Health Strategic Plan Research Articles

Integrating Oral Health into Social Marketing Campaigns: Program Development and Description for San Francisco Children’s Oral Health Strategic Plan

Integrating oral health into an existing San Francisco Department of Public Health (SFDPH) social marketing campaign was a specific goal of the San Francisco Children’s Oral Health Strategic Plan 2014-2017 with the purpose to more fully integrate oral health promotion into the City’s overall health promotion efforts. In the winter of 2015, utilizing a collaborative approach, oral health was successfully integrated in the Open Truth campaign, promoting decreased consumption of sugar sweetened beverages in order to improve health outcomes, including decreasing tooth decay.

Estimating health plan costs with the OneHealth tool, Cambodia.

ObjectiveTo do resource and cost projections for the entire Cambodian health sector using the OneHealth tool, during the development of the third national health strategic plan 2016–2020.MethodsThrough a consultative process, the health ministry estimated the needed and available resources to implement the strategic plan. The health ministry used the OneHealth Tool to estimate costs of expanding public sector service provision and compared these to estimates of projected available financing. Cost estimates covered implementation of health programmes including commodities and programme management costs, and six cross-cutting health system strengthening components. The tool is populated with local demographic, epidemiological, programmatic and unit cost data. We present costs in constant 2015 United States dollars (US$).FindingsWe estimated the five-year cost of the strategic plan to be US$ 2973.8 million. Costs are split between health systems strengthening components (US$ 1516.3 million) and investments in individual disease or public health programmes (US$ 1457.5 million). Health programmes for maternal and neonatal health (US$ 367 million), child health and immunization (US$ 197 million) and noncommunicable disease (US$ 157 million) have the highest costs. Although projected resource needs increase over time, a financial space analysis with ambitious projected increases in government funding indicates that government and donor funding jointly could be sufficient to cover the cost of the strategic plan from 2018 to 2020.ConclusionThe results both informed development of the strategic plan, and contributed to the evidence base for improved budgeting, resource mobilization strategies and stronger overall public sector financial planning.

Commitment and community participation towards health: knowledge creation from the systematization of social experiences

Objective. To reflect on the process of committing to participation in the implementation of a health strategic plan, using Participative Systematization of Social Experiences as a tool. Our study was a qualitative research-intervention study, based on the Dialectical Methodological Conception approach. We designed and implemented a two-day workshop, six hours daily, using Systematization methodology with a Community Work Group (CWG). During the workshop, women systematized their experience, with compromise as axis of the process. Using Grounded Theory techniques, we applied micro-analysis to data in order to identify and strengthen categories that emerged during the systematization process. We completed open and axial coding. The CWG identified that commitment and participation itself is influenced by group dynamics and structural determinants. They also reconsidered the way they understood and exercised commitment and participation, and generated knowledge, empowering them to improve their future practice. Commitment and participation were determined by group dynamics and structural factors such as socioeconomic conditions and gender roles. These determinants must be visible and understood in order to generate proposals that are aimed at strengthening the participation and organization of groups.

State and non-state mental health service collaboration in a South African district: a mixed methods study.

The Life Esidimeni tragedy in South Africa showed that, despite significant global gains in recognizing the salience of integrated public mental health care during the past decade, crucial gaps remain. State and non-state mental health service collaboration is a recognized strategy to increase access to care and optimal use of community resources, but little evidence exist about how it unfolds in low- to middle-income countries. South Africa's Mental Health Policy Framework and Strategic Plan 2013-20 (MHPF) underlines the importance of collaborative public mental health care, though it is unclear how and to what extent this happens. The aim of the study was to explore the extent and nature of state and non-state mental health service collaboration in the Mangaung Metropolitan District, Free State, South Africa. The research involved an equal status, sequential mixed methods design, comprised of social network analysis (SNA) and semi-structured interviews. SNA-structured interviews were conducted with collaborating state and non-state mental health service providers. Semi-structured interviews were conducted with collaborating partners and key stake holders. Descriptive network analyses of the SNA data were performed with Gephi, and thematic analysis of the semi-structured interview data were performed in NVivo. SNA results suggested a fragmented, hospital centric network, with low average density and clustering, and high authority and influence of a specialist psychiatric hospital. Several different types of collaborative interactions emerged, of which housing and treatment adherence a key point of collaboration. Proportional interactions between state and non-state services were low. Qualitative data expanded on these findings, highlighting the range of available mental health services, and pointed to power dynamics as an important consideration in the mental health service network. The fostering of a well-integrated system of care as proposed in the MHPF requires inter-institutional arrangements that include both clinical and social facets of care, and improvements in local governance.

The health status of the Palestinians living in Israel: a cross-sectional study

BackgroundIn mid-2014, 1 350 800 Palestinians were living in Israel (excluding residents of occupied East Jerusalem and the Golan Heights). Palestinians comprise 17% of the total population in Israel. The Palestinian community in Israel is very young, with 36% of Palestinians aged 14 years and younger, whereas in the Naqab, 49% of the Palestinian community is aged 14 years and younger. According to Ministry of Health reports, there is a gap between Arabs and Jews in most health indicators (life expectancy, infant mortality, chronic morbidity, and health behaviours). Most official surveys on the health of Palestinians living in Israel are based on small samples and do not consider specific characteristics of the Arab population (eg, composition, geographic distribution). The aim of this study was to obtain broader data on the health status of Palestinians in Israel as part of a socioeconomic survey. MethodsWe surveyed Palestinian households in the north of Israel, the Haifa region, the Naqab, and central Israel. We used a structured questionnaire to gather data on demographic and socioeconomic status, housing conditions, standards of living, education, culture, health, and environment. Data were collected by trained interviewers in face-to-face interviews. Verbal and written informed consent was obtained from participants. FindingsFieldwork was completed between March 1 and June 30, 2014. 97% of questionnaires were completed, providing data from 1698 Palestinian households (896 households from the north of Israel, 271 from the Haifa region, 293 from the Naqab, and 238 from central of Israel; 7115 participants in total). 15% of all study participants (14% of women and 15% of men) and 2% of participants aged 0–14 years reported chronic diseases. The highest prevalence of chronic diseases was found in mixed cities (22%) and in large communities with more than 15 000 residents (16%), whereas the prevalence of chronic diseases was lowest (4%) in villages that are not officially recognised by Israel. 6% of the participants had diabetes (5% of women and 6% of men). 9% of participants in general and 2% of participants aged 0–14 years had moderate or severe difficulties in their activities of daily living, and the prevalence of people with such difficulties increased with age, reaching 24% in participants aged 50–59 years and 51% in participants aged 60 years and older. 20% of the participants were smokers (4% of women and 36% of men), whereas 7% of participants aged 10 years and older were smokers. About 38% of participants exercised and played sports, and 16% took regular exercise. 42% of marriages were consanguineous, and this percentage increased to 70% of marriages in the Naqab. InterpretationCompared with the Jewish population in Israel, Palestinians with Israeli citizenship have more chronic diseases and more unhealthy behaviours. These findings should be used to inform national health strategic planning and interventions to improve and promote the health status of the Palestinian population in Israel. FundingNone.

Stressing in the Tropics

Non-communicable diseases (NCDs) are the leading cause of death in Fiji (80% of total deaths) and account for 40% of all healthcare costs [ [1] Fiji Ministry of Health and Medical Services National Strategic Plan.(2016-2020). Google Scholar ]. Coronary artery disease (CAD) is the most common of the non-communicable diseases, accounting for nearly 25% of all deaths [ [2] World Health Organization. available at: http://www.who.int/countries/fji/en/. Google Scholar ].

Prevalence of refractive errors in Al Bahar Alahmar province in Sudan

Purpose: The study was carried out to investigate the prevalence of refractive errors in al Bahar Alahmar province in Sudan. The aim was to identify the prevalence in the province and to help in improving the health strategic plans in the area as well as reviewing the eye care services provided in the region. Materials and Methods: Eye testing had been executed on 790 patients with ages ranged between 10 and 59 years and means of 41.7 standard deviation ± 10.1. All patients tested for distance vision using (tumbling E chart) and near vision using (tumbling E chart). The battery kept simple at the beginning of the test; however, noncycloplegic objective refraction followed using a streak retinoscope to refract and prescribe the required optical correction. Results: Decreased in vision was more common in the age group of (40–49) years old, right eye (RE); 38% and left eye (LE); 34% (χ2 = 20.83/df = 20/P = 0.04). Spectacles could improve the vision to 6/6 from 45.8% (unaided) in RE to 91.5% aided and from 44.4% to 90.6% for LE. The prevalence of refractive error was 37.1% for the total; of which 19.6% hypermetropia, 6.6%, myopia and 10.9% astigmatism, respectively. The prevalence of hypermetropia increased in those age (40–49) RE; 38% and LE; 39.4% with highly association with age (χ2 = 58.41/df = 12/probability P = 0.001). Myopia found in the age group (50–59) years old RE; 40.4% and LE; 37.8%, but without any significant association between myopia and age (χ2 = 46.28/df = 12/P = 0.74). In examination site, 66.8% of the ametropes were not wearing correction, but 12.4% wearing distance correction, 15.1% using near correction, and 5.7% wearing distance and near correction. Conclusion: Hypermetropia was the most common type of refractive errors. Refractive errors affect a sizable portion of these three towns, a substantial number of uncorrected refractive errors individuals were waiting for help. Thus, awareness and services must be dramatically improved to meet the needs.

Following on from the Life Esidimeni incident – access to care for people living with severe mental disability, according to national policy

Following the release in February 2017 of the health ombudsman’s report on the deaths of psychiatric patients in Gauteng Province, South Africa (SA) (the Life Esidimeni incident), the South African Society of Psychiatrists (SASOP) has called for a complete overhaul of the mentalhealthcare system in terms of the principles of existing mental-health policy, in particular the National Mental Health Policy Framework and Strategic Plan 2013 - 2020 (NMHPF and SP). Overhauling the mental-healthcare system according to the NMHPF and SP will include the identification and costing of the required facility and staffing interventions that must be put into place to ensure capacity and integration on the different service levels, namely: residential and day-care community-based facilities and programmes, providing a range of care, treatment and rehabilitation services with a fulltime multidisciplinary team available; primary mental-healthcare services at district level;a specialist community-psychiatry service; acute psychiatric units in secondary, tertiary and central general hospitals; and specialised psychiatric beds.

Gathering the Fish and Casting a Net: San Francisco's Children's Oral Health Strategic Plan

Gathering the Fish and Casting a Net: San Francisco's Children's Oral Health Strategic Plan

Epidemiologic characteristics of gastric malignancies among Jordan University Hospital patients.

Objectives:To discover the epidemiologic distribution of gastric malignancies among Jordan University Hospital patients and to compare this distribution with the neighboring Arab countries.Methods:Retrospective study covering the period between January 2006, and May 2016, in Jordan University Hospital, Amman, Jordan. All cases were retrieved from the computer system and analyzed using IBM SPSS version 23 software.Results:One hundred and sixty-five cases were analyzed. Male-to-female ratio was 1.2:1. The mean age was 58.6 with 32.1% of patients aged 50 or younger. Primary adenocarcinoma was the most common tumor, half of which were diffuse type, followed by carcinoid tumors (15.2 %), lymphomas (10.3%), and gastrointestinal stromal tumors (8.5%). Proximally located tumors accounted for 15.4%. Helicobacter pylori were present in approximately half of the cases and 34.6% of cases contained intestinal metaplasia.Conclusion:Jordan is a low-risk area for gastric cancer, but carcinoma occurs at a young age and is associated with gastritis, Helicobacter pylori infection, and intestinal metaplasia in a large proportion of cases. Better strategic health planning and early detection is needed, especially in young patients suffering from gastritis.

Community mental health services in Southern Gauteng: An audit using Gauteng District Health Information Systems data.

BackgroundCommunity mental health services (CMHS) are a central objective of the National Mental Health Policy Framework and Strategic Plan. Three core components are described: residential facilities, day care and outpatient services. Primary mental health care with specialist support is required according to an intervention pyramid. Staffing norms provide for a minimum mental health service coverage of 2.7% of the population for adults and 1.5% for children and adolescents.AimThe aim of this study was to describe the existing CMHS in Southern Gauteng in terms of the National Mental Health Policy.MethodsThe CMHS of the City of Johannesburg, Ekurhuleni, Sedibeng and West Rand districts were studied. Information regarding service organisation and staffing was obtained via the Gauteng Directorate of Mental Health. Routinely collected District Health Information Systems data for the 2014/2015 year were analysed.ResultsThe organisation of services was not consistent with that recommended by the Mental Health Policy, and specialist CMHS were inappropriately situated within primary care. Only 2.23% of clinic visits were for mental health, and 80% of these were at specialist CMHS. Overall mental health coverage was approximately 0.3% of the population for adults and 0.02% for children and adolescents. Staffing, residential facilities and day care were far below the cited norms for minimal cover.ConclusionOur audit revealed that the CMHS in Southern Gauteng did not meet any of the norms cited by the Mental Health Policy. Barriers to implementation of this aspect of the Mental Health Policy need to be explored.

Spatial accessibility to basic public health services in South Sudan.

At independence in 2011, South Sudan’s health sector was almost non-existent. The first national health strategic plan aimed to achieve an integrated health facility network that would mean that 70% of the population were within 5 km of a health service provider. Publically available data on functioning and closed health facilities, population distribution, road networks, land use and elevation were used to compute the fraction of the population within 1 hour walking distance of the nearest public health facility offering curative services. This metric was summarised for each of the 78 counties in South Sudan and compared with simpler metrics of the proportion of the population within 5 km of a health facility. In 2016, it is estimated that there were 1747 public health facilities, out of which 294 were non-functional in part due to the on-going civil conflict. Access to a service provider was poor with only 25.7% of the population living within one-hour walking time to a facility and 28.6% of the population within 5 km. These metrics, when applied sub-nationally, identified the same high priority, most vulnerable counties. Simple metrics based upon population distribution and location of facilities might be as valuable as more complex models of health access, where attribute data on travel routes are imperfect or incomplete and sparse. Disparities exist in South Sudan among counties and those with the poorest health access should be targeted for priority expansion of clinical services.

Prognostic stratification and the healthcare approach in patients with multiple pathologies

Polypathological patients constitute a prevalent, fairly homogeneous population, which is characterized by high clinical complexity, substantial vulnerability and significant resource consumption, in addition to high mortality and the need for comprehensive, coordinated care. It is particularly important to establish a reliable prognosis in these patients. It is also extremely useful for professionals involved in the decision-making process for patients and their families in vital planning and their preferences, for strategic health planning in management fields, and for clinical research, by facilitating their incorporation into clinical trials and other intervention studies. Two prognostic instruments stand out in terms of suitability for polypathological patients: PROFUND and PROFUNCTION. The former faithfully stratifies the risk of dying at 12 months and four years and the latter, the risk of suffering a significant functional deterioration at 12 months. In terms of the healthcare approach in patients with multiple pathologies, creating and executing a consensual, personalized action plan that is adapted to the patient's reality is encouraged. The plan will consider the prognosis, and the evidence and viability of interventions; its ultimate aim will be to ensure the synergy and alignment of the health team's goals and strategies with peoples’ values and preferences, in order to achieve a more proactive health model focused on supporting patients in their ability to manage their illnesses. In the personalized action plan, the main areas of intervention are: health promotion and prevention; patient and caregiver activation and self-management; activation of a social support network and social support; optimization of pharmacotherapy; rehabilitation, functional and cognitive preservation measures; and anticipated decision planning.

Epidemiological Characteristics and Spatial-Temporal Clusters of Mumps in Shandong Province, China, 2005\u20132014

Mumps presents a serious threat to public health in China. We conducted a descriptive analysis to identify the epidemiological characteristics of mumps in Shandong Province. Spatial autocorrelation and space-time scan analyses were utilized to detect spatial-temporal clusters. From 2005 to 2014, 115745 mumps cases were reported in Shandong, with an average male-to-female ratio of 1.94. Mumps occurred mostly in spring (32.17% of all reported cases) and in children aged 5 to 9 (40.79% of all reported cases). The Moran’s I test was significant and local indicators of spatial autocorrelation (LISA) analysis revealed significant spatial clusters with high incidence. The results showed that the mid-west of Shandong Province and some coastal regions (Qingdao City and Weihai City) were high-risk areas, particularly in the center of the Jining City and the junction of Dongying City, Binzhou City and Zibo City. The results could assist local and national public health agencies in formulating better public health strategic planning and resource allocation.

Estratificación pronóstica y abordaje asistencial de los pacientes pluripatológicos

Polypathological patients constitute a prevalent, fairly homogeneous population, which is characterised by high clinical complexity, substantial vulnerability and significant resource consumption, in addition to high mortality and the need for comprehensive, coordinated care. It is particularly important to establish a reliable prognosis in these patients. It is also extremely useful for professionals involved in the decision-making process for patients and their families in vital planning and their preferences, for strategic health planning in management fields, and for clinical research, by facilitating their incorporation into clinical trials and other intervention studies. Two prognostic instruments stand out in terms of suitability for polypathological patients: PROFUND and PROFUNCTION. The former faithfully stratifies the risk of dying at 12 months and four years and the latter, the risk of suffering a significant functional deterioration at 12 months. In terms of the healthcare approach in patients with multiple pathologies, creating and executing a consensual, personalised action plan that is adapted to the patient's reality is encouraged. The plan will consider the prognosis, and the evidence and viability of interventions; its ultimate aim will be to ensure the synergy and alignment of the health team's goals and strategies with peoples’ values and preferences, in order to achieve a more proactive health model focused on supporting patients in their ability to manage their illnesses. In the personalised action plan, the main areas of intervention are: health promotion and prevention; patient and caregiver activation and self-management; activation of a social support network and social support; optimisation of pharmacotherapy; rehabilitation, functional and cognitive preservation measures; and anticipated decision planning.

Staff members’ satisfaction level with the ministry of health and social services strategic plan implementation at three intermediate public hospitals in Namibia

This research aims to explore the staff remembers satisfaction level with strategic decisions implementation in the three intermediate public hospitals in Namibia. Reviewing the literature, 27 variables were identified. The items were then reduced using exploratory factor analysis, which is evaluated using Principal Axis Factoring with Direct Oblimin rotation. Using exploratory factor analysis, variables were categorized into 5 implementation perspectives. This model, in the order of effect, identified Service Provision with a predictor importance of (0.79), Human Resources Management (0.07), Governance (0.06), Financial Management (0.05) while, the Infrastructure Development and Management with predictor importance of (0.03) is the least important. This implies that the Service Provision theme is perceived by the MoHSS staff as having the largest impact of implementation satisfaction and quality of service perceptions at the three intermediate public hospitals. The radar chart also shows that the respondents perceived levels of satisfaction with strategy implementation is rated less than desired levels (yellow) of implementation superiority. The only item perceived to perform better than minimum level (blue) is related infrastructures development and management (IDM-2), Improve health facilities to be responsive to emerging needs’’. This implies that the strategic plans implementation level failed to meet the minimum satisfaction level of the operational staff and hospitals management teams. This further implied that top management shall be recognized that operational staff and hospitals management teams can turn strategic plan implementation into success.

Elimination of hepatitis C in Spain: Adaptation of a mathematical model based on the public health strategic plan for addressing hepatitis C in the National Health System

Elimination of hepatitis C in Spain: Adaptation of a mathematical model based on the public health strategic plan for addressing hepatitis C in the National Health System

Spectrum-Malaria: a user-friendly projection tool for health impact assessment and strategic planning by malaria control programmes in sub-Saharan Africa

BackgroundScale-up of malaria prevention and treatment needs to continue but national strategies and budget allocations are not always evidence-based. This article presents a new modelling tool projecting malaria infection, cases and deaths to support impact evaluation, target setting and strategic planning.MethodsNested in the Spectrum suite of programme planning tools, the model includes historic estimates of case incidence and deaths in groups aged up to 4, 5–14, and 15+ years, and prevalence of Plasmodium falciparum infection (PfPR) among children 2–9 years, for 43 sub-Saharan African countries and their 602 provinces, from the WHO and malaria atlas project. Impacts over 2016–2030 are projected for insecticide-treated nets (ITNs), indoor residual spraying (IRS), seasonal malaria chemoprevention (SMC), and effective management of uncomplicated cases (CMU) and severe cases (CMS), using statistical functions fitted to proportional burden reductions simulated in the P. falciparum dynamic transmission model OpenMalaria.ResultsIn projections for Nigeria, ITNs, IRS, CMU, and CMS scale-up reduced health burdens in all age groups, with largest proportional and especially absolute reductions in children up to 4 years old. Impacts increased from 8 to 10 years following scale-up, reflecting dynamic effects. For scale-up of each intervention to 80% effective coverage, CMU had the largest impacts across all health outcomes, followed by ITNs and IRS; CMS and SMC conferred additional small but rapid mortality impacts.DiscussionSpectrum-Malaria’s user-friendly interface and intuitive display of baseline data and scenario projections holds promise to facilitate capacity building and policy dialogue in malaria programme prioritization. The module’s linking to the OneHealth Tool for costing will support use of the software for strategic budget allocation. In settings with moderately low coverage levels, such as Nigeria, improving case management and achieving universal coverage with ITNs could achieve considerable burden reductions. Projections remain to be refined and validated with local expert input data and actual policy scenarios.

Implementing One Health as an integrated approach to health in Rwanda

It is increasingly clear that resolution of complex global health problems requires interdisciplinary, intersectoral expertise and cooperation from governmental, non-governmental and educational agencies. ‘One Health’ refers to the collaboration of...

Can wildlife surveillance contribute to public health preparedness for climate change? A Canadian perspective

Early warning systems for climate change adaptation, preparedness and response will need to take into consideration the range of factors that can drive risk and vulnerability. There are no data from which to nominate the most effective, efficient and reliable wildlife health signals for public health planning, but there is growing opinion that wildlife health could signal public health vulnerability related to climate change. The objective of this commentary is to explore the potential for wildlife to contribute to climate change early warning for public health protection in Canada. Wildlife impact many determinants of human health through both direct and indirect mechanisms; several of which are strongly interconnected. There is a long history of wildlife serving as bio-sentinels for environmental pollutants and pathogens. Wildlife health could support public health threat detection, risk assessment and risk communication by detecting and tracking infectious and non-infectious hazards, being bio-sentinels of effects of new or changed hazards, providing biologically understandable information to motivate changes in personal risk behaviours and providing insights into new and unanticipated threats. Public health risk communication and strategic planning priorities for climate change could benefit from a wildlife health intelligence system that collects data on incidents of disease and hazard discovery as well as information on social and environmental conditions that affect risk perception and likelihoods of human exposure or harms.