information for decision making Encourages participation of external and internal stakeholders Identifies characteristics that are outside the control of the sector

11. Environmental Factors: Country Example Favorable Growing interest of donors in RH Growing interest of donors in RH Increasing level of literacy and awareness Increasing level of literacy and awareness Growing share of the private sector Growing share of the private sector Stable government Stable government Unfavorable 40% of the people below poverty line 40% of the people below poverty line Dependence on national health policy Dependence on national health policy Disparity between rural and urban health and fertility indicators Disparity between rural and urban health and fertility indicators

12. Internal Analysis: Definition Defined Internal factors include resources, management, and information over which the manager has direct control Example Inadequate FP clinics in rural areas Decrease in budget for RH Information is not used in decision making

13. Internal Analysis Involves…

14. Internal Analysis Describes the human resources, communications, facilities, and information capabilities Identifies characteristics that the organization can control Encourages participation of internal stakeholders

15. Inputs/Resources Defined Inputs include all those resources that are used to produce output.Inputs include all those resources that are used to produce output. Assessment Adequacy and qualityAdequacy and quality Examples RH budget FP clinics Ob/Gyns Drugs and contraceptives Medical supplies Equipment Ambulances Trained health manpower

16. Input Analysis: Rajasthan Example Systems Capacity FavorableUnfavorable Health manpower No performance standards for staff No performance standards for staff Highly politicized transfers & promotions Highly politicized transfers & promotions Health facilities Adequate number of RH facilities Poor maintenance Poor maintenance Uneven distribution rural/urban areas Uneven distribution rural/urban areas Underutilization of facilities in rural areas Underutilization of facilities in rural areas Health budget High level of public expenditure Inadequate budget for drugs and supplies Drugs & supplies Irregular and inadequate supply of drugs

17. Information System Defined Consists of all those elements responsible for the production and transmission of information about the system as well as to the system.Consists of all those elements responsible for the production and transmission of information about the system as well as to the system. Assessment Adequacy and reliabilityAdequacy and reliability Example Collection, analysis, and use of information Flow of information Internal and external information

18. Information System: Rajasthan Example Systems Capacity FavorableUnfavorable Data collection and recording A large number of trained data analysts Inadequate & unreliable information Inadequate & unreliable information Too many reports and records Too many reports and records Under-reporting of morbidity/ mortality Under-reporting of morbidity/ mortality Utilization Financial and other information is not utilized for decision making External information No information regarding the private sector

19. Process/Management Defined Process/management involves all activities that are designed to convert the systems resources into outputProcess/management involves all activities that are designed to convert the systems resources into output Assessment Quality of system processQuality of system process

20. Process/Management Policymakers and managers Current strategy Organizational structure Planning and programming Implementation Evaluation and feedback

21. Current Strategy/ Strategic Approach Describe Describe What is it?What is it? When adopted?When adopted? Who/how developed?Who/how developed? What other options considered?What other options considered? Assessment Assessment How precise and clear? How sound for achieving the goal? How cost effective? How widely accepted? How morally correct?

22. Current Strategy: Rajasthan Example Widen the health infrastructure – network to facilitate delivery of comprehensive health care, especially in rural areas Widen the health infrastructure – network to facilitate delivery of comprehensive health care, especially in rural areas

23. Process: Rajasthan Example Systems Capacity FavorableUnfavorable Managers Untrained managers Strategy No well-conceived, long- term, and theoretically sound strategy Implementation High potential for cost recovery Centralized planning Centralized planning Inadequate financial autonomy at district level Inadequate financial autonomy at district level Weak accountability Weak accountability Evaluation and feedback Weak system of evaluation and feedback

24. Analysis of Process Component What is working and needs to be continued? What is working and can be expanded? What is not working and needs a new, more strategic approach? What is not relevant to current needs and should be dropped? What has not been addressed at all?

25. SWOT Analysis Assesses the feasibility of achieving identified goals, based on internal and financial capabilities or challenges Helps to identify critical factors Internal analyses: strengths & weaknesses External analyses: opportunities & threats Challenge: To Turn Constraints into Opportunities

26. Analysis of External Environment: Country Example Opportunities Growing interest of donors in RH Increasing level of literacy and awareness Growing share of the private sector Stable government Threats 40% of the people below poverty line and growing inequality Dependence on national health policy Disparity between rural and urban health and fertility indicators

27. Analysis of Internal System – Country Example Strengths Committed top leadership open to new ideas and experiments Committed top leadership open to new ideas and experiments Reasonable level of health infrastructure Reasonable level of health infrastructure High degree of public expenditure High degree of public expenditure Weaknesses Lack of transparency and objective accountability Lack of transparency and objective accountability Centralized planning Centralized planning Falsification and underutilization of information Falsification and underutilization of information Irregular supply of contraceptives in rural areas Irregular supply of contraceptives in rural areas

28. Situation Analysis and Strategic Plan Formulation Main findings of the situation analysis provide the basic building blocks for strategic plan formulation Strategic plan formulation involves: Synthesis of the conclusion of situation analysisSynthesis of the conclusion of situation analysis Determination of prioritiesDetermination of priorities Formulation of strategy using obstacles and opportunities identified in the situation analysisFormulation of strategy using obstacles and opportunities identified in the situation analysis