PUBLIC HEALTH PROGRAM MANAGEMENT

• Planning, organizing, monitoring, and evaluating the use of organizational resources

(time, personnel, and money) to prevent or control diseases, disabilities, and premature
mortality.

SIX STEP PLANNING PROCESS

• The Six-Step Process will help us adequately plan and make the best use of our limited
public health resources. Looking ahead, now we can see a bit more clearly how to
establish and effective public health program.

1. Priority Setting
2. Establishing Goals
3. Outcome Objectives
4. Intervention Strategy
5. Evaluation
6. Budget

MANAGEMENT CYCLE
1. PRIORITY SETTING

• Community Health Profile

o What does the health status of our community look like?
o What major health problems are evident?
o What are the health resources available?

o Problem identification through

o Consensus and Community
o Participation

• Basic Priority Rating System (BPRS)

o Provides the opportunity to:
§ Identify explicit factors to be considered in setting priorities
§ Organize the factors into groups that are weighted relative to each other
§ Modify the factors as needed
§ Score each individually
o BPRS = (A + 2B) x C
§ A = Size
§ B = Seriousness
§ C = Intervention effectiveness

o PEARL
§ P – Propriety: Is it your responsibility?
§ E – Economics: Does it make economic sense?
§ A – Acceptability: Will the community accept it?
§ R – Resources: Is funding available?
§ L – Legality: Is the program legal?

• Health Problem Statement

o E.g.
§ The incidence of HIV infection in call center’s in Camarines Sur & Naga
has increased from 200/100,000 in 2012 to 400/100,000 in 2015.
o What - Specific definition of the exact health problem in terms of death, disease,
or disability
o How Much - Magnitude and extent measures in terms of incidence or prevalence
o Who - Populations at risk in terms of characteristics such as age, sex, race,
occupation, socioeconomic status, and culture?
o When - Time of occurrence or seasonal variations
o Where - Geographic locations such as political, neighbourhood, hospital, place of
residence, or other location
• Getting to the Root of the Problem
o Determinants and Contributing Factors
o Health Problem Analysis
• Intervention Pathway
• Developing Objectives
o Outcome; Impact; Process
• Designing an Intervention
• Developing the Work plan
2. ESTABLISHING GOALS

• A goal is a generalized statement of the result or achievement to which your effort is

directed.
• E.g.
o National Immunization Program
o The elimination of vaccine-preventable diseases in our community.
3. OUTCOME OBJECTIVES

• Once you have selected your intervention pathway, you need to develop objectives to
guide your intervention. By developing objectives, you clearly state what your program
interventions should achieve. “What gets measured, gets done.”
• Objectives should be written in such a way that they can answer the questions:
o “What is the level of the problem now?
o “How will it change?”
o “By When?”, and
o “Where?”
• These then become the standards against which you measure your progress, which is
critical in evaluating your program.
• E.G.

• We also said that objectives should be written in such a way that they can answer two
important questions:
o How Much?
o By When?
• By stating objectives this way, we can use them as the standards against which we
measure our program.
• E.g.
o Health Problem: The measles mortality rate in country X for children 5 years of
age and under was 25.0/1000 during the past 12 months
o Outcome Objective: The measles mortality rate in country X for children 5 years
of age and under will decrease from 25.0/1000 to 15.0/1000 in 5 years.
• OUTCOME OBJECTIVE – health problem
o The level to which a health problem is expected to be reduced within a specified
time.
o Example: The measles mortality rate in country X for children 5 years of age
and under will decrease from 25.0/1000 to 15.0/1000 in 5 years.
• IMPACT OBJECTIVE - Determinants and contributing factors of health problem
o The level to which a determinant or contributing factor is expected to change
within a specified time.
o Example: The immunization level for children 5 years of age and under in
country X will increase from 50% to 75% within 2 years.
§ The number of clients accessing immunization clinics will increase from
250 to 350 clients per 100,000 population in districts x, y, and z by the end
of the first year.
• PROCESS OBJECTIVE - Intervention activities in the work plan
o Action statements about what our intervention activities will do. Our intervention
activities are aimed at affecting the contributing factors.
o Example: Conduct a patient flow analysis in the first quarter of Year I.
§ Based on patient flow analysis findings, modify immunization clinic
operations plans by the second quarter of Year I to increase the efficiency
clinics.
• SUMMARY
o The outcome objective is simply a statement of the how the health problem will
be changed at a future date. It should be long term, realistic and measurable.
o Impact objectives relate to the determinants and/or contributing factors -- and not
to the problem
§ The impact objective is the level to which a determinant or contributing
factor is expected to be reduced within a specified period of time. It is
interim (1-5 years), realistic, and measurable.
4. INTERVENTION STRATEGY

• DESIGNING AN INTERVENTION
o The selected intervention pathway tells you what contributing factors you will
change in order to improve the health problem.
o With your outcome and impact objectives, you have also decided how much of a
change you want the intervention to create.
o The next step is to design an intervention by deciding how you will change the
contributing factors selected in your intervention pathway. In other words, what
intervention activities will you use?
o Who is the target of change?
o What, exactly, will change in the target?
o How will you create the change? (What activities will make the change happen?)

• TYPES OF INTERVENTION
o COMMUNITY
§ Awareness, knowledge, attitudes, and behaviours of community members
§ Formal and informal community organizations as partners
§ Designed for specific group of community members (e.g. mothers of
children < 5 years)
§ Complex; many factors outside of your control
§ EXAMPLES:
• educational materials,
• awareness campaigns,
• community organizing,
• mentoring,
• lay health workers,
• community service coalitions,
• peer group discussions,
• health skills training

o ORGANIZATIONAL
§ Improving efficiency and effectiveness of health services within an
organization
§ Within the scope of control of the organization
§ May require buy-in from higher management
§ Can it impact contributing factor enough?
§ EXAMPLES:
• increasing operating hours,
• improving the quality of client services,
• improving the efficiency of organizational operations,
 • changing organizational policies,
• adding new organizational programs or services,
• improving staff skills through training and development,
• improving organizational communications.

o POLICY
§ Regulations, ordinances, rule enforcement, and decisions on distribution
of resources
§ Target can be local to national and may include a wide variety of
institutions
§ Require ability to organize coalitions or influence policy decision-making
process, or both
§ EXAMPLES:
• Carrying out advocacy campaigns for new laws and regulations,
• organizing coalitions to support a sector-wide policy change,
• organizing to influence legislative policy, agendas,
• changing resource allocation to specific organizations to affect a
health issue,
• modifying environmental and occupational regulations or
conditions,
• enforcing existing laws and regulations
• E.G.
• In selecting the intervention pathway, you will discuss and evaluate the impact and
effectiveness of the possible intervention activities you choose in terms of their ability to
change the contributing factors to the health problem.
• In designing an intervention, we will brainstorm possible intervention activities to
address the indirect contributing factors, and then rank them on a scale of 1-10 (1=low to
10=high) on the two dimensions of the intervention decision matrix: a) impact of the
intervention activity on changing the indirect contributing factor, and b) how easy is it to
do the intervention.
• WORK BREAKDOWN STRUCTURE (WBS)
• SCHEDULE: TASK SEQUENCE

• GANTT CHART
o Use the Gantt Chart to:
§ Communicate project plan easily to a variety of audiences
§ Update project progress efficiently
§ Monitor task implementation and make adjustments
• QUESTIONS:
o Were activities and tasks for the intervention completed on time?
o Were resources spent as planned and within budget?
o Is participation as expected?
o How do participants perceive the program quality?
o Are there differences in implementation between sites and if so, why and
with what effect?
o Are significant internal or external events affecting the program, staff, or
clients?
5. EVALUATION

• MONITORING - Assessing the implementation of your work plan activities and

identifying any areas for improvement
• EVALUATION - Periodically measuring and comparing program results on your
measurable process, impact, and outcome objectives
• BENEFITS OF EVALUATION
o Improves understanding of what our intervention activities are achieving
o Provides specific information for improving the program
o Helps determine what strategies work
o Provides information to the stakeholder to continue programs and funding

• MONITORING AND EVALUATION TOOL

6. BUDGET

• ANSWER QUESTIONS:
o What needs to be done?
o Who should do it?
o What resources do they need to do it?
o How much will it cost?
o Physical vs Financial Resources

• 4 STAGES OF FINANCIAL MANAGEMENT DEVELOPMENT

o STAGE 1
§ Program managers not involved in budget development
§ System does not accurately track expenditures and revenues
o STAGE 2
§ Some input from program managers in developing budgets
§ System tracks expenditures only by general line items
§ (salaries, utilities, supplies)
o STAGE 3
§ Budgets developed in conjunction with program managers
§ System tracks expenditure and revenues by line items, with
§ some links to program outputs and services
o STAGE 4
§ Budgets developed jointly with program managers to support
§ programmatic objectives
§ System presents accurate, complete picture of expenditures
§ and revenues in relation to program outputs and services
• E.G.
• COST EFFECTIVENESS