WEEK 8 - HEALTH PROJECT PLANNING

• THREE PHASES OF THE PLANNING PROCESS

  1. Preparatory Phase - identifying health problems, strategic plans, and assessing available resources, identify problems, and prioritize what the project main focus will be. 
  2. Planning Phase - formulate specific strategies, organization of the existing health programs. 
  3. Output - final program that has been formulated. 
• TWO OBJECTS OF THE PLANNING PROCESS

  1. Planning for the programs and services
  2. Planning for projects
• ONE SINGLE OUTPUT

  1. A consolidated health program plan
• COMMUNITY ASSESSMENT

  • A community assessment is an exercise by which a collaborative partnership gathers information on the current strengths, concerns, and conditions of children, families and the community. 
  • The information comes from many sources - especially parents and family members - and is elicited by many techniques, including interviews, focus groups discussions, and scanning demographic data collected by local agencies. 
• • Community assessments focus on local assets, resources, and activities as well as gaps, barriers, or emerging needs. The process of identifying and appraising this information will help your collaborative partnership. 
• • Clearly understand the context in which families live and the issues families want to address; locate hidden strengths or underutilized resources that could be developed. 
  • Determine which resources could contribute to comprehensive strategies, and in what way; 
  • Design effective, collaborative strategies that engage children and families because they respond to real and important conditions; and
  • Empower families and community members by giving them a role in designing and implementing the strategies.  
• PROCESS OF CONDUCTING A COMMUNITY ASSESSMENT

  • Scanning the community to locate existing information, 
  • Developing a family focus, 
  • Identifying community assets and the degree to which they are accessible to the people who can benefit from them, and
  • Analyzing the information obtained through the first three steps. 
• Program

  • Program is a series of coordinated related multiple projects that continue over extended time intended to achieve a goal. 
  • It comprises multiple projects & is created to obtain organizational or technical objectives.
• Project

  • Has an established & specific objective.
  • Has a defined life span with a beginning & an end.
  • Usually the involvement of several departments & professionals. 

  Has specific time, cost performance requirements. 
• MAJOR STEPS IN PLANNING, SUSTAINING & EVALUATING A HEALTH PROMOTION PROJECT

  1. Identify the issues or health problems in the community. 
  2. Prioritize the issues or health problems to identify the one that the project will address. 
  3. Identify risk factors and set the goal for the project. 
  4. Determine contributing factors and state objectives for the project.
  5. Determine what strategies will be. 
  6. Develop the action plan for the project. DO IT!
  7. Sustain the project or keep the project (or some part of it) going. 
  8. Evaluate the project. 
• NEEDS ASSESSMENT

  • Clarifying need is an essential part of deciding what issue or problem the project will address. The term ‘needs assessment’ is used to describe a process of collecting information that will give a good indication of the priority needs of a community. 
  • It provides an opportunity for the community to become involved in the planning from the beginning.
  • It helps with allocating resources and making decisions about where to start with health promotion work. 
• CLASSIFYING NEEDS

  • When undertaking a needs assessment, it is important to consider that needs will be thought of differently, depending on whom you consult. Needs are sometimes classified as:
  • Normative Needs
  • Felt Needs
  • Expressed Needs
  • Comparative Needs. 
• SHARING INFORMATION FROM THE NEEDS ASSESSMENT

  • Sharing the results of the needs assessment with the community is a key part of the planning process. This process will:
  • Raise community awareness about the issues and possible underlying causes. 
  • Stimulate discussion about ways to address the issues.
  •  Allows the community to be involved in planning and decision-making about the project.
• CONSIDER BASELINE DATA

  • Some of the information gathered during the needs assessment may be able to be used as “baseline data”.
  • Baseline data describe the situation or condition at the time the project or intervention starts. 
  • Data collected later during the evaluation is then compared against the baseline data to see the effect of the project. 
• STEP 2: PRIORITIZE THE ISSUES OR HEALTH PROBLEMS

  • At the end of Step 1, the project team will have a list of major issues and potential target groups for the project.
  • There are always competing needs or issues in any community. 
  • Limitations such as time and resources mean that not everything can get addressed. 
  • Issues will need to be prioritized. Needs and priorities vary from individual to individual, family to family, group to group. 
  • It is important to work out criteria to sort out which issue the project will address.
• METHODS OF HEALTH PROBLEM ANALYSIS

  1. Qualitative Method
  2. Analysis of those who participated in the circumstances that surround the problem through focus group discussion (Participant’s Analysis).
  3. Quantitative Method
  4. Construct a problem tree illustrating the direct and the underlying causes of the problem. 
  5. Provides estimates (evidence-based) on the nature and extent of each cause through the use of indicators. 
• METHODS TO ANALYZE CAUSES

  • Ishikawa Diagram 
  • Vector Diagram 
  • Cause & Effect Tree
• ROOT CAUSE ANALYSIS 

  • A root cause analysis is a class of problem solving methods aimed at identifying the root causes of the problems or events instead of simply addressing the obvious symptoms. 
  • The aim is to improve the quality of the products by using systematic ways in order to be effective (Bowen, 2011).
• • Techniques in Root Cause Analysis: 
  • ASK WHY 5 TIMES
  • FAILURE MODE AND EFFECTS ANALYSIS (FMEA)
  • FAULT TREE ANALYSIS (FTA)
  • CURRENT REALITY TREE (CRT)
  • FISHBONE OR ISHIKAWA OR CAUSE-AND-EFFECT DIAGRAMS
  • KEPNER-TREGOE TECHNIQUE
  • RPR PROBLEM DIAGNOSIS
• ASK WHY 5 TIMES

  • This might sound like the technique of a five-year-old wanting to get out of going to bed, but the five whys analysis can be quite useful for getting to the underlying causes of a problem. 
  • By identifying the problem, and then asking “why” five times - getting progressively deeper into the problem, the root cause can be strategically identified and tackled. 
• FAILURE MODE AND EFFECTS ANALYSIS (FMEA)

  • The Failure Mode and Effects Analysis (FMEA) is a technique which is aimed to find various modes for failure within a system. 
  • FMEA requires several steps for execution:
  • All failure modes (the way in which an observed failure occurs) must be determined. 
  • How many times does a cause of failure occur?
  • What actions are implemented to prevent this cause from occuring again?
  • Are the actions effective and efficient?
• FMEA is often performed and updated any time a new product or process is generated, when changes are made to current conditions, or to design, when new regulations occur, or when there is a problem determined through customer feedback. 
• 1. FAULT TREE ANALYSIS (FTA)

  • Uses boolean logic to determine the root causes of an undesirable event. 
  • This technique is usually used in risk analysis & safety analysis. 
  • At the top of the fault tree, the undesirable result is listed. From this event, all potential causes tree down from it. Each potential cause is listed on the diagram in the shape of an upside down tree.
• 1. CURRENT REALITY TREE (CRT)

  • The current reality tree analyzes a system at once. It would be used when many problems exist and you want to get to the root causes of all the problems. 
  • The first step in creating a current reality tree is listing all of the undesirable or, problems. Then being a chart starting with each of those problems using causal language (if…and…then). The tree will depict each potential cause for a problem. 
  • Eventually, the tree will show one cause that is linked to all four problems. 
• 1. FISHBONE OR ISHIKAWA OR CAUSE-AND-EFFECT DIAGRAMS

  • No matter what term you use for the fishbone diagram, the truth is, that it is a useful technique that will help you in your root cause analysis. A fishbone diagram will group cause into categories including: 
  • People
  • Measurements
  • Methods
  • Materials
  • Environments 
  • Machine
• KEPNER-TREGOE TECHNIQUE

  • Also known as the rational process, is intended to break a problem down to its root cause. This process begins with an 

  1. Appraisal of the situation - what are the priorities and orders for concerns for specific issues?
  2. The problem analysis is undertaken to get to the cause of undesired events.
  3. A decision analysis is tackled, outlining various decisions that must be made.
  4. A potential problem analysis is made to ensure that the actions decided upon in step three are sustainable.
• 1. RPR PROBLEM DIAGNOSIS

  • One final technique used in root cause analysis is the RPR Problem Diagnosis. RPR stands for “Rapid Problem Resolution” and it deals with diagnosing the cause of recurrent problems. 
  • This process has three phases: 
  • Discover - team members gather data and analyze their findings. 
  • Investigate - a diagnostic plan is created and the root cause is identified through careful analysis of the diagnostic data.
  • Fix - the problem is fixed and monitored to ensure that the proper root cause was identified. 
• THE PROBLEM TREE - THE WHAT AND THE HOW-TO 

  • A methodology to systematically identify the possible contributory factors that led to the formation of a health problem. 
• Risk Factors

  • Are any aspects of behavior, society or the environment that are directly linked to the health problem. 
  • Risk factors lead to or directly cause the problem. Note that some risk factors can be charged, while others are not able to be modified, for example, family history of a condition. 
• Example of risk factors:

  • Eating high fat food (behavioral) and having a family history of heart diseases (biological) are both risk factors for heart disease. 
  • People can change their food choice (modifiable) but not their genetics (non-modifiable). 
  • Direct exposure to bacteria and germs (environmental) may be a risk factor for diarrhea. 
• • Addressing a problem successfully will require the project to focus on the underlying causes or issues that led to the problem in the first place. 
  • In other words, the goal and objectives of a project need to relate to the underlying causes or issues. 
  • Developing a clear and organized goal and objectives that relate to each other requires some critical analysis of the problem. 
• Contributing Factors

  • Are any aspects of behavior, society or the environment that leads to the risk factors developing. 
  • Contributing factors enable or reinforce the risk factors. They can relate to individual, financial, political, educational, environmental, or other issues. 
• • Examples of contributing factors: 
  • Lack of knowledge about low fat diets (educational) and high cost of low-fat foods in the store (financial) are both contributing factors to the risk factor “eating a high fat diet”.
  • Poor housing conditions (environmental), and lack of home hygiene (behavioral) are both contributing factors to the risk factor “exposure to bacteria and germs”.
• DEVELOPING THE PROJECT GOAL & OBJECTIVE

  1. The Goal & Objectives: 
  2. Make plan clear and focus that energies of the project team. 
  3. Let people know what they can expect to happen as a result of the project. 
  4. Are the basis for planning the evaluation of the project. 
• GOAL

  • The goal is about making changes to the risk factors addressed by the project. 
  • The goal indicates what the planned, longer term outcome of the project is. 
  • It is also intended to inspire, motivate and focus people and encourage team cooperation.
• OBJECTIVES

  • Objectives state what changes the project will make to the contributing factors.
  • The objectives indicate what the impact will be on the contributing factors during the time frame of the project. 
  • The objectives are about what has to change in the short term to get closer to achieving the project goal. 
  • A well written “goal and objectives” state who will achieve how much of what by when. Developing a clear, achievable goal and objectives requires good baseline data. 
• STEP 5:

  • After the objectives are developed, the strategies are determined. Strategies describe what it is the project team will do to try and make the changes required to achieve the objectives. 
  • Relationship between the goal, objectives and strategies

  1. The process for planning a project begins with the big picture (issue of the problem). 
  2. It is an analysis of the big picture issue that gives the framework for developing the plan - from the longer term goal, to more specific objectives, down to the actual strategies, and finally the detail of individual actions. 
• Writing the action plan

  1. Determine project strategies

  2. Include all specific activities, large & small, that will need to be done to implement each of these activities

  3. Identify when activities will be completed

  4. Determine how activities will be evaluated
• The more detail that is worked out for strategies, the easier it will be to accurately identify all the activities to be done
• If the project is large, with many stages, it may not be possible to detail all the specific activities at the beginning of the project