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Health Program Planning

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Title: Health Program Planning


1
Health Program Planning
  • CHSC 433
  • Module 1/Chapter 3
  • UIC School of Public Health
  • L. Michele Issel, PhD, RN

2
Learning ObjectivesWhat you ought to be able to
do by the end of this module
  • List pros and cons of the types of planning
    identified by Beneviste.
  • Appreciate the challenges involved in being a
    health planner.
  • Understand where and how in the planning process
    involvement of stakeholders is appropriate.

3
Notice
  • Lack of planning
  • on your part does not constitute an emergency
  • on my part.

4
Planning is
  • Effort to control social or collective
    uncertainty by taking action now to secure the
    future (Marris in Hoch, 94)
  • Good planning is the popular adoption of
    democratic reforms in the provision of public
    goods. (Hoch,1994)

5
Purpose of Planning
  • To determine the program prioritization and gain
    support for the program
  • Part of Cycle (on next slide)

6
(No Transcript)
7
Brief History of Public Health Planning
  • Environmental planning of water and sewer systems
    in antiquity
  • Population planning with the advent of
    immunizations
  • Blum advocated for rational approach for health
    planning
  • Advocacy planning of the 1960's was a break with
    the rational approach
  • Increasing attention on risks

8
Risks and Protection
  • Risk as a perception about possibilities of
    adverse event
  • Active (requires behavior change) protection
  • Passive (change in the situation or environment,
    not the person) protection
  • Micro (individual) and macro (system) approaches
    to risk reduction

9
Threats to effective risk reduction (Per Blum)
  • Conceptual anemia
  • Wishful thinking
  • Social irresponsibility
  • Failure to analyze problems
  • Failure to examine possible interventions
  • Failure to be conversant with the implementation
    pathways
  • Blaming the victim

10
Planning Perspectives
  • According to Beneviste
  • According to Forester

11
Beneviste Planning Perspectives
  • Comprehensive rational is systems approach
  • Advocacy planning is client focused and citizen
    participation focused
  • Apolitical politics uses technical knowledge to
    achieve compromises
  • Critical planning is concerned with the
    distribution of power and communication
  • Strategic planning focuses on the organization
  • Incrementalism takes small, discrete steps

12
Examples in Public Health (can you think of
other examples?)
  • Comprehensive rational implementation of WIC
    program
  • Advocacy planning CDPHs anti-violence
    planning, advisory boards
  • Apolitical Evidence based approaches to
    medicine and health care
  • Critical planning HIV/AIDS groups
  • Strategic planning state health plan, local
    health department annual plan
  • Incrementalism HP 2010

13
Planning Perspectives Reasons to Reject per
Forrester
  • Rational approach assumes means and ends are
    known, can anticipate the future
  • Problem-solving technalizes social problems,
    assumes have solutions
  • Cybernetic (systems) perspective does not account
    for norms and values
  • Satisficing (meet minimum needs) perspective
    assumes a rational decision making

14
Examples in Public Health (can you think of
other examples?)
  • Rational approach State health plans
  • Problem-solving Health educational programs
  • Cybernetic State-wide immunization programs
  • Satisficing ?

15
Perspective Advocated by Forester
  • Communicative action perspective
  • Shapes attention of stakeholders
  • Changes beliefs of stakeholders
  • Gains consent of those with the problem and the
    solution
  • Engendering trust and understanding of those with
    the problem

16
From Perspectives to Priority

17
Prioritizing A reality
  • Traditional public health approach as typified by
    Dever who drew on Hanlon
  • Utility measures as individual information for
    planning
  • Resource allocation as a prioritization

18
Prioritizing per Dever (1)
  • Determine size of health problem(s)
  • Use health indicators
  • mortality, morbidity, utilization, satisfaction
  • Use epidemilogy measures
  • rates, proportions

19
Prioritizing per Dever (2)
  • Determine seriousness and importance of health
    problem (s)
  • Compare epidemiology and normative data
  • consider relative risk, odds ratio
  • Use utility measures to get at perceived
    seriousness
  • Conduct focus groups or surveys to assess
    perceived importance

20
Prioritizing per Dever (3)
  • Determine intervention effectiveness
  • Review literature on various possible
    interventions, programs, treatments
  • Use evidence-based practice guidelines
  • Conduct pilot program with intervention

21
Logic Model of Public Health Assessment for
Planning
22
Health Resource Allocation 8 Step Strategy
(Patrick Erickson)
  • 1. Specify the health decision
  • 2. Classify health outcomes as health states
  • 3. Assign values to health states by using
    preferences (i.e., utility measures)
  • 4. Measure health related quality of life

23
Health resource allocation strategy (continued)
  • 5. Estimate prognosis and healthy years of life
  • 6. Estimate direct and indirect health care costs
  • 7. Rank costs and outcomes
  • 8. Revise ranking of costs and outcomes

24
Dever/Hanlon Approach
  • Implies apolitical and rationality to problem
    prioritization
  • Reality is that values, preferences, motive can
    surface and affect the process

25
Ways to objectify the Hanlan/Dever Approach
  • Educate group using critical or communication
    approach to planning
  • Gain consensus on the process and decision rules
    about numbers
  • Careful balance in composition of group doing the
    problem prioritization
  • Have adequate resources to do all the steps
  • Address data trustworthiness
  • Consider variability in literature being used

26
Planning at macro level
  • Think across the Pyramid (developed by the
    Maternal and Child Health Bureau)
  • Health Policy formation is decision making

27
Characteristics of Health Policy Decision Making
  • (1) Innovation within customary and implicit
    rules such that the new is subsumed within what
    is already familiar
  • (2) Mutual adjustment by one department (or such)
    in response to the decision made by another
    department
  • (3) Bargaining either through direct negotiation
    or using trade-offs to influence the decision
  • (4) Move and countermove by departments (or such)
    in the fashion of taking unilateral action that
    forces the actions of another

28
(continued)
  • (5) Solutions exist and sometimes come before
    recognizing the problem, just waiting for a
    window of opportunity to be applied
  • (6) The unanticipated consequences of one action
    can lead to the need for other health decisions
    that were in themselves unintended

29
Conclusion
  • Principles
  • Challenges
  • Roles of Planners
  • Paradoxes

30
Planning Principles
  • Have visible, powerful sponsor
  • Involve those affected in the planning
  • Constitute a planning board
  • Have well trained and skilled planning staff
  • Be as objective as possible, given the context
  • Use rationality as much as possible as basis for
    power

31
Challenges in Planning
  • Change is distasteful to those affected
  • Health perspective does not reflect social values
  • Politicians prefer cure, health planners prefer
    prevention
  • Politicians have short term view, health planners
    have long term view
  • Constituents inherently have conflicting
    priorities, preference, etc

32
(Some) Roles of Planners
  • Designer of planning technology, Assistor and
    systems facilitator, Problem solver, Inquirer
  • Priority setter, Regulator, Decision maker,
    Builder of futures
  • Educator, Expander of capabilities, Advocate,
    Activator, Power modifier
  • Agency manger

33
Planning paradoxes
  • Planning is shaped by the same forces that
    created the problems
  • The good of individuals and society
    experiencing the prosperity associated with
    health and well-being is bad to the extent that
    prosperity produces ill health
  • What may be easier and more effective may be less
    acceptable

34
Public Health Pyramid
35
Planning across the Pyramid
  • Individual Level person focused, direct
    clinical services
  • Enabling services aggregate focused, indirect
    care services
  • Population services population focused,
    services delivered to entire population
  • Infrastructure level the health care
    organization, public health system

36
Data for Problem Size, Seriousness, Importance
Across the Pyramid
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