Lesson 3: Key tips for developing an implementation strategy

This article provides guidance on the key steps that are part of the process of establishing a strategy for the plan. In this step, we look to identify the key steps in establishing a strategy for the plan.

Defining priorities and strategies

The selection of objectives and activities needs to take into account the key constraints to be tackled in the early stages of the programme. Priorities will have to be agreed by the planning committee and guided by such variables as:

• Size of health impact in relation to resource demand.
• Visibility of improved service to enhance public support and patient uptake.
• Long term service sustainability with regard to people and funds, involving inbuilt planning for cost-saving, income generation, and optimisation of resource usage.
• Degree of community participation.
• Clear integration of manageable monitoring and evaluation procedures.
• Emphasis on the improvement of management skills.
• Ease of integration with the primary health care system.

A strategy is the total of all the clearly defined activities (and sub-activities) needed to achieve an objective. Activities will have clearly defined individual targets that indicate progress under the action plan. Strategies too may have to be prioritised. The activities in each strategy will
have:

• A sharply defined time schedule.
• Responsibilities clearly and considerately assigned to identified individuals or post holders.
• An even distribution of tasks in the set time, frequently consecutive, rather than overlapping.
• Training programmes included.
• A realistic and pragmatic expectation of resource consumption (a costing).
• A reliable indicator to monitor achievement and enable an evaluation of the programme.

Preparing a timetable

The agreed programme to implement the district plan will bring together activities, responsibilities, time schedules, and budget. The timetable can be set out in a Gantt chart, or, more comprehensively, in detailed action plans (as exemplified in Table 2.2). Experience during implementation will lead this programme to be reviewed and updated on a regular basis. Regular team meetings will lead to better planning.

Preparing a budget
The district programme, integrated within the district PHC service, needs to be accompanied by a carefully planned budget.

Expenditure

1. Capital (one-off)

• Buildings
• Vehicles
• Equipment (maybe externally sourced and therefore not within the local accounting system).

2. Running (repeating)

• Salaries (incentives may be difficult to assess)
• Consumables (difficult to assess as most are donations)
• Overheads (including maintenance and repair).

Note:

• Consider all costs: information on uses of locally generated income can be difficult to research.
• Estimate the amount if an exact figure is not available
• Running costs should be calculated for a year
• A 5-10% contingency can be added.

Sources of income: Some sources are not always applicable:

• Service fees
• Sales, for example from the optical workshop and the pharmacy
• Government, including salaries
• Local support
• International donors, including donations.

Note:

• The goal of financial sustainability requires income to balance or exceed expenditure (see sustainability below).
• Fees should be set at a level that encourages uptake and does not impact negatively on equity.
• Salaries are normally the major expenditure
• Attempts at cost reduction should always accompany the search for new income generation.
• Government support may be more sustainable than NGO finance.
• Sustainability.

Sustainability can be achieved in a number of ways:

1. Cost-recovery, including improved management training and accountability; this may be difficult where the service has historically been free
2. Improved service marketing and quality of outcomes, producing increased awareness and demand
3. Team ethos acquired through a shared acceptance of the need for financial sustainability.