Step 2: System DiagnosisStep 2: System Diagnosis

Learning ObjectivesLearning Objectives

Define “system” and SWOT analysisDefine “system” and SWOT analysis

Participate in strategic planning teamsParticipate in strategic planning teams

Systems ComponentsSystems Components

Environment

Inputs Process Output

Information

Public RH Sector/SystemPublic RH Sector/SystemEnvironment

Political climatePrivate sector

Epidemiological profile

InputsOB/GYN

RH budgetFP centers

ProcessDirector, RH/FPCurrent strategy

Management

OutputCPRMMR

Unmet need

InformationInternal (MIS)

External (private sector)

RH Sector & Its Environment

Public

PrivatePrivate

Culture &Culture &religionreligion

EpidemiologicalEpidemiologicalprofileprofile

SocioeconomicSocioeconomicfactorsfactors

Political Political climateclimate

System DiagnosisSystem Diagnosis

Assessing environmental and internal componentsAssessing environmental and internal components

Identifying factors responsible for the current Identifying factors responsible for the current situationsituation

Identifying critical factorsIdentifying critical factors

System Diagnosis Model/SWOT AnalysisRoot-cause Analysis

SWOTAnalysis

Diagnosing the Current SituationDiagnosing the Current Situation

SystemDiagnosis

Model

•Goal

•Environment

•Input

•Information

•Process

•External Environment

•Opportunities

•Threats

•Internal Environment

•Strengths

•Weaknesses

EnvironmentEnvironment

Defined

• Not under the direct control of the systemNot under the direct control of the system

• Hostile or friendly toward the systemHostile or friendly toward the system

Example

• Political climatePolitical climate

• EconomyEconomy

RH Sector: EnvironmentRH Sector: Environment

EnvironmentEconomy

Political Climate

Commercial Sector

Epidemiological& Demographic

Profile

Legal &Regulatory

Health Policy

Sociocultural

Technology

InternationalDonors

Environmental AnalysisEnvironmental Analysis

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: Environmental Factors: Country ExampleCountry Example

FavorableFavorable

Growing interest of Growing interest of donors in RHdonors in RH

Increasing level of Increasing level of literacy and literacy and awarenessawareness

Growing share of Growing share of the private sector the private sector

Stable governmentStable government

UnfavorableUnfavorable

40% of the people 40% of the people below poverty linebelow poverty line

Dependence on Dependence on national health policynational health policy

Disparity between Disparity between rural and urban health rural and urban health and fertility indicatorsand fertility indicators

Internal Analysis: DefinitionInternal Analysis: Definition

Defined

• Internal factors include resources, management, and information over which the manager has direct control

Example

• Inadequate FP clinics in rural areas

• Decrease in budget for RH

• Information is not used in decision making

Internal Analysis Involves…Internal Analysis Involves…

Inputs/ Resources

Process/Management

Information

Internal AnalysisInternal Analysis

Describes the human resources, communications, facilities, and information capabilities

Identifies characteristics that the organization can control

Encourages participation of internal stakeholders

Inputs/ResourcesInputs/Resources

Defined

• Inputs include all Inputs include all those resources that those resources that are used to produce are used to produce output. output.

Assessment

• Adequacy and Adequacy and qualityquality

Examples• RH budgetRH budget• FP clinicsFP clinics• Ob/GynsOb/Gyns• Drugs and Drugs and

contraceptivescontraceptives• Medical suppliesMedical supplies• EquipmentEquipment• AmbulancesAmbulances• Trained health Trained health

manpowermanpower

Input Analysis: Rajasthan ExampleInput Analysis: Rajasthan ExampleSystem’s System’s CapacityCapacity

FavorableFavorable UnfavorableUnfavorable

Health manpowerHealth manpower No performance standards No performance standards for stafffor staffHighly politicized transfers & Highly politicized transfers & promotionspromotions

Health facilitiesHealth facilities Adequate number of Adequate number of RH facilitiesRH facilities

Poor maintenancePoor maintenanceUneven distribution Uneven distribution rural/urban areas rural/urban areas Underutilization of facilities Underutilization of facilities in rural areasin rural areas

Health budgetHealth budget High level of public High level of public expenditureexpenditure

Inadequate budget for drugs Inadequate budget for drugs and suppliesand supplies

Drugs & suppliesDrugs & supplies Irregular and inadequate Irregular and inadequate supply of drugssupply of drugs

Information SystemInformation System Defined

• Consists of all those Consists of all those elements responsible elements responsible for the production and for the production and transmission of transmission of information information about about the the system as well as system as well as toto the the system.system.

Assessment• Adequacy and Adequacy and

reliabilityreliability

Example

• Collection, Collection, analysis, and use analysis, and use of informationof information

• Flow of Flow of informationinformation

• Internal and Internal and external external informationinformation

Information System: Information System: Rajasthan ExampleRajasthan Example

System’s System’s CapacityCapacity

FavorableFavorable UnfavorableUnfavorable

Data collection and Data collection and recordingrecording

A large number A large number of trained data of trained data analystsanalysts

Inadequate & unreliable Inadequate & unreliable informationinformationToo many reports and recordsToo many reports and recordsUnder-reporting of morbidity/ Under-reporting of morbidity/ mortalitymortality

UtilizationUtilization Financial and other information is Financial and other information is not utilized for decision makingnot utilized for decision making

External External informationinformation

No information regarding the No information regarding the private sectorprivate sector

Process/ManagementProcess/Management

Defined

• Process/management involves all activities Process/management involves all activities that are designed to convert the system’s that are designed to convert the system’s resources into outputresources into output

Assessment

• Quality of system processQuality of system process

Process/ManagementProcess/Management

Policymakers and managers

Current strategy

Organizational structure

Planning and programming

Implementation

Evaluation and feedback

Current Strategy/Current Strategy/Strategic ApproachStrategic Approach

DescribeDescribe

• What is it?What is it?

• When adopted?When adopted?

• Who/how Who/how developed?developed?

• What other options What other options considered?considered?

AssessmentAssessment

• How precise and How precise and clear?clear?

• How sound for How sound for achieving the goal?achieving the goal?

• How cost effective?How cost effective?

• How widely accepted?How widely accepted?

• How morally correct?How morally correct?

Current Strategy: Current Strategy: Rajasthan ExampleRajasthan Example

““Widen the health infrastructure – Widen the health infrastructure – network to facilitate delivery of network to facilitate delivery of comprehensive health care, especially comprehensive health care, especially in rural areas”in rural areas”

Process: Rajasthan ExampleProcess: Rajasthan Example

System’s CapacitySystem’s Capacity FavorableFavorable UnfavorableUnfavorable

ManagersManagers Untrained managersUntrained managers

StrategyStrategy No well-conceived, long-No well-conceived, long-term, and theoretically term, and theoretically sound strategysound strategy

ImplementationImplementation High potential High potential for cost for cost recoveryrecovery

Centralized planningCentralized planningInadequate financial Inadequate financial autonomy at district levelautonomy at district levelWeak accountabilityWeak accountability

Evaluation and Evaluation and feedbackfeedback

Weak system of evaluation Weak system of evaluation and feedbackand feedback

Analysis of Process ComponentAnalysis of Process Component

What is working and needs to be continued?

What is working and can be expanded?

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 AnalysisSWOT Analysis

Assesses the feasibility of achieving identified goals, based on internal and financial capabilities or challenges

Helps to identify critical factors

Internal analyses: strengths & weaknesses

External analyses: opportunities & threats

Challenge: To Turn Constraints into Opportunities

Analysis of External Environment: Analysis of External Environment: Country ExampleCountry Example

Opportunities

Growing interest of donors in RH

Increasing level of literacy and awareness

Growing share of the private sector

Stable government

Threats 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 – Analysis of Internal System – Country ExampleCountry Example

StrengthsStrengths Committed top Committed top

leadership open to leadership open to new ideas and new ideas and experimentsexperiments

Reasonable level of Reasonable level of health infrastructurehealth infrastructure

High degree of High degree of public expenditurepublic expenditure

WeaknessesWeaknesses Lack of transparency and Lack of transparency and

objective accountabilityobjective accountability

Centralized planningCentralized planning

Falsification and Falsification and underutilization of underutilization of informationinformation

Irregular supply of Irregular supply of contraceptives in rural contraceptives in rural areas areas

Situation Analysis and Strategic Situation Analysis and Strategic Plan FormulationPlan Formulation

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 analysisSynthesis of the conclusion of situation analysis

• Determination of prioritiesDetermination of priorities

• Formulation of strategy using obstacles and Formulation of strategy using obstacles and opportunities identified in the situation analysisopportunities identified in the situation analysis