- INTEGRATION POPULATION AND INTEGRATION POPULATION AND GENDER INTO DEVELOPMENTGENDER INTO DEVELOPMENT PLANNING IN HEALTH CAREPLANNING IN HEALTH CARE (cont.)(cont.) PhD. - Example: The shortcomings and main Example: The shortcomings and main reasons for the social inequality in healthreasons for the social inequality in health carecare (1) (1) The financial resources are mainly allocated to the hospitals, tThe financial resources are mainly allocated to the hospitals, to which the poor o which the poor people have less chance to access than the rich, other than the people have less chance to access than the rich, other than the local health care local health care establishmentsestablishments (2)(2)The public expenses on health care sector are mainly for the medThe public expenses on health care sector are mainly for the medical treatment ical treatment other than medical preventionother than medical prevention... - (3) (3) The infrastructure, medical equipments as well as the professionThe infrastructure, medical equipments as well as the professional skills of al skills of medical staff at the uppermedical staff at the upper--level hospitals are all better than that of the local level hospitals are all better than that of the local ones. - On thecontrary, due tocontrary, due to limited investment, at many local health care establishments, thlimited investment, at many local health care establishments, the infrastructuree infrastructure and medical equipments are poor, the competent staff is limitedand medical equipments are poor, the competent staff is limitedand the qualityand the quality of the medical examination and treatment service is very lowof the medical examination and treatment service is very low.. - (4)(4)The allocation structure of the medical staff is unsuitable for The allocation structure of the medical staff is unsuitable for the demand of the the demand of the people and not basing on the characteristics of the disease modepeople and not basing on the characteristics of the disease modell... - disciplinary factors which have disciplinary factors which have impacts on the difference inimpacts on the difference in children’s healthchildren’s health Income, food and foodstuff consumption, education Income, food and foodstuff consumption, education levellevel, using of drinkable water, sanitation, using of drinkable water, sanitation situation, housing characteristics, thesituation, housing characteristics, the convenience of transportation, information andconvenience of transportation, information and environment, etcenvironment, etc. - Regional difference on the factors related to the Regional difference on the factors related to the children’s health, children’s health . - Define the subjects Step 7. - Define the subjects =>. - To define the right subjects, we must answer the questions of Who, where and the seriousness level of the problem For example: Who? Pregnant women, newborn baby, children under 5 years old in poor households Where? Rural and mountainous areas and Central Highland region Seriousness level: The fatality rate of newborn baby in the Central Highland region is 1.75 times higher than the average rate of the nation and 2.73 times higher than the South-east region. - 0* 0--4 year old population is year old population is 7,145,000 peoplepeople ••The malnourished ratio of children under 5 years old is The malnourished ratio of children under 5 years old is Numbers of malnourished children areNumbers of malnourished children are . - Choosing the problems/reasons basing on the following standards: •The seriousness or the urgency of the problem. - Defining the problems and subjects of concern. - Example on the problem tree Malnutrition Short period between the two deliverings Low awarenessNo family planningPsychological customs Low Living standard. - Building the objectives/norms Method of defining the objectives of the plan on ensuring the equality in health care (example on the regional difference on the fatality rate of children under 5 years old). - Learning objectives Learning objectives To understand the method of defining the To understand the method of defining the objectives/norms for the equality inobjectives/norms for the equality in health care within the planning periodhealth care within the planning period. - Objectiveis a more specific statement on the desired result(s. - For example For example Problem: The difference on the children’s health Problem: The difference on the children’s health situationsituation AimAim: Equality in children health care: Equality in children health care Objective: Objective: To improve the difference in health careTo improve the difference in health care for the newborn baby and childrenfor the newborn baby and children Norm:Norm:To reduce the fatality rate of childrenTo reduce the fatality rate of children under 5 years old in the Central Highland regionunder 5 years old in the Central Highland region from down to and 37%from down to and and in other regions as well(2010) and in other regions as well. - Viewpoints in defining the objectives of reducing the regional difference 1.Definingthelevel of objective: Basingonthe national standardfor all regionsor thelessdeveloped regions must reach at least the national average level or the level of the medium developed regions. - Defining the order and priority groups: The objective of attaining the equality in health care through fast reducing for thegroupof poor people, peopleintherural and remote areas and people of ethnic groups, etc. - defining the decisive resources and the supplementary resources.. - Viewpoints in defining the objectives of reducing the regional difference. - Theobjectiveof reducingthedifferenceon children’s health -Reducingthedifferenceonthefatalityrateof children under 5 years old -Reducingthedifferenceonthefatalityrateof children under 1 year old -Reducing the difference on the ratio of catching popular diseases of children under 5 years old -Reducingthedifferenceonthemalnutritionratioof children under 5 years old (in height and weight). - Method of defining the objective Method of defining the objective There are various ways of defining the norm: 1. - The norm on equality in health care is represented in formof improvingthe ratioof anindicator inthemost disadvantagedgroupof regionor groupof people compared to that of the most advantaged one. - Definingdifferent objective for different regions inthe correlation with other regions and the national average can be done by one or the combination of the following methods: 1. - Extrapolation method -Simple extrapolation:What was the changing trend in the past, assuming the same intensity in the future. - -Analytical extrapolation:Byanalyzingtheinfluencing factors, advantages, difficulties, determinationand commitment, mobilization of the resources, etc to fasten or down the intensity.. - Method of defining the objective (cont.) Method of defining the objective (cont.). - Comparative method –similarity With this method, we can use the norm of the advanced regions or nations which have similar conditions as the objective of the planning period. - The chosen territories for application can be: -Various regions in a country -Different countries in the region and in the world. - -The use of this method requires a system of specific and detailed information and data in the time sequence with results of experimental surveys to calculate necessary parameters.. - 1 Method of approach no.1 : Defining the 1 Method of approach no.1 : Defining the objective by shortening the difference betweenobjective by shortening the difference between the most developed region and the least the most developed region and the least developed regiondeveloped region 1. - Calculation of intermediary norm ––Calculating the planned differenceCalculating the planned difference ––Calculating the annual average reduction in the Calculating the annual average reduction in the planning periodplanning period ––Calculating the difference for each plannedCalculating the difference for each planned yearyear 2. - Calculating the fatality rate of children2. - Calculating the fatality rate of children under 5 years old in the planning year under 5 years old in the planning year for the least developed regionfor the least developed region. - aa) Calculation of ) Calculation of PAR indicatorPAR indicator ••For example: the fatality rate of children under 5 yearsFor example: the fatality rate of children under 5 years old in the Central Highland region is 108.1old in the Central Highland region is 108.1‰‰. - in the Red , in the Red River Delta is River Delta is 43.743.7‰‰. - The PARThe PARvalue shows the difference on the fatality rate of value shows the difference on the fatality rate of children under 5 years old in the Central Highland regionchildren under 5 years old in the Central Highland region and the Red River Delta as followsand the Red River Delta as follows . - ii) Calculation of PARindicator in the planning year PARKH x(100% -40. - (iv) CalculatingPARindicator for each year of the planning period PARTN ,t=PARTN,t-1-RTB PARTN PARTN PARTN PARTN PARTN . - Calculation of fatality rate of children under 5 years old in the planning year Mdbsh MTN ,t= ---if MTN,t-Mdbsh>. - Method of approach no. - 22 Improving the norm of the least developed region by comparing with the national average level. - It was estimated that by2005M(Children<5) in the Central Highland region reduced from down to 61.6‰in 2005 and 37‰in2010 (the national average for the first year 2000).. - Calculation of the intermediary indicatorCalculation of the intermediary indicator ((ii) Calculating the increase (decrease. - Calculating the increase (decrease) rate of the normrate of the norm RR. - The average increase rate a yearThe average increase rate a year TTcc: Objective of the planning year: Objective of the planning year TToo: Objective of the first year: Objective of the first year nn: length of the planning period (in this: length of the planning period (in this case, case, nn=5)=5) RR . - Calculation of the intermediary indicatorCalculation of the intermediary indicator. - The fatality rates of childrenThe fatality rates of children under 5 years old in the Central Highlandunder 5 years old in the Central Highland region in the planning years are as followsregion in the planning years are as follows T x(1 –0.1064. - Method of forecasting the national 2. - Total numbers of children under 5 in year nTotal numbers of children under 5 in year n nationwidenationwide ••PinPin. - Total numbers of children under 5 in year nTotal numbers of children under 5 in year ninin regionregionii ••ii: Regional indicator. - Chart 6: Necessary changes in the numbers of malnourished children under 5 years old to obtain the national objective in 2010 (thousands of children 0. - Objective of the lesson -To know the method of defining and determining the problems and solutions in the planning period. - -To understand the theoretical method for each solution -To know how to calculate the norms -To understand the method of forecasting to calculate the demand on + infrastructure + medical human resources + financial resources for health care sector. - From the results of the situation analysis, we can define the causes/impacts -The difference on the provision, usage and possibility of access to medical and health care services -The difference among regions on the quality of the medical services, especially the human resources and the medical equipments at the local establishments -The regional difference on the financial investment -The regional difference on other population and socio-economic factors. - Defining the policies Defining the policies. - For example For example Policy Policy : Preventive health care (medical : Preventive health care (medical prevention other than medical prevention other than medical treatment)treatment) Solution/Strategic planningSolution/Strategic planning:: Promoting the initial health carePromoting the initial health care. - Solution/norm Solutiononmedical andhealthcaredevelopment withthe view to reduce the difference on: -Strengtheningthepossibilityof accessingtomedical services -Strengthening the quality of the medical services -Increasingtheratioof pregnant womenwhoenjoy3or more times of examination -Preventingmalnutritionandimprovingthehealth: preventing anaemia in pregnant women -Ensuringthat pregnant womenareinjectedagainst tetanus -Increasingthefertilityrateat medical establishmentsat which the baby will be cared for by the medical staff -Upgradingthecommunemedical centresandmedical equipments, providingmedicines, livingwater,electricity, etc. - Theinterdisciplinarysolution(interdisciplinary objectives) -Reduingthefertilityrateandimplementingfamily planning -Improving the condition and consumption structure -Improving the living standard -Improving the education level of the women -Increasing the income of the households -Improvingtheinfrastructure, especiallyat commune level.. - Theoretical data for the solution on the Theoretical data for the solution on the provision and use of medical and healthprovision and use of medical and health care servicescare services 1. - Increase in the numbers of health careIncrease in the numbers of health care services with higher quality (thanks toservices with higher quality (thanks to competent medical staffcompetent medical staff)) 2. - Increase in the qualified human resources2. - Increase in the qualified human resources at the grassroots levelat the grassroots level. - Increase in the numbers of health care Increase in the numbers of health care services with higher quality (thanks toservices with higher quality (thanks to competent medical staffcompetent medical staff)) 1. - Reducing the difference on the average visit per capita by competent staff 2 .Reductingthe difference on numbers of deliveringswhich are attended by the medical staff.. - For example, the theoretical data for the solution on the For example, the theoretical data for the solution on the provision and use of medical and initial health care service provision and use of medical and initial health care service for children to reduce the difference on fatality rate of for children to reduce the difference on fatality rate of children under 5 years oldchildren under 5 years old It is estimated that the two decisive norms to It is estimated that the two decisive norms to reduce the difference on the fatality rate of reduce the difference on the fatality rate of children under 5 years old arechildren under 5 years old are. - Reducing the difference on the numbers1. - Reducing the difference on the numbers of average visit per capita by competent of average visit per capita by competent staffstaff ••2 .Reducing the difference on the numbers2 .Reducing the difference on the numbers of delivering which are attended byof delivering which are attended by medical staff.medical staff.. - Estimate the number of health check in 1. - Estimate the number of health check in medical center.medical center. - Evaluate interEvaluate inter--expenses: estimate theexpenses: estimate the number of health check/ personnumber of health check/ person Step Step22 ..Evaluate total demand and the number of healthEvaluate total demand and the number of health check in the medical center all over the country. - check in the medical center all over the country. - Step 3.Evaluate the total number of health check inStep 3.Evaluate the total number of health check in medical center ( basic social services) all over themedical center ( basic social services) all over the country during the periods of plan. - Evaluate and distribute the increase of the number of health check in medical center all over thenumber of health check in medical center all over the country : common increase, increase in population, country : common increase, increase in population, enhance social equality. - Estimate the number of health check / person Define the solution index to decrease the gap among provinces and death rate of children below 5 years old.. - Estimate of total number of health check per year (Q) Q = N x P N –The number of health check/ person P-Population. - Analysis the rate of increase of health check regarding: -Population increase -Due to decrease the gap among locations. - Evaluation method Evaluation method 1.The number of health check. - Definition of program/ projects Definition of program/ projects Policy: Policy: Prevention is better than treatment Strategy: Prevention is better than treatment Strategy: Promotion health care in first stagesPromotion health care in first stages Program 1: Vaccinated programProgram 1: Vaccinated program Projects:Projects:--Supporting Medical center Supporting Medical center --Disease preventionDisease prevention Program 2: Birth health care.Program 2: Birth health care. - Projects:Projects:--Communication promotion in birth health careCommunication promotion in birth health care --Enhance the quality of birth health care inEnhance the quality of birth health care in communecommune --It is better that mother feed their babies by their It is better that mother feed their babies by their own milkown milk . - A collection of logical different activities A collection of logical different activities in the structure to meet targets with thein the structure to meet targets with the specific support . - Step 1: Define the goal ( general goal,Step 1: Define the goal ( general goal, middle term goal, goals for each activity);middle term goal, goals for each activity). - After defining the issues :After defining the issues : 1. - Build activities and define the expected results 2. - Build activities and define the expected results 3. - Define the relationship between cause3. - Define the relationship between cause. - Impact of wide--spreading)spreading)--toto developdevelop ••But, some project has bad impact on otherBut, some project has bad impact on other groupgroup––to improveto improve ••Rule: Project has good impacts on the Rule: Project has good impacts on the receiver but no bad impacts on the otherreceiver but no bad impacts on the other groupsgroups. - Example Example : Program to decrease the: Program to decrease the gap of the rate of below 5 year childgap of the rate of below 5 year child deathdeath 1.1.Program/ Projects Program/ Projects Enhance providing and usage of health care service andEnhance providing and usage of health care service and child health in poor areachild health in poor area--Improve the quality of Improve the quality of health clinic in communes of poor area.health clinic in communes of poor area. - --Training and ensuring human resource for health care Training and ensuring human resource for health care clinic in poor areasclinic in poor areas. - Locations Locations ••Questions : location selection?Questions : location selection? ––The highest riskThe highest risk ––The biggest number of impacted peopleThe biggest number of impacted people ––People without capacity of financePeople without capacity of finance ––Remote and poor area…Remote and poor area…. - Development into budget investment Development into budget investment Define the demand of capitals for Define the demand of capitals for program/projects regarding the number of program/projects regarding the number of children below 5 years old and the populationchildren below 5 years old and the population in each location. - Solution Solution 1.1.ProgramProgram --For children below 5 years oldFor children below 5 years old --Communication of birth health prevention, sexCommunication of birth health prevention, sex education and nutritioneducation and nutrition --Food sanitation securityFood sanitation security --Build in remote and poor areaBuild in remote and poor area --InfrastructureInfrastructure --Vocational educationVocational education. - To understand the integration of PopulationPopulation--Development in theDevelopment in the implementation of the planimplementation of the plan ••2 . - Integrating Population Integrating Population-- Development in the implementation of Development in the implementation of PlanPlan. - Integration of Population Integration of Population-- Development to superviseDevelopment to supervise the implementation of the planthe implementation of the plan. - To supervise the process and results of the To supervise the process and results of the implementation to see whether the plan is put in the implementation to see whether the plan is put in the right place or for the right beneficiariesright place or for the right beneficiaries ••To supervise whether the program is assigned toTo supervise whether the program is assigned to suitable people or they can obtain the appropriate suitable people or they can obtain the appropriate objectiveobjective ••The validity of the supervisionThe validity of the supervision ••To supervise the objectives/norms/solutionsTo supervise the objectives/norms/solutions ••To supervise the implementation scheduleTo supervise the implementation schedule. - Integration of Population Integration of Population --Development toDevelopment to evaluate the implementation of the planevaluate the implementation of the plan + To evaluate the impacts of the project: general + To evaluate the impacts of the project: general and specific impactsand specific impacts --Whether the program/project is carried out Whether the program/project is carried out according to the schedule and basing on theaccording to the schedule and basing on the budget planbudget plan --Whether the program/project can reach theWhether the program/project can reach the beneficiaries