The ABC’s of designing SUSTAINABLE Public Health Programs

The health of a community is dependent on the overall health of its people. Community health initiatives are sometimes designed with the aim of modifying health and disease patterns, peculiar to a specific group of people. A key determinant or measure of success of any health initiative is its long term sustainability. Therefore a frame work to guide program planners at the design stage of any project is critical to assure success. The ABC’s should serve as a guide in checking off a “to-do list”, at the planning phase of a community health project.

  1. Appraisal: Appraisal is defined as an act of assessing something or someone. It is an evaluation of a process, system or population. An appraisal of any given situation or entity is carried out to give the full picture, without redundancy or superfluity. When a thorough appraisal is carried out, it elaborates the situation on ground, and the best approaches to tackle any challenges. For an appraisal of a community health problem to be deemed complete, the following key activities must be included in the program design.
  • Root Cause Analysis: A Root Cause Analysis (RCA) is a term that describes techniques and tools used to uncover the causes of a problem or failure. A RCA is often carried out to get to the bottom of a problem, and not to only focus on the off shoot of the problem-the observable symptom. Any successful community health program should be designed in such a way as to answer key questions as the causes of the problem. A thorough RCA defines the problem, answers all the ‘why’ questions and proffers solutions that lend themselves to routine evaluation in addressing the problems.
  • Determinants of health: What makes one community healthy, and the other unhealthy? What factors contribute to the well being of communities? The determinants of health are a consortium of factors that impact the health and well being of communities. It is important to note that what may positively impact the health of one community, may negatively impact the health of another. Community health practitioners must be able to determine the most important determinants of health and diseases in any community, to potentiate the cost effectiveness of any intervention. The 3 main determinants of health can be summed up as the 3 G’s:

a.) Geography-The physical environment and all the elements of nature. These include access to clean drinking water, healthy food portions, climate change, global warming etc.

b.) Goods-These includes the social and economic environment. People’s relationships, income levels, social status, education levels etc.

c.) Genes-These includes a person’s genetic make-up, which has been shown to have a great impact on health and certain diseases.

Therefore, a thorough analysis and understanding by public health practitioners on the most important contributor to health, and targeting resources to such areas, will increase the likelihood of any health modification campaign.

  • Influence of Community Stakeholders: A stakeholder’s analysis is a process of systematically gathering and analyzing qualitative information to determine whose interests should be taken into account when developing and/or implementing a policy or program. The stakeholders in a process are actors (persons or organizations with a vested interest in the policy or program being implemented. (Stakeholder Analysis Guideline-World Health Organization). After conducting a stakeholder analysis of the key interest groups, it is imperative to determine the influence of community stakeholders on the proposed health modification initiative. Community leaders have a great influence on their constituents. Therefore, the success or ultimate failure of a project depends in part on the role of these key community actors. Vital questions must be asked and answered including but not limited to: what is their interest in the project? What is their knowledge of the project? Do they have an adequate understanding of the major root causes of the problem? Do they proffer alternate ways to address the problem? What is their voting power in the decision making process? These are some of the key factors that may be considered when trying to determine the influence of community stakeholders on the proposed health intervention.The ABCs of sustainability.jpeg
  • The Role of health models on disease causation, interpretation and outcomes: The role of the models of health on disease incidence and survival cannot be overlooked. At the crux of any community health problem is the answer to some ‘why’ questions. It is a well-known fact that models of health including the biological, psychosocial, political economy and biophysical all have a role to play in disease incidence and survival to varying degrees. While one model may play a more significant role in one community, the same may not be the case in another community. For example, while infections and communicable diseases are still a huge burden in many developing countries due to environmental and biophysical concerns including limited access to immunizations, the same is not the case in developed countries. Developed countries tend to grapple more with chronic diseases such as obesity, diabetes, hypertension, cancers, which may be more reliant on the biological and political economy models. It is therefore the responsibility of program planners to determine during the design stages of projects, the models with greater impacts on disease causation and outcome. This approach may increase the likelihood for success than failure of the intervention.

2. Budget: A budget is a financial statement detailing the income and expenditure of an entity over a given period of time. Proper budgeting encompasses adequate planning, both for foreseeable and unforeseeable expenditure. A budget should also include the fixed assets, and in kind or monetary contributions of the program to the execution of any community health initiative. A comprehensive budget should take into account direct and indirect costs including but not limited to personnel costs, travel costs, equipment/supplies, consultants, printing/duplication costs, postage, staff training, rent, telephone expenses, heavy machinery etc. A project with an insufficient budget would be more likely to encounter challenges that may pose as threats to its sustainability, than one which is adequately funded. Therefore, program planners must ensure that their budgets are sufficient enough to run through the entire life cycle of the projects.

3. Community buy-in: It would be an effort in futility if after going through the planning and design phases of a project, you discover that a community is not interested in that line of intervention. This would amount to a humongous waste of time and valuable resources. Therefore, program planners must ensure during the design phase of any project, to get the community’s perspective on that particular line of program approach. This is imperative because apart from getting the community’s perspective on a particular proposal, they may also be able to provide valuable pieces of information that may enhance the sustainability of any project. Community buy-in works in tandem with the role of the community’s stake holders. Successful programs are designed for the people and with the people. Therefore prior to moving in the big equipment or hiring non-key program staff members, getting the perspectives of the community, and ensuring that it aligns adequately with that of a program is paramount to enhancing sustainability.

In summary, at the crux of any planned program intervention in a community is the issue of long-term sustainability. Program planners should become familiar with addressing fundamental elements of successful program interventions. A good place to start is ensuring that the ABC’s have all been taken care of-Appraisal, Budgeting and Community buy-in.

To your continued success. Cheers!

Evi Abada

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