SET UP A PROGRAM

1. SET UP A PROGRAM PUBLIC HEALTH DEPARTMENT FACULTY OF MEDICINE UNIVERSITAS PADJADJARAN 2012

2. WHAT IS PROGRAM?

3. PROGRAM is: • A service if some benefit is bestowed on the individual or groups targeted for specific interventions • Is a sequence of activities designed to implement policies and accomplish objectives and gives a step by step approach to guide the action necessary to reach a certain objectives • Program management is activities involved with the development, implementation and evaluation of interventions addressing health problems

4. Effective program management is an organized response requiring : • A carefully designed problem statement • The availability of an appropriate intervention • The capacity to deliver that intervention in a specific setting Each of these is an essential component of an organized response

5. Health program management seeks: • To organize and direct health workers • Scientifically sound interventions • Appropriate strategies toward spesific health problems

6. The ultimate aim is: • To eliminate or reduce these problems to the maximum extent possible (EFFECTIVENESS) • To achieve these results with the minimum resources necessary (EFFICIENCY) Effectiveness and efficiency are the primary criteria by which programs are judged or evaluated.

7. Situation analysis: analyze problem for determinants and contributing factors • State the problem • Specify resources (manpower,money, materials, skills, knowledge, techniques , time etc) • Project future level of problem • Where are we ? • Set priorities • Identify desired outcome objectives (a planned end point of all activities) 2. Where do we want to be? 5 KEY QUESTIONS FOR MANAGERS 3. Should we do something? • Discontinue current efforts? • Maintain current efforts? • Implement new interventions? • Determine intervention point most likely to succeed contributing the desired outcome objectives. • Develop impact, process objectives, activity measures, work plan and budget 4. What should we do? • Acting the program what has been planned 5. How do we know that we are getting there? • Tract progress toward achieving activity measures and process objectives (doing things right) • Tract progress toward achieving impact and outcome objectives

8. PLANNING & ORGANIZING Program management cycle (managerial functions) Deciding what to do and how to do it ACTUATING & IMPLEMENTATING CONTROLLING & EVALUATING Acting to accomplish what has been planned Comparing the results of what was accomplished with what was intended

9. PRE -PLANNING ANALYZING OF THE HEALTH SITUATION • Preparation for planning : • Government interest • Legislation • Organization for planning • Adninistrative capacity PLANNING AND ORGANIZING FORMULATE HEALTH PROBLEM NO ASSIGN PRIORITIES AMONG PROBLEMS formulate priority problem for planning solution Program management cycle (managerial functions) EVALUATE RESULTS ACHIEVEMENT OF OBJECTIVES DESIGN ALTERNATIVE PROGRAM TO SOLVE PROBLEM EVALUATING & CONTROLLING YES COLLECT DATA FOR EVALUATION ASSIGN PRIORITIES AMONG PROGRAMS (SELECTION BEST PROGRAM (EFFECTIVE AND EFFICIENT) ACTUATING & IMPLEMENTING INITIATE AND OPERATE THE PROGRAM PLAN OF IMPLEMENTATION OF THE PROGRAM DEFINE PROGRAM , ITS OBJECTIVES & HOW TO MEASURE ACHIEVEMENT Resources needed

10. The important pre conditions are: • Government interest: any plan for health of a country must be based on a strong “political will” as manifested by clear directives or policies given by the government B. Legislation: the policies are translated into legislation • Organization for planning: organizational structure, full-time planners for the preparation and design planning D. Administrative capacity: for proper coordination of activities and implementation of the plan at all levels PRE PLANNING

11. Problem Solving Cycle

12. It involves the collection, assessment and interpretation of information in such a way as to provide a clear picture of the health situation. ANALYSIS OF THE HEALTH SITUATION

13. The minimum essential requirement for health planning: • The population, its age, sex and structure (population pyramid), population growth, fertility rate, education, occupation, religion • Geography situation of the health service: catchment area, administrative level, weather (rainy, dry), beach, mountain, transportation • The statistics of morbidity and mortality (morbidity rate according to disease, age specific …> prevalence, incidence, IMR, MMR, GDR, age specific death rate, etc) • Life expectancy Rate • The epidemiology and geographical distribution of different diseases • Resources: manpower, money, material, methods, patients etc, Medical care facilities (Primary, secondary and Tertiary health services) • Attitudes and beliefs of the population towards disease, its cure and prevention The analysis and interpretation of the above data brings out the health problems, health risks, the health needs and health demands of the population ANALYSIS OF THE HEALTH SITUATION

14. INPUT • PROCESS • OUTPUT • OUTCOME (Health Status) • Morbidity • Mortality • Nutritional status Situation Analysis with Systematic Approach

15. POPULATION PYRAMID Examples

17. OCCUPATION

18. GEOGRAPHY

20. HEALTH FACILITIES

23. Based on Situation Analysis • Health Problems • Healthcare Problems (Managerial) Problems Identification

24. The questions are: • Should we solve all the problems at one time? • Can we do that? Priority Problem

25. Answer: No, we should not solve all the problems at one time, because : 1. May be among the problems, there will be the same program that can solve those problems at once, so we choose the main problem only 2. Scarcity of resources Conclusion : assign priorities  how??? ASSIGN PRIORITIES AMONG PROBLEMS

26. Scoring Techniques : PAHO, Matrix • Non Scoring Techniques : Del becq, Delphi Assign Priorities

27. Assign priorities  how???  criteria MATRIX techniques: • Importance of the problem: prevalence, severity, rate of increase, degree of unmeet need, social benefit, public concern, political climate • Appropriate technology • Resources availability ASSIGN PRIORITIES AMONG PROBLEMS

28. To have a good program, we have to define the health problem statement correctly. There are two criteria, those are: • It can be measured : What is the problem, How much, Who, Where, When • Neutral: do not mention that this problem causes by somebody’s fault, or the cause itsself,or how to solve the problems FORMULATE HEALTH PROBLEMS STATEMENTS

30. Why this problem happened? What factors contributed to these problems??? Identification of the Causes of the Problems Next step • Fish Bone Diagram • Problem Trees • Blum Theory approach After that CHECK THE REALITY in the Community  Using Questionnaire

31. 20 % 20 % 10 % 50 % Global burden of disease, Murray & Lopez, WHO, 1996

32. Fish bone diagram (example)

33. Make the alternatives Problem solving for each risk factor/cause of the problems Alternatives Problem Solving

34. Effectiveness of the program: • Magnitude of the problem • Important to intervene the problem • Vulnerability of the program • Efficiency of the program  cost SELECTING PRIORITY AMONG ALTERNATIVES OF PROBLEM SOLVING (EFFECTIVE AND EFFICIENT)

35. Once the program has been selected and approved, programming and implementing are begun • The organizational structure must incorporate well-defined procedures to be followed and sufficient delegation of authority to and fixation of responsibility of different workers for achieving the predetermined objectives during the period prescribed • Many well considered plans have fallen down because of delays in critical supplies, inappropriate use of staff and similar factors. PLAN INPLEMENTATION AND OPERATE PROGRAM

36. PLANNING • ORGANIZING • ACTUATING • CONTROLING & EVALUATING NEXT WEEKS

37. THANK YOU  @iamelia To be continued