Chapter 3: THE PLANNING PROCESS

1.1 Meechai - the role of the champion

A success story in community health promotion

Through the activities of a Thai statesman, Khun Meechai, family planning, with its resultant smaller family numbers, was popularized in Thailand. That reduction in population growth has been credited as a key part to Thailand's dramatic social and economic growth in the past two decades.

Khun Meechai served as an effective champion, a respected and popular personality who was listened to and whose advice was sought and taken.

1.2 Involving Decision makers

The most important aspect of health planning is gaining the support of decision makers

2. Understanding the political and economic realities

• In developing a rationale for a health program, the special interests of those affected, economic realities and the level of interest by high-level decision-makers must be borne in mind.
• Our decisions are not made based solely on health issues, especially where the interests of public health are concerned. At the top of the list is:

Policy = politics x money

• Conservatives versus liberals: Although it could be a checks and balance system, political parties and their vested interests, vocal minorities or silent majorities may swing policy to one extreme or the other.
• Health regulations have historically been in response to political pressures than to health professional thinking.
• Issues of economy are now forcing policy change in environmental and health issues.

3. The contradiction of ethics.

3.1 Societal Benefit versus Individual Rights

• The overall aim of public health and health education is to attain the maximum good for the maximum number within resource constraints. This departs from clinical practice of curative medicine, which focuses on the individual. A radical shift is now occurring with managed care's emphasis on preventive health practices, a direct confrontation with the conventional role of allopathic medicine.
• A basic tenet of American law is that a man's home is his palace. What he (or she) does inside is up to them, but out the door everything belongs to everyone, in a philosophical sense.
• Cultural and religious beliefs, which often conflict with society at large must be weighted against the common good.

3.2 Ethics of the health promoter and provider

• Confidentiality
• Timeliness of information and its dissemination
• Personal interaction with stakeholders
• Informed consent
• Balancing privacy with the need to know

4. Rationale for planning

• A means for gaining support of a program or project. It seems intuitive that we would be interested in things that keep us healthy.
• The following are suggested for developing a rationale. In the policy area these represent "agenda setting", which is carried out in the formulation phase of policy-making.
• These steps don't all have to be used; one or two may be sufficient
  • Epidemiologic Justification
    • Is the illness or health issues really of concern? Is it not just another "Disease of the Month".
    • Coupled with a needs assessment, this helps identify the scope and real nature of the problem.
  • Needs Assessment
    • Is a program or project truly needed? Or does it simply satisfy the developer? Or use money ear-marked for it any way.
    • Usually required of State or Federal programs. More next week.
  • Analysis of Behavior
  • Working through social institutions
  • Goals and Objectives
  • Political Groundwork
  • Implementation
  • Evaluation

These principles are well illustrated in the article 101 Questions for Community Health Promotion Program Planning. Please read that article over carefully. Study questions follow at the end of this session.

5. Creating the rationale Refer to page 30 of the text

Based on the standard decision-making model: 1) identify the problem, 2) identify alternatives to solve the problem, 3) pick one and implement

• Identify the health problem on global terms, with data
• Show the relationship of the problem to the target population. Why is it a problem to this group?
• Name and purpose of the program. State solution and goal. (How the problem will be solved)
• What can be gained? Protection of human resources is the big one. Will the program to that? Be specific and back with data
• What are the measures of success? How will success/failure be evaluated?
• References used in providing the rationale: credible? refereed? national opinion and local bias?

5. The Planning Committee

5.1 Selecting committee members

Often the mention of establishing a committee is viewed as a quick way to stifle/hender/stop the process. It is an important task for health promotion planning and a necessary first step. A key to making a successful committee is to engender a sense of program ownership

• Select members who represent as much as possible the stakeholders. Should be uniform in representing gender, ethnic groups, special interest groups; representation other than the target population is desirable (will bring objectivity to the committee)
• Select those who are interested and want a successful program. Both doers (those willing to dive in and do any task assigned) and influencers (those who can continue/solicit support for the program) are important
• Select a senior member of the organization through which the program will function.
• Re-evaluate the committee occasionally to assure it is meeting its mandate and truly represents the interest of the community. There are always those who bring three own agenda and they need to be identified and controlled.
• Make provisions to add new people as they are identified. One way is to fix term limits (6 months - 2 years) which alternate.
• Size is important: an odd number is best (breaks voting ties), more than 4 but less than 20. In very large committees, subcommittees may be practical to break up the task to be accomplished.
• Facilitator/chair will determine the strength of the committee The key word is facilitator. The selection of that individual is as important as obtaining a program champion

Return to Class Notes

The information for this session was drawn from Needs Assessment Strategies, by Gilmore and Campbell (1996), Planning, Implementing and Evaluating Health Promotion Programs, by McKenzie and Smeltzer (1997) and Community Health, by Reagan and Brookins-Fisher (1996)