Title: Steps of health education program planning process
Course: Level 3 - Health Education and Promotion > Section: Planning, implementing and evaluating a health education program

Figure 6.1 Steps in planning health education activities.

Assess Need

In previous session, you have already learned about need assessment and data collection techniques. Here you need to consider it as one step in planning health education and health promotion activities and programs. So you should recall what you have learned in the previous session. Conducting a need assessment is the first, and probably the most important, step in any successful planning process. A needs assessment is a systematic process for determining and addressing needs, or "gaps" between current conditions and desired conditions or "wants". The discrepancy between the current condition and wanted condition must be measured to appropriately identify the need...

Community health needs assessment is a process that describes the state of health of local people; enables the identification of the major risk factors and causes of ill health, and enables the identification of the actions needed to address these.

a. The community and its general socio-economic, demographic and physical characteristics--- Here you are dealing with the size of the community (average size of the household) and their sex and age group, Average number of pregnancies, births and deaths,the economy and its impact on health, religion and its impact on health, kind of natural resources existing in the community, the transportation routes and the communication network and public and private institutions like schools, religious institutions, health facilities.

b. Health beliefs and practices--- cultural beliefs, attitudes and practices of the community have great influences on the delivery of the health services. Bearing this in mind your assessment result should address how people define good health and disease, the methods used to help maintain their health and other beliefs, attitudes and practices concerning each health service extension packages.

Identifying and Prioritising Health Problems

This step is logically done after the need assessment is completed. From the need assessment result, it is possible to identify and list some community health problems and their potential causes. For example, you can identify such a health problems as HIV/AIDs, Malaria, Tuberculosis, diarrheal disease among under-five children, pneumonia hypertension, and diabetes mellitus in your community.

Identification of the possible causes of disease and another health problem is another activity, and it addresses scientific and cultural perspectives as a cause of a certain disease. For example, you have the probability to identify the cause for HIV/AIDs---curse of supernatural beings. Do you think it would be possible to act up on all the identified problems?. Discuss in the group and come-up with some suggestions and conclusions.

The next step after identifying of the list of problems is prioritisation-- it is a kind of decisions made to put the identified problem (s) in the order of their urgency, importance and changeability. However, the decision is not haphazard or arbitrary. There are five basic criteria to prioritise these problems. Look at the following (box 6.6) shows the basic five criteria for problem identification

Criteria to Prioritise Problems

- Magnitude of the problem. Look at the prevalence of the problem. Is there a lot of it in your community?.
- Are a large number of people affected by the problem? Is the problem widespread in the community?.
- Severity of the problem. Does the problem lead to serious illness, death or disability?.
- Feasibility of the intervention. Are you able to solve the problem with the resources you have? Can the problem be tackled with the resources you have?.
- Government concern. Do the official people want you to tackle this problem?
- Community concern. Does the community want to deal with the problem?

Listing the criteria does not mean that the problem is already prioritised and ready for an intervention. Rather scoring the points from one to five to each of the problems makes the prioritisation process easier. A score of one is the minimum value, and the problem is given less concern, and a score of five is the maximum, and it means the problem is given more concern. Finally, the values are added, and the total is known, and then ranks the problem with a largest total value first and so on. Look at the following table 6.7 shows the scoring process in problem prioritisation.

Table 6.1 Prioritising - Scoring and Ranking Health Problems

 | Problems Identified | Score for Each Criterion | Total Value | Rank
Magnitude | Severity | Feasibility | Community Concern | Government Concern
1 | HIV/AIDs | 5 | 5 | 4 | 3 | 5 | 22 | 3
2 | Tuberculosis | 5 | 5 | 4 | 5 | 5 | 24 | 2
3 | Malaria | 5 | 5 | 5 | 5 | 5 | 25 | 1
4 | Diarrheal disease | 3 | 3 | 5 | 3 | 5 | 19 | 5
5 | Pneumonia | 5 | 5 | 3 | 2 | 5 | 20 | 4
6 | Hypertension | 4 | 3 | 4 | 2 | 4 | 17 | 7
7 | Diabetes mellitus | 4 | 3 | 4 | 3 | 4 | 18 | 6

The second option you have available in prioritising health problems is to ask a group of stakeholders, such as community members or other health workers, to prioritise the problems according to their knowledge and experience. How many problems do you select to address?. That depends on your capacity and the resources you have to deal with them.

Setting Goals and Objectives

As soon as the problems are prioritised, your next duty will be setting appropriate goals and objectives. Both terms imply the target that one's efforts are desired to accomplish. Goals are generically for an achievement or accomplishment for which certain efforts are put.

For example 'The Millennium Development Goals' health educations Objectives are specific targets within the general goal. If you do not have objectives, you cannot evaluate the effectiveness and efficiency of your health education activities. Objectives are time-related to achieve a certain task, and answer the following questions:

- What? Things to be achieved
- Where? Place of action
- Who? The target group
- When? By what time or date?

The extent of achievements: Can you measure the improvement in health that you have achieved? The objective should be 'SMART'--it is an abbreviation and stands for the following five criteria of good objectives S-specific M- Measurable A- Achievable R- Relevant T- Time-bound.

Types of Objectives in Health Education

1. Health objectives--these objectives tell you how big the health problem is, and how much it should be improved. For example under-five diarrheal diseases in our kebele will be reduced by 20% at the end of this year.
2. Behavioural objectives---these objectives are related to what the community need to do or how should they act to prevent and control diseases. For example: At the end of this year, mothers who have under five children will bring their children for immunisation.
3. Learning an educational objectives---these objectives work towards the development of the knowledge, skill and attitude of the community which helps them to prevent and control diseases. For example: At the end of this learning session, mothers will have the skill to prepare oral rehydration salts (ORS) to prevent under-five diarrheal disease
4. Resource objectives--- these objectives are directed to provide the community with the specific environmental support so that they can be able to participate in the program and enabled against any community health problems. For example: At the end of this session all the mothers who attend the session will have the access to the oral rehydration salts (ORS)

Developing Appropriate Methods and Strategies

Once a health extension worker understands the reason behind behaviour that is causing a health problem, she can use many different methods/strategies to encourage a change in that behaviour.There are some basic issues to consider before choosing health education methods/strategies.

- How fast do people change?. Some people are ready for change and are economically able to do the advice easily. On the other hand, Some are ready, but influence from others could hinder.
- How many people are involved?. The number of participants can vary from an individual to family or even to a large number of people
- Is the method appropriate to the local culture?. Culture refers to the ways of life of the community. Therefore, your health education should consider the local knowledge level, beliefs, attitudes and skills of the community.
- What resources are available?. Some methods require the use of: tape recorders, films or slide projectors, which at the same time require electricity. Other methods require the use of teaching aids such as posters, flannel graphs, demonstrations, models, flip charts and the like. On the other hand, some methods require only yourself and the people around you; these include the use of stories and songs, role-plays, group discussions, and community meetings. Therefore, try to look for methods that are inexpensive, culturally acceptable, locally available understandable, and at the same time effective.
- What combined methods are needed?. The use of multiple educational methods makes the audience to easily remember the subject matter. For example, lectures with discussion, lectures with demonstration..., etc
- What methods fit the characteristics (age, sex, religion, etc.) of the target group?. Health education could be designed for various groups of people: old, young, women groups, children and so on. Select and adapt your methods to fit the type of people you meet.

Develop Your Work Plan or Action Plan

A plan of work is simply putting together all the components you have worked out to deliver your health education messages. It is a picture or "map" of what to do when to do it, who will do it, and at what cost each step of activities be accomplished. The plan should contain the following elements:

1. Clear objectives
2. Your strategies
3. A list of activities that you will do
4. Who will help you
5. Resources to be used
6. Timing

Implement Health Education Program

Implementation is a process of bringing the planned activities into action. Or it is converting your planning, objectives and strategies into action according to the plan of work

Monitor and Evaluate Health Education Programs

Monitoring

It is an ongoing process of collecting and analysing data on actual implementation of the program so that any deviations from the planned operations are detected, diagnosis for causes of deviation is carried out, and suitable corrective actions are taken. Monitoring can take place at any time during the implementation process, on a regular or periodic basis. For instance, you will be able to monitor your activities daily, fortnightly or monthly, or as the need arises. You need to monitor the progress of your health education activities by making periodic visits to the households or any other health education activity settings

Types of Monitoring

Figure 6.2. Types of monitoring in health education

1. Input monitoring. Measures the quantity, quality, and timeliness of resources - human, financial and material or equipment like posters, leaflets, flipcharts, computers, LCD and other technological and information - provided for a health education activity/program
2. Output monitoring. Measures the quantity, quality, and timeliness of the products or services - that are the immediate result/effect of a health education activity/program. In output monitoring, you need to assess whether the desired product or the output is obtained due to the effective and efficient utilisation of the resources.
3. Process monitoring. Measures the progress of health education activities in a program and the way these are carried out (for example, referring to the degree of participation).

It is the systematic collection, analysis and reporting of information about health education activities. It is a systematic way of learning from experience and using the lessons learnt to improve current activities and promote better planning by careful selection of alternatives for future action. Evaluating is making judgments about the current status of health education objectives.While you are evaluating health education activities you need to raise the following questions:

- How well did we do?
- Did the plans work?
- What do we do next?
- Why did we succeed? Or fail?
- Did we learn from our mistakes or successes?

- What is the purpose of evaluation of Health education programs?

Health education evaluation is carried out mainly to check program effectiveness and efficiency. Effectiveness-- refers to the extent to which you have achieved your goals and objectives (health objectives, learning objectives, behavioural objectives or resource objectives). Efficiency--- means the extent to which you have achieved your objectives with the available amount of resources. In other words, it refers to the proper utilisation of resources when achieving your health education objectives.

Types of Evaluation

Figure 6.3. Types of evaluation in health education

1. Process Evaluation
What health education methods were used during learning activities?
  - How acceptable were the methods?
  - What health learning materials were used during learning activities?
  - How effective were the materials?
  - What health issues were taught? How were they selected? Were they appropriate topics for health education?
  - What resources were used in health education sessions? Think about Personnel, resources, material and financial and so on.
2. Impact Evaluation
This form of evaluation assesses the immediate effect of the program or change in behaviour (knowledge, attitude and skills) at the end of each health education programs.
3. Outcome Evaluation
Outcome evaluation assesses the long-term effect of the health education program, and you need to assess the decrease in morbidity, mortality and also disability among the target audiences as a result of the health education program. Outcome evaluation assesses the effectiveness as well as the efficiency of the goal/objective at the end of the program.

Steps to Evaluate a Health Education Program

Follow the following six steps to evaluate your health education activities:

Step1. Involve the local people in the process of evaluation.
Step2. Describe the type of health education activity you want to evaluate.
Step3. Select the evaluation methods.
Step4. Collect the important data on the selected activity by using data collection techniques you learnt in your need assessment phase.
Step5. Analyse and interpret the data in meaningful ways.
Step6. Learn from the evaluation--objective achieved or failed? What do you want to do in the future?.