PLANNING AND ASSESSING HEALTH WORKER ACTIVITIES
Item
- Title
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PLANNING
AND ASSESSING
HEALTH WORKER ACTIVITIES - extracted text
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Primary Health (are Management Advancement Programme
PLANNING
AND ASSESSING
HEALTH WORKER ACTIVITIES
MODULE 3
FACILITATOR’S GUIDE
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.
WC/ioo
093 31 ^3
Contents
FOREWORD ............................................................................................ 1
SESSION 1: INTRODUCTION AND OVERVIEW .......................... 7
Transparencies
3-1: Workshop objective.................................................................... 12
3-2: Steps in PHC work planning .................................................... 13
SESSION 2: CATCHMENT AREA AND PRIORITY NEEDS
(STEPS 1 AND 2)..................................................................................... 15
Transparencies
3-3: Session 2: Objectives...................................................................21
3-4: Work planning steps...................................................................22
3-5: A catchment area ...................................................................... 23
3-6: Village/community level information ....................................... 24
3-7: Larger catchment area information ......................................... 25
3-8: Information sources ...................................................................26
3-9: Purpose of mapping...................................................................27
3-10: Purpose of a community/village register ................................28
3-11; Data sources............................................................................... 29
3-12: Indicator categories ...................................................................30
3-13: Sources of indicator information.............................................. 31
SESSION 3: SET PRIORITIES AMONG HEALTH PROBLEMS
AND IDENTIFY HIGH-RISK GROUPS (STEP 3) .......................... 37
Transparencies
3-14: Session 3: Objectives................................................................... 42
3-15: Examples of ranking criteria...................................................... 43
3-16: Relative and attributable risks .................................................. 44
Module 3: FG; contents
if
3-17: Sources of demographic information ....................................... 45
SESSION 4: PLAN PHC ACTIVITIES (STEP 4) ............................ 49
Transparencies
3-18: Session 4: Objectives ................................................................ 55
3-19; Deciding activities and strategies ............................................ 56
3-20: Types of activities ...................................................................... 57
3-21: Formulae to determine staff requirements ..............................59
3-22: Tools for planning community-based and
outreach activities...................................................................... 62
SESSION 5: DEVELOP JOB DESCRIPTIONS AND
RECRUIT STAFF (STEP 5) .................................................................. 65
Transparencies
3-23: Session 5: Objectives.................................................................. 68
3-24: Purposes of a job description.................................................... 70
3-25: Test questions............................................................................. 72
SESSION 6: DEVELOP WORK PLANS AND
ASSESS PERFORMANCE (STEPS 6 AND 7)................................. 73
Transparencies
3-26: Session 6: Objectives.................................................................. 79
3-27: Advantages of work plans......................................................... 80
3-28: Principles of work planning ......................................................81
3-29: Purposes of performance assessments..................................... 82
3-30: Performance assessment principles ......................................... 83
3-31: Suggested performance assessment process............................ 84
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Module 3: 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 3: FG; foreword
2
acquaint the participants with the organisation and content of the User’s
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 Facilitator’s 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 3: FG; foreword
3
An example of a PHC management team in the private sector is the
core staff of 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.
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?
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
Module 3: FG; foreword
4
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 3: 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; all participants
around one table; participants in groups of three or four at smaller tables?
• Is the lighting adequate9
° 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.
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Module 3; FG; foreword
Session 1: Introduction and overview
Objectives:
Participants will be able to:
o Explain the purpose of Module 3.
° Describe at least two limitations of Module 3.
° Explain the steps involved in planning and
assessing health worker activities.
Session outline:
1. Introduction (30 minutes)
II. Overview of workshop (10 minutes)
Ill. Purpose of Module 3 (20 minutes)
IV. Module 3 User’s guide (5 minutes)
Materials:
Module 3 User’s guide
Handout 3-1:
Agenda
Transparency 3-1: Workshop objectives
Transparency 3-2: Steps in PHC work plan
ning
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 3: FG; session 1
s
Session 1: Introduction and overview
I.
Introduction (30 minutes)
Note: Omit Section I if you have presented Mod
ule 1, or some other module, immediately prior to
the presentation of Module 3.
Name tags
or place cards
Flip chart
A. OPENING REMARKS
® Introduce self and other staff, as necessary.
0 Explain your role in the workshop.
0 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 or 8, you may
wish to have them wear name tags or place cards
with their names at places where they are sitting.
° Ask each participant to complete this sen
tence: "As a result of attending this workshop,
I expect..." and write their responses on the
flip chart.
° When all responses have been recorded, say
that you will return to this list after giving an
overview of the workshop.
B. OVERVIEW OF PHC MAP
0 Explain why information is important for
PHC programmes.
• Summarise PHC MAP programme, includ
ing:
Purpose of PHC MAP
Title and purpose of each module and other
materials.
• Make the following points about PHC MAP:
Has been field tested and revised to ensure
usefulness to PHC programme staff.
Module 3: FG; session 1
9
Session 1: Introduction and overview
Modules can be used in any sequence.
Checklists and other materials can, and
should, be adapted to fit a particular situation.
The procedures outlined in the modules can
be adopted as routine monitoring activities in
a PHC programme.
° Explain why MAP is being introduced in this
PHC programme.
Note: The remarks here should be tailored to the
specific programme and should provide the an
swers 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.
IL Overview of workshop (10 minutes)
Transparency 3-1:
Workshop objectives
Handout 3-1: Agenda
0 Review the workshop objectives.
0 Distribute and review the workshop
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.
Suggest, if possible, alternatives for meet
ing the expectations that will not be met in
this workshop.
• Ask for questions or comments.
III. Purpose of Module 3 (20 minutes)
• Explain that the purpose of Module 3 is to
help PHC programme staff to:
Module 3: FG; session 1
10
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Set priorities for meeting community health
needs.
Develop realistic workplans to ensure that
health workers spend their time most effec
tively to meet those needs.
Improve assessment of health worker per
formance.
° Explain that Module 3 does not
Deal with overall PHC programme planning.
Discuss ways to involve communities, al
though community members should be in
volved in setting priorities and evaluating pro
gress.
Provide a comprehensive approach to per
sonnel management.
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Session 1: Introduction and overview
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• Review briefly the steps in Module 3, includ
ing substeps and expected outcomes.
• Ask for questions or comments.
1
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Transparency 3-2:
Steps in PHC work
planning
BB
° Distribute a Users guide to each participant.
° Highlight key sections of the User’s guide:
The overview of PHC MAP with the descrip
tion of modules and other materials, which
they may wish to refer to for review of infor
mation needs met by other modules.
Step-by-step directions for developing work
plans, individual assignments, and perform
ance assessment procedures.
Appendices containing blank worksheets
and other reference material.
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Module 3 User’s guide
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IV. Module 3 User’s guide (5 minutes)
Module 3: FG; session 1
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SAMPLE AGENDA
MODULE 3*
Session 1
(1 hr, 5 mins)
Introduction and
overview
Session 2
(1 hr, 30 mins)
Map catchment area and
identify priority needs
(Steps 1 & 2)
Session 3
(1 hr, 30 mins)
Set priorities among health
problems and identify high-risk
groups
(Step 3)
;
Session 4
(1 hr, 40 mins)
Plan PHC activities
(Step 4)
Session 5
(1 hr, 20 mins)
Develop job descriptions and
recruit staff
(Steps 5)
Session 6:
(1 hr, 25 mins)
Develop work plans and assess
performance
(Step 6 & 7)
’For an actual presentation, substitute the appropriate clock hours in the first column.
Module 3: FG; session 1; handout 3-1
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12
WORKSHOP OBJECTIVES
1. Set up a system that identifies the
PHC programme’s various target
populations, determines their health
needs and sets priorities among those
needs
2. Design simple and effective procedures
to increase health services coverage of
high-risk groups through planning and
assessing of health worker activities
Module 3: FG; session 1; transparency 3-1
13
STEPS UN PMC WORK
PLANNING
Step 1:
Describe and map catchment
area
Step 2:
Identify community needs
and available resources
Step 3:
Set priorities among
health problems and
identify high-risk groups
Step 4:
Plan PHC activities
Step 5:
Develop job descriptions
and recruit staff
Step 6:
Develop individual work
plans and schedules
Step 7:
Assess job performance
Module 3: FG; session 1; transparency 3-2
15
Session 2: Catchment area and priority
needs (Steps 1 and 2)
■Objectives:
Participants will be able to follow the directions
in the Module 3 User’s guide to:
s Define and describe the catchment area and
the target population that the PHC pro
gramme serves.
» Identify community needs and available re
sources.
° Set priorities among health care needs and
identify groups at highest risk.
Session outline:
I. Introduction (5 minutes)
II. Describe and map catchment area (40
minutes)
111. Identify community needs and available re
sources (45 minutes)
Materials:
Module 3 User’s guide
Transparency 3-3: Session 2: Objectives
Transparency 3-4: Work planning steps
Transparency 3-5: Definition of catchment
area
Transparency 3-6: Village/community level
information
Transparency 3-7: Larger catchment area in
formation
Transparency 3-8: Information sources
Module 3: FG; session 2
16
Transparency 3-9: Purpose of mapping
Transparency 3-10: Purpose of a community/
village register
Transparency 3-11: Data sources
Transparency 3-12: Indicator categories
Transparency 3-13: Sources of indicator infor
mation
Handout 3-2:
Worksheet for defining
catchment area
Handout 3-3:
Worksheet for describing
catchment area
Handout 3-4:
Village register
Handout 3-5:
Worksheet to make a
house hold register
Handout 3-6:
Worksheet for determin
ing indicators and their
source
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 3: FG; session 2
17
Session 2: Catchment area and priority needs (Steps 1
and 2)
I. Introduction (5 minutes)
Transparency 3-3:
Session 2: Objectives
transparency 3-4:
Work planning steps
II.
0 Review the session objectives.
° Review the steps to be completed in this
session.
Describe and map catchment area (4-0 minutes)
Transparency 3-5:
Definition of catchment
area
Handout 3-2; Worksheet
for defining catchment
area
Transparency 3-6 and
3-7: Village/community
level, and larger catchment
Transparency 3-8:
Information sources
Handout 3-3: Worksheet
for describing catchment
area
Transparency 3-9:
Purpose of mapping
Module 3: FG; session 2
° Explain that the purpose of this step is to:
Define and describe the catchment area and
target population.
Develop a register of households and/or
individuals in the catchment area.
° Define catchment area.
® Distribute the worksheet and direct partic
ipants to complete the worksheet for their
catchment area. (Exhibit 1, User’s guide, ap
pendix E)
• Explain the types of information needed to
describe a village or community level catch
ment area and larger catchment areas.
Review some possible sources of this infor
mation.
Distribute worksheet and direct partici
pants to fill in the information they have for
their PHC catchment area. (Exhibit 2, User’s
guide, appendix E)
• Review the purpose of mapping catchment
areas.
IB
18
Session 2: Catchment area and priority needs (Steps 1
and 2)
Explain that more than one map may be
required depending on the level of service
delivery and review the information that
should be depicted on each.
District level
Health facility level
Community/village level
Say that it may be useful to show target
populations for different PHC services.
Direct participants to make at least one
User’s guide
type of map of their catchment area, referring
to Exhibits 1 and 2 and Appendix A as neces
sary.
°
Explain
the purpose of making a commu
Transparency 3-10:
Purpose of a
nity/village register.
community/village register
Refer participants to Exhibit 6, and review
User’s guide
the information it contains.
Distribute handout and review the infor
Handout 3-4: Village
register
mation that may be included. (Exhibit 6, User’s
guide, appendix E)
Direct participants to compare the handout
to their own village register (if available) and
discuss differences, if any, or begin to prepare
a village register based on the information
they have.
Explain that someone should be assigned
to maintain the register so that information is
always current.
• Explain that a household register can help
identify individuals or underserved groups in
need of a specific type of PHC service.
Refer participants to Exhibit 7, and review
User’s guide
the information required for household regis
ters.
IB
Module 3: FG; session 2
18
Session 2: Catchment area and priority needs (Steps 1
and 2)
Explain that more than one map may be
required depending on the level of service
delivery and review the information that
should be depicted on each.
District level
Health facility level
Community/village level
Say that it may be useful to show target
populations for different PHC services.
Direct participants to make at least one
User's guide
type of map of their catchment area, referring
to Exhibits 1 and 2 and Appendix A as neces
sary.
» Explain the purpose of making a commuTransparency 3-10-.
Purpose of a
nity/village register.
community/village register
Refer participants to Exhibit 6, and review
User’s guide
the information it contains.
Distribute handout and review the infor
Handout 3-4: Village
register
mation that may be included. (Exhibit 6, User’s
guide, appendix E)
Direct participants to compare the handout
to their own village register (if available) and
discuss differences, if any, or begin to prepare
a village register based on the information
they have.
Explain that someone should be assigned
to maintain the register so that information is
always current.
• Explain that a household register can help
identify individuals or underserved groups in
need of a specific type of PHC service.
Refer participants to Exhibit 7, and review
User’s guide
the information required for household regis
ters.
Module 3: FG; session 2
19
Session 2: Catchment area and priority needs (Steps 1
and 2)
Handout 3-5: Worksheet
to make a household
register
Explain how household registers are used
to determine the size of the target population
for a specific PHC service.
Explain that if a household register cannot
be made the target population can be esti
mated using demographic or census data.
Note: Be prepared to demonstrate how this is
done if the participants cannot describe the
process to you.
Distribute the handout and direct partic
ipants to complete it. (Exhibit 7, User’s guide,
appendix E and page 35 of this FG.)
If participants do not have the information
to complete a register for one household, lead
them in a discussion of the relevance of the
information and how they would modify it to
fit their situation, if at all.
• Ask for questions and comments.
III. Identify community needs and available resources (45
minutes)
Transparency 3-11:
Data sources
Module 3: FG; session 2
• Explain that this step is important because it
enables a PHC programme to:
Identify community needs based on various
data sources.
Identify resources that will help in providing
better service.
• Review some possible sources of information
about community needs and available re
sources.
• Assist participants in selecting indicators
necessary to assess the health status in their
community.
20
Session 2: Catchment area and priority needs (Steps 1
and 2)
User’s guide
Transparency 3-12:
Indicator categories
Handout 3-6: Worksheet
for determining
indicators and their
source
Transparency 3-13:
Sources of indicator
information
Handout 3-6: Worksheet
for determining
indicators and sources of
indicators
Explain that this information will help in
setting priorities and determining strategies.
Discuss the four types of information that
these indicators will measure.
Distribute worksheet and direct partici
pants to fill in the first column. (Exhibit 8,
User’s guide, appendix E)
Facilitate a discussion of what indicators
were chosen and why.
° Review possible sources of information for
the indicators selected. State that similar
sources were used to obtain information about
needs and resources.
° Direct participants to complete Handout 3-6.
° Based on the indicators selected, assist par
ticipants in developing a survey instrument
about the community and the health facilities.
° Refer participants to Appendix C and Module
2 for examples of questionnaires that can be
modified to fit their needs.
° Ask for questions and comments.
Module 3: FG; session 2
21
SESSION 2: OBJECTIVES
1. Define and describe catchment area
and target population
2. Identify community needs and available
resources
3. Set priorities among health care needs
and identify groups at highest risk
Module 3: FG; session 2; transparency 3-3
22
WORK PLANNING STEPS
1. Describe and map catchment area
1.1 Define catchment area
1.2 Describe catchment area
1.3 Map catchment area
1.4 Make a village register
1.5 Make a household register
2. Identity community needs and
available resources
2.1 Select indicators
2.2 Identify sources of information
2.3 Develop a survey instrument
Module 3: FG; session 2; transparency 3-4
s
23
A CATCHMENT AREA ...
• is the geographical area surrounding a
single health facility or group of health
facilities
o includes the target population
o is determined by the type of PHC
service or by geographical or
administrative boundaries
Module 3: FG; session 2; transparency 3-5
24
VSLLAGE/COMMUNHTY
LEVEL EWORMATHON
o Number of individuals/households in
the area
o Age, gender, ethnic group, health status
of household members
® Socio-economic status
o Social activities
• Size and terrain; roads
Bi
Module 3: FG; session 2; transparency 3-6
25
© Roads, transport, cost
@ Social differences
o Industry
o Listing of communities
Module 3: FG; session 2; transparency 3-7
26
E
c
INFORMATION SOURCES
R
s.
© Government offices
® Village registers
r~—
gg
gfc
© Household registers
~
® Community surveys
r
• Interviews and observations
ku
fc
E
E
Bf-
Module 3: FG; session 2; transparency 3-8
g—
27
PURPOSE OF MAPPING
© Plan work assignments
© Conduct surveys
© Monitor services
Q
Determine physical parameters of
service coverage
Module 3: FG; session 2; transparency 3-9
28
£
PURPOSE OF A
COMMUNSTY/VELLAGE
REGISTER
'
“
t'
i
B
Helps identify ethnic, religious, or
social groups; and health facilities
which serve the communities/villages
gy
er
B
ss
6&
£
BE
B
B
Module 3: FG; session 2; transparency 3-10
lES
29
DATA SOURCES
© Existing records
® Surveys
© Interviews with community members
Module 3: FG; session 2; transparency 3-11
30
£
INDICATOR CATEGORIES
® Health problem indicators
©
©
®
©
simple frequencies
community perceptions of priorities
prevalence rates
mortality rates
o Demographic indicators
o
o
o
o
population composition
age-sex distribution
sex ratio
number of births and deaths
® Risk factor indicators
o
©
©
•
•
environmental
biological
socio-economic
behavioural
health care related
• Indicators of existing health services
and available resources
type and quality of health services
number of health providers
access to health services and supplies
community perceptions
other resources, such as transportation and human
resources
Module 3: FG; session 2; transparency 3-12
£
£
31
SOURCES OF ENOECATOR
INFORMATION
® Existing data sources
© Interviews
o Observations
Module 3: FG; session 2; transparency 3-13
Exhibit 1: Worksheet for defining catchment area
a) Select criteria to define the boundaries of your catchment area.
Fixed distance of
X
kms around health facility
Administrative unit (specify level and name)
Panggang (sub district)
in Gunung Kidul (district)
PHC service target group, socio-economic or geographically defined population
A practically defined population (please specify)
b) Define sub-catchment areas for different services:
Module 3: FG; session 2; handout 3-2
Curative care
X
MCH
X
Family planning
TB
Other
?? (? (” Jf OJLfiJUU?■»MlIf■mj!
■ ■ ■ ■RO
™ '1
LVI M MlMIMtW H■
Module 3: FG; session 2; handout 3-3
Exhibit 2: Worksheet for describing catchment area
Level
Information
Data sources
District level
Number of facilities
Name of facilities
Government offices
Government offices
Facility level
Name of villages
Number of villages
Village registers
Village registers
Location of facility(s)
Village registers
Size & terrain of area
Observation
Number of households
position of HHs
Household registers
Household registers
Sources of income
Community surveys
Educational levels
Religion/ethnicity
Status of houses/roads
Distance to health facility
Community surveys
Community surveys
Interviews and observations
Interviews and observations
Village level
Exhibit 6: Village register
District:
S. No
Village
No. of
house
holds
Population
__ ____________ Sub-district:__________________
Local
Health
leaders volunteers
Distance
to health
facility
Being
Priority
(Km.)
addressed
Health problems
Public
transport Others
available remarks
f/fhw kwiiwnwnwnwriwhw ■ ■ ■ ■ ■ anw■« u h iwnvnwnvm
JM! ® Hi jii ’si)
igi Hl uaj is) lai li ta lai lai & & @ & lai isU
Module 3: FG; session 2; handout 3-5
Exhibit 7: Household register
Sector #/House #/ Household #:
Name of head of household:
Household income:
ID No
Name
Date of birth Sex
Father’s/
M/F
*
/age
husband’s name
Registration date:
Occupation:
Centre name:
Chronic
health
problem
Date of:
Death
Risk profile of Household
At least 1 child < 1 yr
>2 Infant deaths in past 5 yrs
>2 children < 5 yrs
Illiterate women
Restriction on mobility of
women
Presence of TB case
Low family income
Improper/no use of toilet
facilities
’ List oldest member first and youngest last
Total
Remarks
Migration
out
Score if
present
1
2
1
2
1
1
1
1
Score
36
Exhibit 8: Worksheet for determining indicators
and sources of indicators
INDICATORS
SOURCE
I. Health status indicators
Clinical
Prevalence rates
Age-specific morbidity rates
Frequency of cause of deaths
Cause-specific mortality rate
Community survey
Clinic/hospital records
Community survey
Community survey
Community survey
Verbal autospy
Verbal autospy
IL Demographic indicators
Age distribution
Sex ratio
CBR
CDR
Community survey
Village household registers
Community survey
Village household registers
Community survey
Village household registers
Community survey
Village household registers
III.Risk factors
Biological
- malnutrition
- immunization status
Environmental
- water
- sanitation
Socio-economic
- literacy
- behavioural
MCH card
MCH card
Observation
Observation
Community survey
Community survey
IV.Health service related
Quantity
Quality
Accessibility
- distance
- cost
Facility survey
Facility survey
Community survey
Community survey
Module 3: FG; session 2; handout 3-6
37
Session 3: Set priorities among health
problems and identify high-risk groups
(Step 3)
Objectives:
Participants will be able to follow the directions
in the Module 3 User’s guide to set priorities to
enable their programme to:
° Provide equitable health care;
° Increase the frequency of services for those in
greater need.
Session outline:
I. Introduction (5 minutes)
II. Set priorities among health problems (20
minutes)
III. Determine the risk factors (20 minutes)
IV. Set priorities for the risk factors (20 minutes)
V. Identify target groups and high-risk groups
(10 minutes)
VI. Use risk factors to monitor high-risk groups
(15 minutes)
Materials:
Module 3 User’s guide
Transparency 3-14: Session 3: Objectives
Transparency 3-15: Examples of ranking cri
teria
Transparency 3-16: Relative and attributable
risks
Transparency 3-17: Sources of demographic
information
Module 3: FG; session 3
38
Handout 3-7:
Handout 3-8:
Handout 3-9:
Equipment:
Worksheet for setting pri
orities among health
problems
Worksheet for setting pri
orities among risk factors
Worksheet for developing
risk profiles of households
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 3: FG; session 3
39
Session 3: Set priorities among health problems and
identify high-risk groups (Step 3)
Introduction (5 minutes)
I.
Transparency 3-14:
Session 3: Objectives
° Review session objectives.
o State that this step should be conducted by the
PHC team and the community, but for the purposes
of this training, it will be done by the participants.
Set priorities among health problems (20 minutes)
II.
Transparency 3-15:
Examples of ranking
criteria
User’s guide
Handout 3-7: Worksheet
for setting priorities
among health problems
III.
® Explain that one method of setting priorities
among health problems is by ranking specified
criteria, and explain the purpose of each criterion.
o Review the information in Exhibit 9, and
explain the difference between multiplicative
and additive scores.
® Distribute Handout 3-7, and assist partici
pants in completing it for their programme.
(Exhibit 9, User’s guide, appendix E)
Determine the risk factors (20 minutes)
o Explain that identifying risk factors will help
in developing appropriate strategies for health
promotion, disease prevention, and the reduc
tion of morbidity, disability and mortality.
• Explain that determination of priority risk
factors should be based on research and data
from the programme site.
• Review broad classifications of risk factors:
-Biological
-Environmental
-Socio-economic
-Behavioural
-Health-care related
Module 3: FG; session 3
40
Session 3: Set priorities among health problems and
identify high-risk groups (Step 3)
Transparency 3-16:
Relative and attributable
risks
0 Assist participants in determining the prior
ity risk factors for their programme.
o Define relative risk and attributable risk, and
explain that these will help determine the
magnitude of risk associated with each factor
identified. (Refer to Appendix B.)
® Assist participants in calculating the relative
and attributable risks for at least one of the
factors they have identified.
Note: If incidence data is not availablefor individ
ual programmes, the Facilitator should provide an
example for participants to work from.
° Ask for questions and comments.
IV. Set priorities among the risk factors (20 minutes)
Handout 3-8:
Worksheet to set
priorities among risk
factors
° Explain that a process similar to the one just
used to set priorities among health problems
can also be used to set priorities among the
risk factors identified.
0 Review modifications to be made for this
process.
• Distribute Handout 3-8 and instruct par
ticipants to complete it for at least one of the
risk factors they have identified.
• Facilitate a discussion about which risk fac
tors were prioritised and why.
V. Identify target groups and high-risk groups (10 minutes)
• Explain how the identification of priority
target groups and high-risk groups are related.
Module 3: FG; session 3
41
Session 3: Set priorities among health problems and
identify high-risk groups (Step 3)
Transparency 3-17:
Sources of demographic
information
User’s guide
° Review sources of demographic information
to be used in the identification of individuals
or households in the target groups.
° Review the example of the maternal health
record card, as an example of a mechanism for
identifying individuals or households.
® Assist participants in identifying individuals
or households that will be the target of their
PHC services, as well as those who are at
higher risk.
° Discuss why this selection was made. This
selection should be consistent with the priori
ties identified by the participants.
VI. Use risk factors to monitor high-risk groups (15 minutes)
User’s guide
Handout 3-8: Worksheet
to develop risk profiles of
households
Module 3: FG; session 3
° Explain the purpose of a risk profile and how
to create one.
0 Explain that groups with high risk scores
(based on the risk profile) are at high risk of
morbidity and mortality.
• Review binomial scoring (0 or 1) and weight
ing.
• Review and explain the information con
tained in Exhibit 11.
• Distribute Handout 3-9, and direct partic
ipants to develop a list of risk conditions and
then complete the worksheet. (Exhibit 11,
User’s guide, appendix E)
• Explain that based on these scores, PHC
services should be organised according to the
special needs of the high-risk groups.
• Ask for questions or comments.
42
SESSION 3: OBJECTIVES
Participants will be able to follow the
directions in the Module 3 User’s guide
to set priorities to enable their
programme to:
1. provide more equitable health care
2. increase the frequency of services for
those in greater need
Module 3: FG; session 3; transparency 3-14
^■2
43
EXAMPLES OF RANKING
CRiiTEIMA
@ seriousness of the disease
• prevalence of the disease
• feasibility of control
© community acceptance
Module 3: FG; session 3; transparency 3-15
RELATIVE AKE; AJTRJIBUTABLE
REEKS_______________________
Relative risk:
Module 3: FG; session 3; transparency 3-16
Relative risk =
Attributable risk:
Attributable risk =
measures association between a
characteristic and the disease. It is
calculated as follows:
Incidence of disease in an exposed group
Incidence of disease in an unexposed
group
measures the additional incidence of
disease following exposure over and
above that experienced in an
unexposed group. It is calculated as
follows:
Incidence in an unexposed group
Incidence in an exposed group
s
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w
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is
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45
SOURCES OF
DEMOGRAPHIC
INFORMATION
® Household registers
® Surveys
® Adnvrustr&iive records
® Interviews of key persons
Module 3: FG; session 3; transparency 3-17
Exhibit 9: Worksheet for setting priorities among
health problems
S
!
1
u
8
j
u
w
Seriousness
Feasibility
of control
Community
acceptance
Additive
sources
Multiplicative
scores (X)
i
''
1
1
!
;
C
C
)
V
u‘
1Q
L£j
Health Problems
Malnutrition
3
3
3
2
11
54
Diarrhoea/
dehydration
3
4
2
4
13
96
Cancer
1
4
1
4
10
16
AIDS
2
4
1
3
10
24
Module 3: FG; session 3; handout 3-7
rwi
fl
l:’i
il li
m rw] n»] rw. rw PT■ ffl
ill
lifl
ii~|.
if i!
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O
1111
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ini
fh
ill:
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fill
IWI
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iiil ial iMi iai 'Ml 'Ml 'MJ Mi Mi M Mi
Module 3: FG; session 3; handout 3-8
Worksheet for setting priorities among risk factors
Health
problems
Prevalence
Seriousness
Feasibility
of control
Community
acceptance
Additive
scores (+)
Multiplicative
score (x)
Exhibit 11: Worksheet to develop risk profiles of
households
SCORE IF
PRESENT
CONDITIONS
HOUSEHOLD No
Module 3: FG; session 3; handout 3-8
Number of infant deaths in past 5 years
*
1
1
1
0
Number of children under the age of 5
*
3
1
1
1
Illiterate mother
1
1
1
0
1
Culture/religious restriction on mobility of women
1
1
1
1
0
Presence of infectious diseases (e.g., TB)
1
0
1
0
0
Low family income (below locally accepted level)
1
1
1
1
1
Improper/no use of toilet facilities
*
1
1
0
1
0
8
6
5
3
Total risk score
’ Weight determined by number of children
Rating scale:
W,
* hzwII iff i!
V V.
li t.
Low risk
Moderate
risk
High risk
0-3
4-6
>7
i't i?in: in inf rf o in
inf n o o ini n o i. >
in. ?>.t
49
Session 4: Plan PHC activities (Step 4)
Objectives:
Participants will be able to follow the directions
in the Module 3 User’s guide to:
° Plan outreach activities for groups at risk for
a priority health problem in their PHC pro
gramme.
° Plan clinic-based services for the same target
group.
Session outline:
I. Introduction (10 minutes)
II. Identify strategies and activities (20 minutes)
III. Plan outreach and community-based activi
ties (35 minutes)
IV. Plan clinic-based activities (35 minutes)
Materials:
Module 3 User’s guide
Transparency 3-18: Session 4: Objectives
Transparency 3-19: Deciding activities and
strategies
Transparency 3-20: Types of activities
Transparency 3-21: Formulae to determine
staff requirements
Transparency 3-22: Tools for planning clinic
based activities
Handout 3-10:
Worksheet for identifying
services, strategies and
activities
Handout 3-11:
Worksheet for planning
PHC activities
Module 3: FG; session 4
50
Handout 3-12:
Equipment:
Worksheet to determine
staff requirements
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 3: FG; session 4
51
Session 4: Plan PHC activities (Step 4)
I. Introduction (10 minutes)
Transparency 3-18:
Session 4: Objectives
User’s guide
° Review session objectives.
° Review the information needed to complete
Step 4.
Programme goals, objectives, and strategies
from Module 1.
Assessment of community needs from Mod
ule 2 (for PHCs with large catchment areas).
Selected PHC components from Module 1.
High-risk group(s) from Module 3, Step 2.
II. Identify strategies and activities (20 minutes)
Transparency 3-19:
Deciding activities and
strategies
Transparency 3-20:
Types of activities
User’s guide
• Remind participants about the group nature
of this activity.
• Review decisions that will need to be made
in deciding on how to provide services.
° Define community-based, outreach, and cen
tre-based activities, and provide examples of
each.
0 Refer participants to Exhibit 12 and explain
the information it contains.
Review basic questions that will help in de
ciding how to provide the services selected
'X What overall strategy will be used to provide
/'each service?
Which activities are needed to provide the
service?
.
Who will perform the activities, how, and at
/ what service delivery level?
Module 3: FG; session 4
52
Session 4: Plan PHC activities (Step 4)
Handout 3-10:
Worksheet for identifying
services, strategies and
activities
III.
• Distribute the worksheet and assist partic
ipants in completing it and identifying each
service or component as community-based,
centre-based, or outreach. (Exhibit 12, User’s
guide, appendix E)
® Ask for questions and comments.
Plan outreach and community-based activities (35 minutes)
User’s guide
Transparency 3-21:
Formulas to determine
staff requirements
9 Describe the relationship between commu
nity-based, clinic-based, and outreach activi
ties.
® Refer participants to Exhibit 13 for a chart
showing the information that will be
developed in this session and explain the
information it contains. State that the same
chart for clinic-based services appears on the
following page in the User’s guide
° Explain the substeps involved in this step and
state that although each activity is examined
separately, activities should be viewed as a
whole.
Determine number of units to be covered.
Determine optimal time interval for each
activity.
Determine resource requirements, using the
formulas provided.
Identify an optimal number of visits.
Review guidelines for frequency.
• Develop tools to plan and monitor activities.
Refer participants to models 1-5 presented
in the User’s guide, and assist them to adapt
one to fit their own PHC programme needs.
Module 3: FG; session 4
Fl Pl Fl Fl Fl Fl 'Fl 'Fl Fl Fl F Fl F! Fi fl Fl Fl ■
53
Session 4: Plan PHC activities (Step 4)
Handout 3-11:
Worksheet for planning
PHC activities
SV. Plan clinic-based activities (35 minutes)
Handout 3-12:
Worksheet to determine
staff requirements
=3
3
..-j
*
—“
Transparency 3-22:
Tools for planning
community and outreach
activities
:3
13
• Distribute worksheet and direct partici
pants to list the community-based outreach
services for a health problem of their choice
in the first column. (Exhibit 13, User’s guide,
appendix E)
9 Assist participants in completing sections A
and B of the worksheet, following the substeps
outlined in the User’s guide.
Module 3: FG; session 4
9 Explain the purpose of planning clinic-based
activities:
Supplement field-based preventive services
by providing back-up referral and centralised
preventive services.
Determine the types of services which are
or will be in demand.
• Explain that section C of the worksheet will
be used for recording the outcomes of the
substeps to planning clinic-based services.
• Assist participants to complete the handout,
referring to each substep used to complete it.
• Determine client load.
Distribute handout and explain the two
methods that can be used to calculate demand
for services or project client load.
Determine staff requirements and resource
requirements.
Determine availability of resources.
Compare availability with need and identify
an optimal solution.
Develop tools to plan clinic-based activities.
Refer participants to examples in the
User’s guide and direct them to develop
one for the services they have planned by:
54
Session 4: Plan PHC activities (Step 4)
developing a new form;
modifying a sample form contained in
the User’s guide; or
modifying a form they are currently
using.
• Ask for questions or comments.
if
Module 3: FG; session 4
3
55
’ SESSION 4: OBJECTIVES
1, Plan outreach activities for households
at risk for a priority health problem in
re food orognamme
33
3
2. Plan clinic-based services for the same
target group
3
z3
:3
fl
*
:■>
fl
- fl
Module 3: FG; session 4; transparency 3-18
56
DECIDING ACTWETSES
AND STRATEGIES
• What overall strategy will be used to
provide each service?
© What activities are needed to provide
the service?
o Who will perform the activities?
• How?
• At what level?
if
Module 3: FG; session 4; transparency 3-1
57
TYPES OF ACTIVITIES
Performed Performed
by:
at:
1. Community Community
based
level
Community
members
2. Outreach
Community
I
level
i
j 3. Centre-based Centre
Health
centre staff
Module 3: FG; session 4; transparency 3-20
Health
centre staff
Exhibit 12: Worksheet for identifying services,
strategies and activities
List
Who will do it
—
1
1
—
Activities
Strategy
d ll
Service/
component
How and when
—
Module 3: FG; session 4; handout 3-10
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Module 3: FG; session 4; transparency 3-21
FORMULAB
DETERMnUE
STAFF EL - ' A -bl U
Staff capacity/month = [days/month] x
Staff requirement =
number of units
that can be
covered per day
per worker
units to be covered
staff capacity
Exhibit 13: Planning PHC Activities (continued, p. 61)
SERVICE/ACTIVITIES NEEDED
A. COMMUNITY TARGET
BASED
GROUP
FREQUENCY
MANPOWER
REQUIRED
TYPE
Module 3: FG; session 4; handout 3-11
* w
NUMBER
(FTEs)
LOGISTICS/SUPPLIES
AVAILABLE
REQUIRED
TYPE
AVAILABLE
OPTIMAL
LEVEL OF
SERVICES
GIVEN
RESOURCE
CONSTRAINTS
AMOUNT
B. OUTREACH
IB bi
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!£.
ifi i»' ia is la lai
imi
ia la ia ia ia ia
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Module 3: FG; session 4; handout 3-11
Exhibit 13: Planning PMC Activities
SERVICE/ACTIVITIES NEEDED
C. CLINIC
BASED
TARGET
GROUP
FREQUENCY
MANPOWER
REQUIRED
TYPE
Total
NUMBER
(FTEs)
LOGIST1CS/SUPPLIES
AVAILABLE
REQUIRED
TYPE
AMOUNT
AVAILABLE
OPTIMAL
LEVEL OF
SERVICES
GIVEN
RESOURCE
CONSTRAINTS
62
TOOLS FOBS PLANNING
COMMUNITY-BASED AND
OUTREACH ATOBVnTBES
o CHW activity register
© Pictorial CHW activity record
© Pictorial TBA activity record
• LHV activity register
• Computer lists of individuals who need
a service
Module 3: FG; session 4; transparency 3-22
Ja
iiil
S
la'
la!
a!
a1
Lal
al
si
ial
la!
LaL1
Lal
la!
ia
ijaJ
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!A!
'A
A
A
A
Module 3: FG; session 4; handout 3-12
Exhibit 14: Worksheet to determine staff requirements
Staff capacity per month = days/month x number of units that can be covered/day per worker
Staff requirement =
units to be covered
staff capacity
Note: When determining the number of units that can be covered for
one type of activity in a day, take into account the time it takes to
effectively cover the units for that activity and travel time if needed.
For example, if you were planning LHV’s outreach support visits:
Number of villages in catchment area: 50
Frequency for visiting each village: once a month
Number of working days per month: 25
Number villages that can be visited per day per LHV: 1
Staff capacity per month = 25 x 1 = 25 per LHVs
Staff requirement = —— = 2 full time (FTE) LHVs
LflJ
65
Session 5: Develop job descriptions and
recruit staff (Step 5)
Objectives:
Participants will be able to follow the directions
in the Module 3 User’s guide to:
° Develop job descriptions for the positions
needed to provide planned PHC services.
° Plan to recruit and hire individuals to fill those
positions.
Session outline:
1. Introduction (5 minutes)
11. Develop role and task list (15 minutes)
III. Prepare job descriptions (25 minutes)
IV. Plan staff recruitment (20 minutes)
V. Agree on expectations (15 minutes)
Materials:
Module 3 User’s guide
Transparency 3-23: Session 5: Objectives
Transparency 3-24: Purposes of a job descrip
tion
Transparency 3-25: Test questions
Handout 3-13:
Worksheet for roles and
tasks
Handout 3-14:
Job description worksheet
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 3: FG; session 5
66
Session 5: Develop job descriptions and recruit staff
(Step 5)
L Introduction (5 minutes)
Transparency 3-23:
Session 5: Objectives
8 Review session objectives.
—I I —IBI I I ■■ IIJHWIHHHIIB.WJ I W W BUI I ■ULl'Il**. .1 !!■■■< .Fl
J
IL Develop role and task list (15 minutes)
User’s guide
Handout 3-13:
Worksheet for roles and
tasks
V
.S.-S0
• Explain that the tasks included in pro
gramme plans are the basis for developing job
descriptions
° Refer participants to Exhibit 24 and explain
each section of the role and tasks list.
° Distribute worksheet and direct partici
pants to complete it for at least one staff
position identified in Step 3. (Exhibit 24, User’s
guide, appendix E)
III. Prepare job descriptions (25 minutes)
Transparency 3-24:
Purposes of a job
description
User’s guide
Handout 3-14: Job
description worksheet
Transparency 3-25:
Test questions
° Explain the purposes of a job description.
° Refer participants to Exhibit 25 and de
scribe the information contained in each sec
tion.
• Distribute Handout 3-13 and assist partic
ipants to complete it based on the role and
task list just completed. (Exhibit 25, User’s
guide, appendix E)
• Recommend that participants check that the
job description is realistic and feasible, using
test questions.
Module 3: FG; session 5
67
3(1
Session 5: Develop job descriptions and recruit staff
(Step 5)
B8
IV. Plan staff recruitment (20 minutes)
Flip chart
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30
° Ask participants to list the steps usually followed by their agency when filling a staff
position and record their responses on the
flip chart (be sure they include necessary approvals).
0 Ask participants to speculate on the outcome
of this process given the way the position
description was developed (better, worse, the
same).
• Facilitate a discussion on this point, depending on the time available.
V. Agree on expectations (15 minutes)
3t
0 Describe the intent and purpose of this substep.
• Explain that this activity will lead to the
successful development of individual work
plans (Step 6).
« Ask participants to comment on the extent to
which this process has been done in the past
with new staff and the extent to which it is
done with current staff.
• Ask for questions and comments.
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Module 3: FG; session 5
i h
68
H O
2. Plan to recruit and hire individuals to fill
those positions
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1. Develop job descriptions for the
positions needed to provide planned
PHC services
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Module 3: FG; session 5; transparency 3-23
69
Exhibit 24: Role and tasks list worksheet
PHC programme goals:
Service objectives:
Strategies:
Position
title
Role
Tasks list
Module 3: FG; session 5; handout 3-13
Experience
Ability/skills
70
PURPOSES OF A JJO®
DESCRIFTIiON
o Describe staff roles and tasks needed to
help achieve programme objectives
o Identify skills and experience required
to carry out role and tasks
o Ensure a mutual understanding of
expectations for job performance
Module 3: FG; session 5; transparency 3-24
71
Exhibit 25: Job description and
announcement
1. POSITION TITLE:
2. POSITION STATUS:
2.1 Full-time a. Permanent
2.2 Part-time b. Temporary
3. DATE OF PREPARATION:
4. POSITION SUMMARY
5. REPORT TO:
6. POSITION DIRECTLY SUPERVISED BY INCUMBENT:
7. SPECIFY REQUIREMENTS:
7.1 Education/professional qualifications
7.2 Experience and training
7.3 Knowledge, skills, ability
8. DESCRIPTION OF DUTIES/RESPONSIB1LITIES:
List duties under two separate headings: REGULAR DUTIES and PERIODIC DUTIES
% TIME SPENT:
A. REGULAR DUTIES/RESPONSIB1L1TIES:
B. PERIODIC DUTIES/RESPONSIB1LITIES:
Module 3: FG; session 5; handout 3-14
72
TEST QUESTIONS
:
© Does the job description adequately
reflect programme needs?
Q
Does the job description include all
necessary activities?
o Is the projected work load reasonable?
© Are suitable candidates available?
• Are they likely to apply, given the terms e ■/
and conditions of the job?
jr• Is the job secure; will there be adequate
funding to continue it?
• Are there any other factors that could Srpositively or negatively affect
recruitment of suitable candidates?
in
Module 3: FG; session 5; transparency 3-25
fe-
73
Session 6: Develop work plans and
assess performance (Steps 6 and 7)
Objectives:
Participants will be able to follow the directions
in the Module 3 User’s guide to:
» Develop individual work plans based on
planned PHC activities.
® Plan for performance assessment based on
individual work plans.
• Plan next steps in implementing work plan
ning and performance assessment.
Session outline:
I. Introduction (10 minutes)
II. Develop work plans (20 minutes)
III. Assess job performance (30 minutes)
IV. Next steps (15 minutes)
V. Conclusion (10 minutes)
Materials:
Module 3 User’s guide
Transparency 3-26: Session 6: Objectives
Transparency 3-27; Advantages of work plans
Transparency 3-28: Principles of work plan
ning
Transparency 3-29: Purposes of performance
assessments
Transparency 3-30: Performance assessment
principles
Transparency 3-31: Performance assessment
process
Module 3: FG; session 6
74
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 3: FG; session 6
Session 6: Develop work plans and assess performance
(Steps 6 and 7)
I. Introduction (10 minutes)
Transparency 3-26:
Session 6; Objectives
° Review session objectives.
° List the information needed from prior steps.
Outreach and clinic-based plans for PHC
services from Step 4 which contain pro
gramme objectives and priorities and provide
basis for determining how much time each
worker will spend:
- on each task
- at each site
- with each individual
Individual job descriptions from Step 5,
which define the role and tasks each worker
is responsible for.
II. Develop work plans (20 minutes)
Transparency 3-27:
Advantages of work plans
Transparency 3-28:
Principles of work
planning
Module 3: FG; session 6
0 Review benefits to programme of developing
and using work plans.
• Explain the principles of work planning.
0 Underscore the importance of a team ap
proach to work planning to ensure common
understanding of who is doing what and
coordination among staff when indicated.
• Explain that work plans link programme/
activity planning to what each worker will do.
• Refer participants to work plan examples in
Exhibits 28 and 29 of the User’s guide and
explain each section, emphasising the focus
on job-related performance.
76
Session 6: Develop work plans and assess performance
(Steps 6 and 7)
User’s guide
° Distribute blank work plan and instruct
participants to develop a work plan for at least
one job description.
Develop an annual work plan based on PHC
activity plans from Step 3 and the job descrip
tion developed in Step 4.
Select one of the types of plans just discussed
and develop a one month work plan based on
the annual plan.
Participants will then explain their monthly
plan and the rationale for their choice of work
plan.
Note: The number ofparticipants who do this will
depend on time available.
® Refer participants to examples of work plan
scheduling forms and explain each type.
- Gantt charts
- Time and task charts
- "To do" lists
- Duty rosters
• Ask for questions and comments.
III. Assess job performance (30 minutes)
Transparency 3-29:
Purposes performance
assessment
Transparency 3-30:
Performance assessment
principles
if
• Review the purposes of performance assess
ments.
• Explain that individual work plans provide
the basis for assessing health worker perform
ance.
• Explain the principles of performance assess
ment, and that this tool links programme goals
to health worker activities.
Module 3: FG; session 6
77
Session 6: Develop work plans and assess performance
(Steps 6 and 7)
User’s guide
Transparency 3-31:
Performance assessment
process
° Stress the importance of continuous and
formal performance assessments.
° Refer participants to the sample performance
review form and explain the purpose and
origin of each section. (Exhibit 34, User’s
guide).
a Suggest a process for carrying out the per
formance assessment.
e Lead participants in a discussion of the per
formance review system they have in place,
with these questions:
What procedures are now in place for assess
ing worker performance?
How are they working? Are they being
followed?
What are the strengths and weaknesses of
the present system?
What changes, if any, would you like to
implement?
• Ask for questions or comments.
IV. Next steps (15 minutes)
Transparency 3-2:
Steps in PHC work
planning
Module 3: FG; session 6
° Briefly summarise the steps in this module
and the outcomes of each step.
• Direct participants to review their completed
worksheets and write down the actions that
they need to take when they return to the job
to:
- Complete tasks begun in the workshop.
- Collect more information.
- Implement or improve work planning and
performance assessment in their PHC
programmes.
78
Session 6: Develop work plans and assess performance
(Steps 6 and 7)
■> Ask each participant (or participant team) to
briefly describe the actions they will take when
they return to their jobs.
V. Conclusion (10 minutes)
Flip chart of
expectations from
Session 1
0 Review the expectations participants ex
pressed at the beginning of the workshop and
ask them to assess informally how well they
think those expectations have been achieved.
If any were not achieved, ask how the work
shop could be improved to make that happen.
8 Thank participants for their time and atten
tion, congratulate them on the effort they
put into the workshop, and wish them good
luck in implementing their plans.
Note: Indicate what follow-on assistance will be
available, if appropriate.
Module 3: FG; session 6
79
SESSION 6: OBJECTIVES
® Develop individual work plans for
planned PHC programme activities
© Plan for performance assessment based
on individual work plans
o Plan steps to implement work planning
and assessment
Module 3: FG; session 6; transparency 3-26
80
ADVANTAGES OF WORK
PLANS
© Monitor activities to ensure that:
© planned activities are carried out
o they are carried out in the correct
sequence
o priority tasks are carried out first
• Help the staff manage its time
efficiently
• Maximise programme impact
• Improve coordination among staff
• Facilitate assessment of worker
performance
Module 3: FG; session 6; transparency 3-27
81
PRUNCEPLES OF WORK
PLANNUNG
© Clearly stated objective
o List of ail tasks necessary to achieve the
objective
o Specification of the priority tasks and
activities
• A specific time frame
• Clear indicators
• Specification of resources
Module 3; FG; session 6; transparency 3-28
82
PURPOSES OF
PERFORMANCE
ASSESSMENTS
o Helps staff improve their effectiveness in reaching objectives
o Increases efficiency in carrying out
work
e
E-
© Allows mutual effort at improving job
performance
£■
Sc
Module 3: FG; session 6; transparency 3-29
83
© Focus on improving worker performance
® Supportive rather than critical
© Praises accomplishments as well as
identifies weaknesses
• Educational rather than judgmental
• Regularly and frequently conducted
• A collaboration between the supervisor and
subordinate, not a top-down, parent-child
relationship
• Based on open, frequent communication,
and mutual trust
• Designed to find solutions to problems, not
to fix blame for them
Module 3: FG; session 6; transparency 3-30
84
1. Worker completes work plan and then
consults with supervisor for final
agreement
2. Worker does self-assessment
3. Supervisor does supervisoryassessment
4. Worker and supervisor meet to discuss
performance, identify strengths and
weaknesses, and make adjustments and
set goals for the next period
5. Frequency of reviews depends on
agency policy and worker performance
Module 3; FG; session 6; transparency 3-31
3
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PHC MAP MANAGEMENT COMMITTEE
Dr. Ronald Wilson 0 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. Nizai Verjee 0 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 • ASEA,N Institute for Health Development, Thailand
Dr. Jumroon Mikhanorn • Somboon Vacharotai Foundation, Thailand
Dr. Nirmala Murthy 0 Foundation for Research in Health Systems, India
PHC MAP TECHNICAL ADVISORY COMMITTEE
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
Ke*!
LTOR’S guide
Primary Health Care Management Advancement Programme
- Media
9361.pdf
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