Implementing Implementing Health ProgramsHealth Programs

Lectured by Bien Nillos, MDLectured by Bien Nillos, MDAssociate ProfessorAssociate Professor

Family and Community MedicineFamily and Community MedicineUniversity of Saint La Salle College of MedicineUniversity of Saint La Salle College of Medicine

20102010

ObjectivesObjectives

To be familiar with current health To be familiar with current health programs in the Philippines (DOH/WHO)programs in the Philippines (DOH/WHO)

To understand importance of planning To understand importance of planning and components of planning prior to and components of planning prior to implementation of health programsimplementation of health programs

To understand principles in To understand principles in implementation of a health programimplementation of a health program

To understand the dynamics in a To understand the dynamics in a community that would affect one’s community that would affect one’s implementation of a health program.implementation of a health program.

““Working up a Patient”Working up a Patient”

Subjective FindingsSubjective Findings Objective FindingsObjective Findings AssessmentAssessment Plan Plan

(Therapeutic/Diagn(Therapeutic/Diagnostic)ostic)

Now Consider a Now Consider a Community…Community…

What is a Community?What is a Community?

BiologistBiologist: “is a group of interacting : “is a group of interacting species sharing an environment.” species sharing an environment.”

TraditionalistTraditionalist: “a group of interacting : “a group of interacting people living in a common location”people living in a common location”

Sociologist:Sociologist: “a group that is organized “a group that is organized around common values and is around common values and is attributed with social cohesion within a attributed with social cohesion within a shared geographical location, generally shared geographical location, generally in social units larger than a household”in social units larger than a household”

Components of a Components of a CommunutyCommunuty

People grouped in Households (Common Culture)People grouped in Households (Common Culture) Common Environment (Common Exposure)Common Environment (Common Exposure) Interaction (Common Medium)Interaction (Common Medium)

It is important to get It is important to get to know the to know the community first.community first.

Tools: Situational Tools: Situational Analysis (Profiling Analysis (Profiling the Community), the Community), Needs assessment Needs assessment (Inventory of Needs), (Inventory of Needs), Mapping Mapping (Geographic (Geographic Information System)Information System)

Community ProfileCommunity Profile No. of householdsNo. of households Age groupsAge groups Total population, Total population,

population per age population per age groups, per groups, per gender, etc.gender, etc.

EconomicsEconomics EducationEducation EmploymentEmployment Hazards in the Hazards in the

CommunityCommunity Etc.Etc.

Health ProfileHealth Profile

What are the needs What are the needs of the community? of the community? (Health needs)(Health needs)

Is the Community Is the Community Sick? What is Sick? What is making them sick?making them sick?

Morbidity and Morbidity and Mortality, Crude Birth Mortality, Crude Birth Rate, Crude Death Rate, Crude Death Rate, Fertility Rate, etcRate, Fertility Rate, etc

Based on the Community and Health Based on the Community and Health Profile, make a Situation Analysis Profile, make a Situation Analysis and Community Diagnosisand Community Diagnosis

What is the “Top” health problems of What is the “Top” health problems of the Community?the Community?

What are the “Causes” of these What are the “Causes” of these health Problems of the Community?health Problems of the Community?

How does the Community regard How does the Community regard these identified health “problems”?these identified health “problems”?

Prioritization of Prioritization of ProblemsProblems

Based on:Based on: Urgency (element of Time)Urgency (element of Time) Magnitude (element of Social Impact)Magnitude (element of Social Impact) Cost-effectiveness (element of Money)Cost-effectiveness (element of Money) Resource Availability (element of Resource Availability (element of

Capability)Capability) Sustainability Sustainability

PlanningPlanning

““Where are Where are we now?”we now?”

““Where are Where are we going?”we going?”

““How do we How do we get there?”get there?”

ExampleExample In 2007, Municipality of Candoni has a In 2007, Municipality of Candoni has a

maternal mortality ratio of 5.6 per 1,000 maternal mortality ratio of 5.6 per 1,000 live birthslive births

It is the objective of the Municipal health It is the objective of the Municipal health office to reduce the number of maternal office to reduce the number of maternal deaths to zero within two years-timedeaths to zero within two years-time

In order to do that, there must be a In order to do that, there must be a strong implementation of the DOH’s strong implementation of the DOH’s policy on facility-based delivery, policy on facility-based delivery, anchored on community support and anchored on community support and local legislation.local legislation.

Where are Where are we now?we now?

Current health Current health statusstatus

Current health Current health problemproblem

Current health Current health resourcesresources

Where are we going?Where are we going?

VisionVision Goals/Goals/

Objectives:Objectives: SpecificSpecific MeasurableMeasurable AttainableAttainable RealisticRealistic Time-boundTime-bound

How do we get there?How do we get there?

Specific activitiesSpecific activities Sequential – “First Sequential – “First

things First”things First” Flexible – Flexible –

“Anticipate the “Anticipate the Unknown”Unknown”

““Universal” – Universal” – Cover all BasesCover all Bases

Clear and Clear and UnambiguousUnambiguous

Most Important QuestionMost Important Question““How do we know that we are already there?”How do we know that we are already there?”

(Evaluation) (Evaluation) What are your indicators?What are your indicators?

Indicators must also be SMART.Indicators must also be SMART. E.g. Maternal Mortality of 0 per 1,000 E.g. Maternal Mortality of 0 per 1,000

LB, 85% of Fully Immunized Children, LB, 85% of Fully Immunized Children, 30 Mother Participants graduated from 30 Mother Participants graduated from Pabasa sa Nutrition Program, etc.Pabasa sa Nutrition Program, etc.

Engaging the CommunityEngaging the Community Remember Alma Ata? – Remember Alma Ata? –

Community has the RIGHT and Community has the RIGHT and DUTY to participate in the DUTY to participate in the Planning, Organizing, Planning, Organizing, Implementation and Evaluation of Implementation and Evaluation of their Primary health Caretheir Primary health Care

Community Engagement Starts Community Engagement Starts Right At Step 1Right At Step 1

““Listen, Above All Else” Listen, Above All Else” – – Desmund TuTuDesmund TuTu

Community Consultation is important. Community Consultation is important. Many health programs in the Many health programs in the government are not successful because government are not successful because they are mostly “hand-me-downs”, they are mostly “hand-me-downs”, lacking community consultation on lacking community consultation on their actual needs and capabilities.their actual needs and capabilities.

Remember, that while you are a Remember, that while you are a doctor, you do not have the doctor, you do not have the MONOPOLY of knowledge.MONOPOLY of knowledge.

Examples of Government Examples of Government Health ProgramsHealth Programs

Expanded Program of ImmunizationExpanded Program of Immunization Healthy Lifestyle ProgramHealthy Lifestyle Program Program on Good NutritionProgram on Good Nutrition Vector-Borne Diseases (Dengue, Malaria, Vector-Borne Diseases (Dengue, Malaria,

Filariasis)Filariasis) National Tuberculosis Program (TB DOTS)National Tuberculosis Program (TB DOTS) Garantisadong Pambata (GP)Garantisadong Pambata (GP) Integrated Management of Childhood IllnesssesIntegrated Management of Childhood Illnessses Sentrong SiglaSentrong Sigla Maternal and Child CareMaternal and Child Care Disaster Preparedness And Emergency ResponseDisaster Preparedness And Emergency Response Fertility Awareness ProgramFertility Awareness Program Etc. (http://www.doh.gov.ph)Etc. (http://www.doh.gov.ph)

Key Actors in the Key Actors in the CommunityCommunity

Mayor, Vice Mayor, etc. Doctor, Nurses, Midwives, etc. Community Volunteers, Barangay Health workers Barangay Captain NGO Governmental Agencies (DSWD, etc) Big Donors, Philanthropists (B&MG foundation,

USAID, EU, etc.)

“Those with the money have no idea of the realities across the thousands of villages across Africa , that’s why they so often fail” -J Nyerere President Tanzania

“ The existing power structures that offer development have a clear agenda , but it is often driven not by equality and respect but by manipulation of the poor world, some think that because they have the money they also possess the monopoly on truth and values” – Jaime Cardinal Sin

“ We will lead and the rest of the world will follow, that’s what they want, to be like us ” – Pres. George Bush

“ I hope that you learn to listen to every nation and grow from their wisdom” - Dalai Lama to the UN

“ Change will come when those who have the resources learn that they do not have all the answers… they need to learn how to listen”- Desmond Tutu

“After all is said and done a lot more is said than done”

CreditsCreditsDr. Ryan Guinaran – for Dr. Ryan Guinaran – for some of the picturessome of the picturesMr. Mike Meegan, Mr. Mike Meegan, ICROSS founder – for ICROSS founder – for some of the text and some of the text and slides (Other Key Actors)slides (Other Key Actors)

For Community ActivityFor Community Activity

Select a FamilySelect a Family Interview the Family and Get to Interview the Family and Get to

know their Family and Health Profileknow their Family and Health Profile From their Health Profile, Make a From their Health Profile, Make a

Needs Assessment: What are their Needs Assessment: What are their health problems? Prioritize these health problems? Prioritize these problemsproblems

Design a Health Plan for the FamilyDesign a Health Plan for the Family