Running Head: EVALUATION FRAMEWORK FOR HEALTH PROMOTION 1

PUBH640 ASSESSMENT TASK 3

GLOBAL HEALTH INITIATIVE: EVALUATION

FRAMEWORK FOR HEALTH PROMOTION

EVALUATION FRAMEWORK FOR HEALTH PROMOTION 2

Table of Contents

Introduction..............................................................................................................................4

1) Problem Definition...............................................................................................................4

2) Solution Generation.............................................................................................................5

The ‘WHO SHAKE the salt habit’ Initiative.........................................................................5

Logic model to explore the inputs, outputs, and impact of the initiative...............................6

3) Resource Mobilisation.........................................................................................................7

Political Commitment............................................................................................................7

Programmed Leadership and Governance.............................................................................7

Effective Partnerships............................................................................................................8

Advocacy................................................................................................................................8

4) Implementation/Outcome Assessment...............................................................................9

Qualitative Design to Evaluate Strategy................................................................................9

Outcomes to Examine Impact of Initiative on Health Priority Area......................................9

Assessment of Outcomes.....................................................................................................10

5) Dissemination.....................................................................................................................11

Conclusion...............................................................................................................................12

References...............................................................................................................................14

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EVALUATION FRAMEWORK FOR HEALTH PROMOTION 3
EVALUATION FRAMEWORK FOR HEALTH PROMOTION 4

Introduction

Infectious diseases can strike the world and can cause huge loss of life. HIV, Malaria,

tuberculosis and much more are some of the lethal disease that have the potential to wipe out

a huge number of people from the world if left untreated. Even if they are not categorised as

outbreaks they still can cause a huge loss to life. Global Health Initiatives (GHIs) are human

initiatives that emerged as a result of need to control these infectious diseases and raise funds

in order to promote immunisation among countries and help in strengthening of the health

systems.

There is a number of GHIs that are currently under progress with the major aim to

raise funds and they promote healthy living among developed as well as developing

countries. In this evaluation report, one such global issue is being discussed along with the

strategies to eradicate or prevent it from causing some life threatening issues.

1) Problem Definition

Cardiovascular diseases are a result of long prevailing blood pressure problems. With

the prevalence of high blood pressure among the individuals, problems like heart attack are

very common. One of the major cause identified behind prevailing high blood pressure is the

high sodium or salt intake. According to the statistics provided by the World Health

Organisation (WHO), the normal or daily salt requirement for an adult individual should not

exceed 2300 to 2400 milligrams a day however, another report from the WHO states that

somehow the average salt intake globally is around 10-12 grams, which is far beyond the

recommended levels (World Health Organization SHARP, 2016).

This 5-folds higher salt intake has been found to be associated with the increase in

blood pressure or hypertension problems and persistent hypertension results into heart attacks

and other cardiovascular issues. If not brought under control, these high salt intakes can result
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into outbreaks of cardiovascular diseases globally ultimately causing a great loss towards

humanity.

2) Solution Generation

The ‘WHO SHAKE the salt habit’ Initiative

Recommended salt intakes do not lead to any of the harmful of the lethal side effects

mentioned above. However, if not controlled, which is the global scenario, hypertension or

high blood pressure alone can n be the cause of more than 9.4 million deaths per year, which

is very high and specifically because it is being caused due to an entity that is being

consumed by almost every individual, every day in every meal (The George Institute, 2013).

Therefore, the only possible solution towards this global issue is to reduce the salt intake.

The only effective strategy that can work in accordance with the minimisation of the

consequences of this issue is reducing the global salt intake rates, which currently are around

12-13 gram per person on an average and bring this data down by at least 30% that is nearly

5-6gm per person per day (Department of Health, 2016). In order to implement the salt

reduction strategy effectively at almost every possible level that is from the state to a

common individual or resident WHO has implied with the ‘WHO SHAKE the salt habit’.

The major role WHO is playing here is, it is bridging the gap between the evidence

and the policy action therefore, helping all the associated or the concerned countries with the

answers to the questions related to not only what works but also how it works. The SHAKE

technical package has been developed by the WHO in collaboration with the Collaborating

Centre for Population Salt Reduction. SHAKE is basically an evidence informed intervention

and policy option, which supports the associated governments to lower the salt consumption

(World Health Organization, 2016).

It has been designed to help the member states with the development, implementation

and monitoring of the salt reduction strategies. Therefore, it can also be considered as a full
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proof tool kit that the WHO provides to the member countries in order to reduce their salt

consumption statistics.

Logic model to explore the inputs, outputs, and impact of the initiative

Inputs

SHAKE is mostly a policy based model that does not require any special investments

however, it requires collaborations, initiatives, spread of knowledge and a target to be

achieved, which can vary according to the member countries and their consumptions. For

example, countries like India had an average salt intake of around 3.5-4.5 grams per day

however, other Asian countries such as China and Japan had it around more than 5 grams per

day therefore, and input required for the implementation can be dynamic depending upon the

needs (World Health Organization, 2016). Further, collaborations from the stakeholders as

well political and industries are required to reduce the salt consumptions.

Outcomes

The major outcome from this initiative will be the reduced salt consumption that is

under the regulatory or normal daily consumption is not more than 1.5 to 1.7 grams per day.

Moreover, another major outcome from this initiative will be reformulations of the food salt

levels, which, as mentioned by Jaenke, Barzi, McMahon, Webster and Brimblecombe (2017),

has always been found higher than the allowed levels and can also be blamed for the

increased salt intake. Further, this initiative will also spread the required data and the

statistics for the people to understand the benefits as well as harms of consuming adequate

and excess salt respectively.

Impacts

One of the major aims of WHO had always been the promotion of healthy living this

initiative is not an exception. With the decreased salt consumption levels, according to WHO

and the Centre for Disease Control and Prevention (CDC) more than 9.4 million individuals
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could be saved, which die due to cardiovascular diseases or any other blood pressure related

diseases. Further, this will also result into a significant decrease among the cases of

hypertension and related problems among the lower age groups (Campanozzi et. al., 2015).

3) Resource Mobilisation

SHAKE is an international initiative taken by the WHO where they are only

providing with the strategies or the policies to the member nations along with the procedure

or the strategy to implement them. However, the next major track that could lead this initiate

to success is how effectively is being applied by the nations. Therefore, in order to achieve

the desired outcomes successfully, enables and the barriers need to be taken into account.

Political commitment, effective partnerships, programmed leadership and governance,

advocacy, and integration with iodine deficiency programs can be the enablers as well as can

also prove barriers towards the implementation and success of this initiative.

Political Commitment

Hawkes et al. (2018) mentioned that political commitment is the major driving force

behind the success of any national or global initiative. This is because sustaining a slat

reduction nationwide program for a longer period of time requires policies and strategies that

can be dynamic from nation to nation and this is also required to provide with the clear and

adequate resources for successful implementation of this program. Further, along with the

political leaders, non-governmental organisations (NGOs), professional groups, academia,

consumer groups are also the major factors that can affect the initiative positively if they

support and negatively if they do not that is affect the awareness regarding the importance of

reduction of slat consumption in accordance with the public health agenda.

Programmed Leadership and Governance

Initiatives such as the salt reduction initiatives, which are to be implemented

nationally or globally requires the responsibility of ensuring that the initiative is being
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effectively implemented this due to the fact that such initiatives requires a large amount of

investments as wells collaborative inputs hence, if policies are not applied effectively all of

the efforts can also go in vain. Therefore, as proposed by the WHO itself these type of

initiatives have been proven effective when implied from a senior level within the

government. Especially because SHARP will also be dealing with the industries and

reduction in salt levels of the packaged food products along with the NGOs or a civil society

work, which require a government support (Department of Health, 2016).

Effective Partnerships

Investment can be a major barrier during the implementation of SHARP and this is

majorly because it is a nationwide health promoting initiatives therefore, multispectral as well

as multi-stakeholder approach along with strong bonds between policy leaders, department

heads, consumer groups and all the affected groups will be required. Further, while

maintaining partnership, transparency needs to be maintained along with the trust over the

tasks performed by the other groups.

Advocacy

Advocacy as suggested by Wilson et al. (2016) is basically influencing the decisions

made by the decision makers. SHAKE is a public health promoting initiative that majorly

states that the policies or strategies implied or to be implied must be in favour of SHAKE

promotion. Advocacy groups are required in order to be held accountable for ensuring that

the pledges or the decisions are being implemented and desired results are being obtained.

Further, in order to foster political will and to increase the financial resources required for the

development and sustainability of program are some of the activities designed to provide ace

to the salt reduction program and are being controlled by advocacies. Therefore, it is required

by the leadership team to seek and engage the support of advisory as well as stakeholders in

whatever possible capacity.

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All the above-mentioned points can be barriers as well as enablers depending upon

their positive and negative functioning. Therefore, in order to identify the influencers for their

functioning, several strategies can be applied, which can ultimately affect their role as enabler

or barrier. These can be identification of the barriers or enablers from the previous similar

initiative, observing the progress or the parties involved with the initiative and by discussing

the potential advantages and disadvantages of the pillars, upon which the policies of the

initiative are based.

4) Implementation/Outcome Assessment

Qualitative Design to Evaluate Strategy

The implementation or the assessment of strategy first requires the choice of data that

will be used and based, upon which the strategies will be implied. According to WHO, many

countries lack the key areas or data patterns related to the average salt consumption of their

residents therefore, it will be difficult to prepare a strategy just by comparing the data (The

George Institute, 2013). Further, the countries that have provided with the data had not

covered every aspect of diet that includes every food, which can affect the daily salt intake.

However, collection of data is not only an important but also is a necessary step in

order to determine the consumption patterns of different nations. Therefore, the USAID

Demographic and Health Survey (DHS) or WHO NCD Stepwise approach to surveillance

can be the potential data sources because they covers all the aspects required for the data

recovery (World Health Organization, 2016).

Outcomes to Examine Impact of Initiative on Health Priority Area

Further, while analysing the population statistics or the consumption patterns on a

global scale, there is a requirement of a baseline or standard, from which the rest of data can

be compared, which was set as 5-gram salt intake per person per day. Therefore, the major

outcome, upon which the initiative is based, is to reduce the salt intake per day. It is also been
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suggested by WHO that since, none of the countries had been identified to be near the

average salt consumption therefore, they should not require any external push in order to

implement the salt reduction strategies. However, this information can also be proven

necessary in order to convince the stakeholders regarding the need of salt reduction and the

reason why this initiative needs to be applied.

In order to gain access regarding the sources of diet among individual, analysis of the

knowledge or the attributes was done, which defined not only the extent of knowledge they

possess regarding the salt intake but also reflects the potential dietary patterns followed by

people and also provided information regarding the decisions during purchase of products

and all this was performed by conducting a questionnaire and group discussion as a part of

population survey (World Health Organization SHARP, 2016).

Reducing the salt content was the major criteria and principle of this initiative, where

SHARP was being progressed based upon this. Therefore, the dietary pattern identification

reflected the potential sources of sodium, which were dynamic from bread and home cooked

meals to complete dependence upon the packaged foods among various analysed population.

Therefore, it was proposed that countries could use two major methods to control the sodium

content that were the chemical analysis of the food or the surveys published by the shops and

restaurants. This was based upon the fact that the shops and restaurants are being controlled

by the health agencies and therefore regular inspections are common. Moreover, the food

labels also reflected the salt content. Further, industries were being analysed by the direct

chemical analysis report sent by them and the average salt consumption levels were then

calculated.

Assessment of Outcomes

Once the data is being collected, monitoring is another essential task, which needs to

be performed. Monitoring and evaluation plans require a series of objectives that needs to be
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followed in order to derive a conclusion. WHO SHARP monitoring suggested that these

initiates can take up to more than 2-3 years to reflect the desired outcomes; therefore, there is

requirement of indication process, which requires regular meetings with the participating

companies where the progress is being recorded accordingly.

Process indicators were suggested to be assessed every 6-12 months and they might

include members of leadership groups, food industry members, reformulation targets,

community outreach, which further may include the media, interventions, and community

education interventions (World Health Organization SHARP, 2016). Further, monitoring is

required as a continuous aspect that cannot be neglected and therefore, needs to be performed

in a continuum. Further, before developing the panel for monitoring, there is requirement that

the objectives or standards, upon which monitoring will be done must be identified.

Moreover, monitoring also includes the aspect of how cost effective the program is so

that in the near future it could be feasible to reflect the investment requirement in such

initiatives and this can also promote more such initiatives if the data is positive. Monitoring

of the U.K salt reduction program had reflected that the levels of salt were being reduced by

up to 55% with significant reduction in the food categories and the salt intake decreased from

9.4 grams per day to 8.1 grams per day and was able save 1.5 billion pounds spent every year

on healthcare and also prevented more than 9000 premature deaths (World Health

Organization SHARP, 2016).

5) Dissemination

Dissemination of the outcomes received is necessary in order to promote the increase

in health initiatives. Likewise, mentioned above the example of salt reduction in U.K can

promote other countries also to incorporate salt reduction strategies. In order to spread the

information, number of strategies can be used depending the reach and effectiveness.
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Communication through mass media and electronic technology had made it possible for the

data to reach people in no time.

Further, the data can reach to large population at the same time. Besides, there is no

limitation to the amount of data that can be shared such as televisions, articles, journals and

summary reports have been found to be most effective. Further, personal face-to-face

contacts along with the briefings or presentations can also be a desired and potential mode

that can be used to address a large number of population. Along with this, internet and social

media had allowed interaction with the population in a very fast and secured manner.

Training of individuals accordingly is also a traditional method that can be used to

disseminate the collected information. Garg, Giordano and Jazayeri (2015) emphasised

towards the use of internet and also suggested that it can be the fastest mode available to

transmit information globally covering a large mass of population, which is not possible with

any other means. Further, they emphasised that the presented report must be of high quality

following the 1:3:25 format in order to be more effective.

Conclusion

Global health initiatives are a moral concept that had been established to eradicate the

life-threatening diseases by accumulation of funds and immunising the current population.

There is a number of GHI that are currently progressing WHO SHARP is also one of them.

Based upon the concept of decreasing the world salt intake, which, is currently on an average,

9-11 grams per day to 1.5-2 grams per day; per individual. This initiative provides the

necessary policies to the members and helps them to implement them in order to achieve the

common goal.

Political commitment, effective partnerships, programmed leadership, governance,

advocacy, and integration with iodine deficiency programs can be established as the barriers

or the enablers for the program and therefore, it can affect the program positively or
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negatively. Further, assessing and monitoring the program is another major task that requires

support from the included members. Dissemination of the acquired information can help

promoting more such Global health initiatives and above-mentioned strategies can be used.
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References

Campanozzi, A., Avallone, S., Barbato, A., Iacone, R., Russo, O., De Filippo, G., ... &

Micillo, M. (2015). High sodium and low potassium intake among Italian children:

relationship with age, body mass and blood pressure. PloS one, 10(4), e0121183

Department of Health, (2016) Evaluation framework for health promotion and disease

programs Retrieved from

https://www2.health.vic.gov.au/Api/downloadmedia/%7BCD822DEB-053E-435C-

B3AB-2EC7DCF4FB92%7D

Garg, K., Giordano, S., & Jazayeri, M. (2015). How Well Does Your Encounter-Based

Application Disseminate Information? In Conference: The 14th IFIP Annual

Mediterranean Ad Hoc Networking Workshop (Med-Hoc-Net)-2015

Hawkes, C., Baker, P., Thow, A. M., Parkhurst, J., Walls, H., Wingrove, K., & Demaio, A.

(2018). What drives political commitment for nutrition. A review and framework

synthesis to inform the United Nations Decade of Action on Nutrition. BMJ Open

Jaenke, R., Barzi, F., McMahon, E., Webster, J., & Brimblecombe, J. (2017). Consumer

acceptance of reformulated food products: A systematic review and meta-analysis of

salt-reduced foods. Critical reviews in food science and nutrition, 57(16), 3357-3372

The George Institute, (2013) World Health Organization Collaborating Centre for

Population Salt Reduction (WHO CC SALT) Retrieved from

https://www.georgeinstitute.org.au/projects/world-health-organization-collaborating-

centre-for-population-salt-reduction-who-cc-salt

Wilson, L., Mendes, I. A. C., Klopper, H., Catrambone, C., Al‐Maaitah, R., Norton, M. E., &

Hill, M. (2016). ‘Global health’ and ‘global nursing’: Proposed definitions from The

Global Advisory Panel on the Future of Nursing. Journal of Advanced Nursing, 72(7),

1529-1540
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World Health Organization, (2016) Global Strategy on Diet, Physical Activity and Health

Retrieved from https://www.who.int/dietphysicalactivity/publications/shake-salt-

habit/en/

World Health Organization SHARP, (2016) The SHAKE Technical Package for Salt

Reduction Retrieved from

https://apps.who.int/iris/bitstream/handle/10665/250135/9789241511346-eng.pdf?

sequence=1