โครงการพฒันาศกัยภาพบคุลากรด้านการประเมินความจ าเป็นด้านสขุภาพ เพ่ือรองรบัการบริหารจดัการเขตสขุภาพท่ี 12

การออกแบบโครงการProject Design

ดร.นพ.วรสิทธ์ิ ศรศรีวิชยั

มลูนิธิสขุภาพภาคใต้

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ระบาดวิทยากบัการป้องกนัควบคมุโรค

ระบาดวิทยา : โรคอะไร เท่าไร กระจายอย่างไรการป้องกนัควบคมุโรค :ปัญหา กลุ่มเป้าหมาย

ระบาดวิทยา : เกิดขึน้ได้อย่างไรการป้องกนัควบคมุโรค :ปัจจยัสาเหตท่ีุต้องควบคมุ

ระบาดวิทยา : มาตรการท่ีเหมาะสมคืออะไรการป้องกนัควบคมุโรค :กิจกรรมท่ีต้องด าเนินการ

ระบาดวิทยา : จะด าเนินมาตรการอย่างไรการป้องกนัควบคมุโรค : ประเมินผลกิจกรรม

การสญูเสียปีสขุภาวะ / 1,000 พนัประชากร เขต 12# ชาย DALY หญิง DALY1 อุบตัเิหตุทางถนน 15 โรคหลอดเลอืดสมอง 122 โรคหวัใจขาดเลอืด 15 โรคเบาหวาน 103 โรคหลอดเลอืดสมอง 13 โรคซมึเศรา้ 74 การถูกท ารา้ย 13 โรคหวัใจขาดเลอืด 75 โรคหอบหดื 10 โรคหอบหดื 66 การตดิเชือ้เอชไอว/ีเอดส์ 8 ตอ้กระจก 57 โรคเบาหวาน 8 โรคขอ้เสือ่ม 48 โรคปอดอุดกัน้เรือ้รงั 7 อุบตัเิหตุทางถนน 49 การเสพตดิเครือ่งดื่มทีม่แีอลกอฮอล์ 6 การตดิเชือ้เอชไอว/ีเอดส์ 4

10ภาวะตบัแขง็ โรคมะเรง็หลอดลมและปอด โรคซมึเศรา้ ตอ้กระจก 4 ภาวะโลหติจาง 43

การบา้น

1. ทบทวนวรรณกรรมหรอืวเิคราะหข์อ้มลู เพือ่หาปัจจยัเส่ียง 3 อนัดบัแรกทีม่คีวามส าคญัของโรคทีร่บัผดิชอบ โดยหา

1. Prevalence

2. Risk ratio (RR) หรอื odds ratio (OR)

3. Attributable fraction among the exposed (AFe) และ population (AFp)

2. ทบทวนวรรณกรรม เพือ่หามาตรการ 3 อนัดบัแรกทีม่คีวามส าคญัในการป้องกนัควบคุมแต่ละปจัจยัเสีย่งในขอ้ 1

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Problem Solving Cycle

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Problem Solving Cycle

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What Is a Project?

• A project is a series of activities aimed at achieving specified objectives within a defined time-period and budget

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Cycle of Operation

The Quality Frame

• A set of quality assessment criteria provided to support structured and consistent analysis and decision making– Relevant – the project meets demonstrated and high priority needs

– Feasible – the project is well designed and will provide sustainable benefits to target groups

– Effective and well managed – the project is delivering the anticipated benefits and is being well managed

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Logical Framework Approach - LFA

• ‘Aid to thinking’ Analytical process and set of tools used to support project planning and management in a logical way so that it is:– Well designed.

– Described objectively

– Can be evaluated

– Clearly structured

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2 Phases of LFA in Project Design

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LFA in Project Implementation & Evaluation

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Hierarchy of Objectives & Evaluation Criteria

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Two Main Phases of LFA

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Stakeholders: Who?

1. Stakeholders: Individuals or institutions that may – directly or indirectly, positively or negatively – affect or be affected by a project or programme.

2. Beneficiaries: Are those who benefit in whatever way from the implementation of the project.

a) Target group(s): The group/entity who will be directly positively affected by the project at the Project Purpose level. This may include the staff from partner organizations;

b) Final beneficiaries: Those who benefit from the project in the long term at the level of the society or sector at large, e.g. “children” due to increased spending on health and education, “consumers” due to improved agricultural production and marketing.

3. Project partners: Those who implement the projects in-country (who are also stakeholders, and may be a ‘target group’). 16

Stakeholder Analysis

• Different groups have different concerns, capacities and interests, and that these need to be explicitly understood and recognized in the process of problem identification, objective setting and strategy selection.

• Whose problems or opportunities are we analyzing?

• Who will benefit or loose-out, and how, from a proposed project intervention?

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Stakeholder Analysis

• Main steps1. ระบุประเดน็ปญัหาใหช้ดั Identify the general development problem

2. Mapping คน้หา stakeholders ทีเ่กีย่วขอ้ง

3. เปรยีบเทยีบ จุดแขง็-จุดอ่อน (บทบาทหน้าที ่ความสนใจ/แรงบนัดาลใจ/แรงจงูใจ อ านาจ ศกัยภาพ/ความสามารถ) ของ stakeholders เหล่านัน้

4. วเิคราะหค์วามสมัพนัธ ์(ความรว่มมอื-ความขดัแยง้) ระหวา่ง stakeholders เหล่านัน้

5. สรุปสงัเคราะหเ์พือ่ออกแบบ project

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Stakeholder Analysis: Main steps

1. Identify the general development problem or opportunity being addressed/considered;

2. Identify all those groups who have a significant interest in the (potential) project;

3. Investigate their respective roles, different interests, relative power and capacity to participate (strengths and weaknesses);

4. Identify the extent of cooperation or conflict in the relationships between stakeholders; and

5. Interpret the findings of the analysis and incorporate relevant information into project design to help ensure that

i. resources are appropriately targeted to meet distributional/equity objectives and the needs of priority groups,

ii. management and coordination arrangements are appropriate to promote stakeholder ownership and participation;

iii. conflicts of stakeholder interest are recognized and explicitly addressed in project design.19

Stakeholder Analysis Matrix

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SWOT analysis

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Venn DiagramsRelationships between Stakeholders

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Spider Diagrams Stakeholder/Institutional Capacity

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Problem Analysis

• Problem analysis identifies the negative aspects of an existing situation and establishes the ‘cause and effect’ relationships between the identified problems.

• 3 main steps:1. Definition of the framework and subject of analysis

2. Identification of the major problems faced by target groups and beneficiaries (What is/are the problem/s? Whose problems?)

3. Visualization of the problems in form of a diagram, called a “problem tree” or “hierarchy of problems” to help analyze and clarify cause–effect relationships.

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Problem AnalysisHow to Establish a Problem Tree?

1. Openly brainstorm problems which stakeholders consider to be a priority.

– can be completely open (no pre-conceived notions on stakeholder’s priority concerns/problems), or more directed, through specifying a ‘known’ high priority problem based on preliminary analysis or initial stakeholder consultations.

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Problem AnalysisHow to Establish a Problem Tree?

2. From the problems identified through the bainstormingexercise, select an individual starter problem.

3. Look for related problems to the starter problem

4. Begin to establish a hierarchy of cause and effects:– Problems which are directly causing the starter problem are put

below

– Problems which are direct effects of the starter problem are put above

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Problem AnalysisHow to Establish a Problem Tree?

5. All other problems sorted in the same way – the guiding question being ‘What causes that?’ If there are two or more causes combining to produce an effect, place them at the same level in the diagram.

6. Connect the problems with cause-effect arrows

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Problem AnalysisHow to Establish a Problem Tree?

7. Review the diagram’s validity and completeness. Ask ‘are there important problems that have not been mentioned yet?’ If so, specify the problems and include them

8. Keep a record and distribute

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Problem Analysis

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Problem Analysis

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Objective Analysis

• Analysis of objectives is a methodological approach to:– Describe the situation in the future once identified problems have

been remedied

– Verify the hierarchy of objectives

– Illustrate the means-ends relationships in a diagram

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Objective Analysis

• The ‘negative situations’ of the problem tree are converted into solutions, expressed as ‘positive achievements’– ‘river water quality is deteriorating’ -> ‘quality of river water is improved’.

• These positive achievements are in fact objectives, presented in a diagram showing a means/ends relationship aims to provide a clear overview of the desired future situation.

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Objective Analysis• Step 1: Reformulate all negative situations of the problems analysis into

positive situations that are:– desirable

– realistically achievable

• Step 2: Check the means-ends relationships to ensure validity and completeness of the hierarchy (cause-effect relationships -> means-ends linkages)

• Step 3: If necessary: – revise statements

– add new objectives if these seem to be relevant and necessary to achieve the objective at the next higher level

– delete objectives which do not seem suitable or necessary33

Problem Analysis -> Objective Analysis

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Objective Analysis

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Strategy Analysis

• Should all the identified problems and/or objectives be tackled, or a selected few?

• What are the positive opportunities that can be built on (i.e from the SWOT analysis)?

• What is the combination of interventions that are most likely to bring about the desired results and promote sustainability of benefits?

• How is local ownership of the project best supported, including development of the capacity of local institutions?

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Strategy Analysis

• What are the likely capital and recurrent costs implications of different possible interventions, and what can realistically be afforded?

• What is the most cost effective option(s)?

• Which strategy will impact most positively on addressing the needs of the poor and other identified vulnerable groups?

• How can potential negative environmental impacts best be mitigated or avoided?

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Key Criteria for Strategy Selection

• Strategic: Expected contribution to key policy objectives, such as poverty reduction or economic integration. Complementarity with other ongoing or planned programs or projects

• Social/distributional: Benefits to target groups – including women and men, young and old, disabled and able, etc

• Financial: Capital and operating cost implications, and local ability to meet recurrent costs

• Economic: cost-benefit

• Institutional: Contribution to institutional capacity building

• Technical: Technical feasibility

• Environmental: Environmental impact 38

Strategy Selection

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Strategy Selection

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Logical Framework Matrix - LFM

• Logical Framework Matrix - LFM or Logframe = a tool in Logical Framework Approach – LFA

• Matrix with 4 columns and 4 (or more) rows, which summarize the key elements of a project plan:– The project’s hierarchy of objectives (Project Description or

Intervention Logic)

– The key external factors critical to the project’s success (Assumptions)

– How the project’s achievements will be monitored and evaluated (Indicators and Sources of Verification)

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Logframe Matrix

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Logframe & Indicator Term

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Intervention Logic: Levels of Project Description

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How to Write Statements

• Overall Objective: ‘To contribute to…`

• Purpose: (benefits to the target group) ‘Increased/improved/ etc…’

• Results: (a tangible result) ‘delivered/produced/conducted etc’

• Activities: present tense starting with an active verb, such as ‘Prepare, design, construct, research …’

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How to Write Statements

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Sequence of Completion

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Necessary and Sufficient Conditions

• Achieving the purpose is necessary but not sufficient to attain the overall objective

• Producing the project results is necessary but may not be sufficient to achieve the purpose;

• Carrying out project activities should be necessary and sufficient to deliver the results;

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Assumptions

• Assumptions are external factors that have the potential to influence (or even determine) the success of a project, but lie outside the direct control of project managers.

• “What external factors may impact on project implementation and the long-term sustainability of benefits, but are outside project management’s control?”

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Assumptions

• Once the Activities have been carried out, and if the Assumptions at this level hold true, results will be achieved;

• Once these Results and the Assumptions at this level are fulfilled, the project Purpose will be achieved

• Once the Purpose has been achieved and the Assumptions at this level are fulfilled, contribution to the achievement of the Overall Objectives will have been made by the project.

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Assumptions and Objective Hierarchy

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Assumptions and Objective Hierarchy

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Objectively Verifiable Indicators OVI

• OVIs describe the project’s objectives in operationally measurable terms (Quantity, Quality, Time – or QQT).

• Helps to check the feasibility of objectives and helps form the basis of the project’s monitoring and evaluation system.

• “How would we know whether or not what has been planned is actually happening or happened? How do we verify success?”

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Objectively Verifiable Indicators - OVI

• OVIs should be measurable in a consistent way and at an acceptable cost.

• A good OVI should also be SMART:1. Specific to the objective it is supposed to measure

2. Measurable (either quantitatively or qualitatively)

3. Available at an acceptable cost

4. Relevant to the information needs of managers

5. Time-bound – so we know when we can expect the objective/target to be achieved

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Indicator & Source of Verification

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Two Main Phases of LFA

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Logframe, Activity and Resource Schedules

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Reference

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