Principles of district planning
This article is adapted from: Planning for VISION 2020 at the district level, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, 2006. In the article we explore the approach and depth required for a situation analysis, suggest the types and sources of information required, and how this stage provides the platform for identifying levels and direction of change.
VISION 2020 - the district
The implementation of VISION 2020 is planned at district level in manageable, optimal service units of between about 0.5 and 2 million population. Such units may have a variety of names in different countries, such as regions, provinces, subdistricts, or districts.
District level VISION 2020 programmes are developed as one year operational plans or phases, open to review and adjustment for each succeeding year and guided by the 5-year national plan.
Key stages in the district planning model
- Where are you now (here)? A situational analysis of needs and resources helps us to describe the present situation in eye health.
- Where do you want to get to (there)? Setting aims and objectives in order to fix targets.
- How will you get there? Deciding on the route you will take with a clear plan, timetable, and budget. Start on the implementation of your plan, carefully managing resources, both human and financial.
- How will you know when you arrive? Monitoring of progress to ensure the efficient and effective implementation of your district plan. Feedback and new problems are likely to influence your targets and resource management and cause you to adjust your plan in the second year.
This is stage 1 of the planning model. Here we identify the size of the problem, the people most affected, and their location.
The need is the gap between the present situation and where you want to reach. To assess need, collect information on:
- Population, e.g. number, density, growth rate, gender, age structure, and distribution in relation to the local geography, cultural, and religious norms
- Population indices, e.g. economic groups, socio-cultural variations, levels of literacy and health problems such as under-5 mortality rates, and measles coverage
- Eye diseases and blindness, e.g. estimates of (1) the prevalence and incidence of blindness and low vision in the district based on appropriate levels of visual acuity, and (2) the main causes of preventable/treatable blindness and their magnitude.
You can obtain population data from a local or national census office, the planning unit of the ministries of health or education, or from internet sites giving national population data.
You can obtain visual impairment and eye disease data from a number of sources:
- Population-based blindness surveys (best option if possible)
- Rapid assessment surveys – Cataract or trachoma
- Extrapolation from disease patterns measured in a similar environment
- Estimation of magnitude from a reference table or a world blindness prevalence map (the least desirable option).
Resources are the personnel, infrastructure, and funds available to tackle the need that has been identified. Questions that should be answered in your assessment include:
- What are the past and present eye care services and their outputs in the district? For example, annual unit totals for: admissions, outpatients, cataract operations, IOL implants, surgical outcomes, and spectacles provided
- What are the barriers to access? How developed and functional are the outreach services to effectively meet screening and referral targets?
- What human resources are available at primary, secondary, and tertiary levels of care? Are there problems of distribution, recruitment, career structure and retention? What training facilities exist for each category of worker?
- What is the involvement of the community in district health care? How is this encouraged and supported? What constraints hinder social mobilisation?
- What infrastructure, e.g.- buildings, equipment, and consumables, serve this district? How dependable is it in terms of availability, quality, or are there shortfalls in relation to recommendations? What provision exists for standardisation, bulk purchasing, the use of appropriate technology, and for repair and maintenance?
- What are the responsibilities of each group in the existing management system? How does this system determine and implement policy, particularly with regard to resource utilisation?
- What data is collected and how is it communicated? What emphasis is placed on increasing output while ensuring quality of outcome?
- What constraints are there on optimum resource use and service delivery? Consider human resources, infrastructure, and finance and management in your assessment of constraints. How can they be overcome?
- What provision is made in the district budget for eye care and blindness prevention? Is the eye care programme integrated horizontally into district health services? What other sources of funding are available?
Once the data is collected, the planning committee will review and identify constraints and possible solutions in preparation for Stage 2 of the district planning model: agreeing aims, objectives and strategies.
District involvement in this discussion creates local ownership for the intended activities and outcomes tailored to the district’s specific needs.
A situation analysis assesses each organisational component and the connections between them. What are the likely challenges when carrying out this assessment?