Step 2 System Diagnosis Learning Objectives n

Step 2: System Diagnosis

Learning Objectives n Define “system” and SWOT analysis n Participate in strategic planning teams

Systems Components Environment Inputs Process Information Output

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

RH Sector & Its Environment Socioeconomic factors Political climate Public Private Epidemiological profile Culture & religion

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

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

Environment n Defined • Not under the direct control of the system • Hostile or friendly toward the system n Example • Political climate • Economy

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

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

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

Internal Analysis Involves… Inputs/ Resources Information Process/ Management

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

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

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

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

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

Process/Management n Defined • Process/management involves all activities that are designed to convert the system’s resources into output n Assessment • Quality of system process

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

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

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

Process: Rajasthan Example System’s Capacity Managers Strategy Implementation Evaluation and feedback Favorable Unfavorable Untrained managers No well-conceived, longterm, and theoretically sound strategy High potential n. Centralized planning for cost recovery n. Inadequate financial autonomy at district level n. Weak accountability Weak system of evaluation and feedback

Analysis of Process Component n What is working and needs to be continued? n What is working and can be expanded? n n n 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 Analysis n Assesses the feasibility of achieving identified goals, based on internal and financial capabilities or challenges n Helps to identify critical factors n Internal analyses: strengths & weaknesses n External analyses: opportunities & threats Challenge: To Turn Constraints into Opportunities

Analysis of External Environment: Country Example Opportunities n n Growing interest of donors in RH Increasing level of literacy and awareness Growing share of the private sector Stable government Threats n n n 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 – Country Example Weaknesses Strengths n n n Committed top leadership open to new ideas and experiments Reasonable level of health infrastructure High degree of public expenditure n n Lack of transparency and objective accountability Centralized planning Falsification and underutilization of information Irregular supply of contraceptives in rural areas

Situation Analysis and Strategic Plan Formulation n n 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 analysis • Determination of priorities • Formulation of strategy using obstacles and opportunities identified in the situation analysis