1 / 27

Strategic Planning In Public Health: A Program Approach

Strategic Planning In Public Health: A Program Approach. TH Tulchinsky MD MPH Braun School of Public Health Hebrew University-Hadassah, Jerusalem October 2003. Strategy.

cmathew
Download Presentation

Strategic Planning In Public Health: A Program Approach

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Strategic Planning In Public Health: A Program Approach TH Tulchinsky MD MPH Braun School of Public Health Hebrew University-Hadassah, Jerusalem October 2003

  2. Strategy • A set of essential measures (preventive and therapeutic) believed sufficient to control a health problem (Last J. Dictionary of Epidemiology, 3rd edition, 2000) • A program or series of measures, stratagems and activities planned and carried out for the purpose of achieving specific objectives (Webtser Dictionary)

  3. Strategy and Tactics • Strategy - A plan or method or series of maneuvers or stratagems for obtaining a specific goal or result. • The art and science of planning and directing large scale use of resources with long range planning and development to ensure success in achieving objectives e.g. prevent or successfully combat disease in a population, plan a military campaign • Tactics – use and deployment of resources in actual field conditions e.g. military, police, firefighting, public health.

  4. How to Fight and Win • Who is the enemy? • What are the enemy’s objectives? • What are our objectives? • What are their resources/capabilities? • What are our resources/capabilities? • How best can we achieve our objectives? • What are the most suitable methods of combat? • Intelligence and modification of strategy and tactics

  5. Battle of the Atlantic • Phase I, June 1939-April, 1943 • Convoy system, British codes broken • German wolf packs control of sea lanes increasing • Allies build quantitative strength, new technology • Air gap 800 miles • Phase II May 1943-1945 • Crisis April-May 1943 -the tide turns • Allied quantitative and qualitative achievements • Air gap closed; convoys plus hunter-killer groups • Technological advances e.g. radar, squid, torpedoes • German innovations too late

  6. “The U-boat was the only thing I really feared in WWII.”Winston Churchill

  7. The Crisis of Battle of the Atlantic, Aug 1/42 to May 21/43Winston Churchill, World War II, Vol 5

  8. Jack Maple’s Law, NYPD 1993-96 • Objective – reduce crime and murder rates • Methods • 1. Accurate and timely intelligence • 2. Rapid deployment • 3. Effective tactics • 4. Relentless follow-up • 5. Continuous assessment and data • Murders fell from 1,946 (1993) to 1,000 (1996)

  9. MVA Mortality and Mileage, United States, 1925-1997 Deaths Vehicle Miles Traveled

  10. Cardiovascular Disease Mortality Rates, United States, 1900-1999

  11. Expanded Host-Agent-Environment Paradigm • Host - genetic, nutritional, life style, personality, psychosocial and other factors • Agent - microbiologic, toxic, stress, work, nutrient excess or deficiency • Environment – vector, physical-societal context • Intervention - clinical, preventive, environment Host Host Environment Agent Environment Agent Intervention

  12. Determinants of Population Health Income & Social Status Social Support Networks Education Physical environments Biology & genetic endowment Employment & working conditions Healthy child development Personal health practices & coping skills Health Services

  13. A Comprehensive Health Services Continuum: Manitoba Promotion Palliation Hospitals Healthy Public Policy Prevention Promotion Protection Support Services To Seniors Community Health Centres Outpatient Ambulatory Care Rural Community Urban Community Tertiary Palliation Community Oriented Services Home Care Extended Treatment & Long Term Care Rehabilitation

  14. Health Resources • Political and public support • Community and media expectations and support • Manpower and training • Money • Facilities for in-patient care – acute and LTC • Community care – clinics, outreach, home care • Drugs • Vaccines • Education

  15. Healthy Infants • Healthy women in age of fertility e.g. iron and folate • Good prenatal care and risk assessment • Good care during delivery e.g. in hospital • Good neonatal care e.g. vitamin K • Good infant care e.g. immunization, • Growth and development monitoring • Breast feeding plus vitamins A, C, D, iron • Formulas to one year • Solid foods from 4 months • Warmth, care, stimulus

  16. Infant Mortality, United States, 1900-1999

  17. Maternal Mortality, United States, 1900-1999

  18. Communicable Disease Control • Sanitation and hygiene • Safe water and food • Sewage collection and treatment • Education - public, professional, patients • Epidemiologic reporting, surveillance • Training in PH, epidemiologic investigation • Up to date immunization program • Good programs for “Social Diseases” i.e TB, STDs, HIV, Hep B, Ca Cx • Good primary and secondary care treatment • Good laboratory support

  19. Social Diseases: TB, STIs, HIV, Hepatitis, Cancer of Cervix • Common risk groups and factors • “Noxious synergy” • Prevention and treatment strategies e.g anti- retroviral drugs, immunization • Ambulatory and community care • Screening and case contact follow-up • Community outreach • Education • Specialized tertiary care and terminal care • Long term strategies for sustainable success

  20. AIDS Incidence, Deaths and Prevalence, United States 1981-2000 1993 Definition Implementation AIDS Deaths Prevalence

  21. Safe Community Water Supplies • Safe water sources – contamination • Coagulation • Filtration • Disinfection and residual chlorine - mandatory • Routine testing – bacterial and chemical • Routine chemical testing • Sanitary engineering inspection • Safe distribution and drainage systems • Updated standards • Epidemiologic monitoring of diseases

  22. Non-Communicable Disease Control • Primary prevention • Reduce CVD risk factors – BMI, exercise, smoking • Good nutrition e.g. much vegetables, little fat • Secondary Prevention • Hypertension and diabetes control • Good treatment of AMI, stroke • Technology assessment and adoption • Tertiary prevention • Good long term care in community • Hospital care in extremis

  23. Motor Vehicle Trauma Control • Primary prevention • Transport policy e.g. trains vs. cars • Laws and policing e.g. speed, seatbelts, helmets • Roads e.g. shoulders, roundabouts, lights • Alcohol control e.g. supply, taxation, • Education • Secondary prevention • Emergency care at site • Good emergency transportation • trauma care in hospital • Good hospital care and training • Tertiary prevention • Good rehabilitation care

  24. Summary • Define the problem • Adopt program approach • Develop an intervention program and budget • Inter-sectoral cooperation • Political support and resources • Management group • Technology - “the state of the art” • Define realistic alternative approaches • Implementation tactical program • Intelligence i.e. continuous monitoring • Reevaluation and revision • Communicate what you are doing

  25. Working Toward Goals

More Related