Public Health Management

Austin Sams Udeh

Project on Public Health Management

Table of Contents

1.0 Introduction ................................................................................................................................... 3

2.0 Healthcare Evaluation and Study Design...................................................................................... 3
3.0 Epidemiological and Statistical Measures .................................................................................... 3
4.0 Healthcare Evaluation and Data Collection .................................................................................. 3
5.0 Principles of Evaluation, Quality Assessment and Assurance ...................................................... 4
6.0 Health service needs and policy development .............................................................................. 5
7.0 Conclusion .................................................................................................................................... 6
References ................................................................................................................................................. 6
Project on Public Health Management

1.0 Introduction
Across the world, managing the health of the country’s workforce has been recognized as
indispensable if nation must be productive and competitive on the global scene. This makes
effective management of public health as an important business of the modern government. It needs
to ensure that the people are healthy.
To achieve this, the management of people’s health span the administrative and managerial
capacities, organizational structures, and systems needed to source for finance and allocate to
deliver health services to the people more efficiently, effectively, and equitably. However, as a
country, achieving commitments to economic growth and developmental agenda requires
maximizing the efficiency and effectiveness of the health workforce which in turns demand a
careful and continuous evaluation of systems and programme for public healthcare service delivery
for assessing value of services.

Essentially, evaluation in healthcare can be formative (evaluation undertaken during an

intervention, so that outcome can be used inform ongoing programme or summative (carried out at
the end of the intervention programme). Interestingly, the key question in healthcare evaluation is
whether healthcare provided fulfils its objectives of effectiveness (the benefits of healthcare
measured by improvements in health), efficiency (matches cost of healthcare to the or benefits
obtained), acceptability (the social, psychological and ethical acceptability of the way people are
treated) and equity (the fair distribution of healthcare amongst various individuals or groups). It is
important to figure how to design evaluation and the key factors to be considered in designing
evaluation.

2.0 Healthcare Evaluation and Study Design

In designing evaluation for healthcare services key factors worth considering include; defining the
population or service being evaluated, approach to adopted (quantitative, qualitative or mixed
method), elimination of bias and confounding (consider whether comparator or control group
should be used in the design) and weigh up, the strengths and weaknesses of each approach.
Generally, some of the study design that can be adopted include;

• Randomized method
• Non-randomized methods
• Ecological studies
• Descriptive studies
• Health technology assessment

2.0 Epidemiological and Statistical Measures

Epidemiology is basically the science of public health. It describes and concern with health and
diseases in populations rather than in individuals. In epidemiology, the patient is the community
and individuals are viewed collectively. Therefore, variables used by field epidemiologists are
summarized with frequency measures such as ratios, proportions, and rates. Incidence, prevalence,
and mortality rates are three frequency measures that are used to characterize the occurrence of
health events in a population.

3.0 Healthcare Evaluation and Data Collection

At the heart of every good study design is a robust data collection method. In healthcare evaluation,
epidemiologists carry out step by steps activities as highlighted below to achieve evaluation
objectives;
Project on Public Health Management

• problem identification
• determination of study objective
• development of data collection tool
• data collection
• analysis and interpretations
• synthesis and drawing conclusions
• implementation of control measures

4.0 Principles of Evaluation, Quality Assessment and Assurance

5.1 Principles of evaluation: Some of the basic tenet in evaluation include;

• Purpose and what to be evaluated must be clearly stated
• Multiples techniques should be used for robustness
• Evaluator should know the limitations of different evaluation models
• Technique must be appropriate
• Evaluation is a means to an end but not an end in itself

However, in practice, several challenges that could emerge when conducting public
health evaluation may include;
• Practicalities of evaluation – issues of finance, time, and other resources need
• Situating the evaluation within local and state policy context
• Managing stakeholders and politics about outcomes
• Evaluation approach - research versus practice, objectivity and rigorously conducted
• Difficulty measuring the intended outcomes.
Some of the frameworks for conducting evaluation include;
SN Framework Unit of Evaluation Parameters
1 Donabedian Evaluating a programme Structure, inputs, process,
outputs and outcomes
2 Black Setting priority for Effectiveness (efficacy),
programme efficiency, equity, and
humanity.
3 Maxwell Screening a programme Effectiveness (efficacy),
efficiency, equity, access,
acceptability, appropriateness

5.2 Quality Assessment and Assurance

Assessment and assurance are both elements that ensure service or intervention is optimally
delivered and parameters are incorporated to indicate if evaluation objective is been achieved.
However, researchers (e.g., Donabedian, Black and Maxwell) all have slight disagreement on the
key factors an evaluation should contain. This is because, differing stakeholders will have different
perspectives on the quality of an evaluation. Interestingly, while assurance tends to guarantee
quality of evaluation, set standards must be clear on how it should be achieved and must be realistic
and achievable.
Project on Public Health Management

6.0 Health service needs and policy development

Health need or assessment mean different things to different people. It is one of the most effective
ways to define health needs and inform public healthcare related policy development leveraging on
epidemiological approach. The epidemiologists are known for adopt health need assessment (HNA)
to identify unmet health and healthcare service need of a community or population and making
changes where necessary to meet the needs. It is a tool to inform health service planning and can
be used to increase involvement of stakeholders’ ownership and sustainability of programmes.
In reality though, like the demand and supply law, healthcare needs are intertwined (as depicts
below) with demand and supply for the services. Demand for health services increase with
accessibility and supply and demand for healthcare is taken as proxy for need.

In order to effectively determine actual health need of a population, several approaches have been
advocated. According to Stevens (1999) and Bradshaw (1972), epidemiological, comparative and
corporate are some of the approaches used to assess community health needs;

SN Approach Explanation
1 Epidemiological This takes into account the epidemiology of the condition, current
service provision, and the cost-effectiveness of interventions and
health care services.
2 Comparative This compares service provision among different groups and large
variations in service use may be caused by several reasons.

3 Corporate This approach determine what healthcare services are needed by

eliciting the views of various stakeholders.

6.1 Needs Assessment and Policy Development

In conducting health need assessment whether to assess need or to inform policy development,
public health experts undertake several activities to achieve the goal. In specifics, key activities
sequentially undertaking are as presented in the table below;
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Steps involves in Health Needs Assessment

SN Thematic area Specific step

1 Getting started • Identifying the population of interest

• Identifying the major stakeholders
• Identifying available resource
2 Identification of • Gathering data on the population of interest
healthcare • Review of current levels of service provision
priorities • Assess evidence of effectiveness
3 Identification Identify issues of most important;
priorities areas • Size and severity impact
for change • Availability of effective, acceptable interventions and actions
• Local commissioning priorities and partnership arrangements

4 Implementation • Implement the change

• Develop monitoring and evaluation
• Measure the impact of the changes in services

7.0 Conclusion
Effective evaluation of health programmes and activities is indispensable to achieve set objectives
for public health management.

References

• Government Health Expenditure in India: A Benchmark Study” (2006): Economic research

Foundation, New Delhi
• David Puncheon, Charles Guest, David Melzer, J. A. Muir Gray (2006): Oxford Handbook of
Public Health Practice, 2nd edition
• Gillam Stephen; Yates, Jan; Badrinath, Padmanabhan (2007). Essential Public Health:
theory and practice.
• Bradshaw J. (1972) “A taxonomy of social need.” in McLachlan G (ed.) Problems and
progress in medical care. Seventh series NPHT/Open University Press.
• Stevens A (1991) “Needs assessment needs assessment…”. Health trends 23: 20-
• Wonderling D, Gruen R, Black N (2005) Introduction to Health Economics. Understanding
Public Health Series.