The Science And Practice To Improve Health Equity

Types of Planning

Discuss About The Science And Practice Improve Health Equity?

Planning is simply deciding on something or making arrangements for something in advance. It outlines where a person or an organization wants to go, ways of getting there and a timeline for the process. Planning takes into account decision making that are reflective of future needs and addresses these needs. In details it therefore involves future goals specification and lay down of courses of action that will bring about the set achievements (Wallerstein & Duran, 2010). In the public sector health service planning context, planning is focused on supporting and developing a high quality service delivery health system to the community. Health service plans precisely seek to progress a given populations health status and at the same time safeguard access, equity and fairness of the health system and its responsiveness to the specific perceived community’s needs. These planning intend to achieve the above goals by providing effective and efficient health services. It is however limited to the available methods, means of healthcare and resources. Therefore, this kind of planning is a process of allying the changing need patterns with service delivery arrangements that are in existence so as to make maximum utilization of the available resources (Stonhope, 2015). It puts into significant service provision the strategic directions and policy of healthcare organizations. The transparent and comprehensive process of defining strategies and service objectives helps in the achievement of the same.

Amongst operational, budgetary, strategic and service enablers planning, health service delivery planning is key. It is oriented to the organizations future adopting a long term perspective compared to the other types of planning. It puts the organization in a strategic position to address health issues that may emerge and are vital to contemporary to healthcare. The environment in which healthcare delivery occurs is more and more dynamic with ever changing technological advances, community expectations and government priorities. There exist ever increasing demands and pressures on the health system of the public sector amidst constrained budgets (Swayne et al., 2012). In future there will be even increased pressure due to increasing chronic disease prevalence and ageing population. In this light, it is vital that services have the capability and are well planned to be in a position to respond to the evolving changes to meet population needs.

These changes include: population needs and populations; it includes studying population characteristics i.e. social economic status, growth, cultural diversity and age groupings. In addition to that, coming up with the populations’ risk factors like excessive consumption of alcohol, smoking and obesity which may lead to different health issues, planning can be done in such a way that services are designed to reduce the target populations’ risks (Trivedi et al., 2012). Emerging technologies and clinical evidence; understanding there impact helps to shape organization and delivery of future services. It includes changes in the understanding and knowledge of disease trend, service delivery models and treatment techniques.  Foretelling service need in future; services demand in future as a result of population changes, treatment technologies change and disease patterns change is taken into account here. Through these assessments future service development decisions are better informed (Polit & Beck, 2012). Resources allocation prioritization; due to limited availability of resources to invest in the health sector, prioritization done to make sure areas of greatest need have resources directed towards them. Service efficiency improvement; exploration is done to bring on board alternative options that can meet increasing demand and optimize delivery of services. These may include service delivery in different settings including homes. Providing sustainable and safe services; service viability i.e. high quality care that exceed or meet minimum set standards. Two methods can however be used in developing a health service plan as follows.

Population-Based Planning

Every communities or countries healthcare service should be focused to reach its entire population. Attend to the populations’ needs and cover promotion, preventive and curative health services. It involves a collaborative and systematic assessment of the needs of the population. Emphases are put on the populations’ current health status identification, health problems determinants and risk factors, development and analysis of interventions and their link to outputs (Drummond et al., 2015). It relies on stakeholders’ effective collaboration and can involve other sectors stake holders to discuss and identify health issues and come to an agreement on regulations that will progress the concerned populations health. It is based on the values of equity (equity in access and outcomes), effectiveness (patients’ level of benefit from the provided service), accessibility (service acceptability, geographical, cultural, physical and affordability), quality (measure of the degree of service conformity to set standards) and efficiency (maximize benefits from resources use). However these planning principles conflict i.e. accessibility vs quality, efficiency vs accessibility and equity vs accessibility.

Population based planning makes use of holistic data. Here needs are assessed through population surveys since it is the frequently used information collection method. This information is then used to set realistic future goals and appropriate allocation of resources. The communities’ main interests are served using this planning method (De Grot et al., 2010). A need assessment process is put into place and it describes the local people’s state of health, identifies causes of illnesses and major health causing risk factors. It also helps in bringing to light how to address these factors. However this is not a one- time process/ activity, it is carried on over time to capture the changes that arise. It is therefore relevant for future use too. Most importantly, this method takes into account the fact that a number of factors affect health. The quality of water people drink, the air they breathe and their physical environment has an effect on their health. Family and friends emotional and social support are part of the social environment and it affects people’s health. The enjoyment of life is reduced by poverty, lifestyle behaviors’ e.g. heavy drinking and smoking will increase risk of diseases like lung cancer and avoiding these behaviors’ significantly reduces its risk. Individual biology and family genetics also play a role in one’s health (Dennis et al., 2012).

• Public inequalities elimination; population based healthcare makes it possible for equitable and quality care to be delivered to communities by practitioners.
• Group empowerment; it gives doctors and healthcare teams a platform to empower communities on precise disease conditions. Through printed materials, posters and workshops these can be achieved. Community healthcare preventive measures are applied here.
• Population based health planning preventive measures; practitioners base their work upon this strategies and concepts.
• Prevention at a primary level; the likelihood of disease occurrence is reduced at this level. This include: healthcare education on lifestyle and behavior, diet, physical activity and psychological support; communicable diseases prevention through vaccination; job opportunities and good housing; safe environment promotion i.e. sanitation, clean air and drinking water; pollution and industrial hazard avoidance.
• Prevention at secondary level; deals with preventing progress of a disease. Its achieved by; case or risk assessment, surveys and early testing, assessments of public health, medical help and basic investigation help (Buntin et al., 2011).
• Prevention at tertiary level: this stage focuses on minimizing suffering from diseases and disabilities that may be caused by the diseases. This can be achieved by education, rehabilitation care, palliative care, psychological support and creating awareness.
• Team focus; it brings together different healthcare practitioners thus creating team building spirit thus achieving more success.

• Assessing populations risk levels and health status can be hectic and difficult.
• Many determinants under these method e.g. social factors are outside the health sector. This is hectic as it requires collaboration with other sectors in order to bring out best results. The health sector may not be able to influence broader social determinants of health since it may lack the capacity to do so (Alessi, 2010).
• It is a lengthy process which can be affected by governments’ politics. Since it involves a lot of stakeholders, they may fail to settle on one view maintaining different cultural, social and environmental views thus hindering implementation.
• Stakeholders may have conflicting interests that may add weight on the planner as they try to control the conflict between political realities and rational planning.
• Many health determinants under this method are not easily identifiable and may not have an action to remedy them.
• Accurate information and data gathering in the health field is always demanding and costly.
• For reliable and timely health action and surveillance, there is need for innovation of technology to help with the same.
• Limited collection, dissemination, analysis and data use affect directly decision making capacity in needs and problem identification, progress tracking, interventions impact evaluation.
• Due to short political time in office, politicians do not have interest in passing long term policies thus funding long term project is not their priority (Berman et al., 2012). Therefore for them to be seen bringing fourth benefits, they will rather fund institutional plans.

It refers to joint care for the public by analyzing first the population they are planning for. Their environment is scanned; these include the internal and external environments. In the external environment, public sector has to plan according to state and national policies (Dulet, 2012). The private sector has to take into account market for their services and competition from other providers. On the other hand the internal environment takes into account their capability to meet future healthcare needs of the population as well as their present needs. Efficiency of services is assessed through benchmarking performance (Park, 2015). The population is profiled; under population demography, education standards, population projections, composition and size are looked at. Housing, health behaviors and social factors are also taken into account. The status of their health profiled; here a variety of factors are looked into i.e. burden of disease, mortality and morbidity rates. Service projections and utilization are analyzed through hospital separations by major diagnostic groups and diagnosis related groups. Current service arrangements are described using private and public bed numbers, occupied bed days, flows in and out of the area, average length of stay per MDG and DRG, occupancy levels by specialty and by facility, number of surgical operations, community service types, and ratio of aged care population beds and through comparison of costs, flows and services.  Geographical catchment; under these public transport cost, access to health centers and availability is looked at. Speed of travel, easiness of the roads, and nearness of the area to the nearest city, communication in terms of broadband speed and access and mobile phone access (Frenk et al., 2010).

Advantages and Disadvantages

The planning process is then done through forecasting changes in disease burden and population composition and projection, establishing current structures through situational analysis, development and revision of service goals, identification of interventions that can be effective, strategies formulation, plan development, its implementation and then evaluation. Therefore institutional based planning is focused on services provision to a certain extent than population need (Green & Thorogood, 2013). Needs are identified from provision and understanding of current services. It relies heavily on data from demographic profiling. It focuses organizations efficiency improvement, enhancing service provision and service quality improvement. It provides collaborate public care through primary health centers’ (primary health care) referral units and sub district hospitals (secondary health care) and medical colleges or by specialty hospitals (tertiary health plans).

• Provides individual needs to a particular individual and it enhances appropriate care delivery.
• In institutional service provision, there is more focus one patients disease condition at a time.
• Here, holistic care is provided.
• Treatment pattern is improved using new technology in screening and diagnosis.
• Provides psychological and personal based care.
• There are new treatments and scientific interventions in place.
• Healthcare/ treatment are provided up to tertiary level all the way from primary level.
• Assists staff requirements planning.
• Available resources are utilized sufficiently.

• Hospital demand projections has limitations when based on present clinical practice due to assumptions as follows; assuming clinical practice does not change over time is a false assumption since it gets better over time.
• Population health doesn’t necessarily stay the same over time as assumed in this model. Cancer and obesity rates increase over time.
• Private health insurance doesn’t remain the same as assumed in the model.
• Hospital beds may be used as nursing home beds since aged care facilities are not expansive thus leading in reduced essential service delivery by hospitals.

Population based health care technique is an ancient way of health planning services as it came about at a time when communities showed low incidences of communicable diseases and lifestyle alteration diseases. Therefore in the early nineties the health service planning was based on a population based approach (Paina & Peters, 2011). It was important then as it focused on finding disease prevalence and public awareness creation. It is very successful in gathering mobility rates, mortality and analyzing health status of a population in cases of an outbreak of an epidemic. It therefore should be core in any countries health services planning as it all starts with the understanding of the needs of a population and outlining the needed precautions and government steps. This method more suits rural areas (Halpern et al., 2012).

On the other hand, institutional based method is a modern method which has been implemented and followed widely. There is a continuous change in the health sector with new technologies, non communicable and non curable diseases prevalence in the population and many more emerging issues. Community and public health care settings cannot treat some of these diseases therefore calling for need to be treated in institutions. This method thus creates a platform that can be used by people with unknown conditions and diseases to find treatment that is appropriate for them (Katherine & Sandra, 2016). A government’ organizations, departments can find ways of supporting people in a particular society.

I could lean more towards institutional health planning to implement disease cures through use of new technology and betterment of health sectors. Effective implementation of institutional method through health care policy changes, hospital infrastructure changes, availability and feasibility of healthcare, it will be affordable to the community. Effective implementation can enhance new treatment findings and even cure to non curable diseases. Institutional care of non communicable and non curable diseases can lead to prolonged life of people and control communicable diseases too. However in planning, the major problems that communities face should be taken into account (Harkness & DE Marco, 2012). By taking note of that, the planning will develop institutional based plans will be promoting a health population and a healthy county.

Institutional-Based Service Planning

Conclusion

Institutional health planning implementation in a population can bring forth interventions that can curb communicable diseases, provide efficient health services, maximum resource utilization.

References

Alessi, E. J., & Martin, J. I. (2010). Conducting an internet-based survey: Benefits, pitfalls, and lessons learned. Social Work Research, 34(2), 122-128.

Berman, E. M., Bowman, J. S., West, J. P., & Van Wart, M. R. (2012). Human resource management in public service: Paradoxes, processes, and problems. Sage.

Buntin, M. B., Burke, M. F., Hoaglin, M. C., & Blumenthal, D. (2011). The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health affairs, 30(3), 464-471.

De Groot, R. S., Alkemade, R., Braat, L., Hein, L., & Willemen, L. (2010). Challenges in integrating the concept of ecosystem services and values in landscape planning, management and decision making. Ecological complexity, 7(3), 260-272.

Demetrius James Porche (2014) “Public & Community Health Nursing Practice: A

Population-Based Approach, SAGE Publications.

Dennis, A., Clark, J., Córdova, D., McIntosh, J., Edlund, K., Wahlin, B., … & Blanchard, K. (2012). Access to contraception after health care reform in Massachusetts: a mixed-methods study investigating benefits and barriers. Contraception, 85(2), 166-172.

Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes. Oxford university press.

Dul, J., Bruder, R., Buckle, P., Carayon, P., Falzon, P., Marras, W. S., … & van der Doelen, B. (2012). A strategy for human factors/ergonomics: developing the discipline and profession. Ergonomics, 55(4), 377-395.

Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., … & Kistnasamy, B. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The lancet, 376(9756), 1923-1958.

Green, J., & Thorogood, N. (2013). Qualitative methods for health research. Sage.

Halpern, B. S., Longo, C., Hardy, D., McLeod, K. L., Samhouri, J. F., Katona, S. K., … & Rosenberg, A. A. (2012). An index to assess the health and benefits of the global ocean. Nature, 488(7413), 615.

Harkness, G. A., & DE Marco, R. (2012), “Community and public health nursing: evidence

for practice”. Philadelphia: Walters Kluwer Health/Lippincott Williams & Wilkins Publishers

Katherine M. Keyes and Sandra Galea (2016)” Population Health Science” (1st edition), OUP

publishers, USA.

Paina, L., & Peters, D. H. (2011). Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health policy and planning, 27(5), 365-373.

Par k., (2015) “Textbook of preventive and social medicine”. , (23rd edition), m/s

Banarasidas Bhanot Publishers, Jabalpur, India.

Polit. F.D and Beck. C.T, (2012). “Nursing Research Generating and Assessing Evidence for

Nursing Practice” (8 th ed.). New York, Lippincott company Publishers.

Shariff, S. R., Moin, N. H., & Omar, M. (2012). Location allocation modeling for healthcare facility planning in Malaysia. Computers & Industrial Engineering, 62(4), 1000-1010.

Stanhope Lancaster, (2015), “Public health nursing.” (9th edition), Philadelphia, Mosby

company Publishers.

Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2012). Strategic management of health care organizations. John Wiley & Sons

Trivedi, A. N., Grebla, R. C., Jiang, L., Yoon, J., Mor, V., & Kizer, K. W. (2012). Duplicate federal payments for dual enrollees in Medicare Advantage plans and the Veterans Affairs health care system. Jama, 308(1), 67-72.

Wallerstein, N., & Duran, B. (2010). Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. American journal of public health, 100(S1), S40-S46.