Design and Planning of PHCs

Setting Goals and Objectives

Gilbert Burnham, MD Johns Hopkins University

The material in this video is subject to the copyright of the owners of the material and is being provided for educational purposes under rules of fair use for registered students in this course only. No additional copies of the copyrighted work may be made or distributed.

Part 1: Thinking about Goals, Objectives, and Indicators

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Project Development Process—1

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Project Development Process—2

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Project Development Process—3

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The Logical Sequence—1

► The Problem Statement leads to program goals or aims

► These say what you are going to do to address the problems and needs identified

► Goals (general)  Objectives (specific)

► Objectives lead to your strategy and methods

► Objectives are the basis of your monitoring system

► Objectives are measured by indicators

► Objectives are what you will be evaluated against during regular and final evaluations

So these have to be right!

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The Logical Sequence—2

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Start with the Goal or Aim or Purpose

► An overall end point—where do we want to be at project end? ► Explain why you are doing the project ► Emphasizes consistency with national plans or with other initiatives and your

organizational mandate ► It says what you hope to achieve by addressing your problem statement ► Can help build recognition of activities ► Goals represent general overall project direction

► Not specific, and not quantifiable, but not vague ► There should be only one overall goal—too many confuses the reader

● May be several subgoals—each of which will have one or more objectives, but don’t make it confusing

► Sets the stage for the objectives, which are specific and quantifiable

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Objectives—1

An objective… ► Is a statement of a specific and quantifiable accomplishment to be attained in a given time

frame ► This says how you intend to achieve your goal, and how you will make a difference in the

lives of the population you serve ► Includes words like—

► “increase” ► “strengthen” ► “decrease” ► “extend” ► “empower”

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Objectives—2

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Objectives—3

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“SMART” Objectives

The famous SMART objectives, now taught in primary schools the world over (with some variations) ► Specific

The objective describes the direct result of the activity, and say how you will achieve them

► Measurable The objective can be quantified—how much, how many, how often They are the change created

► Achievable (also Attainable, Agreed, Assignable) The objective can be attained by the organization—capacity, constraints, resources

► Relevant (also Realistic) This is something which will have practical benefit

► Time-bound (also Time-limited) Results will be achieved within in a given time

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Indicators, Milestones, and Targets

► Indicators—can be qualitative or quantitative ► Variables that help measure changes in health situations and assess the extent to

which the objective and targets of a program are being attained ► Indicators are usually expressed as percentages, rates, or ratios to allow comparisons

to be made, but are not a value themselves ► They are not to be confused with objectives and targets and goals

● They are “value neutral” ► Milestones

► How are your progressing on the path to realizing the objective?

► Targets ► A value to be attained by a certain time in the life of the project

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Indicators and Targets—1

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Indicators and Targets—2

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Qualities of an Indicator

► Valid ► The result is a true representation of what is happening

► Specific ► The indicator measures only the activity that is intended

► Sensitive ► The indicator easily picks up the changes that are intended

► Operational ► Easy to use and it has been tested against other standards

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The Systems Model for Objectives and Indicators—1

Each step in the systems model could have objectives and indicators in many projects- depending on the problem

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The Systems Model for Objectives and Indicators—2

► A measles immunization program for a specified age group ► Input objective: zero stock out of vaccine; indicator: number of days in past 90 days

that vaccine was present ► Process objective: vaccine is stored between 2.0 °C to 8.0 °C; indicator: number of days

in past 90 at correct temperature ► Output objective: 8,000 vaccine doses given past 90 days; indicator: number vaccine

doses given past 90 days ► Outcome objective: 95% measles immunization coverage achieved; indicator: measles

immunization coverage ► Impact objective: no measles death in past 90 days; indicator: recorded deaths in past

90 days

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Targets and Results—1

► Target: a value to be attained by a certain time in the life of the project ► Often confused with goals and objectives ► Generally liked as an advocacy tool: “Lymphatic filariasis will be reduced to 25% of

households.” ● This sounds impressive, but the message could be “relax after the program reaches

the 25% prevalence level” ● Don’t set targets that are to ambitious; you may be setting up for failure

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Targets and Results—2

► Results—has an uncertain definition ► Does it mean outputs or outcomes? Don’t use it unless clearly defined—such as a

“results-based framework”

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Targets and Results—3

► Impact—used in different ways ► The public health team means change in death rates ► As commonly used, just means some change, amount not specified ► Many are hesitant to use this term as it is too vague in standard use

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Dashboard Indicators—1

► Certain indicators are high priority indicators for effective managers ► Some project indicators may change quickly and have important consequences ► These may require quick decision-making from the management team ► A group of indicators may effectively portray the health and functions of a project

► These “dashboards” are a collection of such indicators ► This is a central location that integrates data from many project areas ► Particularly, this is important when a project is complex and many interventions ► Common in hospitals where bed occupancy, ER waiting time, and surgery activities can

be monitored minute by minute by senior hospital management

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Dashboard Indicators—2

Image adapted from: Evidence for Action - MamaYe. (2014). Mchinji district data dashboard and advocacy resources. Lilongwe & London: Evidence for Action.

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USAID Results Framework—1

► Strategic objectives—to be achieved by the end of the project—the “results” or the impact

► Intermediate results—milestones along the way, outcomes in order to achieve strategic objective

► Results framework—the big picture

► One strategic objective may have several intermediate results (IRs) ► Each IR has a strategy ► Each IR can have several activities ► Each IR activity has indicators

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USAID Results Framework—2

The material in this video is subject to the copyright of the owners of the material and is being provided for educational purposes under rules of fair use for registered students in this course only. No additional copies of the copyrighted work may be made or distributed.

Part 2: Putting All This Together in a Logical Framework (Log Frame)

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The Logical Framework

► The log frame (or logic model) is dearly beloved by USAID and others

► Intent is to guide project development in a logical manner ► Promoting a smooth flow from objective to design of

activities to support the objectives ► Encouraging measurable objectives—making the team

return to fix those that are not measurable ► Selecting ways of measuring ► Prevents things from being forgotten ► Helps unify the various parts of the project

► Can be mechanical and time consuming

► You should do this for your project—think of this as the road map to your project

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Log Frame: A Common Format—1

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Log Frame: A Common Format—2

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Log Frame: A Common Format—3

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Log Frame: A Common Format—4

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Log Frame: A Common Format—5

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Log Frame: A Common Format—6

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Log Frame: A Common Format—7

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Log Frame: A Common Format—8

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Monitoring—1

► What happens after implementation? ► How do you know if you are on track? ► What segments are lagging behind? ► Are there some things that are getting ahead?

► Risk of activities getting out of sequence

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Monitoring—2

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Monitoring—3

► What happens after implementation? ► How do you know if you are on track? ► What segments are lagging behind? ► Are there some things that are getting ahead?

► Risk of activities getting out of sequence

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Evaluation—1

► Did the project achieve what was intended? ► Commonly asked at annual evaluations or desk reviews ► And always at end-of-project evaluations

► What went well? What did not?

► How could the design and implementation have been improved?

► Who benefited, and who did not

► Were resources expended on activities in an efficient manner?

► A project cannot be evaluated without specific objectives

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Evaluation—2

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Strengths and Weaknesses of a Log Frame—1

Strengths ► Methodical approach

► Links aims with objectives and methods with outcomes

► Improves thoroughness and connectedness ► Especially important in complex multicomponent programs

► Facilitates evaluation

► Establishes framework for decisions

► Builds common agenda when developed collectively

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Strengths and Weaknesses of a Log Frame—2

Weaknesses ► Concentrates on quantifiable indicators

► “We monitor what we can measure—not what is important”

► Mechanistic logic

► Project may become static

► May alienate staff and community

► Requires large investment of time and other resources

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Beyond Indicators to Indices

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Cold Chain Index

1. Vaccine refrigerator working

2. Sufficient fuel for 30 days

3. Thermometer working

4. Temperature log kept

5. Cold box vaccine carrier (accept one only)

6. Ice packs present and in good condition (accept one only)

7. Adequate immunization cards for 30 days

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Indicators for Complex Events

Patient satisfaction index for a clinic visit—Likert scale

1. Length of waiting time

2. Convenience of the health center

3. Cleanliness of health unit

4. Respectfulness and courtesy of staff

5. Trust in the skills and abilities of the health personnel

6. Ease of getting medications

7. Opening hours of health facility

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Indicators and Indices for the Balanced Scorecard—1

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Indicators and Indices for the Balanced Scorecard—2

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Indicators and Indices for the Balanced Scorecard—3

Use of indicator data for informatics which are effective ways of communicating project achievements

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Summing Up

► Goals and objectives are the heart of the project

► Spend time getting them right in the first place

► You can change them as you develop the project

► You can change them even as the project is running

► The log frame is a critical internal tool to ensure consistence and sequential flow

► It takes time, and sometimes is mechanistic

► But the log frame will help ensure the completeness of your project design

► Every project needs a communication plan, and indicator data can feed this