SET UP A SET UP A PROGRAMPROGRAM

PUBLIC HEALTH DEPARTMENT FACULTY OF MEDICINEPUBLIC HEALTH DEPARTMENT FACULTY OF MEDICINE

UNIVERSITAS PADJADJARANUNIVERSITAS PADJADJARAN

20122012

WHAT IS WHAT IS PROGRAM? PROGRAM?

PROGRAM is:PROGRAM is:

A service if some benefit is bestowed on A service if some benefit is bestowed on the individual or groups targeted for the individual or groups targeted for specific interventionsspecific interventions

Is a sequence of activities designed to Is a sequence of activities designed to implement policies and accomplish implement policies and accomplish objectives and gives a step by step objectives and gives a step by step approach to guide the action necessary to approach to guide the action necessary to reach a certain objectivesreach a certain objectives

Program management is activities Program management is activities involved with the development, involved with the development, implementation and evaluation of implementation and evaluation of interventions addressing health problemsinterventions addressing health problems

Effective program managementEffective program management is an is an organized response requiring :organized response requiring :

A carefully designed problem A carefully designed problem statementstatement

The availability of an appropriate The availability of an appropriate interventionintervention

The capacity to deliver that The capacity to deliver that intervention in a specific settingintervention in a specific setting

Each of these is an essential Each of these is an essential component of an organized responsecomponent of an organized response

Health program management seeks:Health program management seeks:

To organize and direct health workersTo organize and direct health workers

Scientifically sound interventionsScientifically sound interventions

Appropriate strategies toward Appropriate strategies toward spesific health problemsspesific health problems

The ultimate aimThe ultimate aim is: is:

To eliminate or reduce these To eliminate or reduce these problems to the maximum extent problems to the maximum extent possible (EFFECTIVENESS)possible (EFFECTIVENESS)

To achieve these results with the To achieve these results with the minimum resources necessary minimum resources necessary (EFFICIENCY)(EFFICIENCY)

Effectiveness and efficiency are the Effectiveness and efficiency are the primary criteria by which programs primary criteria by which programs are judged or evaluated.are judged or evaluated.

5 KEY QUESTIONS FOR MANAGERS5 KEY QUESTIONS FOR MANAGERS

1. Where are we ? • 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

2. Where do we want to be? • Set priorities • Identify desired outcome objectives (a planned end point of all activities)

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

Program Program management cycle management cycle

(managerial (managerial functions)functions)

PLANNING & ORGANIZING

ACTUATING & IMPLEMENTATING

CONTROLLING & EVALUATING

Deciding what to do and how to do it

Acting to accomplish what has been planned Comparing the results of

what was accomplished with what was intended

Program management cycle (managerial functions)Program management cycle (managerial functions)PRE -PLANNING

Preparation for planning : 1. Government interest2. Legislation3. Organization for planning4. Adninistrative capacity

ANALYZING OF THE HEALTH SITUATION

ASSIGN PRIORITIES AMONG PROBLEMS

DEFINE PROGRAM , ITS OBJECTIVES & HOW TO

MEASURE ACHIEVEMENT

ASSIGN PRIORITIES AMONG PROGRAMS (SELECTION BEST

PROGRAM (EFFECTIVE AND EFFICIENT)

DESIGN ALTERNATIVE PROGRAM TO SOLVE

PROBLEM

PLAN OF IMPLEMENTATION OF THE

PROGRAM

INITIATE AND OPERATE THE PROGRAM

COLLECT DATA FOR EVALUATION

EVALUATE RESULTS ACHIEVEMENT OF

OBJECTIVES

FORMULATE HEALTH PROBLEM

formulate priority problem for planning solution

Resources needed

PLANNING AND

ORGANIZING

ACTUATING &IMPLEMENTING

EVALUATING & CONTROLLING

NO

YES

PR

E P

LAN

NIN

G

PR

E P

LAN

NIN

G

The important pre conditions are:The important pre conditions are:

A.A.Government interest: any plan for Government interest: any plan for health of a country must be based health of a country must be based on a strong “political will” as on a strong “political will” as manifested by clear directives or manifested by clear directives or policies given by the governmentpolicies given by the government

B. Legislation: the policies are B. Legislation: the policies are translated into legislationtranslated into legislation

C.C. Organization for planning: Organization for planning: organizational structure, full-time organizational structure, full-time planners for the preparation and planners for the preparation and design planningdesign planning

D. Administrative capacity: for D. Administrative capacity: for proper coordination of activities proper coordination of activities and implementation of the plan at and implementation of the plan at all levelsall levels

Problem Solving Problem Solving CycleCycle

AN

ALY

SIS

OF

TH

E

AN

ALY

SIS

OF

TH

E

HEA

LTH

SIT

UATIO

N

HEA

LTH

SIT

UATIO

N

It involves the It involves the collection, collection, assessment and assessment and interpretation of interpretation of information in such a information in such a way as to provide a way as to provide a clear picture of the clear picture of the health situation. health situation.

ANALYSIS OF THE ANALYSIS OF THE HEALTH SITUATION HEALTH SITUATION

The minimum essential requirement for health planning:The minimum essential requirement for health planning:

1.1. The populationThe population, its age, sex and structure (population pyramid), , its age, sex and structure (population pyramid), population growth, fertility rate, education, occupation, religionpopulation growth, fertility rate, education, occupation, religion

2.2. Geography situation Geography situation of the health service: catchment area, of the health service: catchment area, administrative level, weather (rainy, dry), beach, mountain, administrative level, weather (rainy, dry), beach, mountain, transportationtransportation

3.3. The statistics of morbidity and mortalityThe statistics of morbidity and mortality (morbidity rate according to (morbidity rate according to disease, age specific …> prevalence, incidence, IMR, MMR, GDR, age disease, age specific …> prevalence, incidence, IMR, MMR, GDR, age specific death rate, etc)specific death rate, etc)

4.4. Life expectancy RateLife expectancy Rate

5.5. The epidemiology and geographical distribution of different diseasesThe epidemiology and geographical distribution of different diseases

6.6. ResourcesResources: manpower, money, material, methods, patients etc, Medical : manpower, money, material, methods, patients etc, Medical care facilities (Primary, secondary and Tertiary health services)care facilities (Primary, secondary and Tertiary health services)

7.7. Attitudes and beliefs Attitudes and beliefs of the population towards disease, its cure and of the population towards disease, its cure and preventionprevention

The analysis and interpretation of the above data brings out The analysis and interpretation of the above data brings out the health the health problems, health risks, the health needs and health demands of the problems, health risks, the health needs and health demands of the populationpopulation

Sit

uati

on A

naly

sis

Sit

uati

on A

naly

sis

wit

h S

yste

mati

c

wit

h S

yste

mati

c A

ppro

ach

Appro

ach

INPUTINPUT

PROCESSPROCESS

OUTPUTOUTPUT

OUTCOME (Health OUTCOME (Health Status)Status)

MorbidityMorbidity

MortalityMortality

Nutritional statusNutritional status

Exa

mple

sExa

mple

s

POPULATION PYRAMID

No Jenis PendidikanTahun 2005

Jumlah

1 Tidak / Belum Sekolah 3486

2 Tidak Tamat SD 1078

3 Belum Tamat SD 4527

4 Tamat SD 4918

5 SLTP 3250

6 SLTA 4457

7 Akademi / Sarjana 362

8 Sarjana 126

Jumlah 22204

OCCUPATION

No Mata PencaharianJumlah

2005 2006

1 PNS 3912 1511

2 TNI / POLRI 168 103

3 Pegawai Swasta 95 4316

4 Petani 42 6

5 Pedagang 195 734

6 Pelajar 7314 5067

7 Pensiunan 139 985

8 Buruh

9809

1024

9 Ibu Rumah Tangga 3550

10 Tidak / Belum Bekerja 1272

GEOGRAPHY

No Kegiatan Jenis Polusi Kel. Sarijadi

1 Industri Garmen

Limbah CairLimbah PadatBahan Beracun dan Berbahaya (B3)

+++

2Tambang Emas Tradisional

MerkuriCyanida -

3 Rumah Tangga (TPS Sementara)

Limbah OrganikLimbah an organic

++

4 Pasar Sampah OrganikSampah an organic

++

5

Sarana KesehatanPuskesmasRumah Sakit BersalinLaboratoriumSarana pelayanan Kesehatan lainya

Limbah Medis

++++

6 Rumah Potong hewan Limbah Medis -

7

Tempat umum lainya :TerminalPelabuhan

Timbal (Timah Hitam)Karbon MonoksidaBelerangDll

----

HEALTH FACILITIES

Fasilitas Tempat Berobat

Rawat Jalan Konsultasi Rawat Inap

(Jumlah Kunjungan) (Jumlah Kunjungan) (Jumlah Hari Rawat)

2005 2006 2005 2006 2005 2006

Praktek Dokter 16917 12761 - 618 - -

Praktek Dokter Gigi 2472 1753 - 468 - -

Puskesmas : - -

- DTP - - - - - -

- Non DTP 30942 30216 2191 2191 - -

Posyandu - - 16051 1324 - -

Posbindu 1589 4394 4686 1780 - -

Batra 848 724 - - - -

RS Bersalin - 602 - - - 54

Bidan Praktek Swasta - 151 - - - 151

Poskestren 289 562 300 323 - -

Pengobatan Alternatif Lainnya 2400 - - - - -

No. Jenis Fasilitas 2005 2006

1 Puskesmas 1 1

2 Balai Pengobatan Gigi 2 1

3 Balai Pengobatan Umum 4 2

4 Rumah Sakit 1 1

5 Praktek Dokter Umum Gigi

157

1612

6 Spesialis Anak Penyakit Dalam Kandungan Kulit Bedah THT Ortopedi

1------

--1----

7 Praktek Bidan 9 10

8 Dukun Bayi Terlatih Belum terlatih

11

11

9 Apotik 4 3

10 Optik - -

11 Laboratorium 1 1

12 Batra - 4

Proble

ms

Proble

ms

Identi

fica

tion

Identi

fica

tion Based on Situation

Based on Situation AnalysisAnalysis

Health Problems

Health ProblemsHealthcare Problems

Healthcare Problems

(Managerial)

(Managerial)

Prio

rity

Pro

ble

m

Prio

rity

Pro

ble

m The questions are:

The questions are:1.1. Should we solve all

Should we solve all

the problems at one

the problems at one

time?time?2.2. Can we do that?

Can we do that?

ASSIGN ASSIGN PRIORITIES PRIORITIES

AMONG AMONG PROBLEMS PROBLEMS

Answer:Answer:

No, we should not solve all the problems at one No, we should not solve all the problems at one time, time,

because :because :

1. May be among the problems, there will be the 1. May be among the problems, there will be the same program that can solve those problems at same program that can solve those problems at once, so we choose the main problem onlyonce, so we choose the main problem only

2. Scarcity of resources2. Scarcity of resources

Conclusion : assign priorities Conclusion : assign priorities how??? how???

Ass

ign P

riori

ties

Ass

ign P

riori

ties

Scoring Techniques : Scoring Techniques : PAHO, MatrixPAHO, Matrix

Non Scoring Non Scoring Techniques : Del becq, Techniques : Del becq, DelphiDelphi

ASSIG

N P

RIO

RIT

IES

ASSIG

N P

RIO

RIT

IES

AM

ON

G

AM

ON

G

PR

OB

LEM

S

PR

OB

LEM

S Assign priorities Assign priorities how??? how???

criteria MATRIX criteria MATRIX techniques:techniques:

1.1. Importance of the Importance of the problem: prevalence, problem: prevalence, severity, rate of severity, rate of increase, degree of increase, degree of unmeet need, social unmeet need, social benefit, public concern, benefit, public concern, political climatepolitical climate

2.2. Appropriate technologyAppropriate technology

3.3. Resources availabilityResources availability

FOR

MU

LATE H

EA

LTH

FOR

MU

LATE H

EA

LTH

PR

OB

LEM

S

PR

OB

LEM

S

STA

TEM

EN

TS

STA

TEM

EN

TS

To have a good program, we To have a good program, we have to define the health have to define the health problem statement problem statement correctlycorrectly..

There are two criteria, those There are two criteria, those are:are:

1.1. It can be measuredIt can be measured : What : What is the problem, How much, is the problem, How much, Who, Where, WhenWho, Where, When

2.2. NeutralNeutral: do not mention : do not mention that this problem causes by that this problem causes by somebody’s fault, or the somebody’s fault, or the cause itsself,or how to cause itsself,or how to solve the problemssolve the problems

Nex

t st

ep

Nex

t st

ep

Why this problem Why this problem happened? What happened? What factors contributed to factors contributed to these problems???these problems???

Identification of the Identification of the Causes of the ProblemsCauses of the Problems

• Fish Bone Diagram• Problem Trees• Blum Theory approach

After that CHECK THE REALITY in the Community Using

Questionnaire

50 %

20 %

20 %

10 %

Global burden of disease, Murray & Lopez, WHO, 1996

FISH BONE DIAGRAM (EXAMPLE)

Alt

ern

ati

ves

Alt

ern

ati

ves

Proble

m S

olv

ing

Proble

m S

olv

ing

Make the alternatives

Make the alternatives

Problem solving for

Problem solving for each risk factor/cause

each risk factor/cause

of the problems

of the problems

SELECTING PRIORITY AMONG SELECTING PRIORITY AMONG ALTERNATIVES OF PROBLEM ALTERNATIVES OF PROBLEM

SOLVING (EFFECTIVE AND SOLVING (EFFECTIVE AND EFFICIENT) EFFICIENT)

1.1. Effectiveness of the Effectiveness of the program:program: Magnitude of the Magnitude of the

problemproblem

Important to intervene Important to intervene the problemthe problem

Vulnerability of the Vulnerability of the programprogram

2.2. Efficiency of the Efficiency of the program program cost cost

PLAN INPLEMENTATION AND OPERATE PROGRAM PLAN INPLEMENTATION AND OPERATE PROGRAM

Once the program has been selected and Once the program has been selected and approved, programming and implementing approved, programming and implementing are begunare begun

The organizational structure must The organizational structure must incorporate well-defined procedures to be incorporate well-defined procedures to be followed and sufficient delegation of followed and sufficient delegation of authority to and fixation of responsibility of authority to and fixation of responsibility of different workers for achieving the different workers for achieving the predetermined objectives during the period predetermined objectives during the period prescribedprescribed

Many well considered plans have fallen Many well considered plans have fallen down because of delays in critical supplies, down because of delays in critical supplies, inappropriate use of staff and similar factors.inappropriate use of staff and similar factors.

NEX

T W

EEK

S

NEX

T W

EEK

S PLANNINGPLANNINGORGANIZING

ORGANIZINGACTUATINGACTUATINGCONTROLING &

CONTROLING & EVALUATINGEVALUATING

To b

e c

onti

nued

To b

e c

onti

nued

THANK YOU

THANK YOU

@iamelia@iamelia