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What is meant by health planning?
Health planning is a term which can be used to describe
a multitude of different activities.These include the crea-
tion of strategic, operational, budgetary, capacity, service,
human resources and technology plans and much more. It
can also cover different time scales with, for example, an-
nual plans, 3 year plans and longer strategic plans. Moreo-
ver, planning may also be undertaken at local, regional,
national or international levels with many countries allo-
cating different planning responsibilities at these different
levels and setting out how they relate.
The way planning is undertaken is also very variable as will
be illustrated with two examples later. However, a quick
overview globally suggests that most health planning is
very technocratic in nature and undertaken by specialist
trained groups of staff rather than by practising clinicians
and managers and with relatively little engagement of the
public and wider stakeholders.This overview also suggests
that most planning is concerned with service provision.
Health and health care are profoundly affected by other
sectors and need to be seen in the context of education,
housing, employment, environmental policies and all the
other external factors that help determine the health of
individuals and populations. An important part of health
planning, therefore, is the extent to which it takes account
of these wider issues.This has led many planners to aim for
a
Health in All Policies
approach where other sectors are in-
volved in assessing their own policies in order to maximise
their health impact. [1]
This breadth of issues also raises questions about govern-
ance and accountability and the extent to which external
stakeholders are involved in both. Planners need to be
thinking about questions such as the
following.Towhat ex-
tent are representatives of external sectors, education or
social care for example, directly involved in the decision
making and governance of health planning and health care
delivery and not just consulted for their opinion? How far
is the health sector accountable to these wider stakeholders
and the public and not just to its funders and patients?
Figure 1 lists some of the main external dimensions that
need to be taken into account in health planning. It is no-
table that successive Portuguese National Plans have been
very comprehensive in this regard and seen all these differ-
ent actors, including citizens, as important contributors to
improving the health of the population.[2]
The relationship between planning and implementation is
also of fundamental importance and can take a number of
different forms. Some plans barely refer to implementa-
tion – reflecting the fact that the planners and the imple-
menters in a health system are often two distinct groups
- while others offer detailed prescriptions.This latter ap-
proach may be equally unpopular with the people who
have to implement the plans because it may offer no flex-
ibility and freedom of manoeuvre. There is a balance to
be struck here between making sure that plans are imple-
mentable, piloting or road testing them for example, and
leaving the implementers the scope to learn and adapt as
they implement. In doing so they will encounter obstacles
and discover unforeseen opportunities.
This brief overview of health planning has attempted to
describe the main issues across the whole field. The re-
mainder of the paper will concentrate on one broad area:
health service planning for a nation, region or large popu-
lation. In doing so it will, of course, raise issues relevant
to other types of planning and plans. This broad area is
well summed up in the following quotation fromWHO
Africa
“Health service planning aims to improve health service
delivery and/or system performance to better meet the
health need of a population. It comprises the process of
aligning the delivery of existing health services to meet the
changing patterns of need and use of services.This aims to
make the most effective use of available and future health
resources (funding, staff and infrastructure).” [3]
Two examples of health planning
The following two examples of health service planning
illustrate some of the common features and the differ-
ences between approaches in two countries which both
spend highly on health.The one, Queensland, is a good
example of a well-worked through, detailed and tech-
nocratic approach. The other, England, is essentially a
market driven approach.The author is familiar with the
English model but has only read about the Queensland
one and chosen it from a brief survey of the materials
published on the internet as a particularly good exem-
plar of its type.
Queensland’s planners, like many others,
have adopted a cyclical approach where
planning is followed by implementation
and review – which in turn feeds into plan-
ning.The literature is rich in similar policy
and planning cycles which illustrate the dy-
namic nature of planning and its constant
evolution and development. The Queens-
land version is shown in Figure 2.
• Relationships with the economy, the affordability and costing of plans
• Integration with education, social care, housing and other social policies
• Understanding of the labour market and the ability to train and recruit
• The extent to which developments will be market-driven rather than planned
• Policies and legislation about the environment, food, alcohol, drugs, smoking,
health and safety all of which affect health
• The engagement of and accountability to the public and wider stakeholders