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

2. 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

3. 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?

4. 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.

5. 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.

6. Typical Planning cycle

7. 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.

8. 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.

9. Conducting a situation analysis

10. 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.

11. 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.

12. Items in a Situation Analysis (1)

13. Items in a Situation Analysis (2)

14. Items in a Situation Analysis (3)

15. 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])?

16. 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

17. 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

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

19. 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

20. 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.

21. 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.”

22. 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

23. 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.

24. 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.

25. 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

26. 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?