ASSESSING INFORMATION NEEDS MODULE 1 FACILITATOR'S GUIDE

Item

Title
ASSESSING INFORMATION NEEDS MODULE 1 FACILITATOR'S GUIDE
extracted text
Primary Health Care Management Advancement Programme

ASSESSING
INFORMATION NEEDS

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MODULE 1
FACILITATOR'S GUIDE

106 08
CPHE
THE PHC MAP SERIES OF MODULES, GUIDES
AND REFERENCE MATERIALS
Each module includes:
• a User’s guide
• a Facilitator’s guide
• computer programs
Module 1 Assessing information needs
Module 2 Assessing community health needs and coverage
Module 3 Planning and assessing health worker activities
Module 4 Surveillance of morbidity and mortality
Module 5 Monitoring and evaluating programmes
Module 6 Assessing the quality of service
Module 7 Assessing the quality of management
Module 8 Cost analysis
Module 9 Sustainability analysis
Manager’s guides and references
• Better management: 100 tips
• Problem-solving
• Computers
• The computerised PR1COR thesaurus
Production Managers: Ronald Wilson, Aga Khan Foundation, Geneva and
Thongchai Sapanuchart, Somboon Vacharotai Foundation, Bangkok, Thailand
Editor: Jennifer Sharpies, Bangkok, Thailand
Design & Layout: Helene Sackstein, France
Desktop Publishing: Marilyn J. Murphy, Suracha Suntarasut, Somboon Vacharotai
Foundation, Bangkok, Thailand
Printing: Thai Wattana Panich, Bangkok, Thailand

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Published in 1993 by the Aga Khan Foundation USA, Suite 700,1901 L Street N.W.,
Washington DC and the Aga Khan Foundation, PO. Box 6179, 1211 Geneva 6,
Switzerland. Additional copies are available at the Aga Khan Foundation Canada
in Toronto; Aga Khan Foundation (United Kingdom) in London; and AKF offices
in Dhaka, Bangladesh; Delhi, India; Nairobi, Kenya; Karachi, Pakistan; Lisbon,
Portugal; and Dar-es-Salaam, Tanzania; the Aga Khan University Faculty of Health
Science in Karachi, Pakistan; the Somboon Vacharotai Foundation and the ASEAN
Institute for Health Development in Thailand

AGA KHAN FOUNDATION

THE AGA KHAN UNIVERSITY

Primary Health Care Management Advancement Programme

ASSESSING
INFORMATION NEEDS

Mary Millar
University Research Corporation

MODULE 1
FACILITATOR S GUIDE

Aga Khan Health Services

University Research Corporation
Center for Human Services

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Dedicated to
Dr. Duane L. Smith (1939-1992),
Dr. William B. Steeler (1948-1992)
and all other health leaders, managers and workers
who follow their example in the effort to bring quality health
care to all in need.

The Primary Health Care Management Advancement
Programme has been funded by the Aga Khan Foundation
Canada, the Commission of the European Communities,
the Aga Khan Foundation U.S.A., the Aga Khan
Foundation’s head office in Geneva, the Rockefeller Foun­
dation, the Canadian International Development Agency,
Alberta Aid, and the United States Agency for Interna­
tional Development under two matching grants to AKF
USA. The first of these grants was, "Strengthening the
Management, Monitoring and Evaluation of PHC Pro­
grams in Selected Countries of Asia and Africa" (cooper­
ative agreement no. OTR-0158-A-00-8161-00, 19881991); and the second was "Strengthening the Effective­
ness, Management and Sustainability of PHC/Mother and
Child Survival Programs in Asia and Africa" (cooperative
agreement no. PCD-0158-A-00-1102-00, 1991-1994).
The development of Modules 6 and 7 was partially funded
through in-kind contributions from the Primary Health
Care Operations Research project (PRICOR) of the Center
for Human Services under its cooperative agreement with
USAID (DSPE-6920-A-00-1048-00).
This support is gratefully acknowledged. The views
and opinions expressed in the PHC MAP materials are
those of the authors and do not necessarily reflect those
of the donors.
All PHC MAP material (written and computer files) is
in the public domain and may be freely copied and
distributed to others.

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Contents
foreword ........................................................................................ i

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SESSION 1: INTRODUCTION AND OVERVIEW ........................... 7

Transparencies
1-1: PHC MAP purpose .................................................................. 15
1-2: PHC MAP modules and the management cycle .................. 17
1-3: Workshop objectives ................................................................ 18
1-4: The PHC MAP systems framework........................................ 20
1-5: The expanded PHC MAP systems framework...................... 21
1-6: A systems diagram of family planning ................................... 22
1-7: The systems framework and the planning-evaluation cycle. .24
1-8: PHC MAP modules related to system elements.................... 25
1-9: PHC MAP modules and PHC programme components....... 26
SESSION 2: DETERMINING INFORMATION NEEDS ............... 27

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Transparencies
1-10: Session 2 objectives.................................................................. 40
1-11: Indicators for breast feeding, growth monitoring, and
nutrition education .................................................................. 41
1-12: Rationale for knowing health status of targets...................... 45
1-13: A and B: Sample health goals..................................................46
1-14: Methods for collecting morbidity/mortality data.................. 48
1-15: Types of cost analysis ...............................................................49

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............ ................................. 51
Transparency
1-16: Session 3 objectives.................................................................. 55

SESSION 3: SETTING PRIORITIES

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Module 1: FG; contents

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Foreword
What is the purpose of the Facilitator’s guide?
The Facilitator’s guide contains a suggested workshop design for use by
individuals who will help PHC managers and staff learn how to use the
Primary Health Care Management Advancement Programme (PHC MAP)
series. There is a Facilitator’s guide for each module in the PHC MAP series.

What information does it contain?
Each Facilitator’s guide contains instructions for conducting a workshop
on one of the modules in the PHC MAP series using the information
contained in the User’s guide.
The instructions are arranged in one to two hour sessions. The number
of sessions depends on the amount of information and/or the number of
steps contained in the User’s guide. The first page of each session lists
session objectives, major topic headings, time required, and materials and
equipment. The following pages describe the instructional activities in
outline form.
The outline is divided into two columns. The right-hand column
indicates what the facilitator says or does to conduct the session. The
left-hand column lists the handouts, overhead transparencies, or other
materials needed to support the activity. Copies of these materials, suitable
for duplication, appear at the end of the session in which they are first used.
Some transparencies are used in more than one session.

How are the workshops organised?
The first session of each workshop contains activities designed to
introduce the PHC MAP series and explain its importance to PHC
programmes, present an overview of the workshop, explain the purpose of
the module, review specific terms or concepts used in the module, and

Module 1: FG; foreword

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acquaint the participants with the organisation and content of the Users
guide.
The final session of each workshop contains activities designed to review
key points of the User’s guide, if appropriate, help participants prepare an
action plan, and brings the workshop to a formal conclusion. The sessions
in between present the steps required to accomplish the purpose of the
module and provide an opportunity for participants to apply those steps
to their own programmes.
Each workshop is designed to be given on consecutive days, uninter­
rupted except for breaks, meals, and rest, if the workshop is longer than
one day. It is recognised, however, that situations vary and the PHC MAP
modules will be used singly or in combination by individuals and or­
ganisations in the field and on university campuses. Therefore, it is
expected that the workshops described in the Facilitator’s guides will be
adapted to fit a range of circumstances. Indeed, those who facilitate PHC
MAP workshops are encouraged to make adaptations to meet the needs
of participants and/or specific PHC programmes.

Who can be a facilitator?
Ideally, the person who serves as facilitator has training and experience
in the fields of public health, management, planning, and evaluation, as well
as sampling and survey design. It is recommended that this person also be
skilful in working with small groups.
The facilitator should be someone from outside the PHC programme,
perhaps from another agency or a university. As a person with no direct
interest in the programme, the facilitator can be neutral in disagreements
that may arise and help the group members resolve an issue objectively.
Having an outside person as facilitator also allows the programme director,
who usually has a leadership role, to contribute his or her knowledge and
experience as a full participant in the work of the group.
It is also recommended that a facilitator have a full set of PHC MAP
User’s guides and Facilitators guides. It is sometimes necessary, in the
course of completing one module, to refer to information in another module.

Who should participate in the workshop?
The primary audience for the PHC MAP series is the team that manages
PHC programmes or other population-based health programmes in either
the public or private sector. An example of a PHC management team in
the public sector is the core staff of a district ranging from 100,000 to
300,000 in size of population served.

Module 1: FG; foreword

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An example of a PHC management team in the private sector is the
COre
°f an NGO that provides PHC services to a specific population
in a given geographic area. The average size of the service population may
range from 40,000 to 60,000, but may be as small as 10,000 or more than
100,000. In either case, the management team should have:
• the knowledge and skills needed to complete the steps in the module,
• the time and resources required to collect and analyse the required data
• the authority to plan and implement improvements in management
systems and procedures based on this analysis.
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If feasible, teams from several districts or from several PHC programmes
within a given NGO, may work simultaneously with one facilitator to
complete a module. It is recommended that one facilitator work with no
more than four teams or 20 people at one time.

What does the facilitator do?
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Understands the needs of participants. If the facilitator is working
with one PHC programme, the most efficient way to gather information
about participants and the programme in which they work is to meet with
the PHC director to determine:
• the nature of the PHC programme (services provided, size and description
of area served, number and type of facilities, number and qualifications
of staff, community involvement, computer capability, strengths, major
problems, etc.);
• if information needs have been clearly identified;
• previous staff training in management information systems or related
topics;
• resources available for training (time, space, equipment);
• possibility for subsequent technical assistance to workshop participants.
Understands the content of Module 1. Read the User’s guide and
Facilitator’s guide for Module 1 and consider options for workshop delivery.
• The purpose of Module 1 is to help participants select priority information
needs and to review some basic concepts underlying management
information systems. Depending on participant background, the amount
of time available, and the need to establish priorities among management
information needs, Module 1 can be presented in its entirety, limited to
Level 1: Quick start, limited to the PHC MAP systems framework, or in

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Module 1: FG; foreword

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summary form as contained in the first session of the Facilitator’s guides
for Modules 2 through 9.
• If information needs have not been clearly identified and participants
have no background in systems, then Module 1 should be presented in
full. The selection of the next module will depend upon priorities set by
the participants as they complete the steps in Module 1.
• If information needs have been clearly identified and participants have
no background in systems, then that portion of Module 1 can be added
to the first session of the selected module.
• If information needs have been clearly identified and participants have a
background in systems, then the overview of PHC MAP in the selected
module will be sufficient.
Understands the content of the selected module. Read the User’s
guide and Facilitator’s guide for the selected module and consider options
for workshop delivery.
• Depending upon the length of the module and the availability of staff for
training, the workshop sessions may be presented as described in the
Facilitator’s guide, or workshop sessions may be delivered at intervals (for
example, every morning for a certain number of days, one session per
week, or one day per week for three or four weeks).
• If follow-on technical assistance is available, the content of the module
could be presented in the workshop and the application of the procedure
to the PHC programme could be conducted on the job.
• Participants could plan steps in the workshop, complete them on the job,
and bring the results to the next workshop session. This approach is
particularly applicable to Module 2 which requires development of a
questionnaire, selection of a survey sample, training of data collectors,
and data collection. These steps cannot actually be carried out within
the time limits of the workshop as contained in the Module 2 Facilitator’s
guide.
• Other options are possible depending upon the circumstances of each
situation.
Determines what programme information, if any, is needed for
completion of the module. For example, census data and lists of households
are required to complete some of the steps in Module 3.

Module 1: FG; foreword

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Determines the most appropriate people to attend the workshop. For
example, Module 7 is best completed by those responsible for planning,
training, supervision, logistics, and other management services.
Discusses the delivery options and participants with the PHC manager
and make decisions regarding the most appropriate option and participant
selection. Also determines if the needed information is available and if it
is not, the alternatives for obtaining the information.

Notifies participants of the date, time, and purpose of the
workshop and confirms attendance. Initial notice of the meeting may come
from the PHC manager, with follow-up by the facilitator.
Prepares the agenda, using as a model the sample in Session 1 of the
Facilitator’s guide for the selected module.

Inspects the room where the workshop will be held and answers these
questions:
• Is the room large enough to seat all the participants?
• Can chairs and tables be arranged in a variety of ways al! participants
around one table; participants in groups of three or four at smaller tables?
• Is the lighting adequate?
• Can temperature and humidity be controlled?
• Is there an electrical outlet for an overhead projector?
• Is a microphone necessary for everyone to hear and to be heard?
• Are toilets conveniently located?
• Is the site convenient to parking, restaurants and public transportation?
• Are supporting facilities available and convenient: duplication, word
processing, computers?
Prepares notes to conduct the workshop using the session outlines in
the Facilitator’s guide for the selected module, and makes the necessary
adaptations. Refer to the appropriate User’s guide for content.

Duplicates the worksheets and other handouts as indicated in
the Facilitator’s guide and obtains the necessary equipment.
Conducts the workshop as planned.
Provides follow-on assistance, if appropriate.

Module 1; FG; foreword

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Session 1: Introduction and overview
Objectives:

Participants will be able to:
• Explain the purpose of PHC MAP
• Explain the connection between management
information and improvement of primary
health care service, quality, coverage, effective­
ness and efficiency.
• Give PHC examples of these terms in the
systems framework: inputs, processes, out­
puts, effects, and impacts.
• Explain the purpose of Module 1.

Session Outline:

I.
II.
III.
IV.

Materials:

Module 1 User’s guide
Handout 1-1:
PHC MAP modules
Handout 1-2:
Agenda
Handout 1-3:
A systems diagram of
management and health
services relationships
Transparency 1-1: PHC MAP purpose
Transparency 1-2: PHC MAP modules and
the management cycle
Transparency 1-3: Workshop objectives

Module 1: FG; session 1

Introduction (15 minutes)
Overview of workshop (10 minutes)
The systems framework (25 minutes)
Module 1 User’s guide (10 minutes)

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Transparency 1-4: The PHC MAP systems
framework
Transparency 1-5: The expanded PHC
MAP systems framework
Transparency 1-6: A systems diagram of
family planning
Transparency 1-7: The systems framework
and the planning-evalua­
tion cycle.
Transparency 1-8: PHC MAP modules re­
lated to system elements
Transparency 1-9: PHC MAP modules and
PHC programme
components
Equipment:

Flip chart, stand, markers, masking tape, over­
head projector and screen

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Module 1: FG; session 1

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Session 1: Introduction and overview
I. Introduction (15 Minutes)

Name tags or
place cards

A. OPENING REMARKS
• Introduce self and other staff, as necessary.
• Explain your role in the workshop.
• If you do not know the participants, ask each
one to state his or her name, position title, and
job location.
Note: If the group is larger than 6 to 8, you may
wish to have them wear name tagsorputcards with
their names at the places where they are sitting.

Flip chart

• Ask each participant to complete this sen­

tence: "As a result of attending this workshop,
I expect."
• When all responses have been recorded, say
that you will return to this list after giving an
overview of the workshop.

Transparency 1-1
PHC MAP purpose

Handout 1-1
PHC MAP
modules

Module 1: FG; session 1

B. OVERVIEW OF PHC MAP
• Summarise PHC MAP programme,
including:
Purpose of PHC MAP
Title and purpose of each module
• Make the following points about PHC MAP:
Has been field-tested and revised to ensure
usefulness to PHC programme staff.
The entire series of modules may be used to
strengthen a PHC programme, or each mod­
ule may be used independently to fill informa­
tion gaps.
Modules can be used in any sequence, al­
though some provide input to others. For
example, the cost analysis data from Module

10

Session 1: Introduction and overview

Transparency 1-2:
MAP modules and
the management
cycle

8 provide a basis for doing a sustainability
analysis (Module 9).
Checklists and other materials can be
adapted to fit a particular situation.
• Explain why information is important to a
PHC programme.
Information is required to plan, operate,
monitor, and evaluate a PHC programme.
Each PHC MAP module helps gather infor­
mation useful to one or more of these phases
in the management cycle.

C. EXPLAIN WHY THE PHC MAP SERIES IS
BEING INTRODUCED IN THIS PHC PRO­
GRAMME.
Note: The remarks here should be tailored to the
specific programme and should provide answers
to these questions:
Why are we doing this workshop?
What do we expect to achieve?
It may be appropriate for the PHC manager to
make these remarks.
II.

Overview of workshop (10 Minutes)
Transparency 1-3;
Workshop objectives

• Review the workshop objectives.
• Distribute and review the workshop agenda,

Handout 1-2: Agenda

describing the activities that will take place to
accomplish the workshop objectives.
• Review the expectations contributed by par­
ticipants at the beginning of the session.
• Indicate which ones will be met and which
ones will not and why.

Module 1: FG; session 1

Session 1: Introduction and overview
!.............................................................................. .
• Suggest, if possible, alternatives for meeting
the expectations that will not be met in this
workshop.
• Ask for questions or comments.
III.

The systems framework (25 Minutes)

Note: Omit this section ifparticipants are familiar
Transparency 1-4:
The PHC MAP
systems framework
Transparency 1-5: The
expanded PHC MAP
systems framework
Transparency 1-6:
A systems diagram of
family planning

with systems concepts and terminology.
• Show the simplified systems framework and
define the terms.

• Show the expanded framework and explain

the different kinds of outcomes.
• Show the family planning example for the

expanded framework.
• Leave Transparency 1-6 on the projector and
ask participants to substitute ORT examples

Handout 1-3: A systems
diagram of management
and health service
relationships

Module 1: FG; session 1

for the family planning example in the ex­
panded diagram.
• Explain the relationship between PHC man­
agement and PHC services.
Management services (for example, plan­
ning, training, supervision, logistics manage­
ment) support the PHC services (for example,
antenatal care, immunization, treatment of
malaria).
Both management services and PHC ser­
vices are systems.
The outcome of the management system, in
this case CHWs with demonstrated compe­
tence in family planning, become inputs to the
family planning system.

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Session 1: Introduction and overview

Use the information on
the IF- THEN relationship
on pages 6-7 in the User’s
guide
Transparency 1-7: The
systems framework and
the planning-evaluation
cycle

The goal (impact on health status) of the
family planning system is increased birth in­
terval.
The management system contributes indi­
rectly to the goals (improved health status)
through support of the health service delivery
system.
Ask for questions and comments.
Explain the link between what goes in at the
beginning of a system and what comes out at
the end of the system.
Explain how the systems framework can help
PHC programmes plan services geared to
needs of their population.
Note: Start at the far right of the transparency
with "needs" work to the left across the top and
then across the bottom to the right, using the
information on pages 6 to 9 in the User's guide

Transparency 1-8:
PHC MAP modules
related to system
elements

Transparency 1-9:
PHC MAP modules and
programme
components

• Explain that the MAP modules help PHC

staff to collect and analyse information about
each of the elements in the system and iden­
tify the modules that provide the most com­
plete data for each element.
• Explain that MAP modules can also be or­
ganised according to whether they help collect
information primarily for health or manage­
ment services.
• Ask for questions and comments.

Module 1: FG; session 1

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Session 1: Introduction and overview
IV. Module 1 User’s guide (10 Minutes)
Module 1 User’s guide

• Distribute a Users guide to each participant.
• Highlight key sections of the User’s guide,

referring participants to appropriate pages in
the guide:
OVERVIEW
The overview of the Primary Health Care
Management Advancement Programme has
details on the purpose of PHC MAP and the
materials included; information that has al­
ready been presented in summary form.
Point out that the diagram on page iv of
the overview is another way to illustrate the
relationship between the modules and the
management cycle (show Transparency 1-2).
Draw attention to the specific health and
mangement services addressed in the PHC
MAP modules.
Describe the PHC MAP Manager’s guides
that supplement the modules.

INTRODUCTION TO MODULE 1
Paraphrase the purpose of the module, as
stated on page i.
Review the programme information that is
helpful to have for this module and provide it,
as appropriate.
Note: This information should be obtained
from the PHC programme manager prior to the
workshop. If it is not available, the need for
Module 2 will become quickly apparent in the
workshop.
Distinguish between level 1 and level 2 and

explain that the level 2 PHC MAP information
audit will be the focus of the workshop. Level

Module 1: FG; session 1

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Session 1: Introduction and overview

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mation needs in detail.
LEVEL 2: THE PHC MAP INFORMATION
AUDIT
Remind participants that the matrix show­
ing modules and the management cycle was
discussed earlier.
Point out that the systems framework has
already been discussed and can be reviewed
by reading this section after the workshop.
Point out key terms on page 5 and the
glossary at the end of the Guide for future
reference.
Explain the diagram illustrating the PHC
boundaries on page 11 and ask participants to
identify what information, if any, they need
from other agencies. Record this list on a flip
chart for future reference.
Say that the remainder of the module con­
tains a series of questions and worksheets to
help participants identify their information
needs and select the MAP modules they will
use to help them collect and analyse that
information.
Ask for questions and comments.

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Module 1: FG; session 1

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PRIMARY HEALTH
CARE MANAGEMENT
ADVANCEMENT
PROGRAMME
(PHC MAP)

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PURPOSE:
to help PHC management teams:
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interpret information
necessary to improve
programme planning and mon­
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Module 1: FG; session 1; transparency 1-1

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PHC MAP Modules
1.

Assessing information needs.

This module helps managers to identify information needs, set priorities, and
determine which PHC MAP modules are likely to be of most use to them.

2.

Assessing community health needs and coverage.

This module provides PHC managers with simple tools to gather required data on
community health needs for planning programme strategies and resource use. The
managers can use the same instruments later to assess programme effects on health
knowledge, behaviour, and coverage, as well as programme impact on morbidity
and mortality.

3.

Planning and assessing health worker activities.

A module that supervisors and other managers can use to help field workers and
clinic staff plan their work better. It shows how to identify individuals in need of
services, set realistic targets, assess individual performance, and take corrective
action, if warranted.

4.

Surveillance of morbidity and mortality.

The module describes the basic indicators of morbidity and mortality to be included
in a PHC surveillance system. It discusses how to set up a surveillance system, how
to monitor the incidence and other rates of diseases, how to identify causes of
mortality and morbidity, and how to use that information to improve programme
planning and implementation

5.

Monitoring and evaluating progammes.

Lists of indicators and guidelines that managers can use to monitor PHC and
management activities for short periods. Managers can also use them to construct
a project-specific "mini-MIS."

6.

Assessing the quality of service.

Simple, but comprehensive, discussion guides and checklists of essential service
resources and processes. Supervisors can use these to assess the quality of care
provided and to set priorities for improving service delivery.

7.

Assessing the quality of management.

Discussion guides and checklists for assessing PHC management services (planning,
training, supervision, etc.).

8.

Cost analysis.

This module can help PHC managers to set up simple systems to monitor costs
themselves. They can also make projections about future revenues and expenses.

9.

Sustainability analysis.

Guidelines and tools that managers can use to develop and analyse alternative
strategies for sustaining health improvement, service coverage, and the PHC
services and resources needed to do so.

Module 1: FG; session 1; handout 1-1

Module L FG; session 2; transparency 1-2

PHC MAP MODULES AND THE MANAGEMENT CYCLE

Module 1: Information needs

Needs
assessment
X

Module 2: Community needs

X

Planning

Monitoring

Evaluation

X

X

X

X
X

Module 3: Work planning

X
X

Module 4: Surveillance
Module 5: Monitoring indicators

X

Module 6: Service quality

X

Module 7: Management quality

X
X

Module 8: Cost analysis
Module 9: Sustainability

X

X

X

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WORKSHOP
OBJECTIVES:

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1. Identify priority information needs
in your PHC programme using the
steps and worksheets contained in
Module 1

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2. Identify one or more of the PHC
MAP Modules 2 through 9 which
will be most helpful in collecting
and analysing that information

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Module 1: FG; session 1; transparency 1-3

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SAMPLEAGENDA
MODULE 1*
Session 1
(1 hr 40 min)

Introduction
and overview

Session 2
(2 hrs 40 min)

Determining
information
needs

Session 3
(1 hr)

Setting
priorities

* For an actual presentation, substitute the appropriate times in the first column.

Module 1: FG; session 1; handout 1-2

THE PHC MAP SYSTEMS FRAMEWORK

Module 1: FG; session 1; transparency 1-4

INPUTS
(resources)

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diagnose diarrhoea
prescribe ORT

Example:
Health worker
OTS packets

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PROCESSES
(activities)

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OUTCOMES
(results)

improved health

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Module 1: FG; session 1; transparency 1-5

THE EXPANDED PHC MAP SYSTEMS FRAMEWORK
INPUTS---- —► PROCESSES—* OUTPUTS —-* EFFECTS ------ * IMPACTS

Resources

Activities

Products &
services

Change in KAP:
knowledge,
attitude,
practices,
behaviour

Changes in
health
status:
morbidity
mortality
fertility
disability

A SYSTEMS DIAGRAM OF FAMILY PLANNING
INPUTS----- ► PROCESSES—* OUTCOMES-—'►EFFECTS---- ► IMPACTS

Trained health
workers

Module 1: FG; session 1; transparency 1-6

Contraceptive
supplies (pills,
IUDs,
condoms)
Examining
table

Taking
reproductive
history

Physical
examination
Patient
teaching

Patients
examined

Patients fitted
with IUD

Patients:

• can name
three
methods of
contraception

Increased
interval
between
children

Patients
instructed in
• are in favor
family planning
of spacing
objectives,
pregnancies
benefits, and
methods
• choose a
contraceptive
method and
use it
correctly

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A SYSTEM DIAGRAM OF MANAGEMENT AND HEALTH
SERVICES RELATIONSHIP
Management services

/
INPUT

PROCESSES

OUTPUT

IMPACTS

trained
CHWS &
ORS
packets

CHWs
diagnose &
prescribe
ORT

ORS
packet
given

avoid
dehydration
and death
ot child

PHC services

bO

THE SYSTEMS FRAMEWORK AND THE
PLANNING-EVALUATION CYCLE
i——----------------- --------- ------ Planning <4---------------------------------------------INPUTS PROCESSES OUTCOMES EFFECTS
IMPACTS
resources

Module 1: FG; session 1; transparency 1-7

CTi

activities

products/
services

health status

KAP

Implementation

Needs

lNPUTs””pROCESSEs”oUTCOMES

EFFECTS

^IMPACTS

______________ > Monitoring/evaluation

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Module 1: FG; session; transparency 1-8

PHC MAP MODULES RELATED TO SYSTEMS
ELEMENTS
INPUTS
(resources)

PROCESSES
(activities)

OUTCOMES
(results)

3 Work planning

3 Work planning

3 Work planning

5 Monitoring
6 Service quality

5 Monitoring
6 Service quality
7 Management
quality

5 Monitoring
6 Service quality

EFFECTS
(KAP)

IMPACTS
(health status)

2 Community
needs

2 Community
needs

3 Work planning
4 Surveillance

7 Management
quality
8 Cost analysis
9 Sustainability

8 Cost analysis
9 Sustainability

7 Management
quality

9 Sustainability

9 Sustainability

Bold lettering indicates the primary modules and types of data to be collected

PHC MAP modules and
programme components
Health services

Management
services

1. Information needs

1. Information needs

2. Community needs
3. Work planning

3. Work planning

4. Surveillance
5. Monitoring
indicators (Part 1)

5. Monitoring
indicators (Part 2)

6. Service quality

7. Management quality

8. Cost analysis

8. Cost analysis

9. Sustainability

9. Sustainability

Module 1: FG; session 1; transparency 1-9

27

Session 2: Determining information needs
Objectives:

Participants will be able to follow the directions
in the Module 1 User’s guide to:
• Determine if they are collecting adequate in­
formation about PHC health services.
• Determine if they are collecting adequate in­
formation about PHC management services.

Session outline:

I.
II.

Materials:

Module 1 User’s guide
Transparency 1-10: Session 2 objectives
Transparency 1-11: Indicators for breast
feeding, growth monitor­
ing, and nutrition educa­
tion
Transparency 1-12: Rationale for knowing
health status of targets
Transparency 1-13: A and B: Sample health
goals

Module 1: FG; session 2

Introduction (10 minutes)
Step 1: List PHC health and mangement
services (20 minutes)
111. Step 2: Define inputs, processes, outputs
and outcomes (40 minutes)
IV. Step 3: Identify information needs for
health services (60 minutes)
V. Step 4: Identify information needs for
health services (30 minutes)

if

28

Transparency 1-14: Methods for collecting
morbidity/mortality data
Transparency 1-15: Types of cost analysis
Handout 1-4:
Worksheet A, defining
service indicators
Handout 1-5:
Worksheet B, summarising information needs
Trainer Reference 1-1; Sample priority matrix
Equipment:

Flip chart, stand, markers, masking tape, overhead projector and screen

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Module 1: FG; session 2

29

Session 2: Determining information needs
Introduction (10 Minutes)
Transparency 1-10:
Session 2 objectives

• Review the session objectives.
• Explain the steps in the information audit.
Step 1 is to list the health and management

Transparency 1-11:
Indicators for
breast feeding,
growth monitoring, and
nutrition education

services in order of importance.
Step 2 is to identify indicators for inputs,
processes, and outcomes of each type of ser­
vice.
Step 3 has two parts: The first involves
asking a series of questions to determine
whether your information system correctly
gives you the data you need for each indicator.
The second involves setting priorities for the
information you need to obtain as high, me­
dium, or low.
Step 4 uses a priority-setting technique to
help you determine which information will be
collected first, if all needs cannot be addressed
at once.
• Explain that steps 1-3 will be completed in
this session.

II. Step 1: list PHC health and management services
(20 Minutes)
Module 1 User’s guide,
PHC MAP overview,
page vi

Flipchart

• Refer participants to the list of PHC services.

• Ask them to name the health services in their
project while you list them on the left side of
a flip chart as they are named.
Note: Use the participants’terminologyfor health
services. For example, vitamin A distribution may
be designated as a service or breastfeeding, growth
monitoring, and nutrition education may be com­
bined.

Module 1: FG; session 2

30

Session 2: Determining information needs
• Direct each participant to list the health

See Trainer
Reference 1-1, page 42,
or a sample matrix

services in order of importance, using 1 to
indicate least important, 2 the next least im­
portant, and so on. If the project offers 7
health services, the highest ranking service
would be numbered 7.
• While participants are ranking the services,
prepare a matrix on the flip chart. The
services are the rows, and initials of each
participant are the columns.
• Next, ask participants, in turn, to call out the
numbers they assigned to each service. For
example, one participant may assign a 2 to
maternal care, a 5 to family planning, a 1 to
BF/GM/NE, and so on.
• When all participants’ rankings have been
recorded, total the numbers for each service.
The service receiving the highest score is top
priority, and so on.
• Repeat these steps for management services.
• Direct participants to review the ranking of
health and management services and indicate
their satisfaction with the rankings in each
category. The ranking process is arbitrary and
may not take all factors into account. If there
is a good rationale for changing the order and
all participants concur, make the indicated
changes.

Module 1: FG; session 2

31

Session 2: Determining information needs
III. Step 2: Define inputs, processes, outputs, and outcomes
(40 Minutes)
• Assign each health service to a small group

of 2 or 3 participants. If the group is large all
health services can be addressed. If the group
is small and the list of services is long, select
only 3 or 4 high scoring (top priority) health
services for the remainder of the information
needs assessment process.
Note: Participants can complete the information
process for the other health services and the
management services after the workshop.
Handout 1-4: Worksheet A, • Distribute Worksheet A to each participant.

Defining service indicators . Direct participants to write in column 2,
Inputs, the name of the health service they
have been assigned, e.g., immunization, family
planning.
• Next, direct participants to describe the tar­
get group of that particular health service, e.g.,
children, women 15-49 and enter that infor­
mation in the first column.
• Direct participants, working on their as­
signed health service in small groups, to iden­
tify the key inputs, processes, outputs, effects,
and impacts for that service.
They may start with inputs in column 2 or
impacts in the last column.
These inputs, processes, outputs, and out­
comes will be the indicators for monitoring
and evaluation.
The example in Figure 7 of the User’s guide
shows two indicators for each category. More
can be listed.

O'H CHOO
Module 1: FG; session 2

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Session 2: Determining information needs

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The important thing is to list the most
significant indicators and be sure they are
logically linked across the rows
Participants may wish to refer to the exam­
ple on page 20 as they select indicators for
their assigned health service. If BF, GM, and
NE or family planning are among the health
services assigned to small groups, participants
should think about what is important to their
PHC programme and not be bound by the
sample indicators on page 20.

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Note: You may wish to provide copies of Module
5, Indicators for Monitoring and Evaluating PHC
programmes, to each group to assist them in
identifying indicators.

• Small groups work on selecting indicators and
writing them in the appropriate columns on
Worksheet A and putting a check next to
those indicators for which information is al­
ready available.
• Reconvene the entire group to review the
selected indicators.
• Ask a member of the first small group to read
the indicators they have chosen for the health
service they were assigned.
• Invite members of the other small groups to
comment or raise questions considering two
major criteria:
Significance of planning and monitoring the
service being provided.
Linkage of indicators from one category to
the next.
• Facilitate discussion until the group reaches

consensus on the indicators for that service.

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Module 1: FG; session 2

33

Session 2: Determining information needs
Ask the entire group to review the final list
of indicators and identify those for which they
clearly have information. Direct small group
members to circle those indicators.
Repeat steps 1-4 until all health services
have been discussed.
Say that the next step in the information
audit involves asking a series of questions to
help you confirm that you are collecting ade­
quate information for the indicators and to
help define more precisely additional informa­
tion needs.

IV.

Step 3: Identify information needs for health services
(60 Minutes)

Module 1 User’s guide,
page 21

Handout 1-5:
Worksheet B,
summarising
information needs

Module 1: FG; session 2

• Refer participants to page 21 and suggest that

they follow along as you explain the three sets
of questions and relate them to the modules
that will help them get the information they
do not have.
• Distribute Worksheet B to each participant.
• Explain to participants that they will record
their answers to each of the 10 questions on
this form.
The information needed is recorded in the
same row as the related module.
Small groups will record the information for
their assigned service.

34

Session 2: Determining information needs

Transparency 1-12:
Rationale for knowing
health status of target
groups
Transparency 1-13: A
and B: Sample health
goals

• Question 1. Do you have enough infor­
mation about the health status of your
target groups?
Explain why health status information is

important.
Review the sample health goals pointing
out the four elements of a good statement in
the first two sample goals. Ask participants to
identify the elements in the next two.
Direct each small group to write a goal
statement containing the four elements for
their assigned health service.
Ask each small group to read their goal
statement aloud and make revisions as
needed, based on comments from other par­
ticipants.
Ask each small group to list the indicators
needed to measure the goal statement and
determine whether that information is already
available.
Direct participants to revise Worksheet A
to be consistent with that determination and
to enter needed information about health sta­
tus in columns 2 and 3 on Worksheet B.

• Question 2. Do you have enough infor­
mation about the coverage of each PHC
service?
Explain why coverage information is im­
portant.
Ask participants to name the target groups
they have listed on Worksheet A, recording
them on the left side of the flip chart as they
do.
Ask for the health services pertaining to
each target group, recording them in the mid­
dle of the flip chart.

Module 1: FG; session 2

35

al

Session 2: Determining information needs
Ask participants to suggest any services
they wish to add to their programme for any
of the target groups.
Ask participants for the indicators of the
effects of these services on the target group.
For newly added services, refer participants
to the examples of indicators on page 28 in
Module 1.
Direct participants to compare the infor­
mation on the flip chart to the information
they have on Worksheet A and to make any
changes in the services they have already
listed.
Note: If new services have been added, assign

3

i

them to the small group that has the services for
the same target group.
Direct participants to enter, on Worksheet

al

B, general information needs and specific in­
dicators for coverage.
Direct participants to the excerpt from a
Module 2 questionnaire on page 30 of the
User’s guide as an example of one of the tools
for collecting information on health status
(impacts) and coverage (effects) provided in
Module 2.

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Module 1 User’s guide,
page 31

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4
Module 1: FG; session 2

• Question 3: Do you have enough infor­
mation about your target groups needs
to plan PHC activities?
Explain why target group information is

important.
Refer participants to the summary of Mod­
ule 3 contents on page 29 of the Module 1
User’s guide and summarise the major steps.
Direct participants to enter in column 2 of
Worksheet B any information they do not have
for work planning, such as:

36
u;.

Session 2: Determining information needs
location of people who need service
job descriptions
work plans and schedules
performance and assessment tools

p-.*—
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• Question 4: Is there adequate informa­
tion about changes in morbidity and
mortality?
Explain why information about changes in
Transparency 1-13:
Methods for collecting
morbi ity/morta ity data

Module 1 User's guide,
page 35

morbidity and mortality is important.
Describe methods that can be used to
collect this information.
Direct participants to enter into column 2
of Worksheet B any needed surveillance data
that they are not already collecting.
• Question 5: Do you have adequate indi­
cators to monitor your PHC services?
Explain why monitoring is important.
Refer participants to the excerpt from Mod­

ule 5 on page 35 of the Module 1 User’s guide.
Explain how the indicators are organised
and what the various categories of indicators
tell you.
Direct participants to review Worksheet A
and see if they have at least one indicator in each
system category to help them monitor services.
Direct each small group to add appropriate
indicators to Worksheet A, place a checkmark
next to those they already have information
on, and transfer information that needs to be
collected to Worksheet B.
• Question 6: Do you know enough about
the quality of your health services?
Explain that Module 6 focuses on informa­

tion about processes and how it can be used
in a PHC programme.

Module 1: FG; session 2

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Session 2: Determining information needs
___ ____ __ . . ..... .
Module 1 User’s guide,
Pa2e 37

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Transparency 1-8:
MAP modules and PHC
programme components

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Refer participants to the excerpt from Modu]e 6 on page 37 of the Module 1 User’s guide
to see a sample checklist.
Direct participants to review their entries
on Worksheet A under processes, make nec­
essary additions and list needed information
that’s not now available on Worksheet B in
column 2.
Summarise health service information
needs.
Remind participants that they are in the
process of identifying information needs to
improve planning and monitoring of their
PHC programmes, the main purpose of Module 1.
Explain that so far they have examined
information needs for health services by an­
swering questions 1-6. Information needs for
health services may be addressed by using
PHC MAP Modules 2-6.
Ask for comments or questions about the
process so far.
Indicate that the next activity will be to
repeat the same process for management services by considering questions 7-10.

V. Step 3B: Define information needs for management services
(30 Minutes)

Question 7: Do you have adequate indi­
cators to monitor your management
services?
• Question 8: Do you know enough about
the quality of your management ser­
vices?

Module 1: FG; session 2

IS!

38

......
Session 2: Determining information needs

Flip chart from Step 1
which list management
services for the PHC
programme
Module 1 User’s guide

Give directions for considering question 7.
See Exhibit 6 (p. 40) of the User’s guide. For
question 8 see Exhibit 7 (p. 42).
Assign a management service to each small
group. If the group is small, assign only pri­
ority services. If the group is large, you may
assign all services.
Direct each small group to read the infor­
mation beginning at the bottom of p. 39 and
ending with question 8 on p. 41 and enter
information needs on Worksheet B for Module
5 (Management) and Module 7.
Remind participants to refer to Worksheet
B on page 21 if they need assistance and to
Module 5 for monitoring indicators, if neces­
sary.
Participants work on questions 7 and 8.
Reconvene the large group.
Ask each group in turn to report the results
of their consideration of these two questions
for their assigned management service.
Ask for comments and suggestions from the
other small groups and direct the first small
group to make revisions, if necessary.
Ask for questions and comments on ques­
tions 7 and 8.

• Question 9: Do you have enough infor­
mation about the cost of your pro­
gramme and its services?

Transparency 1-15: Types
of cost analysis

Explain that Module 8 covers information
needed to analyse costs and can help analyse
costs in nine different ways.
Explain the value of having cost informa­
tion.
Refer participants to the description of
Module 8 on p. 41 of the User’s guide to see

Module 1: FG; session

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Session 2: Determining information needs

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Module 8 User’s guide

what types of information are required for cost
analysis.
Direct participants to enter, on Worksheet
B, the cost information they want for the
programme overall or for any health service
or management service.
• Question 10: Do you have adequate in­
formation to determine how to sustain
the PHC programme in the future?
Explain how Module 9 is organised and the

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Module 1 User’s guide,
page 44

41
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41

4
41

41

41

41

41
Module 1: FG; session 2

process it contains to help a management
team assess programme sustainability.
Explain that they can use the module to
develop strategies to sustain the health status
of the target populations and the PHC services
and resources needed to do so.
Refer participants to the sustainability fac­
tors that can be assessed using Module 9 and
explain the "What-If" analysis it enables
managers to do.
Direct participants to determine if they
need sustainability information and to enter
that in column 2 of Worksheet B if they do.
Ask for questions and comments about
Modules 8 and 9 and the related information
needs.

40

PHC health services

•

PHC management services

0

•

q q tp p

Determine if you need more
information about:

@

SESSION 2: OBJECTIVES

Module 1: FG; session 2; transparency 1-10

Module 1: FG; session 2; transparency 1-11

INDICATORS FOR BREAST FEEDING, GROWTH
MONITORING AND NUTRITION EDUCATION
Inputs -—t>
(resources)

Processes ——► Outcomes —*• Effects ----- -► Impacts
(morbidity,
(activities)
(products/
(knowledge,
mortality,
services)
attitudes,
behaviour/
fertility)
practices)

CHWs
GM cards

weighing
counselling

child weighed
mother
counselled

mother
understands
GM and
nutrition
mother feeds
better

weight gain
malnutrition
rate drops

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SAMPLE PRIORITY MATRIX
Participants

Health
Services
Maternal care

AA

BB

CC

DD

EE

FF

GG

HH

Total

Module 1: FG; session 2; trainer reference 1-1

Family
planning

BF, GM, NE
Child
immunization

DDC/ORT

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Module 1: FG; session 2; handout 1-4

WORKSHEET A: DEFINING SERVICE INDICATORS

Instructions: 1) List each priority PHC or management
service; 2) Identify key indicators you need for planning and/or monitoring; 3) Identify those that are already available
(mark with an x); 4) Identify the low, medium and high priority items, e.g., with *, **, and ”* 5) Revise and update this
list as you proceed through Module 1 and other modules.
TARGET

INPUTS

PROCESSES

OUTPUTS

EFFECTS

IMPACTS

GROUP

(resources)

(activities)

(products and services)

(knowledge,
attitudes,
behaviour/
practice)

(morbidity,
mortality, fertility)

WORKSHEET B: SUMMARISING INFORMATION NEEDS
Instructions: 1) After you list each question,
summarise your general information needs for each type of information under the appropriate module; 2) Identify the
specific type of indicators needed if known; 3) Set priorities for each need, e.g., * for low, ** for medium, and *** for
high.
MODULE

GENERAL INFORMATION NEEDS

SPECIFIC INDICATORS

PRIORITIES

45

RATIONALE FOR KNOW­
ING HEALTH STATUS OF
TARGET GROUPS
To set programme goals
If you don’t know where you are going,
any road will get you there.

To determine programme impact
If you don’t know where you are, you
may already be there, or you may not
be.

Module 1: FG; session 2; transparency 1-12

46

SAMPLE HEALTH
GOALS
MORTALITY
Reduce neonatal deaths among
urban slum dwellers to a rate of
65/1,000 live births by the end of
1994
Indicator:
number of deaths of children under 1 month
of age/1,000 live births

MORBIDITY
Decrease the prevalence of third de­
gree malnutrition among children
under age 3 by 30% by September
1995
Indicator:
number of cases of third degree malnutrition
among children <3 years of age
total number of children <3 years of age

Module 1: FG; session 2; transparency 1-13A

SAMPLE HEALTH
GOALS (continued)
DISABILITY
Decrease the incidence of polio
among children under age 5 to 0
(zero) by the year 2000
Indicator:
number of new polio cases among children
<5 years old
Total number of children < 5 years of age

FERTILITY
Reduce the total fertility rate of
women in the programme area to
4.5 by the end of 1996
Indicator:
total number of births to women 15-45 years old
total number of women 15-45 years old

Module 1: FG; session 2; transparency 1-13B

48

METHODS FOR
COLLECTING
MORBIDITY/
MORTALITY DATA
Vital event registration systems
"Sentinel" systems

Special surveys
Case/outbreak investigations

Module 1: FG; session 2; transparency 1-14

TYPES OF COST
ANALYSIS
Total costs
Expenditures compared to budget
Costs by line item
Costs by site, facility, location
Trends in cost over time
Projection of future costs
Average costs
Revenues
Break-even analysis

Module 1: FG; session 2; transparency 1-15

51

Session 3: Setting priorities
Objectives:

Participants will be able to:
• Set priorities among information needs using
the directions in the Module 1 User’s guide.
• Prepare an action plan for using the MAP
modules selected to help them address priority
information needs.

Session outline:

I.
11.

Materials:

Module 1 User’s guide
Transparency 1-16: Session 3 objectives

Equipment:

Flip chart, stand, markers, masking tape, over­
head projector and screen

Module 1: FG; session 3

Introduction (5 minutes)
Step 4: Summarize information priorities
(25 minutes)
III. Next steps (20 minutes)
IV. Closure (10 minutes)

52

Session 3: Setting priorities
I. Introduction (5 Minutes)

Transparency 1-16:
Session 3 objectives

• Review session objectives.
.Explain the session activities briefly.

II. Step 5: Summarise information priorities (25 Minutes)

• Summarise the steps that have been accom­

plished so far:
Listing the PHC health and management
services that comprise the programme and
selecting priority services in each category.
Defining the principal inputs, processes, and
outputs for the priority services and recording
these on Worksheet A along with the target
group for each health service.
Identifying needed information for planning
and monitoring those services by answering
10 questions and recording the needed infor­
mation on Worksheet B.
• Explain that the next step is to set priorities
for needed information as all needs cannot be
addressed at once.
• Outline the steps in priority setting.
Each small group will list the information
needs for the priority service they were as­
signed on a flip chart.
All flip charts will be assembled so they are
visible to all participants.
Next the large group will establish criteria
for selecting priorities and discuss the criteria
so that all participants understand what they
mean.
Individual participants then rate each infor­
mation need according to the criteria.

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Module 1: FG; session 3

53

Session 3: Setting priorities
Note: See the scoring procedures in Appendix A,
Item 2.
• Ask for questions or comments about the

procedure.
• Direct participants to carry out the priority
setting procedure.
Note: While individual participants are scoring
the items, prepare a matrix similar to the one
shown in Appendix A using the criteria selected
by participants.
• Record the scores of each participant.
• Total the scores.
• Put the number of the module that will help

participants collect the needed information
next to that item on the flip chart. These are
the modules that participants will work on
next.
• Ask for final questions or comments about
Module 1 and the process of identifying infor­
mation needs.
III. Next steps (20 Minutes)
• Ask participants to list the steps necessary to

begin work on the next module, recording
each step on a flip chart as it is named.
• When all steps are listed, ask participants to
arrange them in sequence.
• Next, have participants assign a tentative
completion date to each step and indicate the
name of the responsible person.

Module 1: FG; session 3

&

54

Session 3: Setting priorities

Show Transparency 1-3:
Workshop objectives

• Review the workshop objectives
. Review the list of participant expectations

you recorded on a flip chart in Session 1 and
ask participants to indicate the extent to
which they were met
• Thank participants for their attention and
hard work.

® ® isi

IV. Closure (10 Minutes)

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55

SESSION 3: OBJECTIVES
•

Set priorities for
information needs

•

Prepare an action plan

Module 1: FG; session 3; transparency 1-16

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PHC MAP MANAGEMENT COMMITTEE
Dr. Ronald Wilson • Aga Khan Foundation, Switzerland (Co-Chair)
Dr. Jack Bryant • Aga Khan University, Pakistan (Co-Chair)
Dr. William Steeler • Secretariat of His Highness the Aga Khan, France (Co-Chair)
Dr. Jack Reynolds • Center for Human Services, USA (PHC MAP Director)
Dr. David Nicholas • Center for Human Services, USA
Dr. Duane Smith • Aga Khan Foundation, Switzerland
Dr. Pierre Claquin • Aga Khan Foundation, Switzerland
Mr. Aziz Currimbhoy • Aga Khan Health Service, Pakistan
Mr. Kabir Mitha • Aga Khan Health Service, India
Dr. Nizar Verjee • Aga Khan Health Service, Kenya
Ms. Khatidja Husein • Aga Khan University, Pakistan
Dr. Sadia Chowdhury • Aga Khan Community Health Programme, Bangladesh
Dr. Mizan Siddiqi • Aga Khan Community Health Programme, Bangladesh
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Yawarat Porapakkham • ASEAN Institute for Health Development, Thailand
Dr. Jumroon Mikhanorn • Somboon Vacharotai Foundation, Thailand
Dr. Nirmala Murthy • Foundation for Research in Health Systems, India

PHC MAP TECHNICAL ADVISORY COMMITTEE

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Dr. Nirmala Murthy • Foundation for Research in Health Systems, India (Chair)
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Al Henn • African Medical and Research Foundation (AMREF), formerly of
the Harvard Institute for International Development
Dr. Siraj-ul Haque Mahmud • Ministry of Planning, Pakistan
Dr. Peter Tugwell • Faculty of Medicine, University of Ottawa, Canada
Dr. Dan Kaseje • Christian Medical Commission, Switzerland, formerly of the
University of Nairobi, Kenya

KEY PHC MAP STAFF AT THE CENTER FOR HUMAN SERVICES
Dr. Jack Reynolds (PHC MAP Director)
Dr. Paul Richardson
Dr. David Nicholas
Dr. Wayne Stinson
Ms. Maria Francisco

Dr. Neeraj Kak
Ms. Lori DiPrete Brown
Ms. Pam Homan
Dr. Lynne Miller-Franco
Ms. Mary Millar
Media
10630.pdf

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