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Priorities, timetables and budgets

Introducing the links between objectives and activities.
SPEAKER: Welcome. To by the end of this presentation, you should be able to –describe the link between objectives, activities, and priorities in the planning strategy. –apply the process of ranking priorities, –relate to the priorities for human resource and infrastructure requirements for service provision, and –relate to the eye care needs of various socioeconomic groups who are integrated, sustainable, equitable, and excellent services. This is known ISEE.
In this section, we will be discussing step four of the planning cycle.
It is important that a plan’s aims and objectives have already been agreed and prioritised before any practical decisions on time and money are made. Let’s look at an example. Zrenya Eye Unit has developed a plan which aims to reduce cataract blindness in the district. The plan has three key objectives– increase cataract output by 150 surgeries each year, improve the outcome of cataract surgeries so that less than 10 surgeries have an outcome of less than 660 within a year, and establish a subsidy system of payment within two years.
Many activities need to be done to achieve each of these objectives. For example, improving theatre efficiency, securing additional cataract sets and consumables, and ensuring that the anticipated demand for surgery is costed in an affordable price set for patients. It is tricky to try and do all of these at once, and sometimes it’s not even possible. So planners need to decide what is important and select the order of the actions to be taken. This is known as prioritisation.
There are many ways to prioritise activities. The following method is practical, effective, and straightforward to apply. All the activities that could be carried out are listed. And then for each activity, a scale of one to five points is applied in four categories. One is the lowest score, and is applied to categories that are hard to do or not so important or expensive. Five is the highest score, and is applied to activities that are relatively easy to do, very important, or comparatively cheap. The four categories to be scored for each activity are– severity. For example, if cataract surgical outcome is poor due to high postoperative infections, a severity score of five points would be valid. Importance.
This category is based on local need. So for example, a high district prevalence of cataract blindness might be awarded three points. Feasibility. When scoring this category, planners should ask themselves the question, is it possible to make the change with the available resources, or are additional resources required? For example, if a planner applies a score of one to an activity to obtain a regular supply of intraocular lenses, this implies that this is not a feasible activity for this plan. Cost. This is often a deciding factor. It can refer to present cost or to finances that need to be obtained to carry out the activity. Here, a score of one means that the activity is expensive, and five, that it is cheap.
Finally, all the scores for each activity are added up. Activities with the highest scores are given the highest priorities for action, and this provides a strategy for the plan. Disease and the ability to access services varies by age, gender, and socioeconomic grouping. These factors must be considered when establishing priorities for the plan. For example, cataract is most commonly a problem for people over the age of 50. Older rich people are likely to have access to eye care services already and can afford early intervention. Therefore, it would be reasonable to target access for poor people over the age of 50, particularly women.
A named person must be made responsible for each activity. This person is responsible for managing the activity and ensuring it gets completed.
The most important resources that need to be managed in an activity are people and their time, and money, including the things that money buys. To manage time, an activity time plan, such as a Gantt chart, is developed. Each activity per objective is listed along with an indication of when it will be carried out and completed. This is monitored and updated as the activity is carried out.
Managing money and budgeting. Eye care programmes are integrated into district health services. Planners and managers need to present a budget for their programmes to those who allocated funds, whether they’re government or external donors. Budgets list expenditure, outgoings, or cost, and income. Under expenditure, budgets include capital and running costs. Capital costs are one-time costs. They include items such as buildings, vehicles, and equipment. Running or recurrent costs includes items such as salaries, consumables, and overheads. It is important that all costs and expenditures are included in a budget. If the exact amount is unknown, then an estimate should be used. Finally, a five to 10 percent contingency budget can also be added. Budget should list all of a programme’s sources of income.
These include fees, funding from government, local and international donors, in kind donations, government salaries, income generated from canteens, spectacle sales, and so on.
An itemised budget layout for each activity is established in order to be able to update or vary estimates and quantities.
Information on both expenditure and income is part of a monthly report that should be produced for management. To do this, the percentage of each line item that has been spent– expenditure– or collected– income– is calculated. Items worth 10% or more are especially important.
In conclusion, clear objectives and targets are achieved through a detailed activity plan. Not everything can be done at once. A strategy is the prioritisation of the important activities which must be done. Ranking priorities also allows for the best use of available funds and resources for integrated, sustainable, equitable, and excellent services, known as ISEE.
Timetables and budgets help planners to monitor and manage the progress of activities. And finally, budgets are developed based on targets and activities, and they include both expenditure and income. Budgets are updated and reported on to management every month.

When working it quickly becomes apparent that we cannot do everything at once and we therefore need to consider how to set priorities. In this step we introduce the links between objectives and activities. This represents step 4 in the planning cycle, where planners make practical decisions on time and money as part of the planning strategy.

As you watch, think about the following questions:

  • What practical considerations for prioritisation are suggested in the presentation?
  • Why is it important to remember the age, gender, and socio-economic status of your patients when prioritising activities?
  • Why should a named person be made responsible for each activity?

The planning cycle Click to expand

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Global Blindness: Planning and Managing Eye Care Services

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