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Situation analysis
In this step we look at situation analysis in relation to the planning of eye care services.
SPEAKER: Welcome. By the end of this presentation on situation analysis, you should be able to –understand the definition of situation analysis, –identify its key components, –and be able to apply the concept to an eye unit at the district level. A situation analysis is defined as a collection of methods that planners and managers use to understand an organisation’s performance, and the internal and external factors that affect it. Situation analysis can be used to describe the performance of an eye unit in terms of capacity - numbers of patients treated; capabilities - training for staff and available equipment; difficulties which affect output and outcome; environment - the supports and threats to the unit; and possibilities - these are the opportunities for the unit.
Situation analysis helps us understand where we are now, which is the first stage in any planning cycle. Any situation analysis of an eye unit needs to remember to explore the wider levels of the health system that the unit is part of. Understanding existing policies and programmes at national and district level means that the eye unit can plan to address the burden and need of blindness using the right models of care and with the right resources in place.
At the national level, the key questions to ask include: is there a national prevention of blindness programme? Is there a strategy for universal health coverage? What data already exists on blindness and vision impairment?
Are there targets for diseases such as cataract and refractive error? Is there guidance on ophthalmic human resources, training, and distribution? And who are the leaders in eye care, what their roles, is it possible to get in contact with them? And finally, is there a policy on infrastructure and equipment?
At district level, the key information to gather
includes: the size of the target population the eye unit serves and the kinds of people that make up the population; for example, young or old, male or female, rich or poor. Maps of how the population is distributed and of people’s access to health care. These can highlight previously unknown challenges of geography and infrastructure. Data on the prevalence and causes of eye disease and blindness locally. Knowing these gives an understanding of the need for eye care. And barriers– it is important to find out any reasons blind and vision impaired people have for not coming to the eye unit.
To start gathering this information, we need to know the population in the district and the prevalence of blindness and vision impairment. Then we can calculate the number of blind people– this is equal to the prevalence of blindness multiplied by the population– and the number of visually impaired people. This is equal to the prevalence of vision impairment multiplied by the population.
It is also important to calculate the percentage of cataract blind or visually impaired locally, as cataract is a leading cause of blindness. The five Ms provide guidance on the information that needs to be gathered within the eye unit or hospital during a situation analysis. Manpower, numbers of cadres, available, whether staff work part time or full time, how many volunteers there are, and so on. Materials, the quantity, quality, regularity of supply and so on, for both hard and soft materials. Hard materials are defined as infrastructure, instruments, and equipment. Whereas soft materials are medicines and consumables. Mobility, the kinds of outreach services used. Management, a flowchart is a useful way to represent decision making at the hospital or eye unit.
And money, the sources of funding and amount available. Finding good information for a situation analysis means looking for it in a number of different places. For data on the target population, census data is a good place to start. To estimate the numbers of blind and vision impaired people, we can carry out a local survey or we can extrapolate the information from a previous study in a similar region. For data on manpower, we can look at hospital records, if they exist, or we can observe the unit. For materials information, we can again use hospital records or take our own inventory. For information on services, hospital records again should provide information on outreach models, locations, and outputs.
For information about management, we need to ask the hospital administration. And finally, to know how the unit is funded and how much money is available, we need to ask key stakeholders and look into the hospital finances.
A useful tool to support a situation analysis is a SWOT analysis. A SWOT identifies an organisation’s internal strengths and weaknesses, as well as the external opportunities and threats. For example, a SWOT analysis of an eye unit might identify a strength as having a well trained cataract surgeon already in place. A weakness is having a long waiting list, caused by lack of consumables and not enough available surgery time. An unexplored opportunity, as an NGO, which could provide consumables. And a threat, as a fear of eye surgery amongst many in the local population.
In conclusion, situation analysis is an important first step when considering any change. It provides a depth of local understanding for the possibilities and ability to change. Details provided by situation analysis include understanding the magnitude of the need, available manpower, materials, money, mobility, and management. A SWOT analysis will highlight both internal and external issues, opportunities, and threats. And a situation analysis enables gaps to be identified. Using this knowledge effectively makes change achievable.
Situation analysis is a collection of methods that helps planners and managers understand an organisation’s performance and internal and external factors affecting it. It helps us to understand where we are now, and what should come next in terms of planning.
As you watch, think about who to involve when planning in eye care at a hospital, district, or national level, and what information must be available to conduct a situation analysis.
Discussion
In a SWOT analysis we consider both internal and external environments. In a health system, what is the external environment and why is it important to take it into consideration when planning?
Given what we now know about planning and situation analysis, cast your mind back to your local setting or to Zrenya district from week 2.
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Can the backlog of cataract blindness be addressed? If so what is the key focus for the change that must take place? How do we decide?
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What can be done about refractive services in this district?
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Should change be in stages or all at once?
Let us and the other learners know what you think in the comments area below.
This article is from the online course:
Global Blindness: Planning and Managing Eye Care Services
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Global Blindness: Planning and Managing Eye Care Services
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