Planning and programme design
The steps you have taken so far to analyse the situation should have given you a good idea of what you need to do next. Depending on what you found, next steps may be a simple measure such as revitalising coordination processes, or a more detailed process of developing joint activities.
This section will take you to the next step – action planning – and will help you identify where new actions are needed, as well as where it is feasible to link, coordinate or integrate existing programme activities across different sectors and agencies. This is particularly important in situations where no additional substantial financial resources are available to develop a whole new programme of work.
A successful planning process begins with your shared vision and helps you come up with possible pathways that could be taken to get there. This planning is more easily done through incremental steps, which could be defined annually, biannually or any other appropriate period. It is not necessarily about setting out a multi-year programme of work upfront.
An adaptive approach to planning emphasizes
- Formulation of long-term policies and strategies rather than long-term targets;
- Continuously linking planning to implementation, not detailed pre-implementation planning followed by little monitoring;
- Regular monitoring and evaluation to learn from errors on a continuous basis, not periodic external evaluations;
- Continuous dialogue with intended beneficiaries to adjust activities to their needs.
Tips for success
1 . Think beyond ‘a plan’ as the main objective of the process
In this type of planning process, instead of seeing a written plan as the final output, aim for a process that enables relatively short cycles of planning, implementation, reflection and revision so you can adjust along the way.
You don’t necessarily need new funding to do this, and this adaptive approach can be built into the programme logical framework just as easily as any other plan.
2 . Be adaptive, which is less risky and more likely to deliver results
Assuming that a specific set of activities will deliver certain results by a defined date can be risky, especially because implementing a multisectoral programme involves changes to established ways of working.
Adopting a flexible and adaptive approach helps to reduce risk by not making strict assumptions about what will work, and by allowing changes and adaptations to the design of the programme. This doesn’t mean no plan or no accountability, but rather being accountable to delivering a good process, continuing to monitor, using resources well, etc.
It helps ensure that what you’re doing and spending on is still the right thing to do as the programme progresses.
3 . Start with the problem, not the assumed solution
Although this might seem obvious, many (or even most) programmes are designed with a predetermined approach or solution in mind – which increases the risk of failure. Redefining the approach can be intimidating as it requires thinking ‘outside the box’ and developing new ideas.
First, it’s essential that your situational analysis results in a very well-defined problem, which you will return to throughout the design and review process.
Second, using a stepped approach that reviews existing knowledge and examples of practice and innovations can help make the process easier.
4 . There’s nothing wrong with starting small!
Trying to start a programme around the biggest and most complex challenge, or with many activities, can lead to failure and undermine collaboration.
A good alternative is to start with a pilot in a specific area where there are greater chances of success (this may be due to a vibrant partner group, an active and capable programme manager, or some ‘seed’ funding) and building on successes to gradually increase the scale of the programme.
5 . Get around paralysis
Once the situation analysis has been conducted and initial discussions have begun, it’s not unusual for the process to stall – it might look as if the barriers are too systemic or difficult for the programme to change in the short or medium term.
You can address this by using the problem analysis approaches tool, and by testing various approaches and not giving up if one approach doesn’t work. Keep in mind that even though the programme may not change every deeply-rooted problem, it can itself still be delivered successfully.
Practical planning steps
The planning tool and agenda for joint planning workshop tool will guide you trough this process.
1 . Gather
Use the information gathered so far to set out a clear idea of the problems the programme needs to address, and which institutions and individuals to involve in order to develop a successful plan of action.
2 . Synthesise
Create a shared understanding of the key problems/issues the joint programme will be designed to address, and how existing programmes and interventions relate (or not) to the problems.
3 . Align
Identify what can be done practically, by whom and when, making sure all actions are realistic and achievable, and identify which aspects are not currently being addressed through existing interventions.
4 . Act
Jointly prioritise interventions, and take the necessary actions based on the results of the previous step.
5 . Verify
Agree the key interventions that will be taken forward, in the form of a one-year plan.
6 . Revisit and realign
Put in place a process for periodic review of programme implementation to identify challenges and allow necessary adjustments.
Planning for elimination
Most NTD programmes are set to eliminate or achieve sustained control of a disease, to eventually reduce the need for the programme. This creates certain challenges:
- The smaller the problem is – i.e. the lower the prevalence of a disease becomes – the more expensive it becomes to address remaining pockets of transmission and the expertise to identify, treat and prevent this disease is also diminished. Sustaining political will and funding at this crucial stage also becomes harder;
- Reduced resources and interest in a disease make it difficult to sustain gains, making resurgence a risk. The smaller the programme is, the more reliant it becomes on services and interventions delivered by other agencies and sectors (for example for water, sanitation and hygiene services);
- Once programmes have been in place for some time the incentives attached to them may become strongly embedded, meaning that transferring work into the broader health systems and other sectors can be threatening – especially if programmes close and power and resources are diverted.
NTD programmes should be designed in a manner that prepares them, and their partners, for these inevitable challenges. It is never too early to start planning for the end! The planning for elimination resource sets out the predicted programme phases from morbidity control to post-elimination, and the corresponding intervention areas for each phase.
Financial arrangements for a successful programme
Funding and finance arrangements can have both positive and negative impacts on a programme, so it’s essential to ensure that your budget is comprehensive and includes flexibility to deal with fluctuations in work plans and timelines. A multisectoral programme brings with it additional challenges, including different budgeting and planning schedules across different agencies, different financial management and reporting structures, and so on. These should be acknowledged early on, and financial management and processes should be set out before implementation even begins. Note that although it’s a common assumption that integrated programmes require additional resources, a lot can be achieved with existing or limited new resources. See the improving coordination in low-resource settings resource for more.
The budgeting process should begin with reviewing available resources, as well as any resource gaps for which you’ll need to develop funding proposals or cover through other funding streams. The budget should:
- Be developed by all stakeholders, and finance staff, to ensure commitment, realistic costing, and good management practice;
- Consider different costs in different parts of the country – while there may be average unit costs, keep in mind the specifics of different environments;
- Be comprehensive, covering the duration of the programme and showing which activities are covered by which funding. This will also help identify financial gaps. The cost categories for sanitation programmes recently set out by WaterAid, Plan and UNICEF in a process to develop guidance on rural sanitation are a useful example of programme aspects that should be included: planning, formative research, programme mobilisation, capacity development, programme management, community implementation, supply strengthening, sanitation service chain, sanitation finance, monitoring & evaluation, sustainability support, and environmental sanitation;
- Be detailed in terms of quantities per unit and total costs, and indirect costs like administration, travel and human resources;
- Include an agreed process for expenditure and reporting that supports the government’s financial and management capacity, building on any existing arrangements and processes;
- Acknowledge non-financial contributions. For example, in-kind and time investment might be made by communities, households and other groups;
- Include a contingency line to allow for flexibility and unforeseen activities, and account for inflation (a 3% increase each year is a realistic amount).
The budget items and checklist tool provides further detail and advice.
What does ‘funding for WASH’ mean?
NTD programmes are not expected to assume the responsibility of the WASH sector in terms of full provision of water and sanitation services. Nonetheless, NTD programmes can be expected to
co-implement, and co-fund, certain WASH-related activities. Depending on the specific diseases covered, the costs associated with the following aspects should be considered within NTD
programme financial planning, even if funding comes from other sources:
- Hardware: Water supply infrastructure (boreholes, protected springs/wells) and systems (piped and rainwater harvesting schemes, tanks and pumps); sanitation infrastructure for households (full latrines or latrine components such as slabs or pit liners, solid waste collection infrastructure) and communities (shared/public toilets and bathing facilities);
- Software: Handwashing campaigns, promotion of hygiene practices such as safe cooking, bathing and laundry, sanitation promotion including community-led total sanitation, sanitation marketing, menstrual hygiene management promotion, promotion of environmental sanitation (animal pens, solid/liquid waste management);
- Commodities: Distribution of hygiene products (soap, menstrual pads, handwashing facility components, such as containers), point-of-use water treatment technologies (chlorine, filters) and water storage containers.
These costs should be considered for implementation in households, communities and public places such as schools and clinics, and linked to programmes implemented by government or WASH service providers and agencies. The nature and frequency of WASH costs, especially in relation to operation, maintenance, and non-hardware costs, is at times underestimated by those
not familiar with the workings of the WASH sector, and it is important for the NTD community to have a realistic understanding of expected costs during planning.
The WHO/UN Water TrackFin Initiative, which defines and tests a globally accepted methodology to track financing for WASH at the national level, classifies WASH costs and expenditures into the following categories:
1 . Investment costs
Initial costs of putting new services in place, including hardware such as pipes, toilets, and pumps, and one-off associated software costs, like for design and engineering studies or consultation.
2 . Operating and maintenance costs
Routine maintenance and operation costs to keep services running, including wages, fuel, or any other regular purchases.
3 . Large capital maintenance costs
Occasional large maintenance costs for the renewal, replacement and rehabilitation of a system beyond routine repair and replacement costs.
4 . Financial costs
Capital repayments and costs - including interest on loans, and dividends if a return is paid to shareholders.
5 . Support or software costs
Includes charges for direct and indirect support. Direct support includes construction activities at the local level, like training for community or private sector operators or users. Indirect support includes the cost of planning and policy-making at government level, like strengthening the skills and capacities of professionals and technicians.
6 . Taxes
Put in place a process for periodic review of programme implementation to identify challenges and allow necessary adjustments.