SAS 11: PLANNING FOR COMMUNITY HEALTH PROGRAMS AND SERVICES

THE PLANNING CYCLE

Planning is an important skill for it is a key management function for all health workers and health
managers. Planning is the process of determining in advance what should be accomplished – when, by
whom, how and at what cost.

Four Basic Questions:

 Where are we now?

 Where do we want to go?
 How do we get there?
 How do we are there?

PLANNING PROCESS

 Situational Analysis (Where are we now?)

Situational analysis involves the process of collecting, synthesizing, analysing and interpreting
information. It is the stage where you need to:
- Gather reliable information about the causes of health problems
- Identify the health situation of the community and identify where affected population
groups
- Discover what is currently being done to resolve the identified needs and who is doing it.
- Investigate how well identified needs have been addressed in the past and consider how
you could collaborate with others in the community in order to address current needs.
- Set priority by applying set of selection criteria that establish a standard by which
something can be measured.

SWOT analysis is a tool that can help you analyse situations more easily in your planning
process.
 Goal and Objective Setting (Where do we want to go?)
Goal and Objective Setting is the process of formulating the goals and objectives of the health
program and nursing services
Two important reasons for setting objectives:
- To create a definite plan
- Enables result to be evaluated

SMART objectives

Objectives must satisfy certain criteria; they must be relevant, feasible, and observable or
measurable. All objectives should be SMART:

- S= Simple or Straightforward (understandable by everyone involved)

- M= Measurable (the outcomes can be measured to demonstrate that the objective has been
achieved)
- A= Attainable (the outcome is possible to achieve)
 - R= Realistic (achievable with available resources)
- T= Time-framed (achievable within the time).

 Strategy/ Activity Setting (How do we get there?)

- Identify and sequence activities
This is the stage where you already know what you are trying to achieve and need to list all
the activities and place them in the correct sequence according to their importance and
timing. 
- Identify the resources
This is the time when you have to consider what resources will be needed to complete your
health project activities.
- Analyze constraints and limitations

 Evaluation
Evaluation refers to the assessing the final outcome of the plan.
- Determine outcomes
- Specify criteria and standards

SAS 12: COMMUNITY PROGRAM BASED HEALTH PLAN AND EVALUATION

COMMUNITY BASED HEALTH PLAN

Consists of:

 Program Title: A title should catch the attention of the community

 Objectives: Pertains to the goals in relation to the situation presented
 Activities: Plan of actions in order to achieve the objectives
 Assign Person: Hypothetically assigning individuals’ work in relation to the health plan
 Target Outcomes: Main purpose of the plan
 Manpower: Refers to the people of the community that may help in the program
 Materials: Supplies needed during the program
 Budget: Projected expenses

THE EVALUATION PLAN

- It poses the question “How do we know we are there?” to find out if the programs and services
achieve the purpose for which they are formulated.
- This entails determining the specific input, process and output/outcome indicators of the
program stating criteria and standards of each.

Program evaluation includes the following steps:

1. Deciding what to evaluate in terms of relevance, progress, effectiveness, impact, and efficiency;
2. Designing the evaluation plan specifying the evaluation indicators, data needed, methods, and
tools for data collection and data sources;
3. Collection of relevant data;
 4. Making decisions;
5. Preparing report and providing decision-makers feedback on the program evaluation.
A. Evaluation of Inputs/Resources
-adequacy of manpower, inputs and resources
B. Evaluation of Process
-adequacy of the process
C. Evaluation of Outcome
-effects/results of the program

A CHECKLIST TO EVALUATE PROGRAM PLAN (pp. 4-6)

COMMON PITFALLS IN PROGRAM EVALUATION

The following are the common pitfalls to avoid when evaluating health and/or nursing service programs:
1. With the assumption that more inputs means good health care, experience and observation
shows that it is not always true and that there is often plenty of waste of resources.
2. When evaluation is limited to an enumeration of service activities which indicate that the health
agency has been quite busy, there is a need to assess and evaluate the results or outcomes of
these service activities. Many activities may be done as a matter of routine but may not be
producing any beneficial result.
3. Related to Pitfall No. 2 above, is quantitative bias. Record keeping is often made just for
counting purposes, not for evaluation of quality of services.
4. Deficiencies in the method of evaluation, such as primary reliance on existing records as main
source of evaluative data, unqualified or incompetent service people doing the evaluation, and
use of highly arbitrary and subjective criteria.

SAS 13: ENVIRONMENTAL HEALTH

It is the aspect of public health that is concerned with those forms of life, substances, forces, and
conditions in the surroundings or person that may exert an influence t on human health and well-being
(PD 856).

Environmental health comprises of those aspects of human health, including quality of life, that are
determined by physical, chemical, biological, social and psychosocial factors in the environment that can
potentially affect adversely the health of present and future generations (WHO, 1993).

Objectives of the Environmental Sanitation (ES) Program:

1. Expand and strengthen delivery of quality ES services

2. Institute supportive organizational, policy and management systems
3. Increase financing and investment in ES
4. Enforce regulation policy and standards
5. Establish performance accountability mechanism at all levels

Components:

- Drinking-water supply
 - Sanitation (e.g. sewerage and septage management)
- Zero Open Defecation Program
- Food Sanitation, Air Pollution (indoor and ambient)
- Chemical Safety, WASH in Emergency situations
- Climate Change for Health and Health Impact Assessment (HIA)

Eight environmental health indicators in the Field Health Service Information System (FHSIS):

1. Households with access to improved or safe water

2. Households with sanitary toilets
3. Households with satisfactory disposal of solid waste
4. Households with complete basic sanitation facilities
5. Food establishments
6. Food establishments sanitary permit
7. Food handlers
8. Food handlers with health certificates

Solid Wastes

- Municipal Wastes
Municipal waste is defined as waste collected and treated by or for municipalities. It covers
waste from households, including bulky waste, similar waste from commerce and trade, office
buildings, institutions and small businesses, as well as yard and garden waste, street sweepings,
the contents of litter containers, and market cleansing waste if managed as household waste.
- Healthcare Wastes
Healthcare waste is all the waste generated by healthcare facilities, medical laboratories and
biomedical research facilities, as well as waste from minor or scattered sources. 
 Infectious - waste contaminated with blood and other bodily fluids, cultures and stocks
of infectious agents from laboratory work, or waste from patients with infections
 Pathological - human tissues, organs or fluids, body parts and contaminated animal
carcasses
 Pharmaceutical - expired, unused and contaminated drugs and vaccines
 Chemical - for example solvents and reagents used for laboratory preparations,
disinfectants, sterilants and heavy metals contained in medical devices, and batteries
 Sharps - syringes, needles, disposable scalpels and blades, etc.
 Radioactive - such as products contaminated by radionuclides including radioactive
diagnostic material or radiotherapeutic materials
- Industrial Wastes
Industrial waste is defined as waste generated by manufacturing or industrial processes.
- Hazardous Wastes
Hazardous waste is a waste with properties that make it dangerous or capable of having a
harmful effect on human health or the environment.

Solid Waste Management

- “This discipline associated with the control of generation, storage, collection, transfer and
transport, processing, and disposal of solid wastes in a manner that it is in accord with the best
 principles of public health, economics, engineering, conservation, aesthetics, and other
environmental considerations, and that is also responsive to public attitudes”. – R.A. 9003

Solid Waste Stream

- Waste Generation
- Waste Reduction: Re-Use
- Waste Segregation
- Collection and Transportation
- Waste Recycling
- Waste Treatment and Processing
- Residual Waste Disposal

Waster Segregation

- Black or colorless: non-hazardous and non-biodegradable wastes

- Yellow with biohazard symbol: pathological/anatomical wastes
- Yellow with black band: pharmaceutical, cytotoxic or chemical wastes (labelled separately)
- Orange with radioactive symbol: radioactive wastes

Prohibited on Solid Waste Management

- Open burning of solid waste

- Open dumping
- Burying in flood-prone areas
- Squatting in landfills
- Operation of landfills on any aquifer, groundwater reservoir or watershed
- Constructing of any establishment within 200 meters from a dump or landfill

Environmental Sanitation

Water Supply and Sanitation Program – The lead agency on the determination of standards for quality
of drinking water is the Department of Health (DOH).

The general requirements of safe drinking water include:

- Microbial quality tested through the parameters of total coliform, fecal coliform, and
heterotrophic plate amount.
- Chemical and physical quality tested through parameters of pH, chemical specific level, color,
odor, turbidity, hardness and total dissolved solids.
- Radiological quality tested through the parameters of gross alpha activity, gross beta and radon.

Levels of Access to Safe Water

- Level I (Point Source) refer to protected well or a developed spring with an outlet but without
distribution system, generally adaptable for rural areas where the houses are thinly scattered.
- Level II (communal Faucet System or Standposts) a system composed of source, a reservoir, a
piped distribution network with adequate treatment facility, and communal faucets located not
more than 25 meters from the farthest hose.
 - Level III (Waterworks System) refers to a system with a source transmission pipes, a reservoir,
and a piped distribution network for household taps. – DOH FHSIS, 2008

Prohibitions of the Code of Sanitation on Water Supply

- Washing and bathing within a radius of 25 meters from any well or other source of drinking
water
- Construction of artesian, deep, or shallow well within 25 meters from any source of pollution
(including septic tanks and sewerage system)
- Drilling a well within 50-meter distance from a cemetery
- Construction of dwellings within the catchment area of protected spring water source

Emergency Water Treatments

- Pre-treatment Processes
 Aeration - Aeration is the process by which air is circulated through, mixed with or
dissolved in a liquid or substance.
- Rapidly shake a container that is partially full of water for about 5 minutes
 Settlement - is an operation that removes suspended particles from the water to be
treated. 
- Allowing water to be undisturbed in the dark for a day
 Filtration - the clear water passes through filters that have different pore sizes and are
made of different materials
- Utilizing filters to block particles
- Filters can be clean cloth, sand and ceramics
- Disinfection
 Boiling - Boiling is a very simple method of water disinfection.
- 1 minute rolling boil (at sea level)
- 3 minutes rolling boil (at Higher altitude)
- Aeration after boiling to improve the taste of boiled water
 Chemical Disinfection - use of chemical agents
- Chlorine is most often use
 Solar Disinfection (SODIS) refers to the method of using sunlight to inactivate microbes
in biologically contaminated water. 
- Filling transparent 1-2 liters of plastic container and exposing them direct sunlight for about 5
hours
- Storage and Consumption

Air Purity

Two Major Sources of Air Pollution:

1. Mobile source – Mobile sources are primarily on-road motorized vehicles including cars, trucks,
buses, and motorcycles. They also include non-road equipment such as construction equipment,
recreational vehicles, small-powered equipment, marine vessels, and locomotives.
2. Stationary source - Stationary sources of air pollution, including factories, refineries, boilers, and
power plants, emit a variety of air pollutants.
Particulate matter report results interpretation

- “Unhealthy for sensitive groups”: People with respiratory disease, such as asthma, should
limit outdoor exertion.
- “Very unhealthy”: Pedestrians should avoid heavy traffic areas. People with heart or
respiratory disease, such as asthma should stay indoors and rest as much as possible.
Unnecessary trips should be postponed. People should voluntarily restrict the use of
vehicles.
- “Acutely unhealthy”: People should limit outdoor exertion. People with heart or respiratory
disease, such as asthma should stay indoors and rest as much as possible. Unnecessary trips
should be postponed. Motor vehicle use may be restricted. Industrial activities may be
curtailed.
- “Emergency”: Everyone should remain indoors, (keeping windows and doors closed unless
heat stress is possible). Motor vehicle should be prohibited except for emergency situations.
Industrial activities, except that which is vital for public safety and health, should be
curtailed.