Public health Planning for

hearing Impairment (pre-conference course)

Dr Daksha Patel

Improving health worldwide

www.lshtm.ac.uk

Learning objective

By the end of this session you should be able :

Discuss the key challenges and barriers within health

systems to deliver ear and hearing care services , with

reference to low and middle income countries

360 million people

have disabling hearing

loss, globally 328 million

adults

32 million children

Clinical vs. Public health approaches

Clinical approach

Individual Patient

Public health approach

Population needs

• Take a history

• Examination and Diagnose

• Treat

• Counsel/ follow up

• Survey population need / service gaps • Plan – 1

0,2

0,3

0prevention strategy,

training, technology• Strengthen Health system- Policy • Monitor & Evaluate

What does this means for

health systems?

How people, resources and

their actions are organised

to promote, maintain and

restore health.

Health Systems approach

Governance Responsibility and leadership

Health personnel Ear & hearing health team + ???

Health financing Income and expenditure mgt.

Medicines, technology Infrastructure, consumables etc

Information systems Need, utilisation, monitoring,

evaluation

Service delivery Equitable, excellent, economically OK

Health systems approachGovernan

ceServicedelivery

Information

systems

Medicines,

technology

Health financing

Health personnel

Health systems

360 Million 360 Million

PrebycususPrebycusus

HEARING AIDS ? HEARING AIDS ?

CongenitalCongenital

? COCHLEAR IMPLANTS

HEARING AIDS

? COCHLEAR IMPLANTS

HEARING AIDS

MEASLES / MUMPS / MENINGITIS

MEASLES / MUMPS / MENINGITIS

IMMUNISATION IMMUNISATION

OTOTOXICITY OTOTOXICITY

AWARENESS / GOVERNANCE AWARENESS / GOVERNANCE

CSOMCSOM

EARLY DETECTION AND TREATEMENT

FOCAL

EARLY DETECTION AND TREATEMENT

FOCAL

WAX/ FBWAX/ FB

TREATMENT TREATMENT

CausesCauses

LIMITED PREVENTION

NEEDS AUDIOLOGICAL REHAB

PRIMARY PREVENTION

POSSIBLE

Services required

How do you eat an elephant?

Human

resources

Model for District Level services

PATIENTS

Equipment

Supplies (£)Leadership

Information

Management

Practical approach

I million population I million population

ServicesServices

Primary

Secondary

Tertiary

Primary

Secondary

Tertiary

Where are they Where are they

Data and information

Data and information

Survey Data

Monitoring data

Survey Data

Monitoring data

TechnologyTechnology

Types

Availability

Repair and maintaining

Types

Availability

Repair and maintaining

Is there enough ? Is there enough ?

Finances Finances

Sources

sustainability

Sources

sustainability

Human resources

Human resources

Training

Distribution

Range of Cadres

Training

Distribution

Range of Cadres

How many ? How many ?

GovernanceGovernance

National guideline

National programme

Leadership

National guideline

National programme

Leadership

5.3% hearing impaired = 53,0005.3% hearing impaired = 53,000

HEALTH SYSTEM HEALTH SYSTEM

UNIVERSAL HEALTH COVERAGE

No change

Number of HI will increase :

• Population growth

• Ageing population

CHANGE

• Identify what must be

changed.

• Strengthen each of the

Health systems blocks

• Universal health – equity

and excellence

What are the options?

Health systems - universal health coverage

Universal health – to ensure that all people obtain health services they

need without suffering financial hardship.

EQITABLE – EXCELLENCE- ECONOMIC

Health systems strengthening blocks

GOVERANCE Leadership, National plans etc

PERSONNEL Ear Care Team

FINANCING Income + expenditure management

MEDICINES, TECHNOLOGY Infrastructure, consumables,

Equipment, etc

INFORMATION SYSTEM Need, utilisation , monitoring performance

SERVICE DELIVERY Equitable , excellent , economic

Challenges

HSS BLOCK Challenge

GOVERANCE Leadership, National plans

PERSONNEL Ear Care Team Defining roles and cadres

FINANCING Income + expenditure

management

investment – vertical and

integrated

MEDICINES,

TECHNOLOGY

Infrastructure, consumables,

Equipment, etc

hearing aids ?

Cochlear implants

Diagnostic challenges

INFORMATION SYSTEM Need, utilisation , monitoring

performance

Local data and targets

SERVICE DELIVERY Equitable , excellent ,

economic

setting local priorities

Health services

Community level

District / secondary level

Tertiary level

Ministry of Health National Planning / targets / finances

Local data, research, training

Prevention and treatment

Prevention, early detection,

Rehabilitation, inclusion etc.

Khayelitsha

Question: How do we deal with

hearing loss in situations like this?

Or this?

Human resources

Community level

District / secondary level

Tertiary level

Centers of excellence- university

Primary health workers

Community Rehabilitation workers

ENT Nurse / clinical officers

Audiology technicians

ENT surgeons , ENT Nurses, audiologists,

, speech therapists

ENT surgeons, sub speciality consultants,

ENT Nurses, audiologists,

speech therapists, health systems planners

( research capacity , policy advisor)

How many required per million populations for each cadre?

Human resources ENT / million population

Audiologists / million population

Speech therapists / million population

Take corrective

action: revise plan

Monitor progress

of implementation

Implement the

programMonitor progress of

implementation

Identify

problems and solutions

Midterm review of

implementation

Assess the .

needs in the community

Identify relevant

strategies for primary,

secondary and tertiary

prevention

Assess resources

already available at each level of

delivery

Identify gaps

in current provision

Determine

priorities for action

Convert strategies into a plan of

action with clear objectives and

targets; indicators;

Wh

ere

d

o w

e w

an

t to

be

?

Secure resources start

the program

Manage the program

(money, material,

manpower etc.)

Evaluate the program

Determine if the program can be scaled up elsewhere

End of program

Program planning and management cycle

STEP 1 STEP 2

STEP 3

STEP 4Set priorties ,

Budget and timetable

STEP 5

STEP 6

WHERE ARE WE NOW?

SWOT situation analysis ( one of many tools )

StrengthsStrengths WeaknessWeakness

OpportunitiesOpportunities Threats Threats

Internal factors

External Factors

Positive Negative

The “leaky can” • I Million Population

Prevalence ( Backlog)=

Number of people that

need services

Number treated / habilitated/ provided support

Mortality

New cases? INCIDENCE

Reduce = prevention programme

What resources are available and

being used at present

Local needs

+

Global support SELECTING REGIONAL

PARTNERS

INTER INSTITIUTIONAL

AGREEMENTS

FUNDING

LOCAL FACULTY AND

ADMINISTRATION

Capacity Building Strategy

Epidemiology

Public health strategy for HI

HI children: health & education

Health system challenges

National programmes

Primary ear& hearing health

Planning skills and tools

Developing a local plan –

district level

Monitoring and

evaluation

Advocacy

Online Network-DEAPH

Partner mentoring- 3 years

Local linkages with public health

Conclusion

• Public health Approach is essential to address the growing burden

of hearing impairment and deafness.

• Public health approach has to be targeted at population level

• Planning is an organised process to maximize the utilization of

available resources efficiently and effectively

• Key steps to planning include :

Know the problem – and solution

Know what you have

Know where you want to go and how – Aim and Objectives

Define a logical priority order of activities and timetable – Strategy

Implement – Monitor

Did you get there – Evaluate

Situation analysis

Thank You for listening

“If all my possessions were taken

from me with one exception,

I would choose the power of

communication, for by it I would

soon regain it all”Daniel Webster

Thank you for listening

Video - education and inclusion

• ttp://www.youtube.com/watch?v=AHfC6jqBhkk&feature=em-

share_video_user