PLANNING FOR TB CONTROL

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PLANNING FOR TB CONTROL
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Why do we make plans?

• Material, financial and human resources are often
  scarce
• Plans are the only rational way to organize
  activities to ensure that targets are achieved in
  a timely manner

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What is planning?

• Planning as a process, answers four basic
  questions
• Where are we now?
• Where do we want to go?
• How will we get there?
• How will we know when we arrive?

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Strategic Planning Vs. Action Planning

• For a National TB Programme (or other specific
  disease control or health programme), it is
  useful to consider two types of planning
  processes
• strategic planning at the level of policy
  development, overall service and resource
  planning
• action planning at various operational levels
  (central, peripheral) of a programme/project

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Strategic Planning

• Strategic planning occurs at the policy level. It
  is concerned with feasibility at the broadest
  level in terms of
• availability of resources
• technical factors
• the political process

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Strategic Planning

• Strategic Planning includes
• assessing the situation
• getting agreement on the goal and objectives
• getting agreement on roles and responsibilities
• making accurate budgets and realistic schedules
• securing resources, maintaining external support
• establishing effective mechanisms for day-to-day
  implementation
• deciding on a means of monitoring progress
• adjusting to change

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Strategic PlanningUsing the logical framework
approach
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Why use a Logical Framework?

• Useful in designing, implementing and monitoring
  a plan or a project
• Is a clear concise visual presentation of all the
  key components of a plan and a basis for
  monitoring
• It clarifies
• How the project will work
• What it is going to achieve
• What factors relate to its success
• How progress will be measured

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How is a Logical Framework prepared?

• Always gather as much reliable data and research
  before starting
• Establish your goal then work upwards from an
  agreed baseline
• Consult as widely as possible communicate ideas
  and obtain feedback
• Involve both beneficiaries (primary stakeholders)
  and providers (secondary stakeholders) from the
  start
• Define indicators to measure progress, both in
  terms of quantity and quality

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The five focus areas of a Logical Framework

• Context the broader environment
• Problem current situation
• Objective what is to be achieved
• Choices possible ways to achieve the objective
• Actions what needs to be done

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The Logical Framework - a step-wise approach

• Stakeholder analysis, focusing on the context
• Problem analysis, focusing on the problem
• Objective analysis, focusing on the objective
• Choice or strategy analysis, focusing on the
  choices or alternative ways to achieve the
  objective
• Developing a plan of activities, including the
  inputs, milestones and time frame towards
  achieving each objective

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Step 1 Stakeholder Analysis

• Involve all stakeholders in a workshop
• Analyze who could contribute what, based on
  existing strengths, weaknesses, perceived
  opportunities and threats (SWOT Analysis) and on
  their interest

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Step 2 Problem analysis


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High TB Morbidity and Mortality
Loss of confidence in health system
Increased transmission of TB in society
E F F EC T S

Increased defaults, fall in cure rate
Increase in drug resistance

Poor patient compliance with treatment
PROBLEM

Low importance attached to completing treatment
Lack of interest among providers
CA U S E S

Lack of motivation on part of patients
No training on counselling
No guidance/feed back from senior officers
No transport for tracing late patients




We can see in this example that the effect of
poor supervision and monitoring (the core
problem) is poor case holding in TB treatment.
This in turn becomes a cause and the effect is
increased numbers of default cases, which in
turns becomes a cause, the effect being a fall in
TB cure rates and increased drug resistance cases
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Step 3 Objective Analysis

• Transform the problem tree into an objective tree
• From top down, change problem statements into
  positive statements

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Reduced TB Morbidity and Mortality
ENDS
Regained confidence in PHS
Decreased transmission of TB

Decreased defaults, Increase in cure rate
Decrease in drug resistance

Improve patient compliance with treatment
OBJECTIVE

Pay patients incentives to complete treatment
Motivate/enable providers to ensure DOT

MEANS
Arrange donor funding
Provide transport for tracing patients
Train staff on counselling patients
Undertake regular supportive supervision
Disburse incentives and maintain records




We can see in this example that the effect of
poor supervision and monitoring (the core
problem) is poor case holding in TB treatment.
This in turn becomes a cause and the effect is
increased numbers of default cases, which in
turns becomes a cause, the effect being a fall in
TB cure rates and increased drug resistance cases
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Step 4 Choice (Strategy) Analysis

• Work out possible options to meet the
  objective(s)
• Agree upon one option on the basis of feasibility
• This is your chosen strategy

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Reduced TB Morbidity and Mortality
ENDS
Regained confidence in PHS
Decreased transmission of TB in society

Decreased defaults, Increase in cure rate
Decrease in drug resistance

Improve patient compliance with treatment
OBJECTIVE

Pay patients incentives to complete treatment
Motivate/enable providers to ensure DOT

MEANS
Arrange donor funding
Provide transport for tracing patients
Train staff on counselling patients
Undertake regular supportive supervision
Disburse incentives and maintain records




We can see in this example that the effect of
poor supervision and monitoring (the core
problem) is poor case holding in TB treatment.
This in turn becomes a cause and the effect is
increased numbers of default cases, which in
turns becomes a cause, the effect being a fall in
TB cure rates and increased drug resistance cases
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Choice (Strategy) Analysis
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Step 5 Preparing a plan of activities

• Action plans are developed for different levels
  (central, regional, district, community,
  individual)
• are for a health manager like a blueprint for an
  architect shows all of the smaller steps or
  activities involved in achieving a larger goal
• show the time frame, person responsible,
  resources required and targets for each activity
• Good action plans are flexible - can be adjusted
  wherever necessary they are tools, not final
  documents

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Action Planning

• Using a spreadsheet, prepare a visual plan of the
  project
• Begin with the end in mind - clearly describe the
  desired end point/outcome/ goal, and the date it
  must be achieved
• Break the project down into individual tasks with
  set targets
• Decide who will do which tasks, when, and what
  they will need (resources)
• Develop indicators to monitor the output of each
  activity
• Review progress and revise the plan appropriately

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GOALSOBJECTIVESSTRATEGIES ACTIVITIES
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• A Goal is a broad statement that defines what you
  hope to accomplish. It is measured in terms of
  the impact achieved.
• Example
• To reduce the morbidity and mortality due to
  tuberculosis until it is no longer a public
  health problem

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• An Objective defines the purpose and direction of
  strategies. Objectives should be specific,
  measurable, attainable, relevant and time-bound
  (SMART) Objectives are measured in terms of the
  outcomes achieved
• Example
• An objective toward the stated goal could be
• To ensure all TB patients are cured through
  improving provision of DOT in all districts by
  2005

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• A Strategy is the route that you will take to
  achieve an objective. Different strategies may
  lead to the same end. The choice of strategy
  depends on what you judge as feasible and
  practical. A strategy that addresses a complex
  objective may have several components
• Example
• One of the strategies to achieve this objective
  could be
• Enabling district staff to ensure that all
  patients are provided DOT and followed up till
  cured

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• Each strategy or component strategy must be
  broken down into the activities required to meet
  objective. Activities are measured in terms of
  the outputs that result from successfully
  completing an activity
• Example
• Activities that contribute to the stated
  objective could include
• Ensuring transport (and fuel!) to visit patients
  homes and trace late patients
• Training staff on counseling patients
• Undertaking regular supervision, providing
  written feedback, recognizing and rewarding good
  work

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The matrix of a Logical framework
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