step 2: system diagnosis. learning objectives define system and swot analysis define system and swot...
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Step 2: System DiagnosisStep 2: System Diagnosis
Learning ObjectivesLearning Objectives
Define “system” and SWOT analysisDefine “system” and SWOT analysis
Participate in strategic planning teamsParticipate in strategic planning teams
Systems ComponentsSystems Components
Environment
Inputs Process Output
Information
Public RH Sector/SystemPublic RH Sector/SystemEnvironment
Political climatePrivate sector
Epidemiological profile
InputsOB/GYN
RH budgetFP centers
ProcessDirector, RH/FPCurrent strategy
Management
OutputCPRMMR
Unmet need
InformationInternal (MIS)
External (private sector)
RH Sector & Its Environment
Public
PrivatePrivate
Culture &Culture &religionreligion
EpidemiologicalEpidemiologicalprofileprofile
SocioeconomicSocioeconomicfactorsfactors
Political Political climateclimate
System DiagnosisSystem Diagnosis
Assessing environmental and internal componentsAssessing environmental and internal components
Identifying factors responsible for the current Identifying factors responsible for the current situationsituation
Identifying critical factorsIdentifying critical factors
System Diagnosis Model/SWOT AnalysisRoot-cause Analysis
SWOTAnalysis
Diagnosing the Current SituationDiagnosing the Current Situation
SystemDiagnosis
Model
•Goal
•Environment
•Input
•Information
•Process
•External Environment
•Opportunities
•Threats
•Internal Environment
•Strengths
•Weaknesses
EnvironmentEnvironment
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
RH Sector: EnvironmentRH Sector: Environment
EnvironmentEconomy
Political Climate
Commercial Sector
Epidemiological& Demographic
Profile
Legal &Regulatory
Health Policy
Sociocultural
Technology
InternationalDonors
Environmental AnalysisEnvironmental 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
Environmental Factors: Environmental Factors: Country ExampleCountry Example
FavorableFavorable
Growing interest of Growing interest of donors in RHdonors in RH
Increasing level of Increasing level of literacy and literacy and awarenessawareness
Growing share of Growing share of the private sector the private sector
Stable governmentStable government
UnfavorableUnfavorable
40% of the people 40% of the people below poverty linebelow poverty line
Dependence on Dependence on national health policynational health policy
Disparity between Disparity between rural and urban health rural and urban health and fertility indicatorsand fertility indicators
Internal Analysis: DefinitionInternal 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
Internal Analysis Involves…Internal Analysis Involves…
Inputs/ Resources
Process/Management
Information
Internal AnalysisInternal Analysis
Describes the human resources, communications, facilities, and information capabilities
Identifies characteristics that the organization can control
Encourages participation of internal stakeholders
Inputs/ResourcesInputs/Resources
Defined
• Inputs include all Inputs include all those resources that those resources that are used to produce are used to produce output. output.
Assessment
• Adequacy and Adequacy and qualityquality
Examples• RH budgetRH budget• FP clinicsFP clinics• Ob/GynsOb/Gyns• Drugs and Drugs and
contraceptivescontraceptives• Medical suppliesMedical supplies• EquipmentEquipment• AmbulancesAmbulances• Trained health Trained health
manpowermanpower
Input Analysis: Rajasthan ExampleInput Analysis: Rajasthan ExampleSystem’s System’s CapacityCapacity
FavorableFavorable UnfavorableUnfavorable
Health manpowerHealth manpower No performance standards No performance standards for stafffor staffHighly politicized transfers & Highly politicized transfers & promotionspromotions
Health facilitiesHealth facilities Adequate number of Adequate number of RH facilitiesRH facilities
Poor maintenancePoor maintenanceUneven distribution Uneven distribution rural/urban areas rural/urban areas Underutilization of facilities Underutilization of facilities in rural areasin rural areas
Health budgetHealth budget High level of public High level of public expenditureexpenditure
Inadequate budget for drugs Inadequate budget for drugs and suppliesand supplies
Drugs & suppliesDrugs & supplies Irregular and inadequate Irregular and inadequate supply of drugssupply of drugs
Information SystemInformation System Defined
• Consists of all those Consists of all those elements responsible elements responsible for the production and for the production and transmission of transmission of information information about about the the system as well as system as well as toto the the system.system.
Assessment• Adequacy and Adequacy and
reliabilityreliability
Example
• Collection, Collection, analysis, and use analysis, and use of informationof information
• Flow of Flow of informationinformation
• Internal and Internal and external external informationinformation
Information System: Information System: Rajasthan ExampleRajasthan Example
System’s System’s CapacityCapacity
FavorableFavorable UnfavorableUnfavorable
Data collection and Data collection and recordingrecording
A large number A large number of trained data of trained data analystsanalysts
Inadequate & unreliable Inadequate & unreliable informationinformationToo many reports and recordsToo many reports and recordsUnder-reporting of morbidity/ Under-reporting of morbidity/ mortalitymortality
UtilizationUtilization Financial and other information is Financial and other information is not utilized for decision makingnot utilized for decision making
External External informationinformation
No information regarding the No information regarding the private sectorprivate sector
Process/ManagementProcess/Management
Defined
• Process/management involves all activities Process/management involves all activities that are designed to convert the system’s that are designed to convert the system’s resources into outputresources into output
Assessment
• Quality of system processQuality of system process
Process/ManagementProcess/Management
Policymakers and managers
Current strategy
Organizational structure
Planning and programming
Implementation
Evaluation and feedback
Current Strategy/Current Strategy/Strategic ApproachStrategic Approach
DescribeDescribe
• What is it?What is it?
• When adopted?When adopted?
• Who/how Who/how developed?developed?
• What other options What other options considered?considered?
AssessmentAssessment
• How precise and How precise and clear?clear?
• How sound for How sound for achieving the goal?achieving the goal?
• How cost effective?How cost effective?
• How widely accepted?How widely accepted?
• How morally correct?How morally correct?
Current Strategy: Current Strategy: Rajasthan ExampleRajasthan Example
““Widen the health infrastructure – Widen the health infrastructure – network to facilitate delivery of network to facilitate delivery of comprehensive health care, especially comprehensive health care, especially in rural areas”in rural areas”
Process: Rajasthan ExampleProcess: Rajasthan Example
System’s CapacitySystem’s Capacity FavorableFavorable UnfavorableUnfavorable
ManagersManagers Untrained managersUntrained managers
StrategyStrategy No well-conceived, long-No well-conceived, long-term, and theoretically term, and theoretically sound strategysound strategy
ImplementationImplementation High potential High potential for cost for cost recoveryrecovery
Centralized planningCentralized planningInadequate financial Inadequate financial autonomy at district levelautonomy at district levelWeak accountabilityWeak accountability
Evaluation and Evaluation and feedbackfeedback
Weak system of evaluation Weak system of evaluation and feedbackand feedback
Analysis of Process ComponentAnalysis 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?
SWOT AnalysisSWOT 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
Analysis of External Environment: Analysis of External Environment: Country ExampleCountry 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
Analysis of Internal System – Analysis of Internal System – Country ExampleCountry Example
StrengthsStrengths Committed top Committed top
leadership open to leadership open to new ideas and new ideas and experimentsexperiments
Reasonable level of Reasonable level of health infrastructurehealth infrastructure
High degree of High degree of public expenditurepublic expenditure
WeaknessesWeaknesses Lack of transparency and Lack of transparency and
objective accountabilityobjective accountability
Centralized planningCentralized planning
Falsification and Falsification and underutilization of underutilization of informationinformation
Irregular supply of Irregular supply of contraceptives in rural contraceptives in rural areas areas
Situation Analysis and Strategic Situation Analysis and Strategic Plan FormulationPlan 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 Formulation of strategy using obstacles and opportunities identified in the situation analysisopportunities identified in the situation analysis