How to do a Situation Analysis Rapid Situation Analysis of Maternal, Newborn, Child Health and Related Services in the District

Learning objectives What is a situation analysis (baseline assessment)? Why do we need a situation analysis? What are the critical elements of an appropriate maternal, newborn and child health situation analysis? What are the steps in conducting a maternal, newborn and child health situation analysis? What is a SWOT Analysis? How does it help identify health system factors that influence maternal, newborn and child health clinical outcomes in the district

Why do we need a situation analysis? A Situation Analysis will help describe the current maternal and child health situation in the district It will be used to identify the strengths and gaps (and their reasons) of maternal and child health programmes. It therefore describes and analyses the current situation. More importantly, it will be used to inform your DCST action plan, i.e. where you are going to in terms of MCH services?

What will it be used for? It will be used to develop your action plan. You need an action plan to guide your services, both now and in the future. You need an action plan to share with your district team leadership to show them where you want to go and how you plan to get there. This will both motivate and direct everybody. The situation analysis is fundamental in informing this action plan.

How is it helpful? First step of a planning cycle for the health district ( first task of a newly formed DCST) By documenting the problems and proposed strategies of a district, it can be used as a monitoring and evaluation tool. Brings together different categories of health workers in a team. Contributes to the District Health Plan and Report. Subsequent reports can be regarded as updates and improvements of the situation analysis. Identifies gaps or deficiencies in information available, and contributes to development of a district health information system.

Typical Planning cycle

The presentation of information Each district to prepare its own Situation (baseline) Assessment Very important if the document if it is going to be read widely and if it is to be useful as a planning tool. Important to use information which is clear, appropriate, accurate and up-to-date. Where possible, compare your district to other districts, or against accepted norms and standards.

Where do we get the information? You and the team could find and read all available reports, studies, policies and guidelines? Your primary source is likely to be DHIS data Were there recent epidemiological or qualitative studies done in the area? Was a Demographic Household Survey (DHS) done recently? You could do an internet search You could contact your district , provincial or the national departments and ask them for information. You could do a number of visits to your services and get first hand accounts of some of the issues.

Conducting a situation analysis

Step 1: Develop a framework A framework provides a structure for presenting the information in a logical way. The Initiative for Sub-District Support has developed a framework. If situation analyses are being done in a number of districts in one province it may be useful to use a standard format to make comparisons easier. However, there should be enough room to reflect the unique features of each district.

The scope of a situation analysis The geography of the district as well as the people and communities who live there. The socioeconomic profile of the district. The health status of the people in the district. The health services in the district. The management systems which support the provision of health and MCH services. The political and policy environment of the district. The activities of other sectors which are important in determining the health status of the population e.g., Education, Housing, Water Affairs, Welfare.

Items in a Situation Analysis (1)

Items in a Situation Analysis (2)

Items in a Situation Analysis (3)

Task 1 Each district is expected is to do a baseline assessment of MCNH, and prepare a situation analysis report for the next workshop in about 8 weeks. What should the situation analysis include? Is there anything related to MCNH that needs to be assessed, but is better left for later (after the baseline assessment [8 weeks])?

Assessing the situation - SWOT SWOT analyses are a set of tools to assist you in doing and understanding the situation analysis. An acronym for: Strengths Weaknesses Opportunities Threats

What is a SWOT analysis? Used to identify the strengths and weaknesses of a organisation or programme Used to identify the opportunities and threats an organisation or programme faces Makes a useful contribution to an organisational or programme diagnosis, before planning process starts

Components of a SWOT analysis Positive Negative Strengths Weaknesses Opportunities Threats Local Province DOH

Components of a SWOT analysis Personnel Infrastructure Equipment Budget Management Information Components of a SWOT analysis   Positive (helpful) Negative (harmful) Internal Environment Strengths Things that are good now, maintain them, build on them and use as leverage Weaknesses Things that are bad now, remedy, change or stop them. External Environment Opportunities Things that are good for the future, prioritize them, capture them, build on them and optimize Threats Things that are bad for the future, put in plans to manage them or counter them Legislation Budget Other health influences you cannot change   Positive Negative Internal Environments Strengths Weaknesses External Environments Opportunities Threats

SWOT Strengths Weaknesses Strengths describe the positive attributes, tangible and intangible, internal to your organization. They are within your control. What do you do well? What resources do you have?  Consider your strengths from both an internal perspective, and from the point of view of your clients Weaknesses are factors that are within your control that detract from your ability to offer a good service. Which areas might you improve? Weaknesses might include lack of expertise, limited resources, lack of access to skills or technology, inferior service offerings The more accurately you identify your weaknesses, the more valuable the SWOT will be for your assessment.

SWOT Opportunities Threats Opportunities assess the external attractive factors Does it represent an ongoing opportunity, or is it a window of opportunity? Opportunities are external to your organisation. What factors are potential threats to your functioning? Threats are external – you have no control over them, but you may benefit by having contingency plans to address them if they should occur. Part of this list may be speculative in nature, and still add value to your SWOT analysis. It may be valuable to classify your threats according to their “seriousness” and “probability of occurrence.”

Example of a SWOT analysis   Positive Negative Internal Environment Strengths Willingness of staff to change Perception of quality of services Weaknesses Staff lack of motivation Space constraints Bureaucracy Cultural differences with users External Environment Opportunities Support of district management Availability of women’s groups Threats Poor communities Bad roads Lack of budget   Positive Negative Internal Environments Strengths Weaknesses External Environments Opportunities Threats

Compiling a SWOT Matrix Strengths –S List most important internal strengths e. g. skilled training department Weaknesses – W List most important internal weaknesses, e. g Lack of health promotion interventions in rural communities Lack of outreach support to rural areas Opportunities – O List most important external opportunities, e. g. traditional midwives attend to home births of rural women who has limited access to transport SO Strategies Match internal strengths with relevant external opportunities and record the possible strategies, e. g. teach Infection prevention and control practices to traditional midwives in rural areas WO strategies Match internal weaknesses with relevant external opportunities e.g. health promotion in rural areas through NGO outreach Threats – T List most important external threats, e. g. Pregnant rural women book late for antenatal care or go unbooked due to lack of money and transport ST Strategies Match internal strengths with relevant external threats and report possible strategies, e. g. get traditional midwives on board of MNCH program to promote early antenatal booking WT Strategies Match internal weakness with relevant threat and report possible strategy, e. g. DCST establishes monthly outreach visits to rural areas.

Simple rules for a successful SWOT analysis Be realistic about the strengths and weaknesses of your district. The Analysis should distinguish between where your district is today, and where it could be in the future. Be specific. Avoid grey areas. Analyse in relation to other districts i.e. better than or worse than your district, and national norms and standards if available? Keep your SWOT short and simple. Avoid complexity and over analysis.

What makes a SWOT analysis work? Trust – The questions that SWOT will bring up, particularly in the Weaknesses and Threats categories may be uncomfortable. Your group must be at a point in its working relationship where weaknesses and potential threats can be faced openly and objectively. Ability and willingness to implement change Diversity – The team conducting the SWOT analysis should be representative of your entire planning team Time – Taking time to be thorough

Task 2 Identify the strengths and weaknesses that influence MCH clinical outcomes Identify the opportunities and threats that provide challenges to the MCH programme In discussion, answer the following questions: What can we do to maximise our strengths? What must we build or develop to overcome weaknesses or problem areas? What do we need to do to make use of the opportunities? What can we do to minimise or neutralise threats?