Health Program and

Program Descriptions

Unit 1
 Session Objectives
• At the end of this session students will be able to:
 Define and differentiate program and project
 Identify components of program
 Describe program theory
 Discuss types of the M&E frameworks
Program Logic Model
Conceptual Framework
Result Based Framework
Log frame
 What is a program?
• The term Program is fairly generic but generally
connotes a structured effort to provide a specific set
of services or interventions.

• Program is a set of inter-related activities that are

managed together to achieve objectives.

• A set of resources and activities directed toward one

or more common goals, typically under the direction of
a single manager or management team.
 What is a program? ...
• A program is used to describe the object of evaluation,
which could be any organized public health action.

• It may consist of a very limited set of activities in one

agency or a complex set of activities implemented at
many sites by two or more levels of organizations.

• It is based on broad vision & mission & has multiple

stakeholders of diverse field
 Health Program

• A health program is a totality of an organized

structure designed for the provision of a fairly discrete
health-focused interventions, where that
intervention is designed for a specific target
audience.

• Health programs, particularly in public health, tend to

provide eductional services, have a prevention
focus, and deliver services that are aggregate or
 Project
• It refers to a time-limited or experimental effort to
provide a specific set of services or interventions
through an organizational structure.
• It is a temporary effort undertaken to create a
unique product or service.
• A project consists of a set of activities undertaken to
achieve specific objectives within a given budget
and time period.
• Temporary means that every project has a definite
 Project ...
Projects differ in size, scope, cost & time, but all have the
following characteristics:
 A start and a finish
 A life cycle involving a series of phases in b/n the
beginning and end
 A budget
 A set of activities which are sequential, unique
 Program Vs Project
Program Project
Have broader scope Narrower in scope
Have no definite start and finish Have a definite start and a finish
Have more strategic planning May not require strategic
planning
Runs on the basis of It has its own timeline
organization calendar and
timeline
It is less organized compared to Highly organized in all aspects
projects
Activities are less linear and Activities are usually sequential,
 Definition of Related Terms
• Activity: a specific action/process undertaken over
a specific period of time by an organization to convert
resources to products/services to achieve results.
• Baseline: information collected before the start of a
project/program that provides a basis for planning
&/or assessing subsequent progress & impact.
• Effectiveness: the extent to which an intervention has
attains its major relevant objectives.
• Efficiency: a measure of how economically
 Related Terms ...
• Cost Benefit Analysis: an evaluation of the r/p b/n
program costs & outcomes. Can be used to compare
d/t interventions with the same outcomes to
determine efficiency.

• Evaluability: extent to which an intervention or project

can be evaluated in a reliable and credible fashion.

• Attribution: Can progress on goals and objectives be

shown to be related to your program, as opposed to
 Program Description
A comprehensive program description clarifies all
the components and intended outcomes of the
program, thus helping you focus your evaluation on
the most central and important questions.

It is vital to understand stage of program

development to be evaluated and the context within
which it is currently operating.
 Program Description ...
 Need: What is the big public health problem you aim to
address with your program?
 Targets: Which groups or organizations need to
change or take action to ensure progress on the public
health problem?
 Outcomes: How and in what way do these targets
need to change?
 Activities: What will your program and its staff do to
 Program Description ...
 Outputs: What tangible capacities or products will be
produced by your program’s activities?

 Resources/Inputs: What is needed from the larger

environment in order for the activities to be mounted
successfully?

 Relationship of Activities and Outcomes: Which

activities are being implemented to produce progress
 Program Description ...
• In addition to specifying these components, a complete
program description includes discussion of:
• Stage of development: is the program just getting
started, is it in the implementation stage, or has it been
underway for a significant period of time?
– Three stages of development: planning, implementation,
and maintenance/outcomes achievement
• Context: what factors and trends in the larger
environment may influence program success or failure.
It includes politics, funding, interagency support,
 Program Description ...
Once the components of the program description
have been identified, a visual depiction may
help to summarize the relationship among
components.

This clarity can help with both strategic planning

and program evaluation.
 Components of Program
Inputs:

Resources provided for program implementation.

 Can include human resource, budget, information,

infrastructure etc

Examples:
• Health workers
• Anti-TB drugs
• Laboratory reagents
 Components of Program ...
Activities:
Are a set of actions that results in outputs by using
inputs.
Examples: Counseling, diagnosis and management of
cases, training, educating people, follow-up care etc.…
Examples:
• Training health workers for counseling and testing
• Screening patients for opportunistic infections
• Conducting supervision
 Components of Program ...
Outputs:
The immediate consequences of the inputs utilized &
program activities conducted.
Measured within the setup of service provision, usually
using routine program records
Examples:
• Number of patients treated
• Number of clients counseled
• Number of condoms distributed
• Number of HIV tests carried out
 Components of Program ...
Outcomes:
Effects upon the target population that can lead to the
intended “ultimate goal” of a program
Measured among targets, which could be health
facilities, clients, patients, …
The effects include several types and may focus on
awareness, attitudes, behavior, utilization etc
Examples:
• Increase of condom use
• Improvement of quality of healthcare
 Components of Program ...
Impacts:
Are related to long-term accumulative effects of
programs

They are rarely attributed to a single program or

intervention.

Examples:
• Reduction in incidence of HIV infection
• Reduction of HIV/AIDS mortality
 The human, The processes, The direct products The ultimate
financial, tools, events, and of a program’s The expected intended
organizational, & actions that are activities & may changes in the change in an
community used to bring include types, levels population organization,
resources about a program’s and targets of served that result community, or
available for intended services to be from a program’s other system.
carrying out a changes or delivered by the activities
program’s results program
activities.

Resources/
Inputs
Activities Outputs Outcome Impact

1 2 3 4 5

Your Planned Work Your Intended Results

 Components of Program ...
Alternatively used terms
CDC Donabedian Evidence Based,
(1999) (1990) Strategic Planning
(WB, 2005)
Input Structure Input/Resources
Activities Processes Processes/
Activities
Output Intermediate Short term outcome
results
Outcome Final results Medium and longer term
 Prograam Theory
• A program theory explains how & why a program is
supposed to work. It makes explicit the connection b/n
the things we do in our programs and the outcomes
we hope to achieve.
• It consists of a set of statements that describe a
particular program, explain why, how, and under what
conditions the program effects occur, predict the
outcomes of the program, and specify the requirements
necessary to bring about the desired program effects.
 Prograam Theory ...
• The set of assumptions that guide the way specific
programs, treatments, or interventions are
implemented and are expected to bring about
change.
• A clear program theory makes it much easier to
choose the most appropriate outcomes (results) to
measure.
• Make sure that your theory is based on good
underlying evidence about what makes programs
successful and how people really change.
 Prograam Theory ...
• B/n the “if” & the “then,” there should be some solid
evidence or some well-established connection
supporting the idea that your service package will
accomplish your program goals.
• A good program theory also reflects the fact that
change happens in stages.
• Example: to reduce alcohol use among teens/students
 Trained teachers provide alcohol prevention training to youth
Youth gain knowledge of alcohol avoidance strategies
 Developing a Theory-
Based Program
• Step 1 - Articulate the Problem: clearly articulate
the problem you are trying to address or the goal you
are trying to achieve.
• Step 2 - Identify Plausible Causes and Solutions:
consult relevant theory and empirical research to learn
more about the underlying causes of the problem and
theory-based solutions/strategies given those underlying
causes.
• Step 3 - Select a Course of Action: there is likely
 Developing a Theory-Based
Program ...
• Step 4 - Develop an Intentional Program: figure out
how to do it. In other words, while theory may provide
an outline for your program, it is up to you to fill in the
details. It may also be helpful to consult the literature.

• Step 5 - Evaluate Program Effectiveness: if you find

that your program is ineffective, it may be an
indication that:
1) the theory you pulled from in Step 2 is wrong/doesn’t
generalize to your population,
2) the course of action you selected in Step 3 is inappropriate
 Prograam/M&E Frameworks
Frameworks: diagrammatic/tabular representations
which are useful in helping us understand the
relationships between each element of the program;
 Inputs,
 Processes,
 Outputs,
 Outcomes and, b/n the program activities and the
environmental context where the program will be
implemented.
 M&E Frameworks ...
Program Frameworks enable us to:
a) Clearly understand what results a program intends
to achieve

b) Visualize how a program will achieve its intended

results

c) Clarify and communicate how different

components of a program interact within the
organization
 Types of M&E Frameworks

1. Program logic model

2. Conceptual (research or theoretical) framework

3. Result based frameworks

4. Logical frameworks (Log frame)

 1. Program Logic Model
It is a systematic and visual way to present and share
your understanding of the relationships among the
resources you have to operate your program, the
activities you plan to do, & the changes or results
you hope to achieve.
Shows the logical relationships among the resources
that are invested, the activities that take place, and the
benefits or changes that result.
Is a flow chart that summarizes the key element of a
program:
 Program Logic Model ...
Logic models may depict all or only some of the
following components of your program description,
depending on their intended use:
a) Situation
b) Inputs
c) Outputs(Activities and participation)
d) Outcomes-Impacts
e) Assumptions
 Program Logic Model ...

a) Situation:
 The environment in which a problem or an issue
exists

 The problem that the program is to address sits within

a setting or situation - a complex of sociopolitical,
environmental, and economic conditions.

 Is foundation for logic model development

 Understand the situation correctly and diagnose the

 Program Logic Model ...
 Consider the following questions to understand the
situation and carefully define the problem:
 What is the problem/issue?
 What causes the problem?
 For whom does this problem exist? - individual, HH, group,
community, ...
 Who has a stake in the problem?
 What do we know about the problem/issue/people that are
 Program Logic Model ...
b)Inputs:
 Are the resources that we invest in the program and
help to mount activities.

 Can include human resource, budget, infrastructure

etc…

c)Outputs:
 Are those activities that we conduct and the
 Program Logic Model ...
d)Outcomes:

 Benefits that individuals, groups, or communities

realize.

 The change that occur on the target beneficiaries due

to program output.

 Outcomes do not occur all at one time or immediately;

 Program Logic Model ...
e)Assumptions:
 Beliefs we have about the program and the people involved and the
way we think the program will work.
 Is the "theory" we are talking about: the underlying beliefs in how it
will work.
 These are validated with research and experience.
 Assumptions underlie and influence the program decisions we make.
 Program Logic Model ...
 Assumptions are principles, beliefs, ideas about:
 The problem or situation
 The resources and staff
 The way the program will operate
 What the program expects to achieve
 The knowledge base
 The external environment
 The internal environment
 The participants: how they learn, their behavior, motivations, etc
 Program Logic Model ...
f)External factors: The environment in which the
program exists. It includes cultural milieu/environment,
climate, economic structure, housing patterns,
demographic patterns, political environment, etc.
 External factors may have a major influence on the
achievement of outcomes. Therefore, we can't ignore
them!
 They may affect a variety of things including the
following:
 Program implementation
 Program Logic Model ...
A logic model is valuable in supporting:

Program planning

Program implementation

Program monitoring

Program evaluation
 Program Logic Model ...

 Logic Models are useful:

To build understanding and clarity about your

program

 To identify resources needed for your program

To identify the sequencing of activities that

 Program Logic Model ...
 In general logic model can be used as:
 A communication tool - help to understand our
program and communicate to potential
stakeholders. This facilitate funding.

 M&E tool - help to monitor programs, focus

program evaluation and identify balanced set of
indicators

 Planning tool - help to identify gaps and non-

 Program Logic Model
Format
Resourc Activities Outputs Outcome Impact
es/ s
Inputs
In order In order to By Accomplis Accomplishin
to address the accomplishin hing these g these
accompli identified g the stated activities activities will
sh problem and activities, we will lead to lead to the
desired reach desired will produce the following
activities, outcomes, the following changes in
we need we will need following changes in the long
the to carry out outputs: the term:
following the following medium
resources activities term:
 Program Logic Model Matrix
Program/Project title
Problem statement:
Goal:

Inputs Activities Outputs Outcome Impact

Assumptions External factors

 Program Logic Model ...
Example:

• Problem statement: In recent years, the government

of Ethiopia and the global community have invested
heavily in improving the coverage of effective maternal
and neonatal interventions. Hence, the country has
achieved remarkable success in reducing neonatal and
maternal mortality in recent decades, but still has very
high neonatal mortality rates (29 deaths per 1,000 live
births) and maternal mortality ratios (412 deaths per
100,000 live births).
Program Logic Model ...
 Program Logic Model ...
Group Exercise
• Problem statement: Despite the reduction of the total
fertility rate over the years, Ethiopia has still one of the
highest fertility rates in Africa. The prevalence of any
modern contraceptive use by currently married
Ethiopian women has tripled over the last fifteen years,
jumping from 14% in 2005 to 41% in 2019. However, as
stated in the 2020 report of the FMOH, the health
sector transformation plan-I target (55%) of the national
contraceptive prevalence rate was not achieved. And all
the regions in the country were unable to attain their
 Program Logic Model ...
Group Exercise …
• Based on the given problem statement:

A. Give title for your program/project

B. Set goal

C. Develop program logic model

D.Present your report

 2. Conceptual
Framework
 A diagram that identifies and illustrates the
relationships between all relevant systemic,
organizational, individual, or other factors that may
influence program/project operation and the
successful achievement of program or project goals.
Purpose:
 Shows where a program fits into the wider context
 Clarifies assumptions about causal relationships
 Shows how program components operate to influence
 Conceptual Framework ...
 A conceptual framework is used to help design a sound
health program by identifying the theoretical basis for
the program’s approach.

 The other three frameworks are commonly used to

inform program design as well as guide program
implementation and management.

 Our focus is on understanding the importance of the

frameworks in M&E planning and differentiating 50
 Conceptual Framework ...
Different funders require different frameworks

Some of the frameworks are used for very different

reasons (ex. conceptual frameworks and logic model)

Each framework will help you think about how to

monitor and evaluate your program in a different way

51
 Conceptual
Framework ...
Generic Conceptual Framework in
the Health Field

52
 Conceptual Framework ...
National Tuberculosis (TB) Program
 3. Result Based Framework
 Is an explicit articulation (graphic display, matrix, or
summary) of the d/t levels or chains of results
expected from a particular intervention.
 The results specified typically comprise the longer-
term objectives and the intermediate outcomes
and outputs that precede, and lead to, those desired
longer-term objectives.
 It uses the objective tree approach to link high-level
objectives through a hierarchy to program-level
outcomes.
 Result Based Framework ...
Decrease morbidity and
Goal mortality due to HIV
Increased quality of life

1. Improved

Strategic objectives immunologic and

functional status of
2.Decreased vertical
transmission of HIV
3. Reduced HIV
Transmission rate
patients

1.1. Increased 2.1. Improved 3.1 Improve

Intermediate objectives utilization

of care and
utilization of
the PMTCT
Utilization of
prevention methods
support services (condom, Reduce risky
including ART service behavior

3.2. Improved
1.2. Improved 2.2. Improved
Project objectives access to care and
support services
availability of
PMTCT services
knowledge
of the population
about HIV/AIDS

55
Result based framework for HIV/AIDS programs
Result Based
Framework ... SO1:
SO1:Reduced
Reduced
Malaria
MalariaBurden
Burden

IR1:
IR1:Improved
Improved IR2:
IR2:Improved
Improvedmalaria
malaria IR3:
IR3:Increased
Increasedaccess
access
malaria
malariaprevention
prevention epidemic
epidemicprevention
prevention to
toearly
earlydiagnosis
diagnosis&&
&&management
management prompt
prompttreatment
treatmentof
of
IR1.1 malaria
malaria
IR1.1Access
Accessto
to&& IR2.1
IR2.1Early
Earlydetection
detection
coverage
coverageby
byITNs
ITNs &&appropriate
appropriateresponse
response IR3.1
IR3.1Quality
Qualityof
of
increased
increased improved
improved care
careimproved
improved
IR1.2
IR1.2Improved
Improved IR2.2
IR2.2Epidemic
Epidemic IR3.2
IR3.2Efficiency
Efficiencyinin
access
accessto
toIPT
IPT preparedness
preparednessimproved
improved service
servicedelivery
delivery
IR1.3 improved
improved
IR1.3IRS
IRScoverage
coverage
increased
increasedinin IR2.3
IR2.3Surveillance
Surveillance
system
systemimproved
improved IR3.3
IR3.3Utilization
Utilizationof
of
epidemic
epidemicprone
proneareas
areas
care
careimproved
improved
IR1.4
IR1.4Use
Useof
ofsource
source
reduction/ IR2.4
IR2.4Early
Earlywarning
warning IR3.4
IR3.4Access
Accessto
to
reduction/larviciding
larviciding
increased system
systemstrengthened
strengthened services
servicesimproved
improved
increased
Resu Malaria Control Program
 Result Based Framework ...
 A well-constructed results framework is beneficial for
monitoring, management, and evaluation in several
ways:
It helps focus on specific outcomes
It highlights the key linkages in the theory of change that
underpin the intervention.
 It helps establish an evidence-based approach to monitoring
 Uses of Results Based
Framework
In general results framework can be used for:
 Planning
 Consensus, coordination, and ownership
 Management
 Communication and reporting
 Evaluation
 Harmonization
 Learning from experience
 4. Logical Framework
• A logical framework is a widely used tool to present
information about the key components of a project in a
clear, concise, logical and systematic way.
• It gives answers to questions about the why, what and
how of a project and also about the who, where and
when.
• The log frame is a simple tool that helps you organize
your thinking, set performance indicators,
allocate responsibilities, communicate
 Logical Framework Template
Project Structure Measurable Means of Important risks
indicators verification (Data and
Source) assumptions
GOAL: Wider What are the quantitative What sources of What external
problem the project measures or quali-tative information exist or factors are
will help to resolve judgements whether these can be provided to necessary to
broad objectives have allow the goal to be sustain the
been achieved? measured? objectives in the
long run?
PURPOSE: The What are the quantitative What sources of What external
immediate impact on measures or qualitative information exist or factors are
the project area or judgements by which can be provided to necessary if the
target group (the achievement of the allow the purpose is to
change to be purpose can be judged? achievement of the contribute to the
achieved by the purpose to be achievement of
project) measured? the goal?
OUTPUTS: These What kind and quality of What are the sources What are the
are the specifically outputs and by when will of information to factors not in the
deliverable results they be produced? verify the control of the
 Logical Framework Example
Project Structure Indicator Means of Important
Verification risks and
assumptions
Goal/Impact: Decreased breast Breast cancer morbidity National
cancer morbidity and mortality in and mortality rates in health
LMICs LMICs surveys
Outcomes: Lack of
Long-term: Increase in early # of cancer cases Clinic knowledge is a
detection of cancer detected records significant
Short-term: early barrier to
 Increased awareness relating to Pre- and examinations
breast cancer  % of participants post-tests
 Increased attendance for clinical Participants
demonstrating a 20% (baseline &
have economic
breast examinations (CBEs) increase in knowledge endline
 Increase in breast & physical
by the end of the surveys)
access to
self_x0002_examinations (BSEs) project
 # of attendees of CBEs clinics
 # of BSEs performed Recipients of
text messages
 Logical Framework ...

If activities are implemented, will outputs be

produced?

If outputs are produced, will outcomes result?

If outcomes result, will the objectives be

achieved?
 Logical Framework ...
 A log frame summarizes:
What the project is going to achieve?
 What activities will be carried out to achieve its outputs and
purpose?
 What resources (inputs) are required?
 What are the potential problems which could affect the
success of the project?
 Summary of Frameworks
Framework Brief Description Program Management Basis for M&E
Conceptual Interaction of various Determine which factors No. Can help to
factors the program will influence explain results

Results Logically linked Shows the causal r/p b/n Yes – at the objective
program objectives program objectives level

Logical Logically linked Shows the causal r/p b/n Yes – at the output
program objectives, activities and objectives and objective level
outputs, and activities

Logic model Logically links inputs, Shows the causal r/p b/n Yes – at all stages of
processes, outputs, inputs and the objectives the program from
and outcomes inputs to process to
outputs to outcomes/
objectives