AREA PROGRAM-BASED HEALTH PLANNING (APBHP) METHODOLOGY

WHAT IS PLANNING?

1. Planning is a process of making current decisions in the light of their future effect. Decisions prepared are
directed to achieve goals through optimal utilization of available resources.

2. Planning attempts to alter the shape of coming years in line with what people want it to be. This involves
bridging the gap between a present state and a desired tomorrow through deliberate actions.

Mercado (1993) summarizes the concepts of planning:

1. Planning is futuristic.

2. Planning is change oriented.

3. Planning is a continuous and dynamic process.

4. Planning is flexible.

5. Planning is a systematic process.

PLANNING ANSWERS THE FOLLOWING QUESTIONS:

Where are we now? (Situational analysis)

1. It involves the process of collecting, synthesizing, analyzing and interpreting information in a manner that will
provide a clear picture of the health status of the community.

2. PHN activities:

a. Gathers data about the health status of the community.

b. Identifies and explains the problems.

c. Projects what situation needs to be changed developed or maintained.

Where do we want to go? (Goal and objective setting)

1. Refers to the process of formulating the goals and objectives of the health program and nursing services in order
to change the status quo.

2. It will serve as a guide to the nurse efforts.

3. A goal leads to a desired end. maybe;

a. A total change, improvement, or maintenance of a situation.

b. Directed toward solving the health status problems identified during community diagnosis.

c. Generally broad and not constrained by time or resources.

d. States the ultimate desired state.

4. Objectives are more precise.

a. Considered as planned end point of all activities.

b. Concerned with the resolution of the health problem itself.

c. Stated in specific and measurable terms.

For example:
 HEALTH PROBLEM High incidence and prevalence of common childhood immunizable diseases among children
aged 0-5 years old.

GOAL To reduce the incidence and prevalence of common childhood immunizable diseases among
children aged 0-5 years old of Bgy. Salvacion.

OBJECTIVES 1. 100% of children ages 0-5 years old will have regular BHS visits for immunization.

2. 95% of children ages 0-5 years old will received complete doses/dosage of BCG, OPV,
DPT, Hepatitis B and Measles vaccines immunization.

3. 80% of children ages 0-5 years old who received immunization will be free from signs
and symptoms of vaccine’s adverse reaction.

4. 100% of child-bearing couples will have proper understanding about the importance of
immunization.

5. 100% of needed vaccines/logistic supplies are available and expendable for

immunization.

6. 100% of cases (immunizable diseases) shall be properly and regularly recorded and
reported to proper authority.

How do we get there? (Strategy and activity setting)

1. To realize the goals and objectives.

2. It implies the identification of resources such as; manpower. Money, materials, technology, time and institution-
needed to implement a program.

3. PHN activity:

a. Defines the strategy or approach in a health program. A program is a defined as a time series of
activities to be carried out in order to correct the health problem.
b. Estimates the resources needed for the implementation of the activities.
c. Assess the extent to which constraints or limitations affect planning decisions. It involves three
activities such as:

 Designing the health programs or services.

 Budgeting.

 Making a time plan or schedule.

How do we know we are there? (The evaluation plan)

1. To find out if the programs and services achieve the purpose for which they are formulated.

2. Determines whether the program is relevant, effective, efficient, and adequate. This entails determining the
specific input, process, and output/outcome indicators of the program stating the criteria and standards of each.

3. Program evaluation included the following steps:

4. Deciding what to evaluate in terms of relevance, progress, effectivity, impact and efficiency.

5. Designing the evaluation plan specifying the evaluation indicators, data needed methods and tools for data
collection and data sources.
 6. Collection of relevant data.

7. Making decisions.

8. Preparing reports and providing decision-makers feedback on the program evaluation.

How does planning contribute to effective and efficient health operations?

1. It defines and directs the efforts of health units.

 Goals, strategies and activities are the priority choices made by the managers and health workers from a
selection of various possible courses of action available to them.

2. It organizes people, describes the productive relationships between and among them, and coordinates all
decisions and actions necessary to service delivery outcomes. The plan assigns tasks and roles to everyone
involved in the work.

3. It identifies and estimates the resources (financial, human/manpower, capital and physical) required to produce
the expected output. The levels, allocations and timing of resources requirements are established by the plan.

4. It establishes effective communication to all interested parties (health workers, community leaders, partner
organizations, oversight agencies and particularly clients and beneficiaries)

5. It becomes a basis for useful supervision, monitoring and evaluation. Since the plan states what is expected of
the health units, the same plan can also be a guide to review how it is doing or how it is done, and providing
guidance or support to improve performance.

6. It provides a basis for further capability building of health units. By anticipating the shortcomings in existing
capacity relative to the expected output, the plan becomes a basis for future capacity building inputs.

DOH planning background

1. Early part of the 20th century.

 Health planning practices have been included in the administrative functions of DOH.

2. Two groups of applications came forth in the 1980’s.

 Generic planning approach.(regions, provinces, cities, and districts)

 Approach to operations in program- national disease control and service delivery programs.

3. Mid-80’s: All territorial unit of the department was preparing health plans using the generic approach.

 Limitations: Could not be used in day-to-day operations or to budget preparation and execution.
 Strengths: Yielded well-articulated plans in EPI, TB control, CDD, Malaria Control, and other national impact
programs.
 Main problem: Each program proceeded s if each was the only program being implemented by the field
units. Area managers did not have the adequate tools for integrating program plan effectively.

4. In 1989: New planning system that is based on the strengths and achievements of past planning approaches was
initiated. It is called as AREA PROGRAM-BASED HEALTH PLANING (APBHP)

What is APBHP?

1. It is a planning based on the general guidelines of national programs as applied to specific circumstances of local
areas. This planning methodology essentially translates the generic planning approach into a protocol that
utilizes technical program guidelines as a key planning input, to be utilized by each territorial unit of DOH in
preparing a health plan for the area.
 2. It is a decentralized planning process owned by increasingly autonomous service delivery managers and
frontline service workers of the DOH that was developed in response to the need to reconcile national program
plans and area plans for health.

3. It is a methodology used by health worker for managing their day-to-day operations.

APBHP ADVANTAGES

1. It is already in place and utilized by frontline planners since 1990.

2. Most of the health personnel involved in health planning (MHOs, PHNs, RHMs) have been trained with APBHP
methodology.

3. It is adjustable to LGU requirements.

a. Designed for a deconcentrated DOH.

b. Adjustable to local government’s planning process.

c. Basically the same with the generic framework. Therefore, it is not technically alien to LGUs.

GENERIC PLANNING VS. APBHP APPROACH

1. Situational analysis. 1. Problem analysis.

 Analysis of population.  Health data review
 Analysis of health status.  Program review
 Analysis of ecological factors.  Statement of area-program specific problems.
 Analysis of health resources.  Analysis on priority health problems.
 Analysis of health service delivery.  Analysis of area/program specific problems
 Identification and explanation of
problems.
2. Plan formation. 2. Goal setting.
 Goals.  Statement of program and operational goal.
 Objectives.
 Targets.
3. Strategy formation. 3. Formulation of measures.
 Operational and augmentation plan by program with
budget requirements.
4. Program planning. 4. Activity planning.
 Identification of activities.
 Resource requirements.
5. Implementation. 5. Resource planning.
6. Monitoring. 6. Plan consultation.
7. Evaluation. 7. Plan implementation.
8. Monitoring and evaluation.
 Supervisory scheme of program activities.
 Evaluation scheme of program activities

THE BHS PLAN

The RHM in coordination with MHO, PHN and officials of catchment barangays of the BHS is responsible for the
preparation of BHS plan.

1. General orientation on APBHP.

2. Agreement on guidelines.

3. Minimum data needs.

 Performance in all programs being implemented, latest year available for all catchment barangays.
  Demographic data, latest year available for all catchment barangays.
 Other pertinent data for problem analysis (socio-economic conditions, stationer of facilities available, client
behavior, peace and other conditions, geographic spread of catchment , etc.)

PLANNING AT THE BHS INCLUDES:

1. Problem analysis.

2. Goal setting.

3. Formulation of measures.

4. Activity planning.

5. Resource planning.

6. It Requires consultation with NGOs, other government organizations (OGOs), people’s organizations and other
concerned groups with interest on health service delivery.

7. Work targets by area and program as well as summary of performance targets are consolidated using prescribed
matrices.

PRE-REQUISITES IN THE PREPARATION OF RHU PLAN.

1. General orientation on APBHP.

2. Agreement on guidelines.

 The MHO, PHN and RHM agree on the criteria for problem analysis. The agreement should contain program
parameters and numerical cut-off points for the parameters to be used as indicators of problems.
Performance targets are decided in consultation with the Local Health Board (LHB)

3. Minimum data needs.

 Birth (natality, illness (morbidity), deaths (mortality), statistics, for all BHS in catchments areas.

PRE-REQUISITES IN THE PREPARATION OF RHU PLAN.

1. Program performance statistics, for BHS in catchment.

2. Demographic data, for BHS in catchment.

3. Socio-economic data, other health related and relevant data for the RHU.

4. BHS plans.

PLANNING AT THE CITY LEVEL.

1. Preparing the plan.

 The City Health Officer, City Planning Officer, Administrative Officer, Budget Officer, Accountant, Chief Nurse
and Supply Officer in consultation with the LHB will be responsible for the planning effort.

PRE-REQUISITES IN THE FORMULATION OF A CITY HEALTH PLAN.

1. General orientation on APBHP.

2. Adapted national guidelines/own guidelines.

a. Suggested program parameters and cut-off point for acceptable performance essential to analyze prior
year’s track record, proposed performance targets and work targets for the planning periods.

3. Preliminary resource allocation ceilings per sub-unit that may be provided for planning year.
 4. Planning timetables including schedule of meetings and workshops.

5. Other pertinent instructions regarding technical matters related to planning.

a. Computational procedures.

b. Demographic data.

c. Program specific provisions (like AIDS surveillance, etc)

d. Instructions on how APBHP would be done by the CHO sub-units.

CONTENT OF THE CITY HEALTH PLAN

1. Statement of priority health problem (morbidity/mortality)

2. Program parameters ands cut-off points/performance target.

3. List of programs and areas with the most problems.

4. Account of the important measures proposed for the planning period to address priority problems/programs
and areas.

5. List of specific activities and work targets.

6. Budget summary by program, by area, including support/administrative activities.

7. Plan and budget summary for hospital operations (for cities with hospitals)

8. All summary and consolidation tables.

9. All prescribed worksheets.

10. Documents indicating active and relevant participation in the planning process of NGOs, OGOs and private
sectors.