PLANNING AND EVALUATION

EVALUATION
INTRIODUCTION

The increasing demand for medical and health care services, in the face of limited resources
has brought out the need for careful planning and management of health services.

It is a dynamic process which must remain flexible and responsive to the presentation of new
factors.
WHAT IS PLANNING?
Hence planning is “the systematic approach to defining the problem, setting priorities,
developing specific goals and objectives, determining alternative strategies and a method of
implementation.

A plan is a “decision about a course of action” [EC Banfield].

PURPOSES OF PLANNING

1. To match the limited resources with many problems;

2. To eliminate wasteful expenditure or duplication of expenditure;

3. To develop the best course of action to accomplish a defined objective.

STEPS IN PLANNING PROCESS
1. Needs assessment

2. Determining priorities

3. Development of goals, objectives and activities

4. Identification of resource and constraints

5. Alternative strategies

6. Implementation

7. Supervision

8. Evaluation and revision.

 1. NEED ASSESSMENT
A planner should conduct a needs assessment for the following reasons:

1. To define the problem, its extent and severity.

2. To obtain a profile of the target community, to ascertain the causes of the problem.

3. To evaluate the effectiveness of the programme by obtaining baseline information and comparing
with information obtained at a later date.

This is a very costly endeavour. If the funds are not readily available, the planner may coordinat with
the research activities of other agencies interested in obtaining similar health information on the given
population or investigate surveys that have been done in the past by other organisations.
1. NEED ASSESSMENT (CONT….)
The information gathered are:

General information regarding the number of individuals, geographic distribution, diet,

socioeconomic status, ethnic background, public services available, school systems.
Pattern and distribution of dental disease which can be obtained through clinical examination
records, or consult national health survey for data.
Current status of dental health programmes being implemented in that population.
Learn the way policies are developed and decisions are made.
Funds, facilities and labour available.
Preventive dental programme existing in the community like water fluoridation
2. DETERMINING PRIORITIES
Since resources may be limited, priorities are established to allow for the most efficient allocation.
It is used to set priorities among problems and rank solutions.
If priorities are not determined, the programme may not serve those individuals or groups who need
the care most.

Priority is given to:

1. Those who need care most
2. Diseases affecting large number of people
3. High-risk group

Once the target group and disease has been identified based on the dental problem, the type of
programme is established.
3. DEVELOPMENT OF PROGRAM GOALS, OBJECTIVES AND
ACTIVITIES

Programme goals are broad statements on the overall purpose of a programme to meet
a defined problem.
Programme objectives are more specific and describe in a measurable way the desired
end result of programme activities. It should specify the following:

1. What is the nature of the situation or condition to be attained?

2. Extent or magnitude of the situation to be obtained.
3. For whom is it going to be attained?
4. Where is it going to be conducted?
5. The time “at” or “by” which the desired situation or condition is intended to exist.

For example, by the year 2020, more than 90% of the population aged 6 to 17 years in community X will not have
lost any teeth as a result of caries and at least 40% will be caries-free.
3. DEVELOPMENT OF PROGRAM GOALS, OBJECTIVES AND
ACTIVITIES

Programme activities : include the following components:

1. What is going to be done?

2. Who will be doing it?

3. When it will be done?

4. IDENTIFICATION OF RECOURSES AND CONSTRAINTS

Resources

The resources to be considered are personnel, equipment and supplies, facilities and financial
resources needed for the programme. Some of the criteria to determine what resources should be
used includes:

1. Appropriateness: The most suitable resources to get the job done should be selected.

2. Adequacy: Refers to the extent or degree to which the resources would complete the job.

3. Effectiveness: Refers to how capable the resources are at fulfilling the objective.

4. Efficiency: Refers to the cost and the amount of time expended to complete the job.
4. IDENTIFICATION OF RECOURSES AND
CONSTRAINTS

Constraints
The most obvious constraints or obstacles to meeting the programme objectives are
determined. By identifying these constraints early in the planning, one can modify the design
of the programme and there by create a more practical and realistic plan.
Constraints that commonly occur in community dental programmes are:

a. Lack of funding.
b. Inadequate transportation system.
c. Labour shortages.
d. Lack of or inadequate facilities.
e. Negative community attitudes towards dentistry.
f. Lack of time, etc.
5. ALTERNATIVE STRATEGIES:

Being aware of the existing constraints and given available resources, it is important to
generate a number of alternate plans so that at least one may be considered to be
acceptable. With limited resources, the planner needs to consider the anticipated cost and the
effectiveness of each alternative.
6-8. IMPLIMENTATION, SUPERVISION, EVALUATION AND REVISION:

Implementation
The process of putting the plan into operation is referred to as the implementation phase. It
involves individuals, organizations and community. Only through teamwork between the
individuals and the environment can the implementation be successful.
Rules for implementation

1. Specify clearly the activity (who does what and for whom).

2. Be sure that someone is responsible for the whole activity.

3. Identify all the preparatory steps prior to doing the activity (e.g. prepare training manual, prepare
materials, write articles, acquire equipment, train volunteers, determine treatment protocol).

4. List steps in the order in which they must occur and check for missing steps.

5. Determine when each step should begin and end.

6. Consult with organizations affected by the activity, identify potential problems, opportunity, etc.

7. Specify what resources will be needed and their source.

8. Specify what constraints will need to be addressed.

9. Make sure all people involved know what is expected of them and by when.
 SUPERVISION
Once it has been implemented, the programme requires continuous surveillance of all
activities. The programme’s success is determined by monitoring how well the programme is
meeting its stated objectives, how well individuals are doing their jobs, how well equipment
functions, and how appropriate and adequate facilities are.

•Evaluation and revision

Evaluation, both formal and informal, is done in terms of programme structure, techniques or
methods employed and the programme’s impact on the target disease or population. Before
problems arise in any of these areas, revision must be made to fine tune the programme.
CONCLUSION:
Consumers are more involved than ever before in learning about the types of health care they
should be receiving and are actively questioning the choices available to them.

We must be prepared to meet the challenges of the coming years through the development of
good planning skills, which can then be used to achieve the necessary goals for the
betterment of the community.
EVALUATION
Evaluation is the judgement of merit or worth about a particular person, place or thing. In the
context of community activities, evaluation is the collection and analysis of information to

determine the programme performance.

PURPOSE OF EVALUATION
1. To find out how well the programme works, i.e. to measure its success.

2. To provide information for decision making.

3. To measure the effect.

4. If there is a lack of success then modifications are to be done to improve the programme.
CRITERIA
For evaluation of dental services (given by WHO)

Effectiveness: Have the stated objectives been achieved?

Efficiency: What has been the cost in manpower or finance in relation to the output of the
programme?

Appropriateness: Is the programme acceptable to both the consumers and providers and do the
priorities reflect a proper interpretation of the needs of the population?

Adequacy: Has the intended coverage of the target population been achieved and are the services
readily available?
 TYPES OF EVALUATION
According to Scriven, the two types are:
Formative evaluation
Summative evaluation

Formative evaluation: It is an examination of the process or activities of a programme as they are

taking place. It is usually carried out to aid in the development of a programme in its early phases

It is used by programme developers to ascertain whether various components of a programme are

workable or whether changes should be made to improve programme activities.
Summative evaluation: Summative evaluation judges the merit or worth of a programme
after it has been in operation. It is an attempt to determine whether a fully operational
programme is meeting the goals for which it was developed. Summative evaluation is aimed
at programme decision makers, who will decide whether to continue or terminate a
programme.
 ELEMENTS OF EVALUATION
Elements of Evaluation
Relevance: It relates to the appropriateness of the service, whether it is needed at all. If there is no need, the
service can hardly be of any value. For example, vaccination against smallpox is irrelevant because the
disease no longer exist.
Adequacy: It implies that sufficient attention has been paid to certain previously determined course of action.
For example, if staff allocation is such that targets can be achieved without work overload.
Accessibility: It implies whether the patient can reach you easily. The barriers of accessibility may be:

A. physical (distance, travel, time).

B. Economic (travel cost, free charged)
C. social and cultural (caste or language barrier).
Acceptability: The patient has to accept the programme.

Effectiveness: It is a measure to determine, if the objectives have been achieved.

Efficiency: It is a measure of how well resources (money, manpower, material and time) are
utilized to achieve a given outcome.
.
Impact: It is an expression of long-term outcome of the programme. For example, if the number of
children who brush their teeth twice a day has increased after a session of health education, the
programme is considered impactful
 BASIC STEPS IN EVALUATION
Basic Steps in Evaluation
Determine what is to be evaluated:
1. Evaluation of the structure: This is evaluation of whether facilities, equipment, manpower and organisation meet
the standards.

2. Evaluation of the process: The process of dental care includes the problems of recognition, diagnostic
procedures, treatment and clinical management, care and prevention. The way in which the activities of the
programme is carried out is evaluated by comparing with predetermined standard.

3. Evaluation of outcome: This is concerned with end results of a programme. The end results should improve
dental health in a community.
Establishment of standard and criteria: Standards and criteria must be developed in accordance with the focus
of evaluation.
Structural criteria: For example, physical facilities and equipment.
Process criteria: For example, every prenatal mother must receive 6 checkups.
Outcome criteria: For example, alteration in patient’s health status.
Planning the methodology: The methodology of evaluation in terms of criteria and standards
against which the current programme is to be evaluated are established.

Gathering information: Evaluation requires collection of data. The types of information may include,
political, cultural, economic, environmental and administrative factors. The above factors influence
the health situation as well as the morbidity and mortality statistics.

Analysis of results: Once information has been gathered, the analysis and interpretation of data
should take place within the shortest time.

Then opportunities should be provided for discussing evaluation results.

Taking action: Based on the outcome of the evaluation, shifting priorities, revising objectives, or development of
new programmes or services to meet previously unidentified needs may be implemented.

Revaluation: Evaluation is an on-going process and may be repeated, if required.

Evaluation of quality of dental care programmes: Schonfeld suggested four levels of evaluation.
Evaluate the individual restoration, procedure or service.
Evaluate the mouth that is the relationship of one dental procedure to another.
Consider the patient’s total oral health and the influence that dental care has had on the attitude toward dentistry
and on dentally related behaviour.
A look at the family and community, evaluate the dental services provided for groups and communities and
determine the number of and social distribution of persons receiving adequate dental care.