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Planning, implementation, monitoring and evaluation of health education programs.nning

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Jimma University
Jimma University

The document discusses the planning, implementation, monitoring and evaluation of health education programs. It describes the PRECEDE-PROCEED model, which is a widely used framework for designing, implementing and evaluating health promotion programs. The PRECEDE-PROCEED model involves 5 planning phases (PRECEDE) to identify problems and their causes, followed by 4 implementation phases (PROCEED) which include carrying out the program, and process, impact and outcome evaluation. The document provides an overview of each phase of the model and the steps involved in planning, implementing and evaluating health education programs according to the PRECEDE-PROCEED approach.

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Chapter 7Chapter 7 Planning, implementation, monitoring and evaluation of health education programs. By: Abraham Tamirat(BSc,MPH) 1By:AT (MPH)
Definition of planningDefinition of planning Planning: - is an anticipatory decision making about what needs to be done, how it has to be done, and with what resources. It is central to health education and health promotion process. 2By:AT (MPH)
Purposes of planningPurposes of planning  Best useof scarceresources  Avoid duplication and wasteful expenditure  Helpsfor problem prioritization  Develop abest courseof action 3By:AT (MPH)
Principles of planningPrinciples of planning  Based on careful analysis of the situations  Relate to basic needs and interests of the people  Planned with the people who are involved in its implementation  Flexible enough to meet long time situation.  Should be a continuous process  Should be achievable considering such factors as finance, personnel, time etc. 4By:AT (MPH)
Steps of planning health education andSteps of planning health education and interventionintervention 5By:AT (MPH)
Step I. situational analysisStep I. situational analysis  The local situation is the bench mark from where peopleshould start theprocessof program planning.  After assembling the facts pertaining to local situations, it is important to analyze these facts in such away that they will beuseful to individualsor planners. 6By:AT (MPH)
Information for situational analysisInformation for situational analysis Theinformation collected may include:  Community and itstopography  Demographic and socio-economic characteristics Conductneedassessment 7By:AT (MPH)
Community need assessmentCommunity need assessment • Assessment: is the process of identifying and understanding a problem or set of problems and later planning a series of actions to deal with the problems. Identify ;  What is the problem  Magnitude/size of the problem  Severity of the problem  community practice (KAPB), service/resources, cultural practices/social influences with regard to the problem 8By:AT (MPH)
Sources of data forneed assessmentSources of data forneed assessment 9By:AT (MPH)
Step II. identify problems and prioritizeStep II. identify problems and prioritize What do we have at the end of needs assessment? A number of problems are emerged out of needs assessment. Since it is not possible or feasible to deal with all the problems at once, we will have to prioritize 10By:AT (MPH)
Criteria to prioritizeCriteria to prioritize 1. Magnitude of the problem- How wide spread the problem is ? 2. Severity of the problem – fatality, consequence, disability 3. Feasibility – in terms of time, resources, etc. 4. Government concern –Priority policy 5. Community concern – Felt need of the community 11By:AT (MPH)
S/N Problem s M S F G C Total Rank 1 Malaria 2 TB 3 HIV/AIDS 4 5 6 7 Example of problem prioritization Score each problem out of five (1-5) 12By:AT (MPH)
Step III: Setting objectivesStep III: Setting objectives 13By:AT (MPH)
Step III: Setting objectives….Step III: Setting objectives…. • Once the problems have been prioritized, the next step is to set objective. • It is impossible to evaluate a course or a program efficiently without a clearly stated objective. • A program objective is a series of statement that must answer: • What do we want to achieve? • Where? • Who is the target group? • When do we want to achieve? • Extent of achievement? 14By:AT (MPH)
For example,For example, to increase immunization coverageto increase immunization coverage from 70% to 95%from 70% to 95% among under 5 childrenamong under 5 children inin Jimma townJimma town by 2012.by 2012. What Where Who When Extent InJimmatown Increaseimmunizationcoverage Amongunder5yearchildren By2012 From70% to95% 15By:AT (MPH)
Types of objectivesTypes of objectives 16By:AT (MPH)
Types of objectives …Types of objectives … 1. Health objectives  Describe how health status is to be improved  They are termed as “outcome objective”  They are ends / represent the true bottom line of the program E.g To reduce infant mortality by 2/3rd by the end of 2015 17By:AT (MPH)
2. Behavioral objectives  Behavioral objective refers to the actual things the program will encourage people to do or not to do! E.g To reduce cigarette smokers by 50% 3. Learning objectives  Learning objectives describe knowledge, attitude or skill development E.g Clients should able to describe three ways of HIV/AIDS transmission 18By:AT (MPH)
Hierarchy of learning objectivesHierarchy of learning objectives In order to change behaviors, these four factor must be changed first and you must have objective for each factor if you want to change them. Awareness is easier to change than knowledge, knowledge is easier than attitude and changing skill needs more time and effort. 19By:AT (MPH)
Objectives ….Objectives …. 4.Resource objective : Is what the program planners hope to provide , be it the essential service or material support E.g  To establish three counseling center by the end of 2012  To supply 3000 poster for each health center by the end of 2012.  To distribute 10,000 hagober at the end of 2013 20By:AT (MPH)
Objectives… SMARTObjectives… SMART 21By:AT (MPH)
N.B.  Words open to many interpretations should not be used whilewriting an objective.  For example, know, understand, appreciate, enjoy, believe etc, words open to less interpretation should be used e.g., write, identify, list, define, differentiate, compareetc. 22By:AT (MPH)
Step IV. Develop plan of workStep IV. Develop plan of work  A plan of work is a detailed schedule of activities to be donein agiven period of time.  It should specify the role of different persons involved, the time in which the particular activities have to be carried out, and thedifferent methodsto beused. 23By:AT (MPH)
Work plan…Work plan… In short, an action plan should answer the following questions.  When should it start and when should it becompleted?  Who doesit?  Who isresponsiblefor seeing it isactually carried out?  What materialsand resourcesareneeded? 24By:AT (MPH)
V: Implementation of the programsV: Implementation of the programs  Implementation is carrying out the plan or putting the plan/program into action.  It is translating the goals, objectives and methods into a community based health education programs. 25By:AT (MPH)
MonitoringMonitoring  Monitoring is the systematic collection and analysis of information on the project progress .  It helps to keep the work on track.  Enables the planners to detect any kind of problems related to the performance of the activities as early as possible and to give relevant solutions to the problems detected. 26By:AT (MPH)
EvaluationEvaluation  Evaluation: is the process of assessing whether the health education interventions are attaining their goals and objectives which are predetermined while planning the interventions.  Effectiveness?  Efficiency ? 27By:AT (MPH)
Planning models used in health educationPlanning models used in health education There are many planning model in health education and promotion. Among these models, the Precede-Proceed model is the well known and most frequently used model to plan, implement and evaluate health education and promotion programs. Developed by Lawrence W. Green and his colleagues in 1980 28By:AT (MPH)
The PRECEDE/PROCEED FrameworkThe PRECEDE/PROCEED Framework Lawrence W. Green &Marshall W. KreuterLawrence W. Green &Marshall W. Kreuter PRECEDE P= Predisposing R= Reinforcing E= Enabling C= Causes E= Educational D= Diagnosis E= Evaluation PROCEED P= Policy R= Regulatory O = Organizational C = Constructs E= Educational E=Environmental D= Development 29By:AT (MPH)
PRECEDE-PROCEED MODELPRECEDE-PROCEED MODEL DiagramDiagram Quality of life Phase 1 Social Diagnosis Health Phase 2 Epidemiologi cal Diagnosis Health education Policy regulation organization Public Health Phase Administrative & Policy Diagnosis Phase6 Implementation Phase7 Processevaluation Phase8 Impact evaluation Phase9 Outcomeevaluation Predisposing Reinforcing Enabling Phase4 Educational & Ecological Diagnosis Behavior Environment Phase3 Behavioral & Environmental Diagnosis Green&Kreutzer,HealthPromotionPlanning,3rded.,1999. 30By:AT (MPH)
PRECEDEhas five phases-PLANNING PHASEPRECEDEhas five phases-PLANNING PHASE Phase1: Social diagnosis Phase2: Epidemiological diagnosis Phase3: Behavioral and environmental diagnosis Phase4: Educational and organizational diagnosis Phase5: Administrativeand policy diagnosis 31By:AT (MPH)
Phase 1 – Social DiagnosisPhase 1 – Social Diagnosis  Phase1: seeksto subjectively definetheQuality of life(problems & priorities) of priority individualsor population  needs  Identify social problemsthat impact quality of life,  Identifyhealthissues frompeoplepointof view Quality of Life Phase1 Social diagnosis 32By:AT (MPH)
Phase 2 – Epidemiological DiagnosisPhase 2 – Epidemiological Diagnosis  Determine health issues associated with the quality of life. e.g., morbidity, mortality, risk factors, disability, incidence, prevalence of disease  Objective data is gathered, usually from secondary data sources / Epidemiological data  Creating priorities among the problem or list of problem To identify health problems Phase2 Epidemiological Diagnosis 33By:AT (MPH)
Phase 3: Behavioral and Environmental DiagnosisPhase 3: Behavioral and Environmental Diagnosis In phase 3, indentify behavioral and non- behavioral causes (environmental factors) which seem to be linked to health problems identified in Phase2 and put them separately. Phase3: Behavioral and non- behavioral diagnosis To identify 1.Behavioral and 2. Non-behavioral causefor the health problem 34By:AT (MPH)
Phase 4: Educational &Organizational DiagnosisPhase 4: Educational &Organizational Diagnosis  Identifies causal factors that must be changed to initiate and sustain the process of behavioral and environmental change identified in Phase 3. Educational Diagnosis Organizational Diagnosis 1. Predisposing factors (knowledge, attitude, beliefsetc. ) 2. Enabling factors (money, resource, time, accessibility, availability etc.) 3. Reinforcing factors (peer pressure) Review the organizational objectives and focus on areas that facilitatechanges 35By:AT (MPH)
Phase 5Phase 5:: Administrative and PolicyAdministrative and Policy DiagnosisDiagnosis  Focuses on administrative and organizational concerns which must be addressed prior to program implementation  Includes assessment of resources, budget development and allocation, development of implementation timetable, organization and coordination with others  Analysis of policies, resources and circumstances prevailing organizational situations that could hinder or facilitate the development of the health program Policy Diagnosis 36By:AT (MPH)
PRECEDE- phase ends with aPRECEDE- phase ends with a Comprehensive Intervention plan which isComprehensive Intervention plan which is ready for implementation and PROCEEDready for implementation and PROCEED beginsbegins Design a Comprehensive Intervention planDesign a Comprehensive Intervention plan Ready made plan 37By:AT (MPH)
PROCEED hasfour phases:PROCEED hasfour phases: Phase6: Implementation Phase7: Processevaluation Phase8: Impact evaluation Phase9: Outcomeevaluation 38By:AT (MPH)
Phase 6: ImplementationPhase 6: Implementation Beginning of PROCEED The act of converting program objectives into actions through policy changes, regulation and organization. It is translating the goals, objectives and methods into a community based health education programs. 39By:AT (MPH)
Phases 7 , 8, &9 - EvaluationPhases 7 , 8, &9 - Evaluation  Phase 7: Process evaluation - measurements of implementation process to control, assure, or improve the quality of the program  Phase 8: Impact evaluation - immediate observable effects of program (changes in Knowledge, attitude, beliefs, practice etc.)  Phase 9: Outcome evaluation -long-term effects of the program such as reduction in mortality, morbidity, prevalence of disease, improved health status, life expectancy 40By:AT (MPH)
PRECEDE-PROCEED MODEL DiagramPRECEDE-PROCEED MODEL Diagram Quality of life Phase1 Social Diagnosis Health Phase2 Epidemiological Diagnosis Health education Policy regulation organization Public Health Phase Administrative & Policy Diagnosis Phase6 Implementation Phase7 Processevaluation Phase8 Impact evaluation Phase9 Outcomeevaluation Predisposing Reinforcing Enabling Phase4 Educational & Ecological Diagnosis Behavior Environment Phase3 Behavioral & Environmental Diagnosis Green & Kreutzer, Health Promotion Planning, 3rd ed., 1999. 41By:AT (MPH)
42By:AT (MPH)

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Planning, implementation, monitoring and evaluation of health education programs.nning

  • 1. Chapter 7Chapter 7 Planning, implementation, monitoring and evaluation of health education programs. By: Abraham Tamirat(BSc,MPH) 1By:AT (MPH)
  • 2. Definition of planningDefinition of planning Planning: - is an anticipatory decision making about what needs to be done, how it has to be done, and with what resources. It is central to health education and health promotion process. 2By:AT (MPH)
  • 3. Purposes of planningPurposes of planning  Best useof scarceresources  Avoid duplication and wasteful expenditure  Helpsfor problem prioritization  Develop abest courseof action 3By:AT (MPH)
  • 4. Principles of planningPrinciples of planning  Based on careful analysis of the situations  Relate to basic needs and interests of the people  Planned with the people who are involved in its implementation  Flexible enough to meet long time situation.  Should be a continuous process  Should be achievable considering such factors as finance, personnel, time etc. 4By:AT (MPH)
  • 5. Steps of planning health education andSteps of planning health education and interventionintervention 5By:AT (MPH)
  • 6. Step I. situational analysisStep I. situational analysis  The local situation is the bench mark from where peopleshould start theprocessof program planning.  After assembling the facts pertaining to local situations, it is important to analyze these facts in such away that they will beuseful to individualsor planners. 6By:AT (MPH)
  • 7. Information for situational analysisInformation for situational analysis Theinformation collected may include:  Community and itstopography  Demographic and socio-economic characteristics Conductneedassessment 7By:AT (MPH)
  • 8. Community need assessmentCommunity need assessment • Assessment: is the process of identifying and understanding a problem or set of problems and later planning a series of actions to deal with the problems. Identify ;  What is the problem  Magnitude/size of the problem  Severity of the problem  community practice (KAPB), service/resources, cultural practices/social influences with regard to the problem 8By:AT (MPH)
  • 9. Sources of data forneed assessmentSources of data forneed assessment 9By:AT (MPH)
  • 10. Step II. identify problems and prioritizeStep II. identify problems and prioritize What do we have at the end of needs assessment? A number of problems are emerged out of needs assessment. Since it is not possible or feasible to deal with all the problems at once, we will have to prioritize 10By:AT (MPH)
  • 11. Criteria to prioritizeCriteria to prioritize 1. Magnitude of the problem- How wide spread the problem is ? 2. Severity of the problem – fatality, consequence, disability 3. Feasibility – in terms of time, resources, etc. 4. Government concern –Priority policy 5. Community concern – Felt need of the community 11By:AT (MPH)
  • 12. S/N Problem s M S F G C Total Rank 1 Malaria 2 TB 3 HIV/AIDS 4 5 6 7 Example of problem prioritization Score each problem out of five (1-5) 12By:AT (MPH)
  • 13. Step III: Setting objectivesStep III: Setting objectives 13By:AT (MPH)
  • 14. Step III: Setting objectives….Step III: Setting objectives…. • Once the problems have been prioritized, the next step is to set objective. • It is impossible to evaluate a course or a program efficiently without a clearly stated objective. • A program objective is a series of statement that must answer: • What do we want to achieve? • Where? • Who is the target group? • When do we want to achieve? • Extent of achievement? 14By:AT (MPH)
  • 15. For example,For example, to increase immunization coverageto increase immunization coverage from 70% to 95%from 70% to 95% among under 5 childrenamong under 5 children inin Jimma townJimma town by 2012.by 2012. What Where Who When Extent InJimmatown Increaseimmunizationcoverage Amongunder5yearchildren By2012 From70% to95% 15By:AT (MPH)
  • 16. Types of objectivesTypes of objectives 16By:AT (MPH)
  • 17. Types of objectives …Types of objectives … 1. Health objectives  Describe how health status is to be improved  They are termed as “outcome objective”  They are ends / represent the true bottom line of the program E.g To reduce infant mortality by 2/3rd by the end of 2015 17By:AT (MPH)
  • 18. 2. Behavioral objectives  Behavioral objective refers to the actual things the program will encourage people to do or not to do! E.g To reduce cigarette smokers by 50% 3. Learning objectives  Learning objectives describe knowledge, attitude or skill development E.g Clients should able to describe three ways of HIV/AIDS transmission 18By:AT (MPH)
  • 19. Hierarchy of learning objectivesHierarchy of learning objectives In order to change behaviors, these four factor must be changed first and you must have objective for each factor if you want to change them. Awareness is easier to change than knowledge, knowledge is easier than attitude and changing skill needs more time and effort. 19By:AT (MPH)
  • 20. Objectives ….Objectives …. 4.Resource objective : Is what the program planners hope to provide , be it the essential service or material support E.g  To establish three counseling center by the end of 2012  To supply 3000 poster for each health center by the end of 2012.  To distribute 10,000 hagober at the end of 2013 20By:AT (MPH)
  • 22. N.B.  Words open to many interpretations should not be used whilewriting an objective.  For example, know, understand, appreciate, enjoy, believe etc, words open to less interpretation should be used e.g., write, identify, list, define, differentiate, compareetc. 22By:AT (MPH)
  • 23. Step IV. Develop plan of workStep IV. Develop plan of work  A plan of work is a detailed schedule of activities to be donein agiven period of time.  It should specify the role of different persons involved, the time in which the particular activities have to be carried out, and thedifferent methodsto beused. 23By:AT (MPH)
  • 24. Work plan…Work plan… In short, an action plan should answer the following questions.  When should it start and when should it becompleted?  Who doesit?  Who isresponsiblefor seeing it isactually carried out?  What materialsand resourcesareneeded? 24By:AT (MPH)
  • 25. V: Implementation of the programsV: Implementation of the programs  Implementation is carrying out the plan or putting the plan/program into action.  It is translating the goals, objectives and methods into a community based health education programs. 25By:AT (MPH)
  • 26. MonitoringMonitoring  Monitoring is the systematic collection and analysis of information on the project progress .  It helps to keep the work on track.  Enables the planners to detect any kind of problems related to the performance of the activities as early as possible and to give relevant solutions to the problems detected. 26By:AT (MPH)
  • 27. EvaluationEvaluation  Evaluation: is the process of assessing whether the health education interventions are attaining their goals and objectives which are predetermined while planning the interventions.  Effectiveness?  Efficiency ? 27By:AT (MPH)
  • 28. Planning models used in health educationPlanning models used in health education There are many planning model in health education and promotion. Among these models, the Precede-Proceed model is the well known and most frequently used model to plan, implement and evaluate health education and promotion programs. Developed by Lawrence W. Green and his colleagues in 1980 28By:AT (MPH)
  • 29. The PRECEDE/PROCEED FrameworkThe PRECEDE/PROCEED Framework Lawrence W. Green &Marshall W. KreuterLawrence W. Green &Marshall W. Kreuter PRECEDE P= Predisposing R= Reinforcing E= Enabling C= Causes E= Educational D= Diagnosis E= Evaluation PROCEED P= Policy R= Regulatory O = Organizational C = Constructs E= Educational E=Environmental D= Development 29By:AT (MPH)
  • 30. PRECEDE-PROCEED MODELPRECEDE-PROCEED MODEL DiagramDiagram Quality of life Phase 1 Social Diagnosis Health Phase 2 Epidemiologi cal Diagnosis Health education Policy regulation organization Public Health Phase Administrative & Policy Diagnosis Phase6 Implementation Phase7 Processevaluation Phase8 Impact evaluation Phase9 Outcomeevaluation Predisposing Reinforcing Enabling Phase4 Educational & Ecological Diagnosis Behavior Environment Phase3 Behavioral & Environmental Diagnosis Green&Kreutzer,HealthPromotionPlanning,3rded.,1999. 30By:AT (MPH)
  • 31. PRECEDEhas five phases-PLANNING PHASEPRECEDEhas five phases-PLANNING PHASE Phase1: Social diagnosis Phase2: Epidemiological diagnosis Phase3: Behavioral and environmental diagnosis Phase4: Educational and organizational diagnosis Phase5: Administrativeand policy diagnosis 31By:AT (MPH)
  • 32. Phase 1 – Social DiagnosisPhase 1 – Social Diagnosis  Phase1: seeksto subjectively definetheQuality of life(problems & priorities) of priority individualsor population  needs  Identify social problemsthat impact quality of life,  Identifyhealthissues frompeoplepointof view Quality of Life Phase1 Social diagnosis 32By:AT (MPH)
  • 33. Phase 2 – Epidemiological DiagnosisPhase 2 – Epidemiological Diagnosis  Determine health issues associated with the quality of life. e.g., morbidity, mortality, risk factors, disability, incidence, prevalence of disease  Objective data is gathered, usually from secondary data sources / Epidemiological data  Creating priorities among the problem or list of problem To identify health problems Phase2 Epidemiological Diagnosis 33By:AT (MPH)
  • 34. Phase 3: Behavioral and Environmental DiagnosisPhase 3: Behavioral and Environmental Diagnosis In phase 3, indentify behavioral and non- behavioral causes (environmental factors) which seem to be linked to health problems identified in Phase2 and put them separately. Phase3: Behavioral and non- behavioral diagnosis To identify 1.Behavioral and 2. Non-behavioral causefor the health problem 34By:AT (MPH)
  • 35. Phase 4: Educational &Organizational DiagnosisPhase 4: Educational &Organizational Diagnosis  Identifies causal factors that must be changed to initiate and sustain the process of behavioral and environmental change identified in Phase 3. Educational Diagnosis Organizational Diagnosis 1. Predisposing factors (knowledge, attitude, beliefsetc. ) 2. Enabling factors (money, resource, time, accessibility, availability etc.) 3. Reinforcing factors (peer pressure) Review the organizational objectives and focus on areas that facilitatechanges 35By:AT (MPH)
  • 36. Phase 5Phase 5:: Administrative and PolicyAdministrative and Policy DiagnosisDiagnosis  Focuses on administrative and organizational concerns which must be addressed prior to program implementation  Includes assessment of resources, budget development and allocation, development of implementation timetable, organization and coordination with others  Analysis of policies, resources and circumstances prevailing organizational situations that could hinder or facilitate the development of the health program Policy Diagnosis 36By:AT (MPH)
  • 37. PRECEDE- phase ends with aPRECEDE- phase ends with a Comprehensive Intervention plan which isComprehensive Intervention plan which is ready for implementation and PROCEEDready for implementation and PROCEED beginsbegins Design a Comprehensive Intervention planDesign a Comprehensive Intervention plan Ready made plan 37By:AT (MPH)
  • 38. PROCEED hasfour phases:PROCEED hasfour phases: Phase6: Implementation Phase7: Processevaluation Phase8: Impact evaluation Phase9: Outcomeevaluation 38By:AT (MPH)
  • 39. Phase 6: ImplementationPhase 6: Implementation Beginning of PROCEED The act of converting program objectives into actions through policy changes, regulation and organization. It is translating the goals, objectives and methods into a community based health education programs. 39By:AT (MPH)
  • 40. Phases 7 , 8, &9 - EvaluationPhases 7 , 8, &9 - Evaluation  Phase 7: Process evaluation - measurements of implementation process to control, assure, or improve the quality of the program  Phase 8: Impact evaluation - immediate observable effects of program (changes in Knowledge, attitude, beliefs, practice etc.)  Phase 9: Outcome evaluation -long-term effects of the program such as reduction in mortality, morbidity, prevalence of disease, improved health status, life expectancy 40By:AT (MPH)
  • 41. PRECEDE-PROCEED MODEL DiagramPRECEDE-PROCEED MODEL Diagram Quality of life Phase1 Social Diagnosis Health Phase2 Epidemiological Diagnosis Health education Policy regulation organization Public Health Phase Administrative & Policy Diagnosis Phase6 Implementation Phase7 Processevaluation Phase8 Impact evaluation Phase9 Outcomeevaluation Predisposing Reinforcing Enabling Phase4 Educational & Ecological Diagnosis Behavior Environment Phase3 Behavioral & Environmental Diagnosis Green & Kreutzer, Health Promotion Planning, 3rd ed., 1999. 41By:AT (MPH)