10.2 Using the 'Logframe'

Figure

After the foregoing presentation of a general planning model, let us now consider how a ministry might apply one particular planning approach - an approach that fits within the same sequence of steps - the Logical Framework Analysis (LFA, colloquially known as the 'logframe'). The following example is a hypothetical one from the health sector, and it illustrates how a specific problem might be tackled.

Caring for the Unborn

1. Analysing the Problem

The Ministry of Health is concerned that a high proportion of women in rural areas are not attending ante-natal clinics for a number of reasons other than financial ones. Possible reasons for their reluctance include:

· The long distances from their homes to the clinics;
· Inadequate education on the health risks associated with pregnancy;
· A general lack of money for transport or drugs;
· A widespread preference for traditional medicine during pregnancy;
· Uncertainty and fear of the clinicians;
· Negative attitudes of health facility staff;
· Embarrassment about not having proper underwear;
· Insufficient time due to heavy workloads at home;
· A traditional reliance on TBAs;
· The lack of mobile clinics.

2. Setting Objectives

To tackle the problem, a team of primary health care workers sets itself the following objective: "Over the next year, to increase the number of pregnant rural women attending ante-natal clinics so that at least 75% benefit from the service."

3. Establishing a Strategy

The team now draws up a general strategy for tackling the problem. This will involve building up the resources, both physical and human, necessary for promoting the use of ante-natal clinics. A key training need will be the specific training of midwives in rural service delivery. Regular transport will also be required for patients, and in the most remote areas more mobile clinics will be needed. Perhaps most importantly, the team will have to devise ways of overcoming the negative attitudes that exist towards ante-natal clinics - by promoting the benefits of proper health care during pregnancy, training more midwives from rural areas, and producing more literature for the general public.

4. Designing Activities

After devising its strategy, the team considers specific activities for implementing the ante-natal programme. These include such activities as:

· The provision of four additional antenatal clinics in each district;

· The purchasing of weighing machines, stethoscopes, blood pressure machines, and other necessary items;

· The extension and modification of the national midwifery training curriculum;

· The provision of special training courses for Traditional Birth Attendants (TBAs);

· The recruitment of six additional qualified trainers;

· The training of eight additional midwives - preferably local residents - in each district;

· The provision of a minibus or similar vehicle for each of the existing and new clinics;

· The promotion of the expanded service through national and community radio stations and a school poster campaign;

· The design of a system for managing and monitoring the programme.

5. Defining Outputs

The outputs, or results, of the programme will therefore be:

· Forty eight additional fully-equipped ante-natal clinics across the country;

· Ninety six additional midwives specially trained in community outreach programmes;

· A modified and expanded national midwifery curriculum;

· A series of weekly radio programmes and accompanying literature;

· Award-winning posters for display in schools, community centres and health facilities across the country;

· A specially-designed monitoring and evaluation system, which can be adapted for other primary health care programmes.

6. Assessing Assumptions and Risks

After formulating the activities for establishing the programme, the team will make an assessment of external factors that could influence its chances of success. One key assumption in this case, for example, relates to motivation: "If rural women were better informed about the benefits of ante-natal health and had better access to health facilities, most would want to attend ante-natal clinics." An example of a risk might concern funding: "in the event of political upheaval or global recession, donors might withdraw funds from the ministry's programmes."

7. Identifying Indicators

Once the team has developed a clear-cut strategy for overcoming the rural resistance to modern midwifery, it must establish a system for discovering whether its aims are being achieved. The primary tool in this process is the indicator.

Indicators provide a means of measuring the outputs of activities related to objectives, and set a standard by which to monitor their progress (see the following chapter on 'Monitoring and Evaluation'). In the case of the ante-natal programme, a list of useful indicators might include:

· The number of women attending antenatal clinics in each district;
· The number of midwives trained through the expanded ante-natal curriculum;
· The number of TBAs enrolling in the ministry's special training courses;
· Changes in the number of maternal deaths in each district;
· Records of the size and weight of new-born children from local MCH clinics;
· Audience ratings for the programme's weekly radio shows;
· The number of children submitting entries to the programme's poster competition.

Once the programme is up and running, the team will have to make regular checks on its progress. The use of the logframe for monitoring and evaluation is covered in more detail in the following chapter.