Reproductive Health Package CSR PFI Section IX Project Design Management :: PFI Publication :: KNOWLEDGE MANAGEMENT CENTRE PORTAL, POPULATION FOUNDATION OF INDIA

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Reproductive Health Package CSR PFI Section IX Project Design Management

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Reproductive Health Package CSR PFI Section IX Project Design Management

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Section IX

Project Design and Management

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Section IX

PROJECT DESIGN AND MANAGEMENT

Writing Project Proposals

Project Planning, Monitoring & Evaluation

Scaling up Management Framework

Community Needs Assessment

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chapter 22

WRITING PROJECT PROPOSALS

Voluntary agencies and NGOs working at the micro-level have a good understanding of the people’s

problems and related needs, but are often starved for resources. Developing good project proposals can

help in mobilizing resources. A good project proposal also serves as a guideline for easier and effective

implementation of the project, describing the activities to be undertaken, the timeframe, monitoring

indicators, linkages and financial details. This chapter gives some guidelines on how to develop a

project proposal.

The programme or the intended sets of activities and their objectives is approved on the basis of

details furnished in the project proposal. A sound project proposal reflects the needs of the community.

Any inconsistency, limitation or inaccuracy in it may have a misleading effect on the programme.

A project proposal indicates (a) what is proposed to be done (b) towards achieving what aim, (c) the

way it is to be done, and (d) the consequences it would lead to. It is an information document for

the funding agency and a guide for the implementing agency. It should have an in-built system of

implementation, monitoring and evaluation. It contains factual information in a logical framework,

including the implementation process at all stages. It should be self-explanatory to facilitate easy

evaluation. Project proposals that are specific in details, clearly spelt out and condensed are easy to

evaluate and approve.

A project proposal may be broadly divided into the following sections: title; executive summary;

background of the implementing agency; rationale; objectives; methodology; monitoring and evaluation;

sustainability; budget. The proposal should be accompanied by a detailed logframe or logical framework.

The following paragraphs give details of the different sections of a project proposal.

The Title should precisely communicate the nature and area of the project.

The Executive Summary gives the gist of the project proposal – why it is important and how it will

be implemented.

Background of the Implementing Agency

The background gives all relevant information, supported with enclosures, about the organization: why

and how it was formed, its mission, thrust areas, availability of resources (human, financial and

infrastructure), previous programmes implemented (including amount of funds handled and the respective

funding agencies), linkages with other NGOs/government departments/industrial houses, etc. Some of

the possible information heads are:

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Identification: The name of the organization – to be mentioned on the face sheet (cover), together with

its acronym, if any.

Philosophy: Why and how the organization was formed; the vision and mission; its nature – whether

religious, political, charity, developmental, welfare, commercial, etc. Enclosing a leaflet/brochure of

the organization for ready reference can help.

Structure: Membership pattern, type of members, whether it has a general body or executive body.

Developmental Stages: Initiation and expansion of activities, the geographic and technical expansion

– stating the number of users/beneficiaries, villages and activities.

Thrust Areas: The values and ideology of the

organization, areas of operation, stating the priorities

of involvement. Thrust areas include (i) the nature of

activities the organization prefers to do, depending

upon its expertise and infrastructure; and (ii) the

identified needs of the community.

Legal Status: (a) Registration number, stating the nature,

i.e. whether society, trust or company, etc., along

with date of registration; the date of renewal, if any,

enclosing photocopies of the registration number and

Memorandum of Association; (b) FCRA No. along with date. A one-time permission should be

clearly mentioned, with the duration/time limit. Enclose the latest balance sheet to confirm the

continuity of the FCRA No. (c) Any other registration (with name and date) such as 80G, 12A, KVIC,

etc. and enclose photocopies.

Bank Information: Name and full address of the bank(s), account numbers and their nature. (Maintain

separate accounts for Indian funds and foreign funds.)

Strategy: Write a few words about the strategy of the organization vis-à-vis project information at all

stages. How the organization selects an area, identifies its needs, formulates the project proposal,

implements the project, raises and manages resources, develops linkages with support agencies,

monitors the progress, reviews and evaluates the project, and phases out from the area.

Resources: To show the organization’s capability, indicate the availability of resources with it: (i)

human resources, (ii) financial resources, (iii) infrastructure.

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• Human Resources: Give the number, level, expertise and experience of the staff members who

would be responsible for the programme. The duration of their involvement in developmental/

organizational activities should be highlighted.

• Financial Resources: Write about the financial resources available with your organization. The

organization might have a corpus fund or a regular income from service charges or rent or

consultancy or subscriptions, etc.

• Infrastructure: State the infrastructure available with your organization which can be useful for

project implementation. It may be building, office, vehicles, furniture, equipment, etc. It indirectly

reduces the cost of programme implementation and indicates the possibilities of further expansion

of project activities. Infrastructure also confirms the stability of the organization and the possibility

of easy and early implementation of the project.

Previous Programmes: Programme experience increases the credibility of the organization. Mention the

programmes and projects implemented by your organization so far and those currently being handled,

indicating the funding agencies, components of the project, nature of experience, duration of the

project, area covered, etc. and total funds received for each project and funds raised from the

community, if any.

Enclosing a copy of the latest annual report goes far in imparting information on the nature of the

activities.

Rationale or Purpose

The rationale gives the justification or need of having the proposed programme. The holistic picture

of the community to be served should be projected. In a service delivery or awareness generation

programme, for example, the following sub-headings may be used :

• geographic location (map to be enclosed)

• population (including demographic features)

• literacy level

• health status

• socio-economic status

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Under rationale, clearly state what are the potentials available in the community, how the programme

will tap and develop them. The information on beneficiaries, particularly women, is required to form

a sound basis for the programme.

Also, mention the availability of local groups, availability of human resources, willingness of the

people to cooperate, output and impact envisaged, the magnitude of the problem and the absence of

similar programmes for the community.

Objectives

The objectives provide direction to the project activities. It is what you want to achieve within a

stipulated timeframe. The objectives should have the following characteristics:

• The scope and scale of activities should be clearly stated.

• They should be specific in terms of beneficiaries, area, activity.

• They should be measurable, which can be analysed and explained in well-defined measurable

units.

• They should be practical and not idealistic, keeping in view the capacity of your organization

and the project area.

• A timeframe should be given to achieve the objectives.

Some writers state objectives in the mnemonic SMART – Specific, Measurable, Achievable, Relevant/

Realistic, Time-bound. It is a way of evaluating if the objectives that are being set are appropriate for

the individual project. Objectives can be further divided into “long-term objectives” (or Goal or Main

Objectives) and short-term objectives (or Working Objectives or Specific Objectives).

The long-term objectives are part of the vision that you want to actually see in the community after

a fairly long time, such as improved quality of life, poverty alleviation, etc. They are general in nature,

indicating the long-term impact of the programme. The short-term objectives are the immediate results

envisaged in the programme.

Methodology

The methodology gives details of the implementation strategy of the project. A set of activities are

designated to realize each objective. Indicators are identified to measure the result of the activities.

Each activity should be given a definite timeframe.

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Write the activities of the project in a logical sequence, having relation directly or indirectly with the

stated objectives. The objectives are the condensed summary of expected results while the activities

are the condensed summary of efforts leading to achieve the stated results.

Indicators reveal the result of the activities. One objective may have more than one indicator. They

provide the basis for monitoring and should have not only quantitative units, but qualitative units

also.

The strategy/methodology mentions in detail how the activities will be introduced to the community.

Chronogram Activity Plan

This is an implementation schedule (work plan) of the project activities with reference to time limits.

A chronogram is important for doers and managers both, as it specifies the progress of activities. Write

all the activities of all the components preferably in the order of implementation and shade/check the

column of time. Through a chronogram, one can easily analyse the activities against the planning.

Table 22.1 presents an example.

Activities

1) Development of

Training Material

2) Identification of

Voluntary Agencies

and Participants

3) Training Workshops

4) Mid-term Evaluation

5) Refresher Training

6) Monitoring

7) Upgrading Training

Material

8) Final Evaluation

and Submission

of Report

Table 22.1. Example of a Chronogram

Month

1-4

Project for Training of NGO Workers

Implementation Schedule

5–8 9–12 13–16 17–20 21–24 25–28 29–30

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Monitoring and Evaluation

Monitoring is the mechanism of reviewing the progress of the efforts to achieve the objectives within

the prescribed time limit. A project may be monitored by the staff of the organization, by local

groups, or by the beneficiaries themselves, or all of them combined. The monitoring system should

have a feedback mechanism. The flow of information and the feedback system should be clearly

defined. A well-structured monitoring system, having a systematic management information system,

increases the probability of the success of the project.

Evaluation is the process by which the impact of the programme is analysed from all angles, i.e.

planning process, participation, accounting, attitudinal changes, behavioural changes, etc.

Sustainability

The funding agencies desire that their projects become permanent features of the community. The

proposal should clearly explain the level of sustainability the project would attain, depending on the

nature and objective of the project.

Detailed Logframe

The logical framework or logframe is an analytical tool used to plan, monitor and evaluate projects.

It derives its name from the logical linkages set out by the planner(s) to connect the means of a project

with its ends. The logframe was originally developed by the United States Department of Defense,

and adopted by the United States Agency for International Development in the late 1960s. Since then,

it has been applied and modified by many bilateral donors.

The logical framework is an up-front planner which provides the project team with essential planning

information for the development of project plans. It should be concise. It should be treated as a free-

standing document and should be comprehensible to those coming to it for the first time. Acronyms

should therefore be avoided. It provides a basis for subsequent monitoring and evaluation. It must

therefore be kept under regular review and amended whenever the project changes course. In designing

the project it is normal to start with the problem and work down the levels to thinking about the

resources. It might, however, be that the resources identified are either not available or are inappropriate,

thus requiring modification of the resources or assumptions at each level accordingly.

The logframe has the following advantages:

• It brings together in one place a statement of all the key components of a project (this is

particularly helpful when there is a change of staff).

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• It presents them in a systematic, concise and coherent way, thus clarifying and exposing the logic

of how the project is expected to work.

• It separates out the various levels in the hierarchy of objectives, helping to ensure that inputs

and outputs are not confused with each other or with objectives and that wider-ranging objectives

are not overlooked.

• It clarifies the relationships which underlie judgements about the likely efficiency and effectiveness

of projects.

• It identifies the main factors related to the success of the project.

• It provides a basis for monitoring and evaluation by identifying indicators of success, and means

of quantification or assessment.

• It encourages a multidisciplinary approach to project preparation and supervision.

The main matrix of the logframe comprises:

• Objectives: This column lists out the project objectives. It is what you want to achieve within

a stipulated timeframe.

• Activities: These are series of tasks which need to be carried out in order to achieve each of the

objectives. These should be listed out in the greatest detail for clarity.

• Verifiable Indicators: The emphasis is on the value, not just the type, of the indicators of

achievement. Any indicators used should be susceptible to measurement, or qualitative judgement,

or both. Quantification should not, however, be used just for the sake of it, and in some cases

proxy assessments may be more appropriate. The availability and reliability of data, and the

practicability and cost of collecting them, must be carefully considered both in identifying

suitable indicators and in determining the most cost-effective way of measuring them.

• Means of Verification: This column should set out how, and from what sources of information,

each of the indicators in the previous column will be quantified or assessed. If some of the

data are likely to be unreliable the logical framework should say so.

• Important Assumptions: This column should record the important assumptions on which the

success of the project depends, and the risks that have been considered.

A sample logframe is given in Table 22.2.

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Budget

Project finance is the life of the project. Human resources, material and machines are arranged mainly

on the availability of resources (money).

The total financial requirement for the project is written under the budget head. It should be

calculated keeping every bit of expenditure in mind. All the components should be broken into the

smallest possible segments. The budget should be written separately for each component. The

components can be grouped under two broad heads – non-recurring and recurring. The cost estimates

for each activity should be justified logically. An example of budgeting is given in Table 22.3.

What the Corporate Sector Can Do

• The corporate sector can follow the steps outlined for development of need-based proposals with

clear objectives and methodology.

• It should follow the logframe formats to break down activities into measurable tasks and monitor

the same.

• A practical timeline, taking into account all the sub-activities, needs to be developed.

• It should follow guidelines of budgeting which is activity based.

References

http.//www.who.int/mmh/vision2020/eng/documents/LFA/UNDP.pdf.

DFID. Chapter on “Logical Framework in Tool Development Series”. (http://62-189.42.51/DFID stage/

FOI/tools/Chapter-05-frame.ht)

Nancholas, S., 1998. “How to (or not to do) a Logical Framework” : Health Policy and Planning 13(2);

189-193.

Population Foundation of India, September 1999. “Training Module : Reproductive and Child Health”.

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chapter 23

PROJECT PLANNING,

MONITORING AND EVALUATION

For success, a project needs to be well planned, implemented, monitored, and evaluated.

Project Planning

List the major activities involved. Most of these activities may have already been listed in the project

proposal. However, several other activities, which would facilitate achieving the stipulated goals of

the project, may be identified when the project actually takes off. The plans should cater for local

variations.

Prepare an activity Plan. Drawing up a timeframe is required with respect to the initiation and

completion of each activity. A timeframe helps in monitoring schedules. In case of delay, it helps

in identifying the delayed activity and also the magnitude of the delay. Table 23.1 presents an

example:

Table 23.1. Example of an Activity Plan

Activity

Recruitment of staff

Training of staff members

Initial contact with community

Baseline information collection

Service delivery

Evaluation (final)

12 3 4

↔

↔↔ ↔

Months

56 7 8

9 10 11 12

↔↔ ↔

↔ ↔↔

↔

Working out the Finer Details. Taking account of the major activities of the project, it is also necessary

to draw up the finer details of each of these activities. For example, if a major activity is to undertake

training of volunteers on reproductive health issues, its final details may be identified as: (a) number

of volunteers to be trained; (b) date, duration and venue of training; (c) identification of resource

persons for training; (d) materials required for training; (e) arrangements of lodging and boarding; (f)

logistic support required in conducting training sessions (e.g. audiovisual aids, blackboard, etc.)

Infrastructure and Logistics. The existing infrastructure facilities need to be reviewed and those needed

in future identified. Additional facilities, if required, must be budgeted for. Proper planning is also

needed to ensure continuous supply of logistics.

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Human Resources Requirement. Depending upon the nature of activities to be carried out, the area

to be covered etc., the number of project personnel required at different levels should be clearly

worked out. The workload or capacity of the worker at various levels may be worked out as under:

Workload = No. of units covered per day x number of working days per month.

Implementation

Human Resources Planning and Recruitment. Successful implementation of a project depends upon

coordination between the various workers. Therefore, it is essential that the kind of fieldwork to be

carried out by each level of project personnel is well planned and responsibilities are earmarked

clearly. Recruitment must be done on the basis of responsibilities and workload assigned to each

worker. Job descriptions should be clearly identified. The project manager has to justify the recruitment

of staff and, accordingly, the positions may be filled up.

Human Resources Development. A training-cum-orientation programme may be organized for the new

recruits to facilitate their performance.

Supervision and Guidance. An effective management information system (MIS) has to be evolved

whereby the proper flow of information from below upwards and effective supervision from above

downwards is developed. The project manager should not only supervise her/his immediate subordinate

staff, but also keep an eye on the other workers. Along with supervision, proper guidance is also

required. Regular supervision and guidance helps in assessing the progress of work and rectifying

mistakes.

Field Visits. Implementation of action-oriented projects requires regular field visits by supervisors and

occasionally even by the top-level management. These field visits help in both supervising the progress

of the work and in boosting the morale of the grassroots workers. Field visits by senior staff should

be made not to pick on mistakes committed by the workers, but to help, facilitate and encourage them

to work more effectively and produce the desired results

Periodic Staff Meetings. Holding staff meetings at regular intervals helps in assessing the progress of

work and addressing problem areas and issues. Achievements made so far, and future plans of action

may also be discussed during these meetings. Such meetings also help in keeping the grassroots

workers in tune with the objectives of the project.

Segmentation of the Target Population. A rough estimate should be made of each segment of the target

population such as infants, pregnant women, lactating mothers, eligible couples, adolescents, women

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and men suffering from reproductive tract infections in the project area. For example, if the project

aim is to provide full coverage of children’s immunization, an approximation about the number of

infants in the project area should be made. The number of infants would depend upon the birth rate

prevailing in the project area or it can be borrowed from the experiences of another population having

similar demographic characteristics as in the project area.

People’s Participation in Project Implementation. The purpose of action research projects is to provide

certain services to the community. Hence, it becomes very important to seek the support of the

community for successful implementation of any project. This may be secured by involving community

leaders, beneficiary groups and common people for propagating the facilities available in the project.

Minimizing Deviation. The following measures, if undertaken systematically, may lessen the chances

of deviations between project inputs and outputs:

• use of participation in the planning process to obtain staff commitment for implementation;

• use of experts for advice;

• staff training to reinforce skills and commitment;

• strengthening of supervisory systems;

• giving feedback of suitable information.

Monitoring

Monitoring is a process of measuring, recording, collecting and analysing data on actual implementation

of the programme and communicating it to programme managers so that any deviations from the

planned operations are detected, diagnosed and suitable corrective actions taken.

The plan should identify key result areas and define how they will be measured. It should identify

linkages between inputs and outputs, if necessary, through intermediate indicators. Activities also need

to be prioritized so that they receive adequate emphasis during monitoring.

The monitoring process consists of:

• detecting deviations from plans

• diagnosing causes of deviations

• taking corrective action.

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Detection is carried out by comparing plans with actuals in terms of programme inputs, activities and

outputs. The question here is, “what should be measured and how much deviation should be tolerated

without further investigation.” Reasonable tolerance levels for performance deviation should be set.

Once the areas of shortfall have been detected, the causes of these deviations need to be identified,

followed by taking up corrective actions, if necessary.

Indicators

Indicators are “variables which help to measure changes”. Ideally, indicators should be:

• Valid. They should actually measure what they are supposed to measure.

• Objective. The answer should be the same when measured by different people in similar

circumstances.

• Sensitive. They should be sensitive to the changes in the situation.

• Specific. They should reflect changes only in the situation concerned.

Some of the commonly used indicators which capture socio-economic status, health status and

healthcare are:

• income distribution

• food availability

• increase or decrease in industrialization

• adult literacy rate

• climatic variations affecting agricultural output if the project covers a time span of one year or

• rate of population increase

• prevalence of nutritional disorders of women and children, particularly of pregnant and lactating

women

• maternal mortality rate

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• levels of fertility

• use of contraception by eligible couples and the methods adopted

• coverage of antenatal, natal and post-natal services

• crude death rate/life expectancy at birth

• prevalence of childhood diseases

• infant mortality rates

• nutritional status of children (birth weight/growth monitoring, etc.)

• immunization coverage of children

• prevalence of reproductive tract infections

• health-seeking behaviour of the population.

For each of these indicators, certain indices may be computed. For example, to represent the coverage

of antenatal care, one can collect information from each pregnant woman; whether she has undergone

antenatal examination by a doctor or an auxiliary nurse midwife (minimum three) and the details

regarding tetanus toxoid injections, iron-folic acid tablets, blood pressure check-ups and urine

examination. Based on the number of women receiving this care and the total number of pregnant

women in the area, one can compute the percentage of pregnancies receiving antenatal care.

The baseline data required to identify these indicators has to be collected through a sample survey.

Later, regular field visits may be conducted to collect these data to check the progress of work.

Record Keeping

The first step in monitoring is to evolve a system by which proper records may be maintained. The

system of maintaining records should be developed in a manner that facilitates meaningful analysis

of the data available. It is also important to format these records in a manner by which retrieval is

easy. Records may be of two types:

Documentation of the activities of the project: e.g. number of training sessions conducted, number

of participants in each session, basic background information of each of the participants, number of

times health camps were held, to whom these services were given, etc.

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Records that come from the project area or from the population residing in the project area: e.g.

general characteristics of the population, basic characteristics either of the households or of the

beneficiaries, number of children below age 1, various types of immunization provided to children

below age 1, number of pregnant women and those who are provided with antenatal care, etc. This

type of information is the basis for assessing the project impact on a population.

Information gathering and reporting should be done in a structured manner. Record keeping should

be such that retrieval of records is easy. The use of computers for data entry, analysis and updating

of records proves very useful for larger, long-term projects.

Baseline Information

The purpose of monitoring any action research project is to evaluate its impact on the community.

For this, baseline information is required against which the achievements gained can be measured. The

baseline data usually pertain to the time when the project started. These data reflect the field

conditions at the beginning of the project and any change brought about later may be claimed to have

been achieved due to project activities. The information collected during the initial period is helpful

during the mid-term and final evaluation of the project.

Information Consistency Checks

Proper monitoring also implies that the information and records compiled from the project area are

correct. For this reason, it is required to conduct a few consistency checks on the data collected from

the field. For example, if the information received pertains to the project activities, one needs to cross-

check whether the reported activity has been undertaken at the time, place and venue reported. The

validity of the data should be ascertained. The mnemonic FACTS sums up the essentials of any data:

Factual, Accurate, Concise, Timely, Simple.

Consistency checks require field visits by the project manager. It may be possible to combine such

field visits with the regular supervisory visits.

Presentation of Monitoring Report

As a part of regular monitoring, the information must be presented in a summary form. A report can

be prepared based on the information collected for a specified interval of time. For example, all the

activities carried out during one quarter of the year may be summarized and the vital events occurring

in the project population may be reported. This is called a quarterly progress/monitoring report. The

purpose of such presentation is to analyse the events as and when they are occurring. This would also

help in the process of evaluation of the project.

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Community Participation in Monitoring

In the same manner as the project organizers secure community involvement at the beginning of the

project, they should ensure that monitoring also involves people’s participation. The project personnel

may evolve a system by which a continuous feedback should come from the community regarding the

direction in which project activities are moving.

Evaluation

Evaluation is a continuing managerial process aimed

at correcting and improving actions in order to render

the activities more relevant and effective. This involves

a critical analysis of different aspects of implementation

of a programme, its relevance, its formulation, its

efficiency and effectiveness, its costs, and its acceptance

by the community. An evaluation should not only

identify problems, but should also provide a basis for

recommending actions to solve these problems. While

evaluation is a continuing process, its results have to be summarized and reported at given times or

specified intervals. Often, health programmes require a longer period for their impact to be felt.

Therefore, while the assessment of progress and efficiency may be carried out annually, to see the

process aspect, a longer time span would be required in the assessment of effectiveness and impact.

Before starting an evaluation, the following need to be decided:

• What is to be evaluated?

• At what organizational level(s) is the evaluation to be made?

• What is the purpose of the evaluation? Is it to assess the impact or for any other purpose?

• What are the constraints that could limit the utility of the evaluation or restrict its scope?

• What types of decisions may be taken in the light of the evaluation results?

• To whom are these results going to be communicated?

The process of evaluation consists of the following steps:

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• Specify the particular subject for evaluation.

• Ensure information support.

• Verify relevance.

• Assess adequacy.

• Review progress.

• Assess efficiency.

• Assess effectiveness.

• Assess impact.

Evaluation of the project is generally done at two points: mid-term evaluation and end-line or final

evaluation. Evaluation of the project methodology may be either quantitative or qualitative or both.

• Mid-term evaluation is done to assess the direction in which the project is moving so that

corrective measures may be taken, if necessary.

• End-line or final evaluation is carried out towards the end of the project implementation period

or after the completion of all the project activities. The purpose is to assess the effect and impact

which the project activities have made together with recommendations for future replicability

and experience sharing.

Methodology for Evaluation

The methodologies for evaluation depend on the purpose of evaluation and the policy/programme/

services/institutions under consideration and the constraints of resources. The following strategies are

often used for data collection:

Review of Records. These include those maintained by the health system, including vital events,

registers, etc.

Case Studies. These can be used to collect information to measure satisfaction/non-use of services.

Controlled Experiments. In this, two similar areas are selected and baseline data on relevant health

indicators are collected. In the experimental area, the project interventions are implemented. In the

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control area, no interventions are initiated and care is taken to see that the situation is not disturbed.

At the end of a suitable time interval, data on relevant health indicators are again collected in both

areas. The difference in changes in health indicators is used to assess the impact of the intervention.

Sample Surveys. These are designed specifically for the household and healthcare provider levels. These

surveys often provide quick results and prompt feedback at low expense. However, they have to be

carefully designed and should concentrate on a selected number of indicators.

The sample survey methodology is discussed here in detail, as it is the common methodology adopted

to evaluate health projects.

Sample Survey Methodology

Survey Design. The survey design should include collection of information from the household level,

community health personnel, community leaders, etc. Household surveys should be organized for

units of population that correspond to operational or administrative levels at which the programme

managers need information for decision-making.

Sampling design. A frequently used definition of a household is a group of people living together who

share food from the same kitchen. Households should be selected by simple random sampling,

systematic sampling procedure, multi-stages, stratified sampling, cluster sampling procedures, etc. The

sample size could be determined with the help of statistical experts.

The size of a sample is related to the objectives, level of precision and the availability of time and

funds. The sampling unit (i.e. the unit selected for field enquiry) may be households, eligible women,

direct beneficiaries of the project, etc.

An example of a sampling design is given here.

Say, a project covers 20 slum clusters and a population of nearly 50,000. From these 20 slums, if

we have to select a random sample of 500 households for collection of data on maternal and child

health conditions and contraceptive use, we may adopt the multi-stage stratified sampling procedure.

Stratification refers to the classification of sampling unit (i.e. slums or households) into several groups

so as to make these groups more homogeneous. In other words, if the slums are to be stratified into

homogeneous groups, all the slums with common characteristics may be clubbed under one stratum

while those with different characteristics may be put under other strata. For the purpose of health

projects, we may consider two strata of villages or slums, say, slums which have a health facility

provided by the government and those which lack facilities. Accordingly, two groups of slums may

be formed, each consisting of 10 slums.

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At the next stage, 50 households may be selected from each of the selected slums using either simple

random sampling or by systematic random sampling.

In simple random sampling, 50 households may be selected randomly so that these households

represent any average household of the slum.

In systematic random sampling all the households in the slum are identified by preparing a house list

of all the households and then assigning a household number. After this, a sampling fraction is

calculated based on the number of households to be selected and the total number of households

enumerated in the slum. Using this sampling fraction or sampling interval, the households are selected

in a systematic way with a random start. For example, in a slum of 200 households, 50 households

would be selected at an interval of 4 households from the random start. If the random start number

is 3, then the households selected in the sample would be every 4th household, i.e. 3rd, 7th, 11th,

15th, … and so on. These households would form the sample households.

Tools and Data Collection

The specific tools that are to be used in household surveys should be designed only after the purposes,

objectives and conceptual framework for the evaluation have been established. The data collection

tools should be so constructed that analysis can be carried out easily.

Generally, in a sample survey, a questionnaire is designed and administered to the sample households

to collect the required information. The contents of the questionnaire depend upon the nature of the

data which an evaluator wishes to collect from the field. The number of questions included in the

questionnaire should be in accordance with the cost and time allotted for the survey. These questions

may be either in a closed form (pre-coded, multiple answers) or can be open ended. Apart from the

levels of health conditions, the questionnaire should also include questions related to the project

activities and the likely impact of these activities.

Data Processing and Analysis

Data analysis includes editing, codification, classification, compilation and tabulation, statistical

manipulation and interpretation of data. The data collected through questionnaires must be cross-

examined for their consistency, reliability and validity. After proper editing, the data should preferably

be transferred into numerical codes so that they may be fed into the computer for easy analysis. The

purpose of data analysis is to summarize the completed observation. For analysis, simple computations,

viz., percentage distribution, cross-classifications, etc. should be attempted.

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Report Writing

Preparing a comprehensive report is a crucial aspect. It is only through this report that the activities

undertaken in the project, the impact it has made in the community or on the targeted population,

its successes and failures and future implications can be documented and used for further dissemination.

The report should incorporate the entire experiences of the project implementation right since its

inception till the end, coupled with the results derived through sample survey. It should contain

broadly the major issues like:

• background of the project area

• need for project implementation

• objectives of the project

• methodology adopted

• activities undertaken in the project

• end-line evaluation results

• describing the methodology adopted to derive a sample

• sample results

• sustainability

• implications of its replicability.

People’s Satisfaction in Implementing the Project

While evaluating the project activities on the part of the implementing agency, it is also necessary

to incorporate the viewpoints of the community as far as the impact of the project is concerned. The

evaluation exercise must include the level of satisfaction expressed by the people of the community

for whom the whole project was designed. It is only after assessing their views, and combining them

with the evaluation undertaken by the implementing organization, that objective conclusions may be

drawn.

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What the Corporate Sector Can Do

• Identify the human resources and logistics requirement for the project during the planning stage.

• Focus on human resources development and calculate workload.

• Institutionalize the monitoring plan of a project with details of supervisory meetings and field

visits.

• Have an effective system of record keeping at all levels and management information system for

the project.

• Have an evaluation plan for the project with specific budgetary allocation.

References

Adapted from “Training Module : Reproductive and Child Health”. Population Foundation of India.

September 1999.

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chapter 24

SCALING UP MANAGEMENT

FRAMEWORK

The persistence of poverty and preventable illness in low-income countries after thirty years of

development efforts has drawn attention to the relatively poor record of pilot and demonstration

projects in successfully stimulating systemic change and reaching large populations. In poor and rich

countries alike, service providers and funders find themselves under pressure to reduce costs, improve

social outcomes, and explain why it has proven so difficult to accelerate the spread of best practices.

Scaling up is drawing the attention of an ever-increasing circle of donors, philanthropists, governments,

NGOs, activists, and researchers. As the interest grows, so do their concerns regarding the replicability

of successful innovations and the challenges of reaching large numbers of those in need. Despite this

growing interest and an expanding array of documented cases, relatively little evidence-based advice

exists about maximizing the prospects for new and innovative service-delivery models to achieve scale.

Written primarily for officials charged with making funding decisions and implementing programmes,

this paper seeks to provide concrete advice derived from theory and practice. It is intended to inform

decisions about:

• selecting projects with the potential to go to scale;

• designing projects to maximize their scalability; and

• managing the scaling up process.

The Scaling Up Management (SUM) Framework presented here is organized as a series of Steps and

Tasks. This approach is based on the conviction that scaling-up can be successfully managed and that

this process can be carried out most effectively by breaking it down into concrete strategies and

actions.

The SUM Framework is a three-step process. The steps are: develop a plan; establish preconditions;

and implement the process.

Step 1: Develop a Plan

Planning includes four distinct tasks:

Task 1: Create a Vision

Creating a vision involves answering questions related to what, how, who and where – What is being

scaled up? How will it be accomplished? Who performs the key functions? And where does the scaling

up occur?

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What is Being Scaled up?

The model to be scaled up is normally embedded, at least initially, in a project and can include

technical, process and organizational components. The untested models or individual components of

models are the “innovations”. The projects can be of five different types – pilot (or research and

development), demonstration, capacity building (or infrastructure), policy and service delivery.

Pilot projects have as their primary purpose finding or testing new solutions to a particular problem.

By definition, they include at least one technical, process or organizational innovation. Examples of

each would be: a new technology (technical innovation); a novel service delivery approach (process

innovation); or creative use of a public/private/NGO partnership (organizational innovation). A pilot

project can also take a model that has worked successfully in one context or for one problem and

apply it to a new context or problem.

Demonstration projects take an existing model and raise awareness about its usefulness. The intention

is to make existing solutions better known and more widely accepted by decision-makers and potential

users.

Capacity-building projects are intended to create the institutions, skills, physical infrastructure or

systems needed to make permanent changes in the level or quality of service delivery. These projects

implicitly assume that the other elements necessary for going to scale up already exist or are being

provided elsewhere.

Policy projects emphasize advocacy and research and focus explicitly on bringing about changes in

public policy. These projects target policymakers as their intended audience and do not typically

include direct provision of services to the affected public.

Service-delivery projects attempt to “projectize” service delivery on the assumption that the benefits

or services provided are needed urgently and are not being provided by existing programmes and

institutions. National immunization campaigns offer an obvious case in point. These projects may or

may not contain innovations.

How will Scaling up be Accomplished?

The scaling-up process has three successive stages – effectiveness (developing a solution that works),

efficiency (finding a way to deliver the solutions at an affordable cost), and expansion (developing

a way to provide the solution on a large scale). Scaling up focuses principally on “expansion”, the

third stage. The SUM Framework groups “expansion” methods into three categories – expansion,

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- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -S-C-A-L-IN- -G- U- -P-M- -A-N-A-G-E-M- -E-N-T-F-R- -A-M-E-W- -O-R-K- - - - - - - - -

replication, and collaboration – distinguished from one another by the degree to which the originating

organization (i.e. the organization that managed the initial project) continues to control implementation

as the model goes to scale.

Expansion here refers to taking a model to scale up, increasing the scope of operations of the

organization that originally developed and piloted it. Often, expansion occurs in cases of pilot or

demonstration projects, where a project fills a vacuum in terms of delivering products or services, and

where the model and the organization in which it is embedded are either inextricably linked or the

originating organization is unwilling to relinquish control. The most common form of expansion is

growth, which normally occurs by branching out into new locations. Sometimes this growth is

accompanied by decentralization or restructuring, which we regard here as a distinct method of

expansion because of the special demands it places on the originating organization. Two other

methods of expansion are franchising the model to organizations operating as agents or clones of the

originating organization, and spinning off aspects or parts of the originating organization to operate

independently.

Replication involves increasing the use of a particular process, technology, or model of service delivery

by getting others, including the public sector, to take up and implement the model. In these cases,

an arm’s-length relationship between the originating and “adopting” organizations exists. Replication

can occur between organizations of the same type (e.g. NGO to NGO) or between organizations of

different types. A common type of replication is policy adoption, when a model is scaled up from

a pilot run by an NGO to a programme or practice mandated and often run by the public sector.

Another is grafting, where a model – or one component of a model – is incorporated into another

organization’s array of services or methods of service delivery. Policy adoption and grafting can occur

together, as when a public sector agency incorporates a technique innovated by NGOs into its

services, such as a participatory approach to HIV education. Diffusion and spillover are other methods

of replication. They tend to be spontaneous in nature and occur when a model spreads by informal

networking with new or existing organizations or through the use of more deliberate dissemination

efforts. Use of mass media is a special case of diffusion that bypasses organizations altogether by

marketing new ideas directly to the affected public.

Collaboration falls somewhere between the expansion and replication approaches. Collaboration

mechanisms run the gamut from formal partnerships to informal networks and include a number of

innovative structures and governance arrangements. Formal partnerships, joint ventures, and strategic

alliances are increasingly common methods for organizing collaborative efforts, as are less formal

networks and coalitions based on memoranda of understanding or merely a handshake. Typically, these

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arrangements include some division of responsibility among the collaborating organizations. Some of

these arrangements include the public sector as a key partner; many others are agreements among civil

society groups and/or partnerships with private firms, such as an NGO involved in education and

awareness that partners with media organizations to co-create new methods of delivering products and

services to an expanded audience. Recognition by private firms of commercial opportunities among

the poor and a growing emphasis on corporate social responsibility has greatly expanded the opportunities

for this type of partnerships.

Who Performs the Key Functions?

The originating organization is the organization that develops and pilots the model. The adopting

organization is the organization that takes up the model. The adopting organizations may be newly

created for taking up the model, or may be pre-existing. The originating organization itself may take

up the scaled-up model. Or it may take on one or more partners to implement it, after significant

expansion in its internal structure. When considering potential adopting organizations, it is important

to see how similar are their organizational contexts, capacities, and values to those of the originating

organization.

Experience shows that the tasks involved in successfully transferring or expanding a model can best

be done by, or with the assistance of, a neutral third party or intermediary organization charged

specially with assisting the scaling-up process. The tasks these organizations perform can include

conducting visioning and planning exercises; project evaluation and process documentation; political

mapping and stakeholder assessment; coalition building; design and conduct of advocacy campaigns;

and fund raising. In the case of collaborative strategies for scaling up, intermediary organizations can

also be essential in designing and forming innovative partnerships. In strategies that depend on

expansion or replication, they often plan essential roles in assessing and strengthening the internal

capacity required in originating and adopting organizations.

Where Does the Scaling up Occur?

The fourth and final element needed to complete a vision of the scaling-up process is dimension –

the size of the intended scaling-up effort and the vector along which the model or project is to be

extended. Extension services or benefits of a pilot project can be by extending to new locations

(geographic coverage), extending to more people in the currently serviced categories and localities

(breadth of coverage), extending additional services to current clients (depth of coverage), extending

to new category of clients (client type), and extending current methods to new problems (problem

definition).

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To clarify these distinctions, consider a project being piloted in a particular village and intended to

lower infant mortality by educating pregnant women about infant diseases and the need for ante- and

post-natal care. When scaling up is discussed, frequently only the geographic dimension is considered

– expanding the project to reach more villages or a larger region, such as a district or the entire

country. However, a number of other dimensions might also be considered. These could include

extending services to more pregnant women within the original village (breadth of coverage); offering

nutritional information and/or access to ante- and post-natal care (depth of services); widening the

target population to include all women of childbearing age (client type); or applying the approach to

address other issues, such as maternal mortality (problem definition). Deciding on how many people

will be served and along which of these directions the expansion will occur is the fourth and final

element in developing a vision and broad strategy for scaling up.

Task 2: Assess Scalability

Determining the Viability of the Model for Scaling up

In analysing the comparative scalability of various pilot projects, there are seven useful criteria for

assessing technological or economic innovation models. They must be:

1. credible – based on sound evidence or espoused by respected persons or institutions;

2. observable – to ensure that potential users can see the results in practice;

The Scaling-up Organogram/Role of Resource Organization

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3. relevant – for addressing persistent or sharply felt problems;

4. having a relative advantage over existing practices (positive cost-benefit, including implementation

costs);

5. easy to transfer and adopt;

6. compatible with the existing users’ established values, norms and facilities; and

7. able to be tested or tried without committing the potential user to complete adoption when

results have not yet been seen.

Analysing the Organizational and Social Context

In many types of development projects, organizational factors are most responsible for pilot-scale

success. It is thus particularly important to identify the unique or distinguishing features of the

originating organization that is needed to be retained, re-created, or substituted for scaling up the

model successfully. These features can be identified by undertaking the Institutional Development

Framework that includes organizational culture and values/principles, staffing skills and requirements,

management and leadership style, financial system and resources, external partnerships, and monitoring

and evaluation systems.

The broader social and political context in which projects are located can also exercise a substantial

impact on the scaling-up process, such as: the quality of governance; the respective roles and fiscal

capacity of national, state and local governments; the extent and nature of NGOs and NGO networks;

the prevailing cultural and religious norms; and the extent of social homogeneity.

Task 3: Fill Information Gaps

Tasks 1 and 2 almost always reveal a number of information or documentation gaps that need to be

filled before developing a scaling-up plan. Task 3 is dedicated to filling those gaps, which most

frequently include:

• documentation of the model, including goals and distinguishing technical, organizational and/

or process elements;

• analysis of need and demand for the service among the larger population;

• analysis of the changes needed to make the model applicable to other parts of the country or

to other target groups;

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• (comparative) analysis of the costs associated with the model;

• evaluation of the (comparative) impact and success of the model;

• refinement and simplification of the model;

• analysis of the possibilities for achieving economies of scale;

• analysis of the institutional requirements for implementing the model; and

• identification of the main actions and resources needed to transfer the model.

Task 4: Prepare a Scaling-up Plan

While the scaling-up plan can be organized and presented in several ways, the following outline is

a useful guide:

• Summary of the need, including where possible, hard data on the size and distribution of the

problem.

• Vision, including the history and description of the pilot project; the what (model) how (methods),

who (organizations) and where (dimensions) of the proposed scale-up effort.

• Evidence supporting the value and feasibility of scaling up the model, summarizing any data that

exist on the (comparative) impact and cost-effectiveness of the model, and establishing the

demand for and applicability of the model outside the pilot area.

• Proposed actions grouped under the following headings: legitimizing change, constituency building,

realigning and mobilizing resources, modifying organizational structures, coordinating action,

tracking performance and maintaining momentum.

• Timetable, roles and responsibilities, including a Gantt chart and an organizational responsibility

chart for major activities.

• Resources: identifying the budget and other resources needed to support the scaling-up effort and

for operating at scale.

Step 2: Establish the Preconditions

The intended result of Step 2 is that the decisions and resources needed for scaling up are approved

and in place. It involves three tasks:

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Task 5: Legitimize Change

Because change often represents a significant break from tradition and requires shifts in attitudes and

actions, it is important that there be “legitimizers” or “champions” who enjoy widespread credibility.

These individuals can come from any of the public, non-profit or private sectors. However, if policy

adoption is the chosen method of scaling up, it is essential to attract high-level government involvement

and support at the earliest feasible date. Establishing or increasing legitimacy can be accomplished

through a variety of methods, including:

• enlisting prominent spokespersons or celebrities as advocates;

• developing and popularizing images, slogans and symbols;

• creating “blue-ribbon” commissions;

• establishing high-level advisory boards;

• mounting local, national and international media campaigns;

• implementing public education programmes; and

• conducting policy debates.

Task 6: Build a Constituency

Implementation requires active and ongoing support to overcome common tendencies towards inaction

and backsliding. Likely constituencies include those who can hope to be better off as a result of

scaling up, other organizations working in the field, and/or organizations and individuals who support

the change philosophically. The task of constituency building complements and amplifies the legitimation

process by going beyond passive acceptance of the need for change and mobilizing action in favour

of specific changes and models. For change to be realized and sustained – particularly when that

change primarily benefits poor and unempowered groups – it is important to mobilize a wider range

of stakeholders. Potential tactics for building the needed constituencies include:

• organizing multi-stakeholder coalitions;

• working through one or more political parties;

• conducting advocacy campaigns with legislators and legislative committees;

• direct outreach to business, religious, labour or other civil society groups; and

• mobilizing grassroots campaigns.

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Task 7: Realign and Mobilize Resources

Resources are needed to support both the scaling up process and for operating the new model on an

expanded scale.

Funding for operating a new model at scale implies a redirection of current budget and operational

priorities within a sector, or somehow securing additional resources for that sector. Almost always,

this entails overcoming substantial inertia or active resistance, particularly when budgets are stretched;

when the new model is additional to or more costly than the current alternative; and when the new

model does not self-generate the resources it requires.

The resource problem is not merely financial. Often, no individual, team or agency is charged with

managing the scaling up process and coordinating the introduction of the new programmes, policies

or approaches necessary to implement it; likewise, the adopting organizations often need skills and

systems to scale up. Those managing the task of realigning and mobilizing resources must often reach

beyond the boundaries of individual organizations to find the needed capabilities. Donors can be

particularly useful in supporting internal advocates during this part of the change effort. Some of the

common approaches and mechanisms used during Task 7 are:

• donor roundtables;

• budget hearings and budget transparency campaigns;

• fiscal decentralization;

• bridge financing; and

• expanded use of market mechanisms.

Step 3: Implement the Process

Step 3 involves creating organizational capacity to transfer and receive the model, or in case of

expansion growing the originating organization, actual transfer of the model and monitoring for its

timely modification.

Task 8: Modify and Strengthen Organizations

Changes in the originating organization (if it wants to expand) and adopting organizations will be

required to take a model to scale. For the originating organization changes include changes in attitudes

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and behaviour within as it now faces the prospect of either expanding itself or handing off responsibility

to others. If this organization is responsible for the scaling-up effort, it must also figure out what

actions this requires and how to integrate these actions with its ongoing programmatic responsibilities.

Transfer of knowledge and know-how is one of the most neglected aspects of scaling up. In addition

to procedures such as process engineering, developing manuals, and training of trainers, this often

requires a substantial simplification of the model because the resources necessary for intensive mentoring

and capacity building are often not available. Even when the originating and adopting organization

is the same, major organizational obstacles to change are likely, especially when expansion occurs by

creating new branches. In replication, transferring the technology, process and know-how of the model

can be particularly difficult if the originating and adopting organizations have differing organizational

cultures, values, internal structures, and incentives. In cases where the values and norms of the

adopting and originating organizations are dissimilar, part of the scaling-up effort requires transforming

the model or aligning these values so that transfer can occur. The Institutional Development Framework,

referred to earlier, can be of great use to begin with. Coaching and other leadership development

programmes can also be especially helpful.

Task 9: Coordinate Action

Task 9 focuses on establishing and applying the multi-organization management processes, coordination

mechanisms, and accountability procedures needed to ensure that decisions are translated into concrete

action.

There are four aspects or approaches to coordination – sharing information, sharing resources, joint

planning, and joint action. Coordination is by its nature time consuming, and each of the four

approaches is successively more difficult. The operational implications for those implementing scaling-

up programmes are to limit, where possible, the extent of coordination that is necessary; favour less

complex forms of coordination; and ensure that responsibilities and resources for coordination are

clearly established.

Since coordination and cooperation take time, cost money and entail loss of autonomy by each of

the participating organizations, these efforts succeed only when perceived benefits outweigh the costs

for each of the organizations involved. Central to this task is the establishment of transparent and

efficient governance structures for networks and coalitions. The emerging field of public-private

alliances has, for example, developed a wide range of options for managing pooled and parallel

resources in ways that are directly applicable to scaling up.

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Task 10: Track Performance and Maintain Momentum

It is important to track the effects of introducing the new model and to make adjustments if the results

differ from what was intended. Such monitoring and evaluation ideally begins early in the process,

with assessments during Step 1 of the effectiveness of the pilot project. The management process needs

to anticipate the questions and concerns of the broader audience involved in approving, funding and

implementing the scaling-up process. This puts a particular premium on any such monitoring and

evaluation being done in a credible, public and transparent manner, and there is considerable value

to involving independent third parties in this effort. Also of critical importance is the creation of

avenues for feeding this information back to the public and to decision-makers, and for ensuring that

it is widely discussed. The press, academia, and non-partisan monitoring organizations can play an

important role in this process.

In addition to assessing outcomes, it is important to monitor progress in implementing the scaling-

up process. Among other things, this monitoring is a catalyst for maintaining momentum and

accountability, and for keeping the process on track, following the adage “what gets monitored gets

done”. Such monitoring begins by defining a descriptive list of stages or milestone events in the

scaling-up process and a limited number of expected outcomes. This disaggregates the change process

into “units” that are more easily understood and tracked, and helps managers better analyse the

monitoring and evaluation of information collected. Table 24.1 presents a summary of the steps in

scaling up.

Table 24.1. Summary of Scaling Up

Step 1

Develop a Plan

1. Create a Vision

2. Assess Scalability

3. Fill Information Gaps

4. Prepare a Scaling-up

Plan

Step 2

Establish the Preconditions

Tasks

5. Legitimize Change

6. Build a Constituency

7. Realign and Mobilize Resources

Step 3

Implement the Process

8. Modify and Strengthen Organizations

9. Coordinate Action

10. Track Performance and Maintain

Momentum

References

Cooley, Larry and Richard Kohl, December 2005. “Scaling Up – From Vision to Large-scale Change:

A Management Framework for Practitioners”. Management Systems International.

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chapter 25

COMMUNITY NEEDS

ASSESSMENT

Till 31 March 1996, the national-level targets in respect of different family planning methods used

to be fixed in consultation with the states and Union territories, keeping in view their long-term

demographic goals and past performance levels. These targets became an end in themselves and not

the means to bring about the expected decline in birth rates. The target-based system suffered from

neglect of the quality of services provided to the people under the Family Welfare Programme. Thus,

a need arose to introduce a decentralized participatory approach with emphasis on clients’ satisfaction

and quality of services under a target-free approach.

In 1994 the International Conference on Population and Development held in Cairo recommended

that population-related programmes must be aimed at enabling the couples and individuals to decide

freely and responsibly the number and spacing of their children; to have the information and means

to do so; to ensure informed choices; and to make available a full range of safe and effective methods.

The success of population education and family planning programme in a variety of settings demonstrates

that informed individuals everywhere will act responsibly in the light of their own needs and those

of their families and communities.

Based on this new outlook, the target-free approach for the family welfare programme was extended

all over the country from 1 April 1996 and was renamed as Community Needs Assessment Approach

(CNAA) in 1997-98. The new outlook necessitates decentralized participatory planning. Under this

approach, the planning of family welfare services was to be formulated in consultation with the

community at the grassroots level and it was expected to lead to improvement in the quality of

services and client satisfaction.

Community needs assessment refers to need assessment and planning for the services with the

involvement of the community, NGOs, community health volunteers, women’s groups and the

panchayat. Since the emphasis is on providing quality health services as well as on promoting use of

birth-spacing methods, the community needs assessment concept means that these would be based

on the actual needs of the people, and not the needs as perceived by the top professionals and

administrators.

Like any other programme, this programme initially lacked intersectoral coordination, thereby reducing

the effectiveness of plans in the health sector. It was observed that infrastructure was getting more

focus here than the functions of the district and state authorities. The CNA programme is nevertheless

picking up speed gradually. Action plans are being formulated through house-to-house surveys in many

districts, and birth and death registers are being maintained by panchayat workers in some districts.

In order to get direct interaction with clients other voluntary agencies’ participation is also undertaken.

Besides, monitoring and evaluation of the performance also require a fresh look at the issues of quality

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of care at different levels of the primary healthcare system. Decentralized planning implies close

association of the community and its opinion leaders such as village pradhans, Mahila Swasthya

Sanghs, primary schoolteachers, etc. in the formulation of the PHC-based family welfare and healthcare

plan.

The CNA Approach

Through the CNA approach, the services to be provided to the community are based on their actual

needs, since these are assessed systematically. This would help in:

• setting priorities;

• identifying target as well as high-risk groups;

• leading to realistic estimation of services and matching of resources needed for the same;

• developing realistic action plan/work plan for the functionaries/service providers that would be

relevant to local situations.

This approach can be used for distribution of contraceptives (oral pills, condoms), provide sexuality

and gender education and counselling, and create awareness concerning family planning and childcare

(use of home-available fluid and oral rehydration solution (ORS)), the importance of breast-feeding

and nutrition, etc. It also facilitates organizing family life education.

The process of CNA involves the following steps:

• epidemiological and planning skills

• defining population groups

• producing health information intervention

• assessing health status, health problems and needs for reproductive and child healthcare services

• prioritizing

• choosing alternative reproductive and child healthcare services as per estimated needs

• increasing, assessing and focusing on the quality of services

• evaluating effectiveness

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CNA Plan at Various Levels

In favour of decentralized planning, it is said that the decentralized planner tends to be more aware

of the local problems and resources, the needs and aspirations of the people and is thus in a better

position to plan for the neglected regions, sectors and sections of the community and thereby ensure

the equity concern in development. Secondly, with people’s participation ensured under decentralized

planning, the focus is attuned to solving local problems such as area-specific health needs and under-

utilization of locally available resources. The emphasis now is on setting targets and priorities at each

level, in a multi-level approach, beginning with the village level.

Village Level

A community worker, preferably an accredited social health activist (ASHA), should go house to house

and update information on health and reproductive health indicators. At the end of each month this

can be discussed with village health and sanitation committees and the health needs of the village

can be reviewed. The compilation of these health needs should go into the sub-centre plan.

Sub-Centre Plan and Primary Health Centre Plans

The sub-centre plans are sent to the PHC, which compiles them and adds the components of other

services provided at the PHC level, such as number of medial termination of pregnancies (MTPs) to

be done, number of reproductive tract infections cases to be treated and referred, to prepare an action

plan for each PHC.

Since the health data generated at sub-centre level and compiled at first referral unit (FRU) level would

provide the base for analysis and developing district-specific rates, the quality of CNA carried out at

the sub-centre level will affect the specific rates being determined by the FRU, the district, and the

national level. Effective implementation of various health policies and programmes largely depends

upon the supervision and control exercised by district officers over the management of the health

centres in the district.

To attain this objective it needs to be ensured that the following steps are followed by the health

workers at each sub-centre level.

• Develop a working team consisting of Anganwadi Workers, Birth Attendants, Mahila Swasthya

Sangh members, link persons and leaders of youth organizations at every village.

• Form a consultative group of panchayat members, teachers, priests, opinion leaders, etc.

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• Conduct household surveys with the help of the working team.

• Consult the consultative members for collection of more information and confirmation or

validation of the information collected through the survey.

• Estimate the needs for each health and family welfare service based on the analysis of survey

data.

• Hold meetings of the working team and consultative members every month regularly.

• Share information regarding services provided and seek feedback.

District-level Action Plan

1. Identify area of the centre and its catchment area.

2. Compile data from the centre, conduct a household survey to collect relevant additional

information not available through Form 1.

3. Conduct group meetings for consultation with the other working members and block and village

representatives.

4. Compare these estimates with demographic calculations.

5. Identify high-risk groups.

6. Prioritize the needed services in the area.

7. Determine workload and resource requirement for each component.

8. Set targets and norms.

9. Match them with supplies and facilities.

10. Prepare a month-wise activity plan for the year.

The plan would be a compilation of the entire Sub Action Plans under that particular centre. The

materials, vaccines, medicines, etc. required are calculated. Depending on the existing stock of

supplies, one must work out the net requirement for serving the felt needs of the population. The

additional information that is not generated at the sub-centre level, e.g., number of medical termination

of pregnancies done, number of reproductive tract infection cases treated and referred would be added

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at the district level. Special attention to certain matters such as family planning services and in

particular male sterilization should be paid, since it is only 3 per cent of the total number of

sterilization operations.

Validating Data

Once the needs or the requirements are assessed by the consultative process, the data derived would

have to be compared with the figures of earlier years as well as the number of pregnancies estimated

based on demographic calculations. This would enable the planners at the district level to appraise

the validity of the requirements assessed. The estimates based on the state or district statistics will

be more precise and should be used for planning. This information can be collected from the District

Statistical Officer/District Family Welfare Bureau. To estimate the probable number of pregnancies

that may occur in any area, the following formula could be used:

Probable number of pregnancies = population of the area x birth rate of the area (district/state)

+ 10 per cent for pregnancy wastage.

For example:

If the population of the PHC area is 30,000 and the district birth rate is 30 per 1000 live births, then

the calculation would be:

population x birth rate = 30,000 x 30 / 1000 = 900

Add 10 per cent for pregnancy wastage = 900 + 90 = 990

If the survey data for number of pregnancies is less than 990, it may indicate that:

• acceptance of family planning methods is high;

• the auxiliary nurse midwife is not carrying out the survey properly;

• reporting is inadequate;

• the population of the area has migrated.

Some Pregnancy-related Indicators

• The number of pregnancies will indicate the number of deliveries that are expected in the PHC

area. This would also be the target of antenatal registration. Accordingly, the number of antenatal

care visits, requirement of tetanus toxoid doses, iron-folic acid tablets can be worked out.

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It has been estimated that 15 per cent of antenatal mothers registered are usually high-risk cases.

For example:

Birth rate being 30 per 1000 in the given population of 30,000

Detection and referral of high risk pregnancies (i.e., 15 per cent)

= 990 x 15 / 100 = 148.5

990 being the probable number of pregnancies.

• It has also been estimated that 50 per cent of the antenatal cases registered are anaemic.

For example:

Birth rate being 30 per 1000 in the given population of 30,000

Detection and treatment of anaemic mothers (i.e., 50 per cent)

= 990 x 50 / 100 = 495

990 being the probable number of pregnancies.

• The number of live births to be expected or deliveries to be expected is estimated by the

following formula:

Number of live births = Population of the area x birth rate of the area

The figures of high-risk new-born are estimated to be 10 per cent of the number of live births. The

number of infants who have died during the year can be calculated by using the infant mortality rate

of the year.

• The number of under-3 children can be estimated from the fact that the population of under-

3 children is 8 per cent of the total population.

• Under-5 children constitute 13 per cent of the population.

• The number of referrals will be an indication of how well the auxiliary nurse midwife is doing

her job.

• As regards reproductive tract infections, it has been observed that 20–25 per cent of men and

women suffer from RTI.

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• With regard to oral rehydration, the performance data relating to the whole country indicate that

oral rehydration provided to affected children is still only about 50 per cent cases. If the work

regarding oral rehydration therapy is attended to properly, the increase in work during the year

should always be more than 15–20 per cent compared to the previous year.

Filling up the Action Plan forms

• The ANM will compile information from the

census reports for the state/district and

information with regard to population and birth

rate from the census books, which are available

with the District Family Welfare Officer or in

the District Collectorate or with the District

Statistical Officer.

• Assessment of needs relating to antenatal or

prenatal care, deliveries, vaccinations, etc. must be done after an extensive consultation process

with the community.

• With regard to services such as antenatal, natal care, etc., a comparison should be made with

the performance of the previous year. Usually, there should be an increase in coverage for each

item by more than 5 per cent every year because of the normal increase in population and the

rise in facilities to be provided to the citizens. If the increase is less than 5 per cent, it should

indicate that the assessment is probably incomplete or an under-estimate. If the increase is more

than 25 per cent, it should alert the superior officers that perhaps the assessment of the needs

that has been made is unrealistic.

• In family planning, special attention needs to be given to persuade men and women to use

spacing methods if they have less than two children, or sterilization if they have two children.

What the Corporate Sector Can Do

• Provide training in human resource management as well as administration as a whole. The

corporate sector can involve itself in providing training on leadership, motivation, crisis management

and problem solving.

• Facilitate formation, training and capacitating VHSCs and their functionaries in their field areas.

• Ensure that the process of CNA is followed in the community-based programmes to calculate

realistic RH needs of the community and provide need-based services.

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• Facilitate and act as a catalyst in advocacy between the community and government.

• Help in printing and promoting of the Annual Plan forms.

• Provide infrastructure facilities such as computer systems at the district and sub-centre level,

provide training to the involved personnel in computer applications.

• Encourage community monitoring of services by facilitating the monitoring of the programme at

the grassroots level or integrate with local community-based organizations or NGOs for support

to the process.

• Involve in the advocacy on the importance of community needs assessment process with

stakeholders.

References

Butler, Lorna Michael and Robert E. Howell 1980. “Coping with Growth: Community Needs Assessment

Technique. Corvallis”, OR : Western Rural Development Center.

Carter, Keith A., Gerald E. Klonglan, Frank A. Fear, Richard D. Warren, Christopher E. Marshall,

Rodney F. Ganey, and Erik R. Andersen 1977. “Social Indicators for Rural Development: Descriptive

Social Reporting. Ames, IA: Conducting A Community Needs Assessment” : Department of

Sociology and Anthropology, Iowa State University, Report No. 141.

Keith A. Carter and Lionel J. Beaulieu. 1992. “Conducting A Community Needs Assessment : Primary

Data Collection Techniques”. Florida : Cooperative Extension Service. www.nwu.edu

Pandey Shruti, Visiting Faculty, MSW, Patna University (2008), “Class Notes on Project Management”.

Sharma Aparna, Lanum Mindy and Suarez-Balcazar Yolanda. 2000. “A Community Needs Assessment

Guide : Chicago : Centre for Urban Research and Learning and Department of Psychology”,

Loyala University.

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POPULATION FOUNDATION OF INDIA

B-28, Qutab Institutional Area, Tara Crescent, New Delhi 110 016

Tel. No : 42899770, Fax : 42899795

Website : www.popfound.org, E-mail : popfound@sify.com