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Health Education, Advocacy and Community Mobilisation Module: 12. Planning Health Education Programmes: 1
Study Session 12 Planning Health Education Programmes: 1
Introduction
Careful planning is essential to the success of all health education activities. This study session is the first of two sessions that will help you to learn about ways in which you can plan your health education activities. In this study session, you will learn about the purpose of planning health education interventions, the basic concepts of planning, and what steps to take when you are planning. The study session will focus in particular on needs assessment, which is the first step in planning health education and promotion. You will learn about categories of needs and techniques that you can use when carrying out needs assessment.
You may have covered some aspects of planning in other modules such as the Health Management, Ethics and Research Module. However, planning in this study session refers specifically to the health education planning process (Figure 12.1).
Learning Outcomes for Study Session 12
When you have studied this session, you should be able to:
12.1 Define and use correctly all of the key words printed in bold. (SAQs 12.1 and 12.2)
12.2 Explaiin the purpose of planning health education activities. (SAQ 12.2)
12.3 List the principles of planning in health education practice. (SAQ 12.2)
12.4 Describe the six steps of planning health education interventions. (SAQ 12.3)
12.5 Describe the main categories of needs assessment. (SAQs 12.4 and 12.5)
12.5 Discuss some of the techniques of needs assessment. (SAQs 12.4 and 12.6)
12.1 Planning health education activities
Before you can begin planning your health education activities, you 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. Planning is central to health education and health promotion activities (Box 12.1). If you do not have a plan, it will not be clear to you how and when you are going to carry out necessary tasks. Everyone makes plans — for looking after their family, for cooking, and so on. You can build on experience you already have in planning, and apply it to health education.
Box 12.1 Key questions to ask when planning
- What will be done?
- When will it be done?
- Where will it be done?
- Who will do it?
- What resources are required?
12.2 The purpose of planning in health education
There are several benefits to planning your activities. Firstly, planning enables you to match your resources to the problem you intend to solve (Figure 12.2). Secondly, planning helps you to use resources more efficiently so you can ensure the best use of scarce resources. Thirdly, it can help avoid duplication of activities. For example, you wouldn’t offer health education to households on the same topic at every visit. Fourthly, planning helps you prioritise needs and activities. This is useful because your community may have a lot of problems, but not the resources or the capacity to solve all these problems at the same time. Finally, planning enables you to think about how to develop the best methods with which to solve a problem.
Haimonot is a Health Extension Practitioner. She is working at a health post near your village. Haimonot is doing health education activities — but not planning them. How would you convince her that planning health education activities would be helpful? What points would you want to talk about? Use the paragraph above to help you plan what you want to say.
To convince Haimonot to plan her own health education activities, you could explain the purpose of planning to her. You could explain that:
- Planning will make it easier for her to identify what she needs to do, and be more efficient in her work.
- Planning would help her to prioritise the health problems in her community that need intervention.
- Planning would help her choose the problems that are most important, and to match resources with the problems she intends to address. This would enable her to use her scarce resources more efficiently, and avoid unnecessary activities.
12.3 Principles of planning in health education
In this section you will learn about the principles you should apply when planning any activity in the community. Planning is not haphazard — that means there is a principle, or a rule, which you should take into account when developing your health education plans. You should always consider the principles shown in Box 12.2 when you plan a piece of work.
Box 12.2 Six principles of planning in health education
- It is important that plans are made with the needs and context of the community in mind. You should try to understand what is currently happening in the community you work in.
- Consider the basic needs and interests of the community. If you do not consider the local needs and interests, your plans will not be effective.
- Plan with the people involved in the implementation of an activity. If you include people they will be more likely to participate, and the plan will be more likely to succeed.
- Identify and use all relevant community resources.
- Planning should be flexible, not rigid. You can modify your plans when necessary. For example, you would have to change your priorities if a new problem, needing an urgent response, arose.
- The planned activity should be achievable, and take into consideration the financial, personnel, and time constraints on the resources you have available. You should not plan unachievable activities.
Meserete is a Health Extension Practitioner. Some time ago she developed a health education programme for her community. At the beginning, she identified some important health problems that were occurring in her community. Local people were recruited to identify their own health problems, and to look for a solution appropriate to their setting. Meserete also identified local resources that would be helpful for her health education activities. Finally, she developed a plan to meet the needs of the community and started to implement it. However, she faced a shortage of resources to carry out all of the items in her plan, so she prioritised the items and modified her plan according to the resources that were available. Look at Box 12.2 above, and work out which principles of planning you think Meserete used.
Meserete has worked well, and used all the principles of planning. She understood local problems [principle 1], and considered the interests of the community [2]. Local people participated in the programme at all stages [3]. She also identified local resources for her health education programme [4], and made sure that her plan was flexible [5]. Meserete also modified her plan, and she thought very carefully about what was achievable [6].
12.4 Steps involved in planning health education activities
Planning is a continuous process. It doesn’t just happen at the start of a project. If you are involved in improving and promoting individual, family and community health, you should make sure that you plan your activities. Planning can be thought of as a cycle that has six steps (Figure 12.3). In this section, you will learn the basic steps to take when planning your health education activities.
12.5 Needs assessment
Conducting a needs assessment is the first, and probably the most important, step in any successful planning process. Sufficient time should be given for each needs assessment. The amount of time required for a needs assessment will depend on the time you have available to address the problem, and the nature and urgency of the problem being assessed.
Needs assessment is the process of identifying and understanding the health problems of the community, and their possible causes (Figure 12.4). The problems are then analysed so that priorities can be set for any necessary interventions. The information you collect during a needs assessment will serve as a baseline for monitoring and evaluation at a later stage.
Before you begin a needs assessment, it is important to become familiar with the community you are working in. This involves identifying and talking with the key community members such as the kebele leaders, as well as religious and idir leaders. Ideally, you would involve key community members throughout the planning process, and in the implementation and evaluation of your health education activities.
There are various categories of needs assessment. In order to develop a workable and appropriate plan, several types of needs should be identified, including health needs and resource needs, which are outlined below.
12.5.1 Health needs assessment
In a health needs assessment, you identify health problems prevalent in your community. In other words, you look into any local health conditions which are associated with morbidity, mortality and disability. The local problems may include malaria, TB, HIV/AIDS, diarrhoea, or other conditions arising from the local context, such as goitre caused by lack of iodine in the diet.
Having identified the problems, you need to think about the extent to which local health conditions are a result of insufficient education. For example, are people lacking in knowledge about malaria, or HIV, or diarrhoea? Are they aware that some of their behaviours may be part of the problem?
12.5.2 Resource needs assessment
A resource needs assessment identifies the resources needed to tackle the identified health problems in your community. You should consider whether there is a lack of resources or materials that is preventing the community from practising healthy behaviours. For example, a mother may have good knowledge about malaria and its prevention methods, and want to use Insecticide Treated Bed Nets (ITNs). However, if ITNs are not available, it may not be possible for her to avoid malaria. Therefore, a bed net is a resource which is required to bring about behaviour change. Similarly, a woman may intend to use contraception. However, if contraceptive services are not available in her locality, she remains at risk of unplanned pregnancies. In order to facilitate behaviour change, you should identify ways of addressing this lack of contraceptive resources.
Be aware too that education is in itself one of the great resources you can call on. An education needs assessment should also be part of you plan.
12.5.3 Community resources
First read Case Study 12.1 to help you think about community needs.
Case Study 12.1 Tigist
Ms Tigist is a Health Extension Practitioner. She has been working for three years in a village called Burka. She has conducted a needs assessment in order to develop an appropriate health education plan. During the needs assessment, Ms Tigist identified that malaria, TB, HIV/AIDS and harmful traditional practices, such as female genital mutilation (FGM), were prevalent problems in the village. In addition, she identified that many community members did not know the causes of these problems, or any methods of prevention. For example, many young people did not like to use condoms, and many households did not use bed nets properly due to lack of knowledge. Ms Tigist also identified that many households did not own bed nets.
During a needs assessment, you also need to identify the resources available in the community, such as labour power. This would include finding out about the help that community leaders and volunteers could give, and the local materials and spaces in which to conduct health education sessions. When looking at community resources, you should include local information such as the number of people in each household, their ages and their economic characteristics. You would also include information on community groups and their impact on local health activities and communication networks.
Read Case Study 12.1 again, and then answer the questions below.
- a.Which categories of needs assessment has Ms Tigist conducted?
- b.List the problems Ms Tigist has identified in each of the categories of needs assessment.
a. Ms Tigist has undertaken a health needs assessment (look at Section 12.5.1 if you need to clarify this), and a resource needs assessment (see Section 12.5.2).
b. Problems identified in the health needs assessment showed that malaria, TB, HIV/AIDS and harmful traditional practices were prevalent, and that there is a lack of knowledge about causes and prevention methods for these problems. The main resource need identified was mosquito bed nets in some households.
If you identify malaria as a common health problem in your locality, what additional information would you need in order to plan and implement an appropriate intervention? You will find that looking at Section 12.5.2 again should help here. The important information you need to consider is the effect of current behaviours on the health problem you have chosen.
You should conduct a further assessment for this specific disease to identify the reasons why malaria is a problem in your locality. Knowing it is a problem is only the start. You may identify behavioural factors such as not using bed nets, not seeking timely treatment, or not clearing stagnant water around the dwellings. When all these behavioural factors have been identified, proper health education strategies can be developed to address them, including resources that are needed, and whether you can get them.
12.6 Assessment techniques
Data related to the health needs of the community can be obtained from two main sources — these are called primary and secondary sources. Primary sources are data which you collect during a needs assessment, using techniques such as observation, in-depth interviews, key informant interviews, and focus group discussions. Secondary sources are data that were collected and documented for other purposes, including health centre and health post records, activity reports, and research reports. You may also be able to review data which has already been collected by other people to identify local health problems.
Think about a health education issue you are aware of in your community. Make a list of primary and secondary sources of information you could collect on this issue.
You could collect primary information by conducting some interviews with key people in your community, or holding focus group discussions. Secondary sources of information about the health issue may be available from your local health centre, or health post data.
Various techniques can be used to collect data from the community. These include observation, in-depth interviews, key informant interviews, and focus group discussions — which we describe next.
12.6.1 Observation
To carry out an observation, you watch and record events as they are happening. Box 12.3 outlines some situations where observation can be a useful method of collecting relevant data.
Box 12.3 Observation is useful to understand
- Community cultures, norms and values in their social context.
- Human behaviour that may be complex and hidden.
When you are observing households, individuals, or more general practice or behaviour in your community, you may find it useful to use a checklist. For example, you could prepare a checklist to keep a detailed record of household practice and environmental hygiene. Following your checklist might help you to be more systematic about the things you are observing. You cannot observe everything at the same time, so the checklist will help you prioritise what to observe, and how to record what you have seen. A checklist is a very helpful tool for observation, and more generally with planning. There is an example of a checklist in Box 12.4.
Box 12.4 Checklist to organise observations
A Health Extension Practitioner has prepared a checklist to help organise her observations when she visits pregnant mothers in her community to put up new insecticide-treated mosquito nets (ITNs).
The checklist includes the following points:
- Is the net hung above the bed? Yes/No
- Has it been tied at all four angles above the bed? Yes/No
- Is the net tucked under the mattress? Yes/No
- Does the net have a hole anywhere where an insect might get in? Yes/No
You have probably already gathered a lot of information by using observation within your community. If you keep alert to all the things that are happening around you, you will be able to gather a lot of very useful information. Systematically observing and recording what you see is an important technique that you can use to identify health problems and their possible causes (Figure 12.5).
Observation is a real skill, and one you can practise very easily. Make a list of a number of small observations you can make in the next week or so. It doesn’t even have to be work related! Then just try a few out, and make a brief checklist for each.
You could observe how many people greet you over one half-hour period, and make a note of how they do it. You could observe how many bicycles go past in ten minutes and the age of the people riding them. Or choose an observation on health education. The important thing is to really pay attention, and then make some sort of record.
12.6.2 Interviews
The in-depth interview is another important method of data collection. This technique can be used when you want to explore individual beliefs, practices, experiences and attitudes in greater detail. It is usually conducted as a direct personal interview with one person — a single respondent. Using in-depth interviews as a Health Extension Practitioner, you can discover an individual’s motivations, beliefs, attitudes and feelings about health and illness. For example, you may want to explore a mother’s attitudes to — and use of — contraception.
It is a good idea to use open-ended questions to encourage the respondent to talk, rather than closed questions that just require a yes or no answer.
An in-depth interview can take around 30–90 minutes. Box 12.5 lists the steps you should take when conducting an in-depth interview.
Box 12.5 Conducting an in-depth interview
- Identify an individual with whom you are going to conduct an in-depth interview, obtain their consent and arrange a time.
- Prepare your interview guide — this is a list of questions you can use to guide you during the interview. You can generate more questions during the interview if other issues arise that you want to follow up.
- Write down the responses as accurately as you can. You can also use a tape recorder to record the responses. However, you should ask permission from the respondent to use a tape recorder.
- After the interview is completed, review your notes or listen to the tape and prepare a detailed report of what you have learned.
Perhaps you could practise inventing open-ended questions. Try it out on your family and friends until it becomes easy to do. A closed question goes like this: Do you like vegetables? The person can only really say yes or no. An open question goes like this: Tell me something about how vegetables fit into your diet? Then the person can start talking about vegetables much more — and you will get a lot more information.
A good time to do an in-depth interview is when the subject matter is sensitive; for example, gathering data from women regarding their feelings about sexuality and family planning, or if the woman has had an abortion. This is a useful technique when you need to explore an individual’s experiences, beliefs and attitudes in greater detail.
12.6.3 Key informants
Key informants are people who have first-hand knowledge about the community. They include community leaders, cultural leaders, religious leaders, and other people with lots of experience in the community. These community experts, with their particular knowledge and understanding, represent the views of an important sector of the community. They can provide you with detailed information about the community, its health beliefs, cultural practices, and other relevant information that might help you in your work. How do you feel about talking to leaders and people with lots of experience? Do you ask them different sorts of questions from those you ask of other people? Although beliefs and attitudes apply to key informants too, you also have a chance to find out some answers to questions about ‘the bigger picture’ of your community when people are public figures.
12.6.4 Focus group discussions
Focus group discussions are group discussions where around 6 to 12 people meet to discuss health problems in detail. The discussion is led by a person known as a ‘facilitator’. Box 12.6 describes the steps to use if you want to conduct a focus group discussion.
Box 12.6 Conducting a focus group discussion
- Select 6–12 participants for your focus group discussion. For the discussion of some sensitive issues, it might be necessary to lead one focus group of men only (Figure 12.7), and another of women only. For other issues, a mixed group could lead to interesting and informative discussions.
- Prepare a focus group discussion guide. This is a set of questions which are used to facilitate the discussion. While the discussion is going, you can also generate more questions to ask the participants.
- There should be one person who facilitates the discussion, and another person who takes notes during the discussion. If possible, it is also useful to record the discussion using a tape recorder, so that you can listen and analyse it later.
You may find it useful to use focus group discussions in the following situations:
- When group interaction might produce better quality data. Interaction between the participants can stimulate richer responses, and allow new and valuable issues to emerge.
- Where resources and time are limited. Focus groups can be done more quickly, and are generally less expensive than a series of in-depth interviews.
In this study session, you have learnt four techniques that will help you to conduct needs assessments. You can either select one technique which best fits the aims of your needs assessment, or use a combination of more than one technique to build a more complete picture of the issues you need more information about.
Spend a few moments thinking about these four techniques. Do you feel more at home with one than another? Do you think it might be best to use more than one method with a particular health education issue?
You do not have to use all of these techniques all the time. Some work better in some situations. But it is worth practising, so that if and when you need a particular technique you have it at your finger tips.
Summary of Study Session 12
In Study Session 12, you have learned that:
- 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.
- Planning health education activities has several advantages. It enables you to prioritise problems, use your resources efficiently, avoid duplication of activities, and develop the most effective methods to solve community health problems.
- Planning should be based on your local situation, and take into account all the interests and needs of the community.
- A needs assessment is the usual starting point for the health planning process. There are a variety of techniques you can use for this, including observation, interviews and focus group discussions.
- No matter what techniques are used to conduct your health and resource needs assessments, the basic concept is to find out more about health problems in your community, and gather information about their underlying causes.
Planning is covered in more depth in Study Session 13.
Self-Assessment Questions (SAQs) for Study Session 12
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.
SAQ 12.1 (tests Learning Outcome 12.1)
What do you think are the most important elements of:
- a.Health planning?
- b.Health needs assessment?
Answer
- a.Planning involves creative thinking. It is the process of making decisions about what needs to be done, when it will be done, where it will be done, who will do it, and with what resources. Planning is central to health education and health promotion activities.
- b.Needs assessment is the process of identifying and understanding the health problems in your community, and their possible causes. This is used to analyse problems and set priorities for intervention.
SAQ 12.2 (tests Learning Outcomes 12.1, 12.2 and 12.3)
Which of the following statements about planning health education activities are false? In each case, explain what is incorrect.
A Planning should be rigid.
B Planning will create duplication of effort and activities.
C Planning should be based on the local situation.
D It is not important to consider the interests of local people when planning health education activities.
E We should not worry about the availability of resources when we plan our health education activities.
Answer
A is false because planning is not rigid. You can adjust or modify your plan at any time.
B is false, planning helps you avoid duplication of activities.
C is true because the local situation is the foundation for all planning. A plan which is not based on local facts cannot be a good plan.
D is false because engagement with the local community in health education activity is one of the core principles of planning. The interest and the needs of the community should be kept at the centre of planning.
E is false because a plan cannot be executed without sufficient resources. Resources are one of the important things that you should consider while planning health education activities.
SAQ 12.3 (tests Learning Outcome 12.4)
Below are the steps you need to go through when planning your health education activities, but they are not in the correct order. Match the steps to the numbers 1 to 6 in the order you should do them.
Using the following two lists, match each numbered item with the correct letter.
Needs assessment
Problem identification and prioritisation
Setting goals and objectives
Develop your strategy
Implementation
Monitoring and evaluation
a.3.
b.2.
c.5.
d.6.
e.4.
f.1.
- 1 = f
- 2 = b
- 3 = a
- 4 = e
- 5 = c
- 6 = d
SAQ 12.4 (tests Learning Outcomes 12.5 and 12.6)
Suppose you are asked to develop a health education plan for the community in which you are working. What are the three categories of needs assessment? What techniques might you use to conduct a health needs assessment?
Answer
Categories of needs assessment include health needs assessment, educational needs assessment, and resource needs assessment. In addition, information related to community resources and demographic characteristics should be collected during needs assessment.
Techniques of needs assessment include observation, in-depth interviews, key informant interviews and focus group discussions.
SAQ 12.5 (tests Learning Outcome 12.5)
Derartu has conducted a health needs assessment to develop her health education activity plan. She has assessed the following needs. Which category of need would you put each of these into?
- a.Lack of knowledge about the benefits of latrine use.
- b.Lack of skill in using insecticide-treated bed nets.
- c.Having a negative attitude towards condom use.
- d.Condoms are not available in the village.
- e.Belief that malaria is caused by drinking dirty water.
Answer
- a.Educational
- b.Educational
- c.Educational
- d.Resources
- e.Educational.
Read Case Study 12.1 about Ms Tigist again, to see how her needs assessment covered a range of issues.
SAQ 12.6 (tests Learning Outcome 12.6)
Match the correct descriptions with each of the needs assessment techniques.
Using the following two lists, match each numbered item with the correct letter.
Uses a checklist
Used to explore individual beliefs
Used when the subject is not sensitive
Interviews with religious and other community leaders
a.Key informant
b.In-depth interview
c.Observation
d.Focus group discussion
- 1 = c
- 2 = b
- 3 = d
- 4 = a