Applied Health Promotion and Education BPH, Second Year, Fourth Semester

Transcription

1 Applied Health Promotion and Education BPH, Second Year, Fourth Semester

2 Course Objectives: To develop the practical knowledge on the development and establishment of health education and promotion interventions in national health system. At the end of the course students shall be able to: Critically appraise health education, promotion and policy, strategy and activities in Nepal Carry out school health promoting activities including life skill education Plan health promotion and education program. Implement, monitor and evaluate health education programs in Nepal.

3 8 hours Health Promotion and Education in Nepal Policy, strategy and programs of health promotion and education in Nepal Institutions responsible for delivering the health promotion and education in Nepal Review of the health promotion and education activities at different institutions. NHEICC and its programs, policy and activities

4 10 hours Health Promoting Institutions Meaning, importance, areas, steps and life skill education Health promoting work place.

5 15 hours Planning of Health Promotion and Education Program Meaning, importance and steps of planning Health risk appraisal and management issues PRECED-PROCEED framework of health education diagnosis, planning and evaluation: Concept, steps and its application in priority PHC program interventions Different planning approaches in health promotion and education

6 15 hours Implementation, Monitoring and Evaluation of Health Promotion and Education Program Implementation approaches (community, organization, leadership, participation) Monitoring indicator promotion of health education program (process, effects and impact indicators)

7 References 1. Armin MF Goidschmidt. Bemd Hofer, Communication between Doctor and Patients in Thailand. Saarbncken David K. Berio. The process of communication. Holt. Rinehert and Winston inc Devid Bedworh & Albert Bed Worth. Health Education: A Process of human effectiveness. Harper and raw NY, Freire Paulo. Pedagogy of Oppressed. New York, the Seaburt Press Guilbert.J.J. Educational Hand book for Health professional, Geneva: WHO, International Journal of Health Promotion and Education, Quarterly- An official publication of International Union of Health Promotion and Education; Different volumes 7. Joseph Luft. Group Processes - An introduction to group dynamics. Joseph 2 nd edition, Murray G. Ross. Community Organization. Harper and Row Publishers, Skinner, B.F. About Behaviouralism, New York, Alped A Knoff

8 National Health Communication Policy 2012

9 Outline Background Past efforts Current situation Problems and challenges Need of new policy Goal Objectives Policy Strategy (or action policy) Institutional structure Economic Aspect Legal Provision Monitoring and Evaluation Risk

10 Background Right to health and information on any matter of public concern (Interim constitution of Nepal, 2063) Nepal, a signatory to MDG (targets to reduce morbidity, mortality and to increase coverage of services) 51% die in Nepal due to NCDs, 42% due to CDs and 7% accidental injuries (WHO, 2010) Thus, important to promote hygiene and healthy behavior to improve health Communications media proved to be effective in doing so

11 Past efforts Vector borne disease control unit-1957 Health education section-1961 NHEICC-1993 HE prioritized by periodic plans subsequently NHEICC highlighted by SLTHP NHSP IP-1 ( ) accepted Health communication as cross-cutting issue for all health programs, and has said that BCC would support EHCS package Further felt need of organizing the health communication programs by formulating organized policy

12 Current situation HEC key component of preventive and promotive health services (NHP-1991) NHSP-2 ( ) has prioritized public health promotion under Health education and Communication Heading Mass media extensively used throughout the country for HE messages Still, high burden of death from major communicable and non-communicable diseases

13 Problems and challenges Though prioritized in policies, several challenges for implementation Inadequate coordination between NHEICC and other organizations working in HEC Most of the HE materials currently in Nepali language which is difficult to be understood by many ethnic groups Demand and supply gap regarding HE materials Misperception that HEC is the sole responsibility of the government Inadequate standards and conducts regarding health behaviors.

14 Need of new policy Assist to improve people's health status Assist in the implementation of national health policy Assist in the implementation of Nepal Health Sector Program and to achieve MDGs Assist in achieving health services and program goals and objectives Increase access and utilization of essential health services to mass people

15 Prevent unauthorized dissemination and duplication through coordination and collaboration among different health related institutions and communication media Arrange to disseminate health message or information through all communication media in a proportionate manner Maintain quality, accuracy, reliability, uniformity and appropriateness in messages or information, materials and programs produced and disseminated from different health related institutions Increase human, financial and physical capacity related to health communication

16 Goal The main goal of national health communication policy is to sustain healthy lifestyle of mass citizens by promoting health services, programs and healthy behavior; by preventing and controlling disease and by increasing accessibility and utilization of health services.

17 Objectives Mobilize and use modern and traditional communication multimedia and methods in an extensive and proportionate manner Strengthen, expand and implement health communication programs at central, region, district and community level Generate, collect and mobilize sufficient resources for HEC at local level Prevent unauthorized dissemination and duplication of health related messages or information and materials Enhance capacity on health communication in order to develop, produce and disseminate quality, correct, authorized, uniform and appropriate messages or information, materials and programs. Provide quality health messages or information through appropriate media and method to the citizens, who have no access to health message or information.

18 Policy Implement health communication programs in decentralized manner. Provide continuity to working in planning and implementation of communication programs of all health services and programs in an integrated approach and through one-door system. Allocate at least 2 percent budget annually of the total annual budget of Ministry of Health and Population annually for managing adequate financial resource to implement health communication related programs

19 Policy Promote participation, coordination and cooperation of relevant organizations and stakeholders for effective implementation of health communication programs. Use extensively modern and traditional multimedia especially mass, interpersonal and social communication media and methods based on the appropriateness to disseminate health messages or information.

20 Policy Make arrangement for the dissemination of health message or information based on need, approved standard and classification through all communication media and methods to reach all intended audiences by direct negotiated agreement in transparent and proportionate manner. Disseminate health messages or information in an educative, artistic and entertaining manner in local language and in culturally appropriate manner.

21 Policy Prevent dissemination of health messages or information without taking pre-consent from Government of Nepal by making necessary arrangement for maintaining quality, correctness, authorized, uniformity and appropriateness, avoiding duplication and making policy-based of health messages or information. Make arrangement to encourage communication media, institutions, health workers, journalist or health issue centered communication media, which have made significant contribution in disseminating health messages or information.

22 Policy Encourage and facilitate dissemination of health messages or information or materials through different communication media and methods in public private partnerships under the corporate social responsibility. Regulate, control and ban dissemination of any types of messages or information that can be adversely affected human health, exaggerated, misled nature and unauthorized.

23 Policy Make transparent and informed by disseminating health services, programs, proper use of medicines and medicine and service charges provided to people by governmental, nongovernmental and private organizations. Make arrangement to obtain health message or information or materials easily by physically and mentally disabled person and senior citizens.

24 Policy Give priority to issues related to control lifestyle related diseases and encourage improving daily lifestyle of human from simple behavior of individual. Ensure good governance and management of health services and institutions of all level for effective planning and implementation of health communication programs by building capacity of health promotion and communication.

25 Policy Provide quality health messages or information to mass citizens particularly people living in remote village with no access and geographically, ethnicity and gender wise disadvantaged, poor and marginalized population in an appropriate time and from appropriate media and methods, Link health messages or information and programs with services and these health messages or information will be socially inclusive, gender friendly and right, fact and audience based.

26 Policy Promote and use advanced modern communication technology for dissemination of health messages or information. Emphasize quality health promotion and communication by developing and producing manpower related to health promotion and communication. Develop and use monitoring and evaluation mechanism for the overall use of message and materials and the effectiveness of the programs related with health communication.

27 Strategy (see the MS Word file) Strategy

28 Bloom s Taxonomy of learning domains

29 Introduction A committee of colleges, led by Benjamin Bloom (1956), identified three domains of educational activities: Cognitive: Mental skills (Knowledge) Affective: growth in feelings or emotional areas (Attitude) Psychomotor: manual or physical skills (Skills)

30 Cognitive It further includes six domains like knowledge, comprehension, application, analysis, synthesis and, evaluation

31 Knowledge Recalling specific and general items of information and also information about methods, processes and patterns Key Words: defines, describes, identifies, knows, labels, lists, matches, names, outlines, recalls, recognizes, reproduces, selects, states.

32 Comprehension Recognition of items of information settings similar to but different from those in which they were first encountered. Key Words: comprehends, converts, defends, distinguishes, estimates, explains, extends, generalizes, gives an example, infers, interprets, paraphrases, predicts, rewrites, summarizes, translates.

33 Application Explaining previously unseen data or events by applying knowledge from other situations Key Words: applies, changes, computes, constructs, demonstrates, discovers, manipulates, modifies, operates, predicts, prepares, produces, relates, shows, solves, uses.

34 Analysis Breaking down blocks of information into elements for the purpose of clarification. Key Words: analyzes, breaks down, compares, contrasts, diagrams, deconstructs, differentiates, discriminates, distinguishes, identifies, illustrates, infers, outlines, relates, selects, separates.

35 Synthesis Combining elements to form coherent units of information. Key Words: categorizes, combines, compiles, composes, creates, devises, designs, explains, generates, modifies, organizes, plans, rearranges, reconstructs, relates, reorganizes, revises, rewrites, summarizes, tells, writes.

36 Evaluation Making judgment about the value of information, materials or methods for given purposes Key Words: appraises, compares, concludes, contrasts, criticizes, critiques, defends, describes, discriminates, evaluates, explains, interprets, justifies, relates, summarizes, supports.

37 Affective The affective domain includes the manner in which we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes.

38 Affective They are further divided into five levels: Receiving: Sensitivity to certain stimuli and a willingness to receive or attend to them. Key Words: asks, chooses, describes, follows, gives, holds, identifies, locates, names, points to, selects, sits, erects, replies, uses.

39 Affective Responding: Involvement in a subject or activity or event to the extent of seeking it out, working with it or engaging in it. Key Words: answers, assists, aids, complies, conforms, discusses, greets, helps, labels, performs, practices, presents, reads, recites, reports, selects, tells, writes..

40 Affective Valuing: Commitment to or conviction in certain goals, ideas or beliefs Key Words: completes, demonstrates, differentiates, explains, follows, forms, initiates, invites, joins, justifies, proposes, reads, reports, selects, shares, studies, works.

41 Affective Organisation: Organisation of values into a system, awareness of relevance of and relations between appropriate values and the establishment of dominant personal values. Key Words: adheres, alters, arranges, combines, compares, completes, defends, explains, formulates, generalizes, identifies, integrates, modifies, orders, organizes, prepares, relates, synthesizes.

42 Affective Characterisation by a Value Complex: Integration of beliefs, ideas and attitudes into a total philosophy of world view. Key Words: acts, discriminates, displays, influences, listens, modifies, performs, practices, proposes, qualifies, questions, revises, serves, solves, verifies.

43 Psychomotor domain A person performing a demonstration

44 Introduction The psychomotor domain includes physical movement, coordination, and use of the motor-skill areas. Development of these skills requires practice measured in terms of speed, precision, distance, procedures, or techniques in execution.

45 Introduction It talks about the third level of performance with the help of physical movement when the cognitive and affective levels have already met. It goes beyond the classroom setting and focuses on ability to apply the learnt things in practical life.

46 Hence, the learner is able to use sensory cues (signals) to guide motor activity which gradually extends up to the level in which he Introduction The learner has reached the level to perform in front of other novice learners. Hence, the student has reached the level in which he is mentally prepared to act physically.

47 Detail of the domain The different categories of the psychomotor domain from simple to complex level are given below: 1. Perception: The ability to use sensory cues to guide motor activity. Also called the selection step Key Words: chooses, describes, detects, differentiates, distinguishes, identifies, isolates, relates, selects.

48 Categories 2. Set: Readiness to act. It includes mental, physical, and emotional sets. Key Words: begins, displays, explains, moves, proceeds, reacts, shows, states, volunteers.

49 Categories 3. Guided Response: The early stages in learning a complex skill that includes imitation and trial and error. Adequacy of performance is achieved by practicing. Key Words: copies, traces, follows, react, reproduce, responds

50 Categories 4. Mechanism: This is the intermediate stage in learning a complex skill. Learned responses have become habitual and the movements can be performed with some confidence and proficiency. Key Words: assembles, calibrates, constructs, dismantles, displays, fastens, fixes, grinds, heats, manipulates, measures, mends, mixes, organizes, sketches.

51 Categories 5. Complex Overt Response: The skillful performance of motor acts that involve complex movement patterns. Proficiency is indicated by a quick, accurate, and highly coordinated performance, requiring a minimum of energy. This category includes performing without hesitation, and automatic performance. The Key Words are the same as Mechanism, but will have adverbs or adjectives that indicate that the performance is quicker, better, more accurate, etc.

52 Categories 6. Adaptation: Skills are well developed and the individual can modify movement patterns to fit special requirements. Key Words: adapts, alters, changes, rearranges, reorganizes, revises, varies.

53 Categories 7. Origination: Creating new movement patterns to fit a particular situation or specific problem. Learning outcomes emphasize creativity based upon highly developed skills. Key Words: arranges, builds, combines, composes, constructs, creates, designs, initiate, makes, originates.

54 National Health Education Information and Communication Program Raj K. Subedi

55 Goal The goal of the National Health Education, Information and Communication program is to contribute to attaining the national health programme goals and objectives by providing support for all health services and programmes

56 General Objective The general objective of National Health Education, information and Communication program is to raise the health awareness of the people as a means to promote improved health status and to prevent disease through the efforts of the people themselves and through full utilization of available resources.

57 Specific Objectives Increase awareness and knowledge of the people on health issues and promote desired behavior change on EHCS and beyond. Create demand for quality EHCS among all castes and ethnic groups, and disadvantaged and hard to reach populations. Advocate for required resources (human and financial) and capacity development for effective communication programmes and interventions to achieve the NHSP 2 goals. Increase access to new information and technology on health programmes. Increase positive attitudes towards health care.

58 Specific Objectives Increase healthy behavior. Increase participation of the people in the health intervention programs at all levels of health services. Intensify and strengthen action against tobacco use, both smoked and smokeless, excessive use of alcohol, unhealthy diets and physical inactivity. Promote environment health, hygiene and sanitation. Control the tobacco and Non Communicable Diseases (NCDs)

59 Major Strategies: Health communication programs will be implemented through health structures at centre, region, district and community levels in decentralized manner. Coordination and collaboration will be made with local bodies and other stakeholders for implementing health communication programs in decentralized manner. The policy of planning and implementing health related communication programs of all health service and programs in onedoor system and integrated approach will be implemented through Ministry of Health and Population, National Health Education, Information and Communication Centre. Advocacy, community mobilization and behavior change communication programs will be implemented at different levels by formulating subject wise health communication strategies of health services and programs in an integrated manner.

60 Strategies Health communication programs of different health service and programs will be integrated while formulating annual programs and budget of Ministry of Health and Population and will be implemented through National Health Education, Information and Communication Centre. Budget will be allocated annually according to the policy for the implementation of health communication related programs while formulating annual program and budget. The bodies under UN and external development partners will be encouraged and facilitated to invest in health communication programs.

61 Strategies Certain tax will be levied on any services or commodities used by general public and on behavior or commodities that adversely affect health. Some percent of the tax will be deposited in health messages or information dissemination management fund for utilizing to implement health promotion and communication programs. The practice of free distribution and use will be discouraged and managed by developing standards of health related communication messages or information, materials, equipment and services. Health Communication Coordination Committee will be formed comprising stakeholders to assist in the implementation of policy and decisions taken by high level health communication direction committee.

62 Strategies Adolescents, youths, journalists, professionals, institution and various organizations will be mobilized for the promotion of healthy behavior, basic health services and programs in coordination and collaboration with different relevant ministries and institutions, group, youth and other social and professional organizations in religious preacher, media, female community health volunteers, consumers' group, mothers' group, youth and other social and professional organizations in such programmes.

63 Strategies Modern electronic communication media such as radio, television, FM radio, website, telephone, mobile etc will also be used timely to disseminate health messages. Arrangements will be made to include health message and its link in all governmental websites. Booklet, pamphlet, poster, calendar, dairy, signage, sticker, flipchart, wall chart, flyer, flash card, flex, bulletin hoarding board will be produced, published and displayed for effective dissemination of health message or information. Also health messages or information will be published and displayed through various means and materials like outer cover page of text and practical books, package and bags of various materials and food items, tickets, postal letters, Tshirts.

64 Strategies Traditional and local folk art, culture and rituals like Maruni, Rodi, Dhan Nach, Shakewa Nach, Nautanki, Dohori Geet, Deuda, Ghatu, Dhami Jhankri, Gaine, Fine Art, Street Drama, Puppet Dance, Miking etc of powerful folk communication media and its related arts will be used timely to disseminate health related message Various carnivals, festivals, days, events, exhibitions will be organized to spread health message and information effectively up to the public community.

65 Strategies Innovative ideas of art especially articles, Radio and Television program, Interaction, Drama, Film, songs with message, dance, fine art, sculpture etc will be encouraged for raising health awareness. Other sectors will also be encouraged for conducting similar types of activities. Interpersonal communication is a major and effective medium in disseminating health messages or information widely. Therefore, emphasis will be given to mobilize community people and groups like local organizations, intellectuals, teachers, students, peer groups, religious preacher, media, female community health volunteers, consumers' group, mothers'

66 Chapter 9 Development Partners DEVELOPMENT PARTNERS The outcomes discussed in the previous chapters is the result of combined efforts of MoHP/GoN and the development partners (multilateral, bilateral organizations and international and national NGOs). Department of Health Services highly acknowledges partnership with these organizations and their contribution in the health sector in Nepal. This section presents major program focus of these organizations and their contact details to help the readers find more details about them and their programs. Pooled Funding World Bank, UK s Department for International Development (DFID), Government of Australian, KfW and GAVI Alliance have been providing pooled fund to support MoHP/GoN via Sector-Wide Approach (SWAp). The pool funding supports the government s five year NHSP2 (2010/ /15) to achieve its three objectives: (i) increase access to and utilization of quality essential health services (ii) reduce cultural and economic barriers to accessing health care services and harmful cultural practices in partnership with non-state actors and (iii) improve health systems to achieve universal coverage of essential health care services. The current support is a continuation of the previous Health SWAp (Nepal Health Sector Program 2004/ /10). The coverage is nationwide and in alignment with the NHSP2. The areas of support include the overall sector governance, child health, population and reproductive health, health system performance, gender equality and social inclusion, HIV/AIDS and nutrition. For the NHSP 2, the disbursements from the pooled funding partners till FY 2012/2013 were as follows: World Bank: USD million disbursed for the NHSP 2 till date (out of total committed USD million) DFID: GBP 14 million (USD 22.5 million) disbursed to NHSP 2 till FY 2012/2013 (out of a total commitment of GBP 52 million (USD 83.5 million) Australian Government: A $ 20.8 million disbursed until FY 2012/2013 (out of a total commitment of A$ 26 million). KfW: KfW under German Financial Cooperation contributed Euro 3.78 million in the Pool Fund in and Euro 1.83 million through its Sector Program Health and Family Planning which also includes the co-financing of maintenance of medical equipment in the Mid West and Far stern Regions of the country. GAVI: The total commitment for the year is USD 5.7 million. USD 1,773, is in the process of disbursement as first of two tranches for expenditures for year 2012/13. Apart from the fully flexible pooled funding to the GoN in support of NHSP2, some pooled funding partners also supported other activities which have been presented in the table below which also shows contributions from other non-pooled partners. DoHS, Annual Report 2069/70 (2012/2013) 244

67 Development Partners Development Partners Contributing to Health Sector in Nepal 9.1 MULTILATERAL ORGANIZATIONS Organization Major program focus Geographical coverage UNFPA Adolescent Sexual and Reproductive Health (ASRH) Family Planning Safe-Motherhood (including midwifery and RH Morbidities) HIV/AIDs & STI Emergency preparedness and response in health sector Saptari, Sarlahi, Rautahat, Mahottari, Sunsari, Dang, Rukum, Rolpa, Pyuthan, Arghakhanchi, Kapilvastu, Dadeldhura, Baitadi, Bajura, Bajhang, Sindhuli, Udahapur & Budget for health sector for 2012/13 Allocated : USD 2,022,500 Expenditure from July 2012-June 2013: USD 1,094,000 Achham UNICEF Child Health National with focus on 15 Allocated Budget Maternal and new-born health priority districts: Mugu, USD 2.36 million HIV/AIDS (PMTCT) Kalikot, Jumla, Humla, Nutrition Dolpa, Bajhang, Baitadi, Expenditure: Doti, Bajura, Dadeldhura, USD 3.6 million Saptari, Dhanusha, (including support Mahottari, Rautahat, to procure polio Parsa vaccine) World Bank Health system strengthening National Committed: USD million World Food Programme (WFP) Mother and Child Health Nutrition (MCHN) 9 districts: Humla, Jumla, Kalikot, Mugu, Dolpa, Solukhumbu, Bhajhang, Bajura and Darchula. Disbursed: USD million FY 2012/13: US$ 3 million FY 2013/14: US$ 2 million Contact details UNFPA Nepal Jhamsikhel, Lalitpur Tel: Fax: registry-np@unfpa.org Web: UNICEF Nepal, UN house, Pulchowk, Lalitpur Tel: Fax: kathmandu@unicef.org Web: The World Bank Nepal Country Office The Yak and Yeti Complex Durbar Marg PO Box 798 Kathmandu WFP Country Office, Chakupat, Patan Dhoka, Lalitpur, Nepal P. O. Box No 107, Kathmandu, Nepal Phone No: DoHS, Annual Report 2069/70 (2012/2013)

68 Development Partners Organization Major program focus Geographical coverage WHO Nepal Health Policy and Health Systems, Capacity building and training, Immunization, Nutrition, Maternal Health, Child Health, Communicable disease, HIV/AIDS, TB, Malaria, Neglected Tropical disease, Non Communicable disease, Oral Health, Mental Health, Emergency Health, Environmental health, Health Research and Health care financing. 9.2 BILATERAL ORGANIZATIONS Budget for health sector for 2012/13 National US$ million Budget reflected is core biennium planned budget for 2012/2013 only. The planned and expenditure cover both off and on budget. Covers the period for November November :45 ratio for year 1 and 2 Contact details VSAT: or 1346-Ext No Fax No: Website: WHO Country Office Nepal UN House Jawalakhel, Nepal Tel: (1301) Fax: Organization Major program focus AusAID Health SWAp Access Equity Quality Governance Geographical coverage Budget for health sector for 2012/13 National Commitment: A$ 26 million Disbursed: A$ 20.8 million disbursed Contact details Australian Embassy Bansbari, Kathmandu GPO Box 879 Tel: ; Fax: ausaid.kathmandu@dfat.gov. au untries/southasia/nepal/page s/home.aspx DoHS, Annual Report 2069/70 (2012/2013) 246

69 Development Partners Organization Major program focus Department for International Development (DFID) Deutsche Gesellschaft Für Internationale Zusammenarbeit (GiZ) Health for Life (H4L) Geographical coverage Budget for health sector for 2012/13 Health SWAp Nation wide Commitment: USD 83.5 million A. Health Sector Support Program Decentralization and quality improvement Fair Financing and Social Health Protection Promotion of Sexual and Reproductive Health and Rights with a focus on young people B. Harm Reduction Access to qualitative Opioid Substitution Therapy (OST) and HIV services for injecting drug users Health system governance Evidence-based health policy National stewardship of health sector Quality improvement Capacity of health workers and volunteers Knowledge, behavior and use of health services Logistics system Dhading, Banke, Bardiya, Surkhet, Dailekh, Jumla, Dang Salyan, Mugu, Kalikot, Kailali, Dadeldhura, Doti, Achham, Baitadi, Kanchanpur Disbursed: USD 22.5 million Allocated: Euro 1.57 million Expenditure: Euro 1.57 million Nationwide Allocated : Euro 0.7 million. Expenditure: Euro 0.7 million National focus plus 14 Districts: 12 in MWDR and 2 in WDR: Dang, Rolpa, Pyuthan, Rukum, Jajarkot, Salyan, Banke, Bardiya, Surkhet, Daliekh, Kalikot, Jumla, Argakhanchi, and Kapilbastu USAID Maternal, newborn and child health Nationwide, plus focused program in 34 districts Allocated: $18.25 million for 5 years (Dec 2012 to Dec 2017) Contact details DFID Nepal, Ekantakuna, Lalitpur Tel: Fax: n-mesko@dfid.gov.uk Web: Office : MoHP-GIZ Health Sector Support Programme (HSSP), Teku, Kathmandu Tel: Fax: hssp@giz.org.np Web: GIZ.de/nepal Health for Life P.O. Box 3172, Oasis Complex, Patan Dhoka, Lalitpur, Nepal Fax: rtimmons@rti.org Web: US$ 14,331 U.S. Embassy Building, Maharajgunj G.P.O Box: DoHS, Annual Report 2069/70 (2012/2013)

70 Development Partners Organization Major program focus Geographical coverage Family planning and reproductive health Nationwide, plus focused program in 51 districts Nutrition 35 districts US$ 6,622 HIV/AIDS & STI 23 districts US$ 2,925 Neglected tropical and vaccine preventable diseases Nationwide US$ 1.61 Logistics and supply chain management Nationwide US$ 500 Environmental health Achham, Surkhet plus 20 districts of Suaahara project Disabilities Banke, Dang, National population-based surveys and capacity building Kanchanpur, Kathmandu, Morang, Sarlahi, Surkhet Budget for health sector for 2012/13 Contact details US$ 11,810 Tel: Fax: US$ 2,100 US$ 1.06 Nationwide US$ INTERNATIONAL NON-GOVERNMENT ORGANIZATIONS (INGOs) Organization Major program focus Action Aid International Nepal (AAIN) Community sensitization Access of communities in local health facilities Action research Conduct REFLECT Circle to empower communities on improving health governance and services Geographical coverage Budget for health sector for 2012/13 30 districts Allocated: NRS 41,40,526 Expenditure: NRS 41,40,526 Contact details Apsara Marga, Lazimpat Ward No. 3, Kathmandu Nepal Tel: Fax: Website: Adventist Maternal child health and family planning services 15 districts Kathmandu Nepal DoHS, Annual Report 2069/70 (2012/2013) 248

71 Development Partners Organization Major program focus Development and Relief Agency (ADRA) Nepal Uterine prolapse VCT Britain Nepal Medical Trust (BNMT) Tuberculosis Health policy Children, Adolescent and Youth health Family planning Sexual and reproductive health Safe motherhood Peace building Nutrition HIV/AIDS Climate change and health CARE Nepal Maternal health Neonatal /child health Family Planning HIV and AIDS Health governance Strengthening health service delivery Chlorhexidine Navi Care Program/JSI R&T inc. Scaling of use of Chlorhexidine for better cord care CBNCP FHI 360 Nepal (managing USAIDfunded Saath-Saath Project) October September 2016 HIV prevention to care, support and treatment services Integrated family planning (FP)/HIV services Community and home based care Surveillance & research Capacity strengthening of SSP s partners 249 Geographical coverage 39 districts in 5 development regions Budget for health sector for 2012/13 Budget: 140,795,000 Expenditure: 122,177,000 Contact details Tel: ; Fax: info@adranepal.org Web: Lazimpat, Kathmandu, Nepal GPO Box: Tel: / Fax: trust.org.uk info@bnmt.org.np 9 districts: Bajura, Bajhang, Accham, Doti, Dadeldhura, Kailali, Kanchanpur, Nawalparasi, Rupandehi All geographical regions Rupendehi and Pyuthan districts Budget: USD 1,328,674 Expenditure: USD 1,226,151 Allocated: USD 2 million for 3 years Expenditure: USD Dhobighat P.O. Box 1661, Kathmandu, Tel: Fax: carenepal@np.care.org Web: Oasis Complex, Patan Dhoka Tel: Fax: cncpjsi@cncp.org.np 33 districts Gopal Bhawan, Anamika Galli, Kathmanu-4, Nepal; GPO 8803 Tel: ; Fax: fhinepal@fhi360.org DoHS, Annual Report 2069/70 (2012/2013)

72 Development Partners Organization Major program focus Health Right International Helen Keller International International Network for Rational Use of Drugs (INRUD, Nepal) Geographical coverage Maternal and newborn health, family planning Arghakhanchi and Kapilvastu districts Nutrition (Action against malnutrition through Agriculture - AAMA) Monitoring prescribing practices and availability of free drugs at PHC outlets to improve rational use of medicines Provides technical support to DoHS/MoHP to the set activities Ipas Nepal Safe abortion care Reproductive health care Integrated safe abortion with family planning Leprosy Mission Nepal 8 districts: Baitadi, Kailali, Darchula, Bajhang, Bajura, Manang, Rasuwa, Solukhumbu Budget for health sector for 2012/13 Allocated: Rs 211,310,175 Expenditure: Rs 183,747,978 Contact details Oasis 49 Dhara, 403, 4 th Floor, Patan Dhoka, Patan Telephone: P.O Box : 3752 Green Block, Ward #10 Chakupat, Patan, Lalitpur Tel: , , Fax: ddavis@hki.org Web: 12 districts Rs million 34, Surya Bikram Gyawali Marg, Baneswor, Kathmandu Tel: Fax: kumudkafle@gmail.com Web: 27 districts: 256 sites providing MA services 10 districts: 15 sites providing 2nd trimester services Leprosy All over the country Allocated: Rs 11,05,17,696 NRs. 140 million Tewa Tower, Teku, Kathmandu P.O. Box: Telephone: Fax: Web: Expenditure: Rs 11,00,92,147 P.O. Box 151 Kathmandu, Nepal Tel: shovakhark@tlmnepal.org Web: DoHS, Annual Report 2069/70 (2012/2013) 250

73 Development Partners Organization Major program focus The Micronutrient Initiative (MI) Micronutrient supplementation Food fortification Netherlands Leprosy Relief (NLR) Leprosy Control Rehabilitation through CBR (Disability management TB Control Plan Nepal Construction/Rehabilitation of birthing centers SBA training Safe motherhood Community based newborn and child health Prevention, treatment and rehabilitation of children with disability PMTCT Population Services International/Nepa l (PSI/Nepal) Family planning Reproductive health Malaria prevention HIV prevention among MSM and TG population Save the Children Maternal, Newborn & Child health Nutrition HR for health 251 Geographical coverage Budget for health sector for 2012/13 30 districts Allocated: Rs 18,203,726 All 16 districts of eastern region and all 9 districts of Far western region 3. All districts of far western region 7 districts: Morang, Sunsari, Rautahat, Makwanpur, Sindhuli, Banke, Bardiaya Expenditure: Rs 8,990,197 Allocated: 3,57,49,656 Expenditure: 2,66,87,521 Budget: Rs 42,414,456 Expenditure: Rs. 40,320, districts Allocated: USD Expenditure: USD 4,776,264 Contact details Uttardhoka Marg, 424/2, 2 nd Floor, Lazimpat Telephone: Fax: minepal@micronutrient.org Web: Anamnagar, Kathmandu Tel: Fax: nlrcro@ntc.net.np nlrcroktm@gmail.com Web: Ward. No. 3, Shree Durbar, Pulchwok, Lalitpur, Nepal Tel: , , Fax: www plan- international.org/ nepal Shree Mahalaxmi Sadan, Mahalaxmisthan, Lagankhel Lalitpur, Nepal; GPO Box: Tel: / info@psi.org.np 13 districts Bag Durbar, Sundhara, Kathmandu, Nepal Tel: , DoHS, Annual Report 2069/70 (2012/2013)

74 Development Partners Organization Major program focus United Mission to Nepal (UMN) Water Aid Nepal (WAN) World Education, Nepal World Vision International Nepal (WVIN) Maternal and Newborn Health, Adolescent Sexual and Reproductive Health, Mental Health, Water Sanitation and Hygiene, Food security and Nutrition, Community health, HIV and AIDS, Child to Child health program Geographical coverage Budget for health sector for 2012/13 Contact details 10 districts Thapathali, Kathmandu, Nepal. Tel: , , Fax: Web: WASH 23 districts Kupandole, Lalitpur, Nepal Tel: Maternal and child health 8 districts Ratopul, Kathmandu, Nepal Nutritional status of U5 children Childhood illness prevention and management Sanitation and hygiene 8 districts Allocated: Not available Expenditure: Rs 34,789,948 Tel: shyam@wei.org.np Lalitpur -3, Jhamsikhel, Nepal Tel : , Fax : GPO Box # Non-Governmental Organizations Organization Major program focus CRS Company Maternal child health Family planning HIV prevention Family Planning Association of Nepal (FPAN) Family planning Reproductive health Safe abortion HIV/AIDS/STI Geographical coverage 75 districts through its products and services Budget for health sector for 2012/13 Contact details Tokha Road, Mahadev Taar, Gongabu, Kathmandu, Nepal P.O. Box. 842, Phone: , Fax: mis@crs.org.np mis@crs.org.np 42 districts Pulchowk, Lalitpur, P. O. Box 486, Kathmandu, Nepal Phone: , ; Fax: DoHS, Annual Report 2069/70 (2012/2013) 252

75 Development Partners Organization Major program focus Kidasha Maternal, newborn and child health Nutrition, hygiene and sanitation Early childhood development Parenting capacity Primary healthcare Sunaulo Parivar Nepal Nepal Red Cross Society (NRCS) Sexual and Reproductive Health Training on RH Social marketing of Feminyl, Jodi, Mariprist Maternal and Child health Community Health hygiene, sanitation, Malaria, water supply, eye care, first- aid, HIV/AIDS Blood transfusion and Ambulence service Earth Quake preparedness Combating Trafficking, Nepali Technical Assistance Group (NTAG) Maternal and child nutrition Multi-sectoral training to health workers, FCHVs and others Promotion and advocacy of National Vitamin A Program Research and surveys 253 Geographical coverage Western Development Region, District: Kaski and Rupandehi Budget for health sector for 2012/13 Allocated: Rs.15,094,937 Expenditure: Rs.12,012, districts Budget: Around NRs. 30 crore 75 districts Allocated: Rs 275,056, districts (Suaahara) 75 districts (National Vitamin A Program) 3 districts (PoSHAN Community Studies) Expenditure: Rs 148,295,601 Suaahara Budget: RS.108,912,957 Expenditure: RS. 94,360,535 National Vit A Prog. Budget: RS. 3,905,433 Expenditure: RS. 3,757,766 Contact details fpandg@fpan.org.np Web: Nagdhunga-8, Pokhara Tel: / Fax: kidasha@kidasha.org Web: kidasha@kidasha.org Ph: Fax: rajesh@msinepal.org.np Red Cross Road Kalimati, Kathmandu Tel: , , Fax: nrcs@nrcs.org Web: Maitighar, Kathmandu, Nepal GPO Box 7518 Tel: / Fax: nvatag@mail.com.np Web: PoSHAN Budget: RS. 26,212,960 Expenditure: DoHS, Annual Report 2069/70 (2012/2013)

76 Development Partners Organization Major program focus Nick Simons Institute (NSI) Sushma Koirala Memorial Hospital Geographical coverage Training 74 / 75 districts, with participants selected by NHTC Rural staff support 7 districts: Bajhang, Doti, Kalikot, Salyan, Kapilvastu, Gulmi, Dolakha Advocacy All 75 districts Plastic and Reconstructive Surgery Mountain, Hill and Terai Region Source: Report received from respective agencies to HMIS Section, MDS/DoHS Budget for health sector for 2012/13 RS. 3,632,210 Allocated: Rs. 185,765,062 (USD 1,935,052) Expenditure: Rs. 159,230,104 (USD 1,658,646) Budget Rs. 40,261,890 Expenditure: Rs. 36,801,492 Contact details Box 8975; EPC 1813, Sanepa, Lalitpur Nepal Phone Fax nsi@nsi.edu.np Salambutar, Sankhu, Kathmandu, Nepal Tel: , Fax: skm@wlink.com.np Web: DoHS, Annual Report 2069/70 (2012/2013) 254

77 Development Partners 255 DoHS, Annual Report 2069/70 (2012/2013)

78 LESSON PLAN FORMAT Date: 2071/4/11 Time : 10 :00-12 :00 am Venue : CIST College, Room 102 Target group : BPH fourth semester students (40 in number) Level: Bachelors (BPH) Subject: Applied Health Education Lesson: evaluation of health education Facilitators: Raj Subedi (MPH) Educational and Behavioral objectives After the successful completion of the lesson, the participants will be able to: 1. Describe the concept of health education evaluation. 2. Recall 3. Demonstrate. 4. Construct. Methodology matrix: Time Topics Methods Resources Introduction to health education evaluation Lecture, video display Whiteboard, DVD Player, speakers, Multimedia

79 projector Levels of evaluation (Kirkpatrick s model) Powerpoint presentation CPU, Multimedia projector, USB stick 10:30-11:00 Follow same technique as displayed above Follow same technique as displayed above Follow same technique as displayed above 11:00-11:50 Follow same technique as displayed above Follow same technique as displayed above Follow same technique as displayed above Evaluation 1. Observe the degree of participation of the trainees 2. After the session, ask the following questions to the trainees at random a. What is. b. What are the different types of.. 3. Ask the trainees at random to perform the following after the session a. Draw the on the copy b. Display the on the whiteboard Closure

80 NATIONAL HEALTH EDUCATION, INFORMATION AND COMMUNICATION CENTRE

81 What is HE???? Health education and promotion is more than information dissemination process of helping people to improve the quality of lives by increasing the control or influence they have over the determinants of health that affect them

82 Background Health Education Section was established in 1961 upgraded into the National Health Education, Information and Communication Center (NHEICC) in 1993 focal point for all health related BCC activities

83 What NHEICC do.. Provide support to health programs and services by planning, implementation and evaluation of health education, information and communication policies, strategies, programs and activities in an integrated approach in the country

84 General Objective To raise the health awareness of the people as a means to promote improved health status and to prevent disease through the efforts of the people themselves and through full utilization of available resources

85 Also. To enable them to identify health issues, develop positive attitude towards health care and increase access to new information and technology of health and health programs for the people

86 Core Functions Advocacy Information dissemination Capacity building Establish partnerships following norms and standards using appropriate tools and guidelines

87 NHEICC Organogram

88 Health Education and Promotion Section Implement an integrated health services and programs by coordinating health education, promotion and communication policy, strategy, program and activities through planning, implementation, monitoring and evaluation with the concerned authority. Make an effort, especially among ministries, to develop healthy public policy for health promotion. Implement activities to create a supportive environment for health promotion and health education. Conduct capacity building activities to develop knowledge, attitude and skills individually and in groups for health education and promotion.

89 Contd. Conduct refresher program at various level for health education and promotion. Develop and run different health promotional programs in hospitals, schools, communities, working places, industries and occupational settings. Develop and produce local education materials for local communication media. Approve health messages and education materials developed, produced and disseminated by government and non-government organization following a necessary process. Conduct coordination and technical committee meeting on health promotion, education and communication and prepare reports.

90 Contd. Conduct timely monitoring, supervision and evaluation of all the health promotion, education and communication activities at all level, prepare and submit report to the concerned authority. Plan, implement, monitor and evaluate policy, strategy, program and activities for prevention and control of using tobacco, alcohol and other addictives. Design, develop, pretest, and produce health message for health education, promotion and communication in coordination with health communication section. Conduct Behavior Change Communication programs.

91 Environmental and Community Health Section Develop pretest, produce and disseminate messages from various communication medias in health education and communication policy, planning activities and programs regarding environmental health, sanitation, mental health, deafness, blindness and other communicable and non communicable diseases in coordination with the concerned authority. Provide support on behalf of NHEICC for prevention and control of epidemics and natural disaster at the various geographic areas of the nation. Identify need, conduct research and analysis on health education promotion and communication. Conduct mobile health education promotion and communication activities.

92 Contd. Strengthen, implement, monitor and evaluate school health education program in coordination with concerned authority. Plan, implement and monitor health education activities based on local folk culture. Plan, monitor, report and submit health education, information and communication related annual program of district and centre in coordination with division and section. Prepare and disseminate health education, information and communication program guidelines. Manage resources in coordination with and in relation to national and international organizations related to health education, information and communication.

93 Contd. Support district and region in health education program planning, implementation and monitoring. Support to establish and run health education corner in all health institution. Develop and conduct social mobilization programs. Conduct health promotion, education and communication programs and activities up to ward level through FCHV and activities and motivational activities for FCHVs. Develop and conduct advocacy programs.

94 Health Communication Section Disseminate health messages through interpersonal communication, group, folk culture and mass communication. Share ideas during dissemination and distribution of health messages. Maintain relations and coordinate with national and local level communication medias. Disseminate health messages by publication and broadcasting through electronic communication, magazines and press.

95 Contd. Exhibit video films related to health and arrange exhibition and miking during different day celebration and opportunities. Compile news, disseminate and press conference during different opportunities related to health. Collect, conduct and maintain communication materials and equipments. Compile and disseminate materials and programs produced by other sections. Broadcast, publish, exhibit and distribute health education materials. Prepare graphic design for educational materials.

96 Contd. Disseminate health messages through cinema/film. Disseminate health message by planning, conducting, coordinating and extending HELLIS Library. Disseminate health message through website, and internet services. Disseminate health messages through different other methods and medias. Disseminate health message by running national IEC clearing house at NHEICC.

97 Administration Section Support daily administrative activities. Maintain office security, sanitation, building, equipment and other materials Order, compile, procure, sell and auction office equipment. Enter and distribute office materials and educational materials. Manage and protect expendable and not expendable office materials. Support planning, releasing and expensing budget. Support accounting and reporting of expense, deposit and revenue. Support auditing and clearing irregularities.

98 HEIC activities at service delivery Role of NHEICC at different levels

99 Background As per the mandate, NHEICC develops, produces and disseminates health HEIC activities to support the all health programs and services in an integrated approach in the country. HEIC efforts are to facilitate people to improve their health status by themselves and encourage them to be benefited from health services most.

100 Background Though, there are numerous plausible ways of describing national health HEIC program, the program strategies describe a number of features of the approaches to materialize the strategic activities through media and partnership. To present HEIC programs, in terms of policies, strategies, types of messages, communication channels, media, methods and audience characteristics, the HEIC activities at central, regional, district and below level are in the following slides:

101 At central level Message and Material Development Workshop Development and Production of Printed HEIC Materials Development and Production of Audio Visual HEIC Materials Distribution and Dissemination of HEIC Materials and Messages through Proper Channel Observation of Special Events/Days

102 At central level Organize Scientific Study Access of New Information: Health Literature and Library Information Services (HELLIS) Capacity Building HEIC Equipment Support to Region and District Mobile HEIC Campaigns Organize contests

103 At Regional Level Production and Airing of Radio Program Production and Airing of Radio Spot Supervision and Monitoring of District HEIC Activities Annual Review Meeting

104 At District And Below Level Organize Meetings and Discussions School Teachers Workshop School Health Education Program Health Workers Workshop on Gender Issues

105 At District And Below Level Local Cultural and Folk Events Printed Material Development and Production Health Education Exhibition Health Education Corner in the Hospital

106 At District And Below Level FM Radio Program Printed HEIC Material Distribution Interaction Program with Journalist and other Influential Persons Street Drama Cinema Slide or Celluloid Film Show Message Publication in Local Newspaper Social Mobilization and Public Address HEIC Campaigns

107 Formulation of Compatible HEIC Program (Criteria for Selecting Program/Activity) Feasibility Public Demand Political Commitment Preventable Affordable Accessible Acceptable Cost Benefit Availability Burden of Diseases Severity Trend Exposure

108 Target audiences Influential people Political and Religious leaders Health personnel General public Patient and relatives Community Children in or out of school Parents Priority risk groups Volunteers Men, Women Adolescents Elderly women Shopkeepers Teachers Couple Other

109 HEIC message should be able to influence Current physical state, future pain, discomfort or memory of past pain Rational stimuli based on knowledge and reasoning, if have the facts, they may choose to do the right thing. Person's emotional intensity of feeling and fear, love or hope Person's capacity to adopt and continue a new behavior Influence from family and peers Impact of social, economic, legal and technological factors on the daily life of a person.

110 To make the message memorable Use thematic organization to tie materials together by a theme and person in logical, irreversible sequence, repeat key points. Use rhythm and rhyme. Use concrete rather than abstract terms. Use zeitgeist effect leave the audience with an incomplete message, something to ponder so that they have to make an effort to achieve closure. Tell the audience the implications of their conclusion.

111 Reducing Risk Protecting Healthy life Prepared By: Rajendra P. Ghimire MPH, 10 th Batch

112 Risk Approach World Health report Discussion on risk to health- May 2002 Confronting their health risk by government representatives Report focused on risk assessment, risk communication, risk management Willingness to reduce the risk in their countries Explain the best risk reduction policy Underlying determinants- poverty Tobacco, alcohol, unhealthy diet are common risk factors in low and middle income countries High BP, tobacco, alcohol, inactivity, obesity and cholesterol major threats to health globally

113 Why Focus in risk to health? Key to preventing disease and injury More efforts and resources directed to treat disease Assessing risk and risk management ( cost effectiveness and policy formulation)

114 Define and Assessing risk Risk : Probability of an adverse outcome or the factors raise the probability Assessing risk: - Hazard identification - Exposure assessment - Dose response assessment - Risk characterization

115 Some strategies to reduce risks Risk reduction and behavior. Individual based versus population approaches to risk reduction. The role of Government and legislation.

116 Childhood undernutrition Interventions. Complimentary feeding. Complimentary feeding with growth monitoring and promotion. Results-The complimentary feeding with growth monitoring approach is cost-effective than other.

117 Iron deficiency and micronutrient Iron fortification. Iron supplementation. Results more than 95%of total death averted by fortification.

118 IMCI (Integrated management childhood illness) Assessment Integral approach. Pneumonia,diarrhoea, measles, malaria, and malnutrition. Over 80 developing countries have adopted.

119 Blood pressure. Population wide salt reduction-15% reduction in sodium intake. Individual- based hypertension treatment and education.

120 Cholesterol. Population wide health education through mass media. Individual based treatment and education.

121 Combining Interventions to reduce the risk of cardiovascular events. Individual based treatment and education for systolic blood pressure and cholesterol. Population wide combination of intervention to reduce hypertension and cholesterol. Absolute risk approach. Combined population interventions and the absolute risk approach. (Low salt intake, reduce cholesterol and reduce body mass index)

122 Unsafe sex and HIV/AIDS. Voluntary counseling and testing (VCT) Out reach peer education programmes for commercial sex workers and their clients. Social marketing of condoms. Population- wide mass media using the combination of television, radio and print. School based Aids education targeted at youth aged yrs.

123 Addictive substances -smoking. Interventions:- Taxation Clean indoor air laws in public places, through legislation and enforcement Information dissemination through health warning labels, counter advertising and various consumers information packages. Nicotine replacement therapy (NRT) -targeted all current smokers yrs

124 Unsafe water, sanitation and hygiene. Disinfection at point of use-using chlorine and safe storage. Improved water supply and sanitation, low technologies. Improved water supply and sanitation,with disinfection at point of use. Improved water supply and sanitation, high technologies (98%people received safe water ) By all intervention 17% diarrhoeal cases will be reduced.

125 Nepal Family Health Program ;fyl lziff(peer Education) eg]sf] s] xf] < ;lhnf] zabdf egg" kbf{ Ps jf a(l ;fyln] c fkm\gf ;fylnfo{ l z If f lbg" g} ;fyl l z If f xf]. oxf l z If f lbg] JolQm ljz]if! l z If s geo{ c fkm\g} ;fylx? dwo]af^ x"g%. l z If f lbg] JolQmnfO{ æ;fyl l z If s Æ (Peer Educator) elgg%.

126 Nepal Family Health Program ;fyl lziff lsg < nlift ;d'xdf g} c fwfl/t M ;fyl lzifs c fkm} g} nlift ;d'x s} x"g] epsf]n] pko"qm sfo{qmd jf ;+b]z k efjsf/l?kdf lbg ;lsg%. ;DjGw ljsfzsf] nflu ;do lbg" gkg]{. ;+:s[lt rfnrng c g"?k M Pr=c fo{=el= P*\; tyf of}g;+u ;DjGwLt c lt g} ;+j]bgzln s"/fx? ug{ ;lsg], h"g jflx/l JolQmn] ug{ ;Sb}g. 3= nlift ;d'xnfo{ dfgo M aflx/l dflg;n] ug]{ s"/f egbf c fkm\g} ;d'xsf ;fyln] o:tf ;+j]bgzln s"/f ubf{ dfgo x"g] jf ;xh?kdf o:tf s"/f ug{ ;lsg%. 4= kmf/f] M ;/;fdfg jfx]s c Go vr{ ug"{ gkg]{, n l If t ;d'xd} a:g] tyf sfo{ ug]{ epsf]n] a(l k efjsf/l x"g] epsf]n] w]/} g} ækmf/f]æ (Economical) %.

127 Nepal Family Health Program ;fyl lzifsdf x"g" kg]{ u")fx? 1. c fkm\gf ;fylx?;+u :ki^ ;+rf/ ug{ ;Sg]. 2. c Gt/ JolQm ;+rf/ l;k /fd f] x"g"k%{. ;"Gg] l;k ;lxt. 3. 3= n l If t ;d'xsf] h:t} k[i& e'ld epsf] -h:t} M pd]/, lné, ;fdflhs :t/, z } l If s :t/, k]zf OTofbL_ 4. 4= nlift ;d'x -c? ;fylx?_ n] dfgg] tyf cfb/ ug]{ lsl;dsf] x"g"k%{. 5. 5= t^:y wf/)ff epsf]. 6. 6= c fkm'n] lziff lbg] ljifo jf/] /fd f]!fg epsf] x"g"k%{. 7. 7= o:tf] l z If f lbg] sfo{df?lr epsf] / ;do klg lbg ;Sg].8= %l/tf], km'lt{nf] cftdljzjf; epsf] tyf g]t[tj ;DxfNg ;Sg] Ifdtf epsf]. 8. 9= c ;n rfn rng epsf].

128 Nepal Family Health Program ;fylx?nfo{ lziff lbg s] s:tf lqmofsnfk ug{ ;lsg% < %nkmn k Zg-pQ/ dlitis dgyg e'ldsf lgjf{x ;d'x sfo{ #^gf ljzn]if)f

129 k jrg Nepal Family Health Program ;fylx?nfo{ lziff lbg s] s:tf lqmofsnfk ug{ ;lsg% < jfbljjfb k ltof]lutf xflh/l hjfkm k ltof]lutf kf]i^/ k ltof]lutf ;*s gf^s s&k"tnl k bz{g rnlrq k bz{g lgjgw k ltof]lutf

130 Nepal Family Health Program ;fyl lziff sxf sxf lbg ;lsg% < s"g} klg &fp hxf tkfo{+ / tkfo{+sf] ;fylx? o:tf] lziffsf] nflu ;lhnf] nfu%. h:t} M #/, v]t, :s'nsf] d}bfg, sf]&f, ;*s %]pm, jf/l OTofbL.

131 Nepal Family Health Program ;fyl lzifsn] ug"{kg]{ sfo{x? 1= of}g /f]u / Pr=c fo{=el= P*\; ;g]{ tyf arfj^ jf/] ljbfyl{ ;fylx?nfo{lzifflbg]. 2= pknaw u/fopsf z } l If s ;fdfu Lsf] plrt e)*f/ tyf ljt/)f. 3= c fkm'n] lbpsf] hfgsf/l &Ls % ls %}g eg]/ Pr=c fo{=el= P*\; tyf of}g /f]u jf/] af/daf/ c Woog ug]{. 4= l z If s tyf c? ;fylx?;+u ldn]/ sfo{qmd ;+rfng ug]{. 5= c fkm'nfo{ klg P*\; tyf of}g /f]uaf^ arfpg]. 6= ;fyl;+u epsf uf]ko s"/fx? c?nfo{ gegg]. 7= c fkm'n] P*\; of}g /f]u jf/] s"/fx? c?nfo{ klg egg ;fylx?nfo{ k f]t;flxt ug]{. 8= klxnf] of}g ;DjGw c lxn] g} lsg gug]{ egg]jf/] ;fylx?nfo{ lziff lbg]. 9= of}g ;DjGw x"g ;Sg] ;+efjgf epsf kl/l:yltaf^ s;/l arg] egg]jf/] ;fylx?nfo{ l z If f lbg].

132 Health Promoting School (HPS)

133 Presentation Outline The Concept What is a HPS? Advantages of HPS Core Elements of HPS Comprehensive SHP Strategies for HPS FRESH Framework Sep 14,

134 The Concept WHO initiated global HPS since th ICHP set the HPS as one of ten priority areas for 21 st century. The concept of health promoting schools(hps) is about helping schools to build and use their entire organizational capacity to improve health among the pupils, staff, families and community members. A HPS is described as a school constantly strengthening its capacity as healthy setting for living, learning and working. It focuses on creating health and preventing important causes of death, disease and disability by helping school children, staff, family members and community members to: Care for themselves; Make decisions and have control over circumstances that affect their health; Create conditions that are conducive to health. Sep 14,

135 What is a HPS? A HPS is a place where all members of the school community work together to provide students with integrated and positive experiences and structures that promote and protect their health. This includes both the formal and informal curricula in health, the creation of a safe and healthy school environment, the provision of appropriate health services and the involvement of the family and wider community in efforts to promote health. -Health Edu. & Promotion Unit, WHO Sep 14,

136 What is Cont A HPS focuses on : Caring for oneself and others Making healthy decisions and taking control over life s circumstances Creating conditions that are conducive to health (through policies, services, physical/social conditions) Building capacities for peace, shelter, education, food, income, a stable ecosystem, equity, social justice, sustainable development Preventing leading causes of death, disease and disability: helminthes, tobacco use, HIV/AIDS/STDs, sedentary lifestyle, drugs and alcohol, violence and injuries, unhealthy nutrition. Influencing health related behaviors: knowledge, beliefs, skills, attitudes, values, support. Sep 14,

137 Advantages of HPS The HPS: Offers a holistic model of health that includes the interrelationships between the physical, mental, social and environmental aspects of health; Provides the opportunity for families to take part in the development of health skills and knowledge of their children; Addresses the significance of the physical environment (e.g., shaded play area) in contributing to the health of children; Recognizes the importance of the social ethos of the school in supporting a positive learning environment, one in which healthy relationships and the emotional wellbeing of students are strengthened; Sep 14,

138 Advantages Cont Links regional and local health services with the school to address specific health concerns that affect school children; Focuses on active student participation in the formal curriculum to develop a range of life-long healthrelated skills and knowledge; Enhances equity in education and health; Provides a positive and supportive working environment for school staff; and Enables the school and the local community to collaborate in health initiatives which benefit students, their families and community members. Sep 14,

139 Core elements of HPS The formal curriculum Ethos & Environment Family community & health links Sep 14,

140 Formal Curriculum The SHE curriculum is central to the development of a HPS. A well organized programme of SHE which takes account of knowledge, skills and attitudes can help to lay the foundations for young people to develop healthy lifestyles Sep 14,

141 Ethos and Environment Provides pupils with hidden messages beyond the taught curriculum. A HPS will ensure the these messages support and reinforce the messages in the SHE curriculum. Ethos=characteristic culture of a community manifested by attitudes Sep 14,

142 Family, Community & Health Links The school shares responsibility with the family and the community for the development of appropriate health behaviors. The HPS will work in partnership with parents and provide opportunities for involving them so that what is learned at school can be enhanced by congruous experience in the home and the community. Sep 14,

143 Components of Comprehensive SHP 1. School health service 2. School health education 3. Healthful school environment-physical & psychological 4. School-community project and school outreach program 5. Health promotion for school personnel 6. Nutrition and food safety 7. Physical education and recreation 8. Mental health, counseling and social supports -Center for Disease Control, USA, 1980 Sep 14,

144 Strategies for HPS Beautify and maintain clean environment Develop and improve school health curriculum Improve and sustain school health services Increase community action and participation Sep 14,

145 FRESH Framework FRESH is the acronym for Focusing Resources on Effective School Health FRESH is the common strategy for child friendly school and HPS Developed by WHO, UNICEF, UNESCO and WB for launching globally the HPS 2000 AD. The main theme is Good health increases enrollment and reduces absenteeism and brings more of the poorest and most disadvantaged children to school Sep 14,

146 FRESH Cont The four core elements of the FRESH are: School-based health and nutrition services; Healthy, safe and secure learning environment; Skill based health education; and Health related school policies Sep 14,

147 Health Promoting Hospitals

148 Background Based on the Ottawa Charter, the first conceptual developments on HPH started in 1988 A first model project "Health and Hospital", was initiated in 1989 at the Rudolfstiftung Hospital in Vienna, Austria, and successfully finished in 1996 In 1990, the WHO International Network of Health Promoting Hospitals was founded as a multi city action plan of the WHO Healthy Cities Network

149 Background In 1991, the HPH network, which was in the beginning an alliance of experts, launched its first policy document, the Budapest Declaration on Health Promoting Hospitals HPH has become a global movement with national and regional networks, individual member hospitals and health promotion initiatives on all continents. HPH member hospitals currently exist in Australia, Austria, Belgium, Brasil, Bulgaria, Canada, Czech Republic, Denmark, England, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Japan, Korea, Latvia, Lithuania, Northern Ireland, Norway, Poland, Russian Federation, Scotland, Serbia, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, and the USA

150 Background Health enhancement by empowering patients, relatives and employees in the improvement of their health-related physical, mental and social well-being. Hospitals play an important role in promoting health, preventing disease and providing rehabilitation services. Some of these activities have been an essential part of hospital work, however, the increasing prevalence of lifestyle-related and chronic diseases require a more expanded scope and systematic provision of activities such as therapeutic education, effective communication strategies to enable patients to take an active role in chronic disease-management or motivational counselling.

151 Principles Settings approach (good environment), empowerment and enablement, participation, a holistic concept of health (somato-psycho-social concept of health), intersectoral cooperation, equity, sustainability, and multi-strategy

152 Pre-requisites In order to realise the full potential of the comprehensive HPH approach for increasing the health gain of hospital patients, staff, and the community, HPH needs to be supported by an organisational structure: Support from top management, a management structure that embraces all organisatial units, a budget, specific aims and targets, action plans, projects, and programs, standards, guidelines and other tools for implementing health promotion into everyday business. This needs to be supported by evaluation and monitoring, professional training and education, research and dissemination.

153 Health Promoting workplace

154 The workplace, along with the school, hospital, city, island, and marketplace, has been established as one of the priority settings for health promotion into the 21st century. The workplace directly influences the physical, mental, economic and social well-being of workers and in turn the health of their families, communities and society. It offers an ideal setting and infrastructure to support the promotion of health of a large audience. The health of workers is also affected by non-work related factors.

155 The concept of the health promoting workplace (HPW) is becoming increasingly relevant as more private and public organisations recognize that future success in a globalizing marketplace can only be achieved with a healthy, qualified and motivated workforce. A HPW can ensure a flexible and dynamic balance between customer expectations and organisational targets on the one hand and employees skills and health needs on the other, which can assist companies and work organisations to compete in the marketplace. For nations, the development of HPW will be a prerequisite for sustainable social and economic development.

156 Aspects of Health Promoting Workplaces Participation of employees in the process of improving work organisation Active involvement and consultation of employees in improving their work environment All measures aimed at enhancing wellbeing at work, for example enabling flexible working hours or working from home Raising the topic of healthy eating at work, giving information on healthy nutrition as well as offering healthy canteen food or facilities to prepare own food

157 Aspects of Health Promoting Workplaces Tobacco awareness, including the offer of free participation in smoking cessation programmes as well as declaring a comprehensive smoking ban at the whole company site Mental health promotion, offering courses for managers on how to deal with stress and tension within their team, providing the opportunity for anonymous psychological consultancy for all employees Exercises and physical activity, offering sport courses, encouraging physical activity, promoting an active and healthy culture at work Health monitoring, offering checks such as blood pressure or cholesterol level

158 Benefits To the organization a well-managed health and safety programme a positive and caring image improved staff morale reduced staff turnover reduced absenteeism increased productivity reduced health care/insurance costs reduced risk of fines and litigation To the employee a safe and healthy work environment enhanced self-esteem reduced stress improved morale increased job satisfaction increased skills for health protection improved health improved sense of well-being

159 Life Skills

160 SHIFTING LIFE SKILL CONCEPT From survival and income generation skills (i.e. livelihood skills) to: individual's capacity to fully function and participate in daily life (i.e. life skills)

161 defined by the World Health Organization (WHO) as abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life. They represent the psycho-social skills that determine valued behaviour and include reflective skills such as problem-solving and critical thinking, to personal skills such as selfawareness, and to interpersonal skills.

162 Ten core life skills Self awareness Empathy Critical thinking Creative thinking Decision making Problem solving Effective communication Interpersonal relationship Coping with stress Coping with emotion

163 Continued.

164 Planning of Health Education Program (An introduction) Question: Who Should Plan? Answer: Who should not plan??

165 Background Any program should not be started all of sudden and neither should health education. It needs some careful systematic approach. Health education does not mean only to relay health information through use of medias. It must also aims at bringing change in attitude and behavior in relation to the specific health problems of the people. Most of changes require a planned health education program.

166 Introduction Before we begin planning our health education activities, we need to have a clear understanding of what planning means. Planning is the process of making thoughtful and systematic decisions about what needs to be done, how it has to be done, by whom, and with what resources. A plan is a blueprint for action. Its components are objectives, programs, schedules and budget.

167 Introduction Planning requires the assessment of NEEDS and RESOURCES, as also their proper matching, so that maximum needs may be fulfilled while utilizing minimum resources in the shortest possible time. Health needs defined as deficiencies in health that call for preventive, curative, control or eradication measures. Resources money, material, manpower, knowledge, skills, techniques and time. Since resources are limited proper planning is a must. This leads to the concept of 'priorities', which signifies selection of outstanding needs and meeting them more urgently than others that may wait till resources develop.

168 G.W. Steward says HE should be planned!! (and what do you say?) Health Education is that component of health and medical program that consists of planned attempt to change individual, group and community behaviour (What people feel, think and do) with the objective of helping achieve promotive, preventive, curative and rehabilitative ends G.W. Steward

169 Characteristics of Planning 1. Purposeful and need based. 2. Should consider the available resources and appropriate technology. 3. Should consider the socio-political environment. 4. Be participative and coordinated. 6. Be systematic. 7. It must be documented. 8. Be flexible 9. It must have continuity.

170 Importance To conduct health education program in a systematic way and accomplish the set objectives within scheduled time. To conduct health education program based on the problems. To obtain the rational use of resources in health education program. To accomplish health education program in an economic way. To enable health education workers take appropriate guidelines. To convey the same information to solve the problems with same nature.

171 Popular planning models and theories used in Health Education and Promotion The Rational Model (KAP Model) Health Belief Model PRECEDE-PROCEED Model Extended Parallel process Model Trans-theoretical Model of change Theory of Planned Behavior The activated health education model Social cognitive theory Communication theory Diffusion of innovation theory

172 Why are these theories and models so useful? They can be used as: i. A toolbox (for moving beyond intuition to designing and evaluating interventions) ii. A foundation (to design plans consistent with current emphasis) iii. A roadmap (studying problems, developing interventions, identifying indicators, evaluating impacts) iv. A guide (to explain the process for changing health behavior and factors) v. A compass (to help planners in identifying most suitable methodology)

173 Health Education Planning pyramid CURRICULUM/LESSON PLAN BOTTOM UP PLANNING STRATEGIES & INTERVENTIONS & PROGRAME ACTIVITIES GOALS & OBJECTIVES DETERMINANTS BEHAVIORS HEALTH PROBLEM

174 Steps of HE Program planning 1. Collection of baseline data or information 2. Identifying health & health education needs and priorities 3. Establishment of goals and objectives 4. Deciding target groups 5. Deciding content for health education 6. Deciding appropriate methods and media 7. Identifying necessary and available resources 8. Developing a detail plan of action (Scheduling) 9. Determining time and technique of evaluation

175 Need prioritization score table Needs Severity Community interest National priority Feasibility Sustainability Evaluation Total score 1 2 3

176 Realistic rational planning (Spiral rather than cycle) Formative Summative How many and which indicator Planning spiral Popn, area, infrastructure, political envt, health needs, health services, efficiency, equity, resources Rigor and value judgment, who, what, and economic appraisal Perception of needs How often and by whom Must link with budget Achievable objective Resource required and availability Social, economic and political effect. Equity and efficiency

177 Organizational levels of health education planning: Health ministry (National strategic plan) Regional health organizations (Regional plans) Private sector organizations (Business plans) District health organizations (District plans) NGOs (organizational plans) PHC/ HP/ SHP (Service Plan)

178 To be continued

179 Detail Plan of Action Tribhuvan University Institute of Medicine Maharajgunj Campus Venue: Training hall of Sharadanagar HP Duration: From 2064 Shrawan 21 to 27 Contents Specific Related Factors Message to convey Target Methods Resource Time Evaluation objectives Positive Negative group / Media Persons techniques Meaning of typhoid with its characteristic features At the end of the session, 80% of participants will be able to understand of typhoid Many cases are treated after confirmatory diagnosis of typhoid People believe that the fever is seasonal and it can be subsided spontaneously after few days Typhoid is a systemic infection - typical continuous fever for 3 to 4 weeks, relative bradicardia with rash (rose spot) on 2 nd week, Loss of appetite, Constipation, then -School children -FCHVs -Teachers -Local leaders -Mini lecture -Posters -Pamphlets -Flip chart - AHW - BPH students 1 hr Question/ Answer responses Mode of transmission of diseases Meaning of environmental sanitation At the end of session 90% of the participants will explain mode of transmission of typhoid At the end of session 80% of participants will be able to define environmental sanitation People believe that diseases may be transmitted through Faeces, food and urine People know that good surroundings protects health Do not know about the route of transmission of diseases But their belief is that human excreta disposal only mean of sanitation Diarrhoea Transmission of diseases through food, faeces, fingers, fluid, flies, field etc. Environmental sanitation control all the factors that affect health Same group and mothers as well as community key people - School children - FCHVs - Teachers - Local leaders - Mothers -Role play -Discussion -Demonstration -Posters -Pamphlets -Flip chart - Mini lecture - Discussion - Posters - Pamphlets - AHW - FCHVs - MCHW - BPH students - AHW - FCHVs - MCHW - BPH students 3 hrs Question/ Answer responses 1 hr Question/ Answer responses

180 Contents Sanitation barrier Importance of constructing toilet Importance of drinking purified water Waste disposal methods Specific objectives At the end of session 80% of the participants will understand the importance of sanitation barrier 80% of participants will be able to describe the importance of constructing latrine 90% participants will be able to describe the importance of drinking purified water 60% of participants will be able to describe waste disposal methods Related Factors Message to convey Target Positive Negative group Know that Do not know Sanitation barrier - school defecation in about protects healthy children latrine sanitation individual from - FCHVs makes barrier having infection - Teachers surroundings through food, - local clean faeces, urine via leaders 5Fs - mothers Toilet prevents foul smelling and makes surroundings clean Pure water is good for health Wastes everywhere looks unclean Its expensive to construct toilet and not really necessary Water boiling causes to loss original quality Sanitation is only toilet construction Toilet prevents fly breeding and acts as a sanitation barrier Water should be either treated or boiled to protect from water borne diseases Proper disposal of domestic waste and other degradable and non degradable wastes is the must group Same as above Same as above Methods / Media - Mini lecture - Discussion - Audio/ video - Posters - Pamphlets - Mini lecture - Group discussion - Audio/ video - Posters - Pamphlets - Mini lecture - Group discussion - Audio/ video - Posters - Pamphlets Resource Persons - AHW - FCHVs - MCHW - BPH students - AHW - FCHVs - MCHW - BPH students - AHW - FCHVs - MCHW - BPH students Time 1 1 /2 hr Evaluation techniques Question/ Answer responses 3 hrs Question/ Answer responses 3 hrs Question/ Answer responses Same as - Mini lecture - AHW 5 hrs Question/ above - Group - FCHVs Answer discussion - MCHW responses - Audio/ video - BPH - Posters students - Pamphlets Prepared by: Prakash Raj Sharma/ BPH 19 th Batch/ Roll No. 278

181 SOURCE OF DATA

182 Source of Data 1. Population census 2. Records of vital statistics 3. Records of health departments 4. Records of health institutions 5. Reports of special surveys 6. Experiments/ Periodical publications 7. Miscellaneous

183 1. Population census The total process of collecting, compiling and publishing demographic, economic and social data at specified time or times pertaining to all persons in a country or delimited territory, is called a population census. UN Hand Book of Population Census Methods

184 Population census An important source of health information In old days, it was carried out to count people for taxation and army recruitment. Now, it is carried out to assess the national needs and plan program for the people's welfare.

185 Characteristics Features of Population census Full count of population which includes each and every individual and is carried out at regular interval, usually it is being done every ten years. It pertains to a particular territory and the information is collected by making house to house visit on the specified dates in the first quarter of the first year of each decade.

186 Topic covered in census Total population at the time of census Age, sex composition and marital status Language spoken, education and economic status Fertility Citizenship, place of birth, urban and rural population

187 Use of Population Census Forms basis for calculation of health indices birth, death, morbidity, marriage rate etc. Planning health services Computation of average rate of growth Planning other welfare services schools, orphanages, food supplies

188 2. Records of Vital Statistics Statistics relating to population figures (birth, marriage and death) Civil registration system Birth Death Marriage London Bill of Mortality i.e. record of baptism, burials, marriage at the church by John Graunt ( ) Father of Vital Statistics

189 3. Records of health departments Department of Health Services (DoHS) Annual Report Notification of epidemic diseases e.g. cholera District Health Office/ District Public Health Office (DHO/ DPHO) Service records Records of diseases/ health related events/ behaviours

190 4. Records of Health Institutions Hospital, Primary Health Care Centre, Health Post and Sub-health Post Data s are biased do not cover the entire population Can not be generalized to the entire population

191 5. Reports of Special Surveys Look carefully at all of the population. Well conducted and comprehensive surveys give useful data about the health status of the community and the progress made to the measures adopted. Incidence and prevalence (epidemiological study) Diseases, births, deaths, nutritional status

192 Reports of Special Surveys Survey provide: Changing trends in health status, morbidity, mortality, nutritional status, environmental hazards, health practices; Feedback which may be expected to modify policy and system itself and lead redefinition of objectives; and Timely warning of public health hazards.

193 Reports of Special Surveys The essential requirement of a good survey: A well defined objective A well drafted plan of operations and questionnaire An epidemiologist or health expert Adequate statistical facilities Sufficiently trained and willing staff for field, with other needed facilities such as good transport, medicines, to get good cooperation

194 6. Periodical publications Publication of WHO Publications of Central Bureau of Statistics (CBS) Publication of NGO/ INGO Publication of MoH/ DoHS/ DHOs/ DPHOs Articles published in national and international journals Unpublished articles

195 7. Experiments Test or trial done carefully in order to study what happens and gain new knowledge. Performed in laboratory of: Physiology, Biochemistry, Clinical pathology or Hospital wards The data collected with specific object.

196 7. Miscellaneous Data from insurance companies e.g. death records Data from industries e.g. morbidity and mortality Data from these sources are insufficient for generalization in the population

197 Health Risk Appraisal

198 Introduction Health Risk Appraisal (HRA) refers to an approach to promoting healthy behaviors via providing a patient with factual evidence of how their current lifestyle may be damaging their future health. HRA originated in work by Robbins and Hall in the early 1970s. They applied actuarial procedures to estimate the likely impact of current behaviors, health status and previous health history on a person's risk of dying prematurely. This was the cornerstone of their idea of practicing "prospective medicine" by which they meant that physicians should treat not only current illnesses, but should anticipate and forestall the development of future conditions.

199 Current Trend The patient completes a computerized questionnaire that covers demographics, current health habits, and a brief family health history (e.g., what your parents died from). The system also requires data on BP, lipid levels, height, weight, etc. These data are processed using risk equations derived from epidemiological studies that estimate the person's risk of premature death; typically the estimate covers risk of dying from the 10 commonest causes of death over the coming 10 years. This risk is sometimes expressed as an equivalent health age: if a 50 year-old smokes and is overweight, he may be equivalent in health expectancy to a 55 or even a 60 year-old. To indicate the impact of each adverse health habit, the system then calculates the extent to which the person could improve their "health age" if they were to quit smoking, lose weight, etc.

200 Linkage to Health Promotion In theory, HRA should motivate change because it gives personalized information, it shows the improvement that could occur with altered lifestyle, it is precise, and is delivered in a health care setting in which support can be provided to help the person change. HRA is therefore an adjunct to health promotion.

201 Benefits The Wellness Councils of America (WELCOA) outlines 10 key benefits of conducting personal health risk assessments. Health risk assessments: Provide employees with a snapshot of their current health status. Enable individuals to monitor their health status over time. Provide employees with concrete information thus preparing them for lifestyle change. Help individuals get involved with health coaching. Provide important information concerning employees' readiness to change.

202 Benefits Help employers measure and monitor population health status. Provide employers with important information that can help them build results-oriented health promotion programmes. Can provide employers with important information on productivity. Allow employers to evaluate changes in health behaviour and health risks over time. Engage both employers and employees in the health management process.

203 Limitations Since HRAs are used for appraisal of risks, rather than the diagnosis of disease, it should not be used as an substitute for medical consultation and diagnosis

204 EASTERN PHILOSOPHY OF MEDICINE (AYURVEDA)

205 Ayurveda cfo' M hljgù j]b M lj1fg The Science of Life The Knowledge of Life

206 FOUR DIMENSIONS OF LIFE Personal Health and hygiene HITAYU AHITAYU Social Health and Hygiene SUKHAYU DUKHAYU

207 WHAT IS HEALTH? BALANCED BODY - SHARIR DOSHAS BYLOGICAL ELEMENTS DHATUS - TISSUES AGNI METABOLIC FIRE (Enzymes) MALAS BODY EXCRETAS HAPPINESS OR CAMNESS MIND - MANA SENSE ORGANS -INDRIYA SOUL- AATMA

208 WHERE AYURVEDA CAME FROM? Ayurveda was a divine system of medicine 5000 BC to 4000 BC Comes from Vedas Atharva veda details about Ayurveda

209 How Ayurveda comes on Earth The Ayurveda founder - Brahma THE KNOWLEDGE OF AYURVEDA COMES FROM BRAHMA TO DAKSHA PRAJAPATI ASHWINI KUMARA INDRA BHARDHWAJ

210 WHY AYURVEDA COMES ON EARTH PEOPLES START TO LIVE AGAINST NATURE EAT AGAINST NATURE BECOMES LAZY

211 WHO THOUGHT OF BRINGING AYURVEDA TO EARTH: ANICIENT SAINTS STRESHED ABOUT DISEASES MEETING ON HIMALYAS DICIDE TO SENT MAHARISHI BHARDWAJ

212 SCHOOLS OF AYURVEDA ATRYA : the school of physicians DHANWANTRI : the school of surgeons

213 THREE MAIN TEXT BOOKS OF AYURVEDA Caraka Samhita (approximately 1500 BC) Ashtang Hridyam (approximately 500 AD) Sushrut Samhita (approximately AD)

214 AIMS OF AYURVEDA TO ACHIEVE POSITIVE HEALTH FOR THE INDIVIDUAL. PROTECTION OF THE HEALTH OF INDIVIDUAL. ULTIMATE LIBERATION.

215 Comparison of Ayurvedic System of Medicine with Allopathy Ayurvedic System Experiential Holistic Philophical Health oriented Diet oriented Green pharmacy Pro-nature Client oriented Active on all humans No side effects Allopathic System Experimental Reductionistic Physical Disease oriented Drug and surgery oriented Red pharmacy Anti-nature Profession oriented Active on 30% humans Side effects Mode of action unknown Mode of action known? Slow effects Fast effects 12

216

217 Social Marketing

218 Background In the more than half a century since Wiebe ( ) posed his famous question Why can t you sell brotherhood like soap? the concept of social marketing has had enormous appeal for health promotion and social change programs Slowly, it was realized that key perspectives, principles, and tactics adapted from commercial marketing for social change programs can improve the strategic value of health communication and increase the likelihood that people will make healthy behavioral choices.

219 Definitions Social marketing is the application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence the voluntary behavior of target audiences in order to improve their personal welfare and that of their society (Andreasen, 1994) The Centers for Disease Control and Prevention (CDC) has thrown its institutional weight behind social marketing for health in the form of a new National Center for Health Marketing, which their Web site describes as an approach that draws from traditional marketing theories and principles and adds science-based strategies to prevention, health promotion and health protection (Bernhardt, 2006; Centers for Disease Control and Prevention, 2007).

220 Comparison between social marketing and commercial marketting Areas Social marketting Commercial marketing Primary locus of benefit Type of outcomes Characteristics of audience Market type Individuals and community people, target groups Change in knowledge, attitude and practice related to health; gratifications are delayed but benefit is longterm Mostly less affluent, diverse, harder to reach, disadvantaged; sometimes might be the general community people as a whole Product less tangible and complex, subsidized advertisement in most cases, Maretting organizations, producers of marketed goods Purchase of goods and products ; gratification immediate but benefit may be shortterm Tend to be more affluent, living in urban areas, who are having greater access to media, who are near the market Product more tangible, advertisement cost might be high because of profit motive and high taxation

221 Basic principles of social marketting Focus on behavioral outcomes Prioritizing consumers benefits rather than marketers benefit Maintaining an ecological perspective Effective communication strategy Audience segmentation where necessary

222

223 Planning a Health Education Program

224 Planning of health education program Planning is a process of developing a detailed and systematic program in order to accomplish a determined purpose. Health education does not mean only to relay health information through different medias, it must also aim at bringing change in attitude and behavior in relation to specific health problem of the people.

225 Planning of health education program Health education planning sets goals, objectives and methodologies to implement plan. A series of sequential steps have to be followed in order to develop a realistic and effective tactical health education program.

226 Steps in planning a health education program 1. Assessing health needs and gathering information: The first step in planning health education program

227 Steps of Planning a Health Education program Collecting baseline data and information: Vital statistics Status of health KAP Sanitary condition and facilities Availability of health services in the community Educational status Communication facilities Local resources

228 Steps in planning a health education program 1. Assessing health needs and gathering information The following information is important: Demographic information (population size, age structure, gender, culture etc) to decide relevant aspect of health promotion Information on frequency of specific causative factors related and allied disease to decide concentration on effort

229 Steps in planning a health education program 1. Assessing health needs and gathering information Health related life-style in the community (smoking, drinking alcohol, eating habits, hygiene practice and so on) Environmental influences on health (water resources, industries, transport etc)

230 Steps in planning a health education program 1. Assessing health needs and gathering information Attitude on health worries and health related behaviors good and bad (work, eating habits, exercises, drinking habits, smoking habits) People s knowledge about health related issues. Sources of health information of community people (counseling clinic, health professionals, parents, friends, medias, leaders etc)

231 Steps of Planning a Health Education program 2. Identify health and health education needs on priority basis: Magnitude of the problem Felt needs of the people Feasible to meet the needs Have the short solution time Problem not being addressed by other agencies in the community

232 Behavioral Matrix More changeable More important High priority for program focus (High Priority Quadrant I) Less important Low priority except to demonstrate change for political purposes (Low priority Quadrant III) Less changeable Priority for innovative program; evaluation crucial (Quadrant II) No program (Quadrant IV) 10

233 Steps in planning a health education program 3. Setting goals and objectives: The broad areas that health promotion will address Health promotion aims at changing lifestyle and therefore requires a good knowledge of cultural background and dynamic of target groups.

234 Steps in planning a health education program 3. Setting goals and objectives The information required for goal setting are: Demographic Prevalence of certain diseases Knowledge of what could be changed The aims will be derived from the information available

235 Steps in planning a health education program 3. Setting goals and objectives For effective disease control, the goal should be set according to the current situation and those which need to be focused mainly are addressed e.g. certain diseases, involvement of cost, mortality

236 Steps of Planning a Health Education program 3. Establishing goal and objectives Goal: A goal is expressed in general or broad term, which denotes overall fulfillment of the program. Example: To provide health education to the families of Chaukot VDC on the need and importance of safe disposal of excreta and motivate them to construct a latrine in their house within one years of time.

237 Steps of Planning a Health Education program 3. Establishing goal and objectives Objectives: Objectives lead to the precise direction and are developed to fulfill the goal of the program. The objective should fulfill the SMART characteristics. Example of objectives: 90% of the target people can state the importance of safe disposal of human excreta. 60% of the houses construct and use their latrine.

238 Steps in planning a health education 3. Setting objectives: program The objectives are important because they will guide activities and are used for evaluation of planned activities at the end.

239 Steps in planning a health education program 3. Setting objectives An objective for effective communication should specify: The intended change in a detailed form Amount of change above the initial stage To whom the change is directed Time scale over which the change takes place Change that are relevant and realistic

240 Steps in planning a health education program 4. Selecting target groups: Health promotion activities should match to the needs of the groups. Plan a series of linked activities aimed at different groups.

241 Steps in planning a health education program 4. Selecting target groups Different groups of population have different needs and therefore information should target these needs. Objectives are set according to the information on target groups.

242 Steps of Planning a Health Education program 4. Deciding target group: Most in need of education because of the existing health problem Most likely to be open to the introduction of new ideas affecting their health behaviour Most likely to be able to change their behaviour and also influence for the change of others behavior

243 Steps in planning a health education program 5. Listing the options and implementation: After setting objectives and identifying target groups, one has to consider what activities will be undertaken to achieve the objectives. The different ways in which the objectives could be achieved need to be listed with there advantages and disadvantages.

244 Steps in planning a health education program 5. Listing the options and implementation Then their effectiveness, resources and acceptability of the target population should be assessed with the options and activities.

245 Steps in planning a health education program 5. Listing the options and implementation In the action plan identify the resources, time, people needed for each activity and monitor the outputs against the planned activities. Implementation process includes implementing the action plan, monitoring and evaluation.

246 Steps of Planning a Health Education program 6. Deciding contents to be taught: Should be based on the objectives set As explained in objectives, here the contents can be: Need and importance of safe disposal of human excreta Foecal-oral transmission process of disease Technique of construction of a latrine Location and proper use of latrine

247 Steps of Planning a Health Education program 7. Deciding for appropriate methods and media: The methods and media for health education should depend upon: The nature of the objectives, Contents and Target people.

248 Steps in planning a health education program 8. Identifying necessary and available resources: Must include the locally available health resources Resources available for health services Skilled persons Community people and leaders

249 Steps in planning a health education program 8. Identifying necessary and available resources: Must include the locally available health resources People having special interest and good knowledge about various diseases and support health promotion activities Other resources: - schools, NGOs, social workers

250 Steps in planning a health education program 8. Identifying necessary and available resources: Government institutions Donor agencies Private sector industries Individual willing to provide funds

251 Steps of Planning a Health Education program 8. Identifying necessary and available resources: Types according to the source: Internal and external Type according to the nature Human resources, Money, Material, Time and Technology

252 Steps of Planning a Health Education program 9. Developing a detailed plan of action: This is the steps of developing an operational plan. Specific objectives to be dealt with Contents to be taught Target group to be dealt with Methods and media to be used Kinds human resources to be involved Date and time of teaching with duration Location

253 Steps in planning a health education program 10. Determining time and technique of evaluation: Evaluation is the method by which the effectiveness of a program is determined. It is the systematic and scientific method for determining the extent to which an action or set of actions were successful in the achievement of predetermined objectives.

254 Steps in planning a health education program 10. Determining time and technique of evaluation It involves the measurement of adequacy, effectiveness, and efficiency of health services. Evaluation enables improvements in the design and assessing the outcome and its impact.

255 Steps of Planning a Health Education program Determining time and technique of evaluation: It is done at three levels: Planning process at beginning, Progress of program during implementation and Achievement of the program at the end

256 Thank You

257 Different planning approaches in HPE

258 Approaches An Educational and Ecological Approach (PRECEDE PROCEED MODEL) also known as diagnostic approach Intervention mapping approach Participatory approach Systems approach

259 Intervention Mapping approach the needs assessment the definition of performance and change objectives based upon scientific analyses of health problems and problem causing factors; the selection of theory-based intervention methods and practical applications to change (determinants of) health-related behavior; the production of program components, design and production; the anticipation of program adoption, implementation and sustainability; and the anticipation of process and effect evaluation.

260 Participatory approach

261 Systems approach

262 HEALTH EDUCATION AND PROMOTION METHODS & APPROACHES

263 APPROACHES Medical or Preventive Behaviour Change Educational Empowerment Social Change

264 THE MEDICAL APPROACH Aim is freedom from medically-defined disease and disability such as infectious diseases Involves medical intervention to prevent or ameliorate ill-health Values preventive medical procedures and the medical profession s responsibility to ensure that patients comply with recommended procedures

265 THE BEHAVIOUR CHANGE APPROACH Aim is to change people s individual attitudes and behaviour so that they adopt a healthy lifestyle Examples include teaching people how to stop smoking, encouraging people to take exercise, eat the right food, look after their teeth etc Proponent of this approach will be convinced that a healthy lifestyle is in the interest of their clients and that they are responsible to encourage as many people as possible to adopt a healthy lifestyle

266 THE EDUCATIONAL APPROACH Aim is to give information and ensure knowledge and understanding of health issues and to enable wellinformed decisions to be made Information about health is presented and people are helped to explore their values and attitudes and make their own decisions Help in carrying out those decisions and adopting new health practices may also be offered

267 THE EDUCATIONAL APPROACH (Cont d) Proponent of this approach will value the educational process and respect the right of the individual to choose their own health behaviour Resposibility to raise with clients the health issues which they think will be in their client s best interests

268 THE CLIENT-CENTRED APPROACH (EMPOWERMENT) Aim is to work with clients in order to help them to identify what they want to know about and take action on and make their own decisions and choices according to their own interest and values Health promoter s role is to act as a facilitator in helping people to identify their own concerns and gain the knowledge and skills they require to make things happen

269 THE CLIENT-CENTRED APPROACH (EMPOWERMENT) (Cont d) Self-empowerment of the client is seen as central to this aim Clients are valued as equal who have knowledge, skills and abilities to contribute, and who have an absolute right to control their own health destinies

270 THE SOCIETAL CHANGE APPROACH Aim is to effect changes on the physical, social and economic environment, in order to make it more conducive to good health Focus is on changing society not on changing the behavior of individuals Proponent of this approach will value their democratic right to change society and will be committed to putting health on the political agenda

271 APPROACHES SUMMARY APPROACH AIMS METHODS WORKER/CLIENT RELATIONSHIP Medical To identify those at risk from disease. Primary health care consultation, e.g. measurement of body mass index. Expert led. Passive, conforming client. Behaviour change To encourage individuals to take responsibility for their own health and choose healthier lifestyles. Persuasion through one-toone advice, information, mass campaigns, e.g. Look After Your Heart dietary messages. Expert led. Dependent client. Victim blaming ideology.

272 APPROAC H Educational Empowerm ent Social change AIMS METHODS WORKER/CLIENT RELATIONSHIP To increase knowledge and skills about healthy lifestyles. To work with clients or communities to meet their perceived needs. To address inequities in health based on class, race, gender, geography. Information. Exploration of attitudes through small group work. Development of skills, e.g. women s health group. Advocacy Negotiation Networking Facilitation e.g. food co-op, fat women s group. Development of organisational policy, e.g. hospital catering policy. Public health legislation, e.g. food labelling. Fiscal controls, e.g. subsidy to farmers to produce lean meat. May be expert led May also involve client in negotiation of issues for discussion. Health promoter is facilitator. Client becomes empowered. Entails social regulation and is top-down.

273 IMPORTANT HEALTH DAYS OBSERVED Compiled by Mr. Chiranjeebi Shah M.Sc. M.P.H.

274 January Jan World Leprosy Eradication Day

275 February World Cancer Day Sexual & Reproductive Health Awareness Day

276 March Glucoma Day International Women s Day No Smoking Day World Kidney Day World Disabled Day / World Consumer Rights Day Measles Immunization Day World Day for Water World TB Day

277 April World Health Day World Haemophilia Day World Liver Day Earth Day World Malaria Day

278 May World Asthma Day World Red Cross Day World Thalassaemia Day World Chronic Fatigue Syndrome Awareness Day/International Nurses day World Hepatitis Day International Women s Health Day Anti-tobacco Day/World no tobacco Day

279 June World Environment Day World Brain Tumor Day World Blood Donation Day

280 July Doctors Day (In India) World Population Day ORS Day

281 August World Breast Feeding Week 25th Aug 8 th Sept Eye Donation Fortnight

282 September 1 to National Nutrition week World Oral Health Day World Alzheimer s Day World Day of the Deaf World Heart Day / World Rabies Day

283 October International Day for the Elderly National Anti Drug Addiction Day World Mental Health Day World Sight Day (Thursday of October Every Year) World Arthritis World Food Day World Trauma Day World Osteoporosis Day World Iodine Deficiency Day World Polio Day World Obesity Day World Stroke Day World Thrift Day

284 November 2--- World Pneumonia Day World Immunization Day Diabetes Day World Epilepsy Day World COPD Day 15 to New Born Care Week

285 December 1--- World AIDS Day National Pollution Prevention Day International Day of Disabled Persons World Patient Safety Day

286

287 Implementation of Health Education Programme Raj K Subedi CIST College

288 Meaning of Implementation It is the phase in which the planner is ready to utilize the resources, materials, and methods to do what has been planned. It is time to take care of needs as determined by the needs assessment. During implementation 1. Make final preparations, and plan social marketing, community education,, and so on. 2. Be sure all equipment, services, utilities, licenses, and permits are in place Implementation is the most critical part of the planning process; a plan that is not implemented is no plan at all.

289

290 Developing the Implementation Strategy I keep six honest serving-me (they taught me all I know); Their names are WHAT and WHY and WHEN and HOW and WHERE and WHO. I send them over land and sea, I sent them east and west; But after they have worked for me I give them all a rest. From "The Elephant's Child" by J. Rudyard Kipling

291 Nine factors used to plan implementation activities (Why) the effect of the objectives to be achieved. (What) the activities required to achieve the objectives. (Who) the individuals responsible for each activity. (When) a chronological sequence of activities and timing in relation to project implementation activities or organization events. (How) the materials, supplies, technology, devices, methods, media, approaches, flow of activities (patients), or techniques to be used. (Where) which activities will take place at what location in the community, at the health promotion site, facility, office, clinic, center? (Cost) an estimate of expenses for materials, personnel, facilities, and time. (Feedback) when and how to tell if the activities are happening as they should be and if adjustments are needed; use timelines. (Evaluation) the assessment of progress, success, efficiency, effectiveness, quality, use of resources, meeting goals and objectives, effect on target population, short-term results, long-term outcomes.

292 Health Education Implementation phase involves: HE program activation, and HE Program operation activation This means making arrangements to have the program started. It involves coordination and allocation of resources to make it operational. operation This is practical management of a program. Here, project inputs are transformed into outputs to achieve immediate objectives. 6

293 Approaches to HE Program implementation Top-down approach Implementation mainly done by agencies from outside the community with limited involvement by the beneficiaries. Bottom-up approach Beneficiaries implement the program. Outside agencies may provide the financial resources and technical assistance. Collaborative participatory approach Both top-down and bottom-up approaches to program implementation are applied in the process. 7

294 Project implementation plans The following methods may be used to implement the projects Gantt chart Critical Path Method (CPM) or Net work analysis Project Evaluation and Review Techniques (PERT) Simple formats 8

295 What is a GANTT Chart? The Gantt chart is also referred to as the progress chart. It is a chart showing the timing of program activities using horizontal bars. It is one of the techniques of scheduling, which depicts the frequency of activities and determines the period of time for implementation. 9

296 How to determine a GANTT chart Determine the parts or implementation phases of the HE Program and the sequence in which the associated activities shall be carried out Then estimate the amount of time required for each activity List the activities that can be carried out at the same time and identify those to be carried out sequentially 10

297 How to construct a GANTT chart Time represented on the horizontal axis, and activities on the vertical axis. Bars are entered to indicate the time period allocated for each activity and the state of progress at any particular point in time. 11

298 Example of implementation plan of a Health Education Project Activity Evaluation of education Skill development training Giving education by lecture Selecting target group Generating resources Preparing content J F M A M J J A S O N D Time period/ months 12

299 Delivery: The core of HE implementation Once the educator (trainer), course, content, equipment, topics are ready, the delivery of the HE program is done. Completing implementation plan does not mean the work is done because implementation phase requires continuous adjusting, redesigning, and refining. Preparation is the most important factor to taste the success.

300 Implementation (delivery) phases 1. Before the program The educator should be familiar with training goal, estimated budget, strategy, time limit etc. The educator should informed earlier about venue, nature of participants etc. 14

301 Implementation.. 2. Just before the program The trainer The trainer need to be prepared mentally before the delivery of content. Trainer prepares materials and activities well in advance. comfortable with course content and is flexible in his approach. Physical set-up Good physical set up is pre-requisite for effective and successful training Classrooms should not be very small or big but as nearly square as possible. Other for eg. Flip Chart, Marker, Card board, Table, Computer, OHP, Slide, Board, White paper, Adequate stationery, mike, etc. 15

302 Implementation.. 3. During the training Establishing rapport with participants There are various ways by which a trainer can establish good rapport and participation during the training session with trainees by: Greeting participants simple way to ease those initial tense moments Encouraging informal conversation Remembering their first name Pairing up the learners and have them familiarized with one another 16

303 Implementation.. Listening carefully to trainees comments and opinions Telling the learners by what name the trainer wants to be addressed Getting to class before the arrival of learners Starting the class promptly at the scheduled time Using familiar examples Varying his instructional techniques Using the alternate approach if one seems to bog down 17

304 Implementation.. 4. Just After the program After the program, trainer should provide time to tell training experience, learning experience, behavior and attitude change experience, acknowledging to organizer and other participant, final rapport building and evaluation of training. 18

305 Barriers to implementation of HE Program Lack of interest by the potential participants that may be due to a poor need assessment or lack of one, because need assessments should identify this problem. Lack of understanding by administration, participants, staff, board, or community organizations, often due to poor communication. Lack of financial payment system, reimbursement, or support. Lack of quality educational content. Inadequate quantity of educational materials. Insufficient communication about the program; little or no social marketing or poor marketing. dissatisfaction with the health education program delivery. Placing personnel in positions for which they are not trained or qualified. Poor management of the implementation and initial phases of the program

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307 EVALUATION IN HEALTH PROMOTION

308 EVALUATION IN HEALTH PROMOTION Does Health Promotion work? Can we demonstrate the success of Health Promotion? How can do we measure success in Health Promotion? What is evaluation in Health Promotion?

309 EVALUATION Making a value judgement about something. A critical assessment of the good and bad points of an intervention, and how it can be improved. Answers the question: Have the programme objectives been achieved?

310 DOES HEALTH PROMOTION WORK? The north Karelia Project launched in 1971 was a heart disease prevention project located in an area in Finland which had the highest rate of premature deaths from coronary heart disease in Europe. The project used an integrated community-wide approach which included the mass media, the development of a schools programme, use of volunteers to act as lay educators and role models in the community, and the production of low-fat foods. Evaluation showed that risk behaviours, such as fat consumption and smoking, declined more dramatically in North Karelia than in the rest of Finland. This change in behaviour was matched by a reduction in risk factors for CHD, such as mean serum cholesterol and blood pressure, which again was greater than for the rest of Finland. The population reported improvements in their health and general well-being. There was a greater reduction in the death rate from CHD in North Kerala than for Finland as a whole. Source: Tones et al.,

311 SOME DEFINITION Evaluation is the process of assessing what has been achieved (whether the specified goals, objectives and targets have been met) and how it has been achieved. (Simnett, I) A process that attempts to determine as systematically and objectively as possible the relevance, effectiveness and impact of activities in the light of their objectives. (Last, J.M., A Dictionary of Epidemiology)

312 SOME TERMS Effectiveness what has been achieved Efficiency how the outcome has been achieved, and how good is the process (value for money, use of time & other resources)

313 WHY EVALUATE? To assess results and to determine if objectives have been met. To justify the use of resources. To demonstrate success in order to compete for scarce resources. To assist future planning by providing a knowledge base. To improve our own practice by building on our success and learning from our mistakes.

314 WHY EVALUATE? cont/... To determine the effectiveness and efficiency of different methods of Health Promotion. This helps in deciding the best use of resources. To win credibility and support for Health Promotion. To inform other health promoters so that they don t have to reinvent the wheel. This helps others to improve their practice.

315 WHAT TO EVALUATE? WHAT has been achieved - the outcome HOW it has been achieved - the process

316 TYPES OF EVALUATION Process evaluation Impact evaluation Outcome evaluation

317 PROCESS EVALUATION The process refers to what happens between the input and the outcome. PE is concerned with assessing the process of programme implementation and how the programme id performing as implementation takes place. Ongoing, a method of quality control. Monitors progress of the programme, whether the planned activities are carried out efficiently, cost effectively and as scheduled.

318 IMPACT EVALUATION Impact refers to immediate effects of the intervention or short-term outcome. It is carried out at the end of the programme.

319 OUTCOME EVALUATION Outcome are the long-term consequences; they are usually the ultimate goals of a programme. Outcome evaluation involves an assessment of long-term effects of a programme. More difficult & time-consuming to implement.

320 HOW TO EVALUATE?

321 PROCESS EVALUATION Measuring the programme inputs i.e. the resources expended in implementing the programme in order to determine whether the programme was worthwhile (efficient and cost effective) Using performance indicators to measure activity. PI provide a quantifiable measure activity. Examples are: Number of health educational materials produced and distributed.

322 PROCESS EVALUATION cont/... Obtaining feedback from other people e.g. colleagues and other staff. Obtaining feedback from the clients or participants of HP programmes their reactions, perceptions and suggestions methods include observation, interview or questionnaires Documentation e.g. reports, checklist, diaries, videotaping, slides etc.

323 PROCESS EVALUATION cont/... Number of health educational materials produced and distributed. Number of people attending educational activities. Screening uptake rates. Uptake of physical activities formed and number of people involved. o PIs need to be identified at the planning stage. o Monitoring PIs helps you to determine how well your programme is progressing.

324 IMPACT EVALUATION Measure changes in health awareness, knowledge and attitudes. Measure interest shown by target groups e.g. uptake of health education materials, phone-ins, participation in activities etc. Observation, questionnaires, interviews, discussions etc. Use of attitude scales.

325 IMPACT EVALUATION cont/... Evaluate behaviour change Observing what clients do. Recording behaviour e.g. number of people attending exercise sessions, health screening, stop smoking etc. Interview or questionnaire. Evaluate policy changes Introduction of pro-health policies in schools, workplaces etc. Such as safety policies, healthy food, exercise, No Smoking etc.

326 IMPACT EVALUATION cont/... Changes in the environment Cleaner air. Less/no littering. Creation of no-smoking zones/areas. Provision of public toilets. Provision of safe water supply and better housing. Increase in % of food premises with acceptable hygienic rating. Reduction in Aedes breeding sites.

327 IMPACT EVALUATION cont/... Changes in health status Improvements in BMI, blood pressure, fitness levels, blood cholesterol levels etc.

328 OUTCOME EVALUATION