Health Care Program Development,

Implementation and Evaluation

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Objectives:

Define health care program.

Discuss various aspects of health care development, implementation and

evaluation.

Discuss the role of the family and the community in program development
and implementation.

Discuss importance of strategic planning in providing health care programs

in the community

Assess communities for programming needs and feasibility

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Introduction:
 Program management consist of assessing, planning, implementation and
evaluation of the life cycle of the program
 Program management is parallel to nursing process where program
management applied to the program itself while nursing process is applied to
client
 The process of program management like nursing process consists of (problem
identification), to know the end results of the program (assessment), how they
want to be at the end of the program ( planning) , how they can develop and

perform the plan (implementation) and what to measure (evaluation )

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 Definitions:

Planning: the selecting and carrying out of a series of actions to achieve

stated goals.

Program:
It is an organized response designed to meet the assessed needs of individual,
families, groups or communities by reducing or eliminating health problems. E.g:
immunization program, health screening program, family planning program

Program planning: the process of exploring the community situation,

deciding on a more desirable situation, and designing actions to create the
desirable situation.
e.g: community situation (poor immunization coverage )
Desirable situation (increase number of immunized children
Designing action (Increase immunization program, health ed., program )

Program implementation: is carrying out the designed actions.

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Program evaluation: Is an ongoing process from the initial planning phase
until termination of the program so that programs can be improved along the
way, and, at the conclusion of the program, assessing the results or
outcomes, the community situation.

Formative evaluation: evaluation for the purpose of assessing whether

objectives are met or planned activities are completed.

Summative evaluation: evaluation to assess program outcome activities or

as a follow up of the results of the program activities.

Project: Small organized activities with a limited timeframe.

Community health planning: population focused puts the wellbeing of the

public above private interests.

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Benefits of program planning:
1. Meet clients need
2. Focus attention on what the organization and health provider are attempting to
do for clients
3. Help in identifying resources and activities are essential to achieve objectives
4. Reduce role confusion
5. Enhance abilities of the provider and agency to cope with the external
environment
6. Allows for quality decision making .

7. Planning reduces role ambiguity (uncertainty) by giving responsibility to specific

providers to meet program objectives.

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 Approaches to health care
A: Medical approach:
 Medical practitioner
 Focus on detection , treatment and reducing risk factors
 Focus on disease and disability
 . E.g. the eradication of small pox through massive immunization
programs is an example of medical approach in the global population.

B: Behavioral approach:
 Focus on reduction of risk behaviors and promote healthy lifestyles
 Approaches to health care
c: socio-environmental approach:
 Control life and having a meaning for life
 Social wellbeing
Examples are family caregivers, support networks, and
media watch programs to detect and change media
messages that are hazardous to health.

D: Ecological (environmental/biological) approach:

 Includes three previous approach
 World is interconnected
 5 planning Methods
1.Planning, programming and budgeting system (PPBS):
 Method of resource allocation / economic tool
 Used for planning broad-scale government programs

2. Program planning method (PPM)

 Used by nurse to involve client directly in the planning
process and consists of 5 stages
3. Program evaluation review technique (PERT)
 Useful for large scale projects with large number of
activities
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 5 planning Methods
4. Critical path method (CPM)
 Network program planning
 Allow for frequent review of the progress by program
planners

5. Multi attribute utility technique (MAUT)

 Based on decision theory as take decision regarding single
client care or national health program separate all elements
of the decision and evaluate each element separately

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 Planning process:
 Health program planning is affected by the government
control over the program fund, licensure, and by the cultural
and beliefs of system of the community
 Stages of planning process

1.Formulation:
2.Conceptualization
3.Detailing
4.Evaluation (plan)

11 5. Implementation
  Steps of planning process

1.Formulation: (defining the problem and assess client

needs) it is the most critical step in planning a health program
is to define problem and assesses clients needs
a. Pre-active, projecting a future need;
b. reactive, defining the problem based on past needs identified by the
client or the agency;
c. inactive, defining the problem based on the existing health status of the
population to be served; or
d. Interactive, describing the problem using past and present data to project
future population needs. group.

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 Steps of assessing needs are:
Assessment of health needs may be either
 A: Community needs assessment
 B: Population needs assessment

A: Community needs assessment: Comprehensive view to the entire community

 to provide a clear overall view of the community health status., identify high risk,
 Determine unmet health needs
 Assess environment impact on health
 Begins with collect existing data
 Collected through : survey, key informant, interview of the community

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 6 Steps of needs assessment process

Identify client
population

Identify program Identify needs

resources

Identify size and

distribution
Clarify program
perspectives

Set group
boundaries
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 Steps of assessing needs are:
Process of population needs assessment

1. Identify client population

2. Identify needs

3. Identify size and distribution

4. Set boundaries

5. Clarify program perspectives

6. Identify program resources

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 Steps of assessing needs are:
Population needs assessment
1. Identify client population
community or group, as families, or as individuals.

For example, in a community with a large number of preschool children who require
immunizations to enter school, the client population may be described as all children
between 4 and 6 years.

2. Identify needs: through health education program ,alert the population to the
existing need. Need for immunization to prevent spread of communicable diseases

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3. Identify the size and distribution of a client population:
it involves defining the number of persons with the problem/ need who are
underserved by existing programs.

For example, preschool immunization program. In planning the program,

estimates total numbers of preschool children in the country through census
data or birth certificates.

The nurse then must determine the number of children who are not
immunized.

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4. Set group boundaries:

it is established by defining the size and distribution of the client population.

The boundaries will identify who is included and who is excluded in the
health program.

E.g:
If the immunization program were designed to serve only preschool children
of low-income families, all other preschool children would be excluded.

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5. Clarify program perspectives:

or what people think about the need for a program), might differ among
health providers, agency administrators, policy makers, and potential
clients.

Collecting data on the opinions and attitudes of all persons involved with
the program. It will examine program success, if the program is
necessary the need to redefine the problems, or the decision to develop a
new program or expand an existing program.

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6. identify available resources:

Before implementing a health program, one must also identify the program
resources which include:
1. What personnel needed
2. What facilities needed
3. What equipment needed and what is available
4. Is funding and financing elements of the program are available
5. Are resources being donated or available, what is the type and amount of
the resources

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Tools used to assess need

1. Census data
2. Key informants
3. Focus (effort) group
4. Community forums (media, setting, scene)
5. Survey client population
6. Statistical data (morbidity/ mortality rate, incidence rate, birth rate)

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Conceptualization: conceptualization stage of planning:

a. set of options to solve the problem and consider alternatives

b. test each solution if it will help in solving the problem or not. Each solution is
examined in relation to its risk and consequences
c. What are the expected outcome from each solution
d. Draw decision tree to see problem solving process
-In the immunization example,
-Options:
-A. Immunize all children
-B- Immunized preschool only

-the best solution is :all children are immunized.

- It is valuable and cost effective to the parents, and community to prevent communicable
disease or mortality and increased need for more expensive services to treat the diseases if
children are not immunized.

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Detailing the plan:

In this phase the provider, with client input, considers:

What are the objectives for each solution (objectives of the program)

possibilities of solving a problem using one of the solution.

 What are the activities needed to achieve each solution or alternatives

Resources required,

Who will be accountable/responsible for implementing the plan

Using the proposed solution of encouraging the parents to provide the

immunizations (the best consequence), examples of activities include developing a
script for a health education program and implementing a television program to
encourage them to take children to the physician.

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 Formulation of program Objectives

The most important step in the planning and evaluation process is the writing of
program objectives.

Because program objectives provide direction for conducting the program and
provide the mechanism for evaluating the total program.

Characteristics of good objectives: (clear, concise, measurable, single activity,

with time frame objectives) because if the objectives are too general, evaluation of
the program will be very difficult.

E.g. “decrease (action verb) the incidence of early childhood disease in AL-Qassim
region (result) by providing immunization clinics in all schools (purpose) between
August and December of 2005 (timeframe).

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Levels of program objectives

The first level consists of general and broad objectives that are sometimes called
goals. Their purpose is to focus on the major reason for the program.

A general program (goal) : Broad goal:

e.g: reduce the incidence of low-birth-weight babies in Qassim area by 2012 by

improving access to prenatal care. To achieve this goal, more than one sub-
objectives should be achieved first then you will achieve broad goal

A specific objective for this program may be to open a prenatal clinic in within the
area of AL-Qassim by January 2021 to serve the population in a comprehensive
level of care.

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 Evaluation of the plan: : In this stage you will assess:

 Which of the alternative solution is most acceptable , benefits

and cost effective to :

a. the client population,

b. acceptable to the community,

c. acceptable to the agency administrator

d. and to you as a planner

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 Implementation of the program plan:

In the implementation phase of the planning process, the clients,

providers, and administrators select:

best plan to solve the original problem.

 Providing reasons/ rationale why a particular solution was

chosen

Involving clients and administrators throughout the planning,

Is there a need for additional funding

When can the program begin: give date.

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 Evaluation of the program: which
involves determining whether the program goal was
achieved.

• Determine type of the evaluation

• Identify goal for evaluation: why you want to
evaluate the health program
• Decide who will be involve in the evaluation
process (personnel)
• Answer: if the program make a difference in
solving problem

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 Types of evaluation:
a. Formative evaluation: ongoing evaluation
b. Summative: overall evaluation
Aspects of evaluation:
c. Relevance : need of the program
d. Efficiency: Relationship between program outcome and resources
expended
e. Effectiveness : The ability of the program to meet program objectives
f. progress : track program activities to meet program objectives
g. impact : long term change in the client population

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 6 Steps of Planning for program evaluation:

Identify
people

Hold meeting to
Write plan for eval discuss cons/pros
process

Make decision to
evaluate
Plan method of
evaluation

Review of lit

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 Planning for program evaluation:

1. Identify relevant people for evaluation

2. Discus benefits from evaluation
3. Make decision to evaluate
4. Review literature
5. Plan a method for evaluation
6. Write plan for evaluation process

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 Evaluation process:
1. Set goal: values and beliefs of the agency, provider of the program,
client population who benefits from the program

2. Determine goal measurement: how you will measure the goal

E,g: reduce incidence rate it is reduced from 7% to 5 % it is achieved

3. Identify goal attainment activities: identify what are the activities

used to achieve this goal, it is suitable, enough

4. Make activities operational: actual activities done to achieve goal :

giving immunization in polyclinic

5. Measure goal effect: measure incidence rate before and after the
program

6. Evaluate program goal: does program goal achieved

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 3 Sources of information for Program Evaluation

1. program participants:
Clients are examined through survey about their benefits from the program,
necessary of the program

2. program records,
Review clinical records about the care given to the client and the
results of that care.
Incidence rate decreased or not.

3. community health indices.

Health and illness indicators, such as mortality and morbidity data.
Health and illness indicators are useful in evaluating the effects of
health care programs on the total community.

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Models and techniques of Program Evaluation

1. Structure-process-outcome model

2. Tracer method

3. Case register

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 Recording of the program:
 It is a vital process where program records are a major source of
information for program evaluation
 Techniques of evaluating consumer acceptability of the program
are (surveys, interview, observation, etc…)

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 Cost studies applied to program management
 Cost accounting: studies done to find out the actual cost of the program

 Cost benefit: assess desirability of the program. If the benefit is

outweigh/ more than the cost, the program has positive impact.

 Cost effectiveness: analysis, which weigh quality of the program as it

relates to cost. It is a subset of benefit analysis, commonly use in nursing

 Cost efficiency : analysis the actual cost of performing a number of

program services. It measures the relationship between what the nurse
does and how much it costs to do it.

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 Program funding

 Provide adequate fund to the program to meet the needs of

the population.

 If money is not available, non profit organization seeks fund

outside the organization
 Nurse may seek for external grant

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 Levels of prevention applied to program palnning and
evaluation

 Primary:
 Plan a community wide program with the local government and health
department to make all public businesses smoke free to prevent
exposure to secondhand smoke

 Secondary:
 Develop screening program for all workers to determine incidence and
prevalence rate

 Tertiary:
 Evaluate incidence and prevalence rate among non smoking , provide
program decrease complications from the disease

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Objectives missing:
Discuss the role of the family and the community in program
development and implementation.

?How to assess Health problems in a community

1.Examine local epidemiologic data (e.g. incidence, morbidity,

and mortality rates) to identify major health problems.

2.Examine local health services data to identify major causes of

hospitalizations and emergency department visits.

3.Consult with key community leaders (e.g political, religious ,

business , educational, health and cultural leader) about their
perception of identified health problems.
4.Mobilize community groups to elicit discussions and identify
perceived health priorities within the community (e.g. focus groups,
neighborhood forums).

5.Analyze community environmental health hazards and pollutants

(e.g. water).

6.Identify cultural priorities and beliefs about health among social,

cultural, racial or national origin group.
7.Assess community members’ interpretations and of degrees of trust
in assistance programs.

8. Engage community members in conducting surveys to assess

specific health problems.
 How to assess Health problems in an
individual?

1. Obtain history of physical and mental health problems.

2. Ask the individual to identify major health problems. Start

with what the individual views as important.

3. Obtain family history of the disease , identify possible genetic

factors.

4. Perform clinical examination.

5. Evaluate health risk based on lifestyle.

6. Identify immediate and long-range safety concerns.

7. Assess individual’s cultural beliefs about health

Assess social support.

8. Examine knowledge and practice of preventive health care.

9. Provide appropriate age-based screening (e.g cancer

screening).
 Nursing Diagnosis
1. High risk for spread of infection related to susceptible host,
infection secretion from infected person
2. High risk for complication related to low immunity
3. Alteration in comfort (pain and itching) relate to skin rash

Levels of preventive intervention

• Primary Prevention.
• Secondary Prevention.
• Tertiary Prevention.