Overview of strategies of public health services in a typical rural and urban settings.pptx

Rural, Urban and International Health
Ashok Pandey
5/26/2022 Ashok Pandey 1

Unit 3: Overview of strategies of public health
services in a typical rural and urban settings
3.1 Advocacy of public health perspective in the urban and rural municipalities for
establishment of public- health focused section/unit and program plan
3.2 Incorporation of public health core actions (promotive, preventive, protective,
control and encouragement for early detection and treatment of diseases) and
intervention, such as educational policy-regulatory, infrastructural, community
organizational and managerial interventions in municipal health plans supported by
human resources for implementation
3.3 Mobilization of local clubs and organizations
3.4 Inter-organizational coordination, cooperation and resource mobilization
3.5 Excessive use of local (specifically in rural setting) and mass media (specifically
in urban setting)
3.6 Establishment of public health service centers at wards
3.7 Special roles and functions of public health practitioners at the local health and
medical service centers in the rural and urban settings

3.1 Advocacy of public health perspective in the urban and
rural municipalities for establishment of public- health focused
section/unit and program plan
• A powerful strategy for promoting health promotion goals including
for establishment of public- health focused section/unit and program
plan .
• The Ottawa Charter (1986) identified 3 main strategies for health
promotion:
1. Advocacy
2. Enablement, and
3. Mediation

Contd..
Kickbusch (1995) identifies that the aim of public health is to
improve the health of communities through:
•Advocating for healthy public policies
•Mediating between diff. interests in society to benefit health, and
•Enabling communities and individuals to achieve their full
potential

Definition of advocacy
a ‘combination of individual and social actions designed to
gain political commitment, policy support, social
acceptance and systems support for a particular health goal
or programme’ (WHO, 1995).
refers to the actions of health professionals to influence and
shape the decisions and actions of decision - makers and
policy - makers in communities and government sectors
who have some control over the resources which affect or
influence health (PAHO, 1996).

Need for Advocacy of public health perspective in the
urban and rural municipalities for establishment of
public- health focused section/unit and program plan
• “I believe that working with local advocacy groups to change the
system can have an effect, even if it may be small.”
• “I hope to make an impact…particularly for children in urban areas,
by increasing awareness & advocating for reform.”
• “I see myself getting politically active in advocating for the ridiculous
prices of prescription drugs to be more regulated…”
• “Be an advocate for patients who normally fall thru the cracks in the
healthcare system.”

Needs….
• Employs the methods of political advocates to bring about changes in
the systems that influence the health of populations.
• Can be confrontational- challenging powerful anti-health interests
• Targets policies, laws and regulations that affects the lives of
populations
• Focusses on broader determinants of health embedded in social
policies
• Shift from behaviours of the victims to the behaviours of corporate
leaders (profit from harmful conditions or products) and public
decision-makers

How else can you influence policy?
• Develop relationship with & be a resource for a politician & his/her
staff
• Personal staff:
• Chief of Staff or Legislative Director
• Scheduler
• Legislative Assistant or Legislative Correspondent
• Committee staff:
• Committee Chairperson & Ranking Minority member

Examples of Successful Advocacy
• Nepal's universal salt iodization program
• Water and Sanitation (WASH) program
• Safety and Security of Health Workers and Health Institutions in Nepal
• Malpractice insurance rate relief in Maryland, 2004
• Maryland insurance chief bars conversion of CareFirst to for-profit status, 2003

Advocacy for establishment of public- health-
focused section/unit and program plan
• providing information to policy - and decision - makers,
• promoting public involvement and participation in decisions
about health - related issues,
• direct attempts to influence key decision - makers at
appropriate levels of government to make decisions and
implement action that will improve the health of the
community.

MEDIA ADVOCACY
• Mass media are unparalleled vehicles for setting public and political
agendas.
• The more media coverage an issue receives, the more likely it is a public
concern
• Media provides access to the people who count (in government and
corporate sector)
• Media campaigns emphasise the “information gap”, which suggests that
health problems are caused by lack of information on the part of individuals
with the problem or at risk.
• Essential for the issue to be covered extensively and positively in the news
media before it can be visible.
• News media have an impressive record in directly influencing public health
policies

ADVOCACY CAMPAIGN
Components of an effective public health advocacy campaign:
1. Information about public health problems and their causes or
determinants, and about effective solutions or responses.
2. Health professionals are important in establishing an agenda, or in
proposing courses of action (credible)

ADVOCACY CAMPAIGN
3. Bureaucrats play crucial roles in translating the agenda of public
health into the language and thinking of the government of the
day. Can influence procedures re. resource allocation.
4. Partnerships or coalitions with key stakeholders: individuals or
organisations. Critical because most of the decisions affecting the
health of individuals and communities are made by and in sectors
other than health.

ADVOCACY CAMPAIGN
5. Champions or leaders to draw public and political attention to the
issue and proposed solutions. Particularly skilled at working with
the mass media, negotiating directly with multiple stakeholders,
including politicians, community and business leaders and
individuals.
6. Rally, orientation

ADVOCACY CAMPAIGN
6. Community educators and organisers to build widespread,
community support for action to address an issue, for generating
solutions, and for supporting proposed changes in policy.
7. Journalists to engage community attention, to initiate and
encourage debate about both the problem and suggested
solutions.

ADVOCACY CAMPAIGN
8. A recognised constituency : the advocate needs the backing of a
significant, credible, and respected constituency.
9. Research, including market research, to identify problems, test
solutions, and to assess the “readiness” of communities to take
action on a given public health issue
10. Evaluation to assess the effects of the diff. components, including
impact and outcomes

ADVOCACY:CONCLUSION
• A powerful strategy for promoting health. Contributes by:
• Setting the agenda and creating visibility about a public health
problem (using mass media)
• Shaping the debate and getting the state involved, and
• Shifting public opinion and advancing policy

ADVOCACY:CONCLUSION
• Public health advocacy contributes to building community
agreement that an issue is a priority for action and that the
proposed solutions are acceptable
• Its effectiveness can be measured by success in changes in
laws, organizational policies, and in environments
• Advocacy changes the policies and environments that in
turn shape people’s access to healthy choices

3.2 Incorporation of public health core actions (promotive, preventive,
protective, control and encouragement for early detection and treatment
of diseases) and intervention, such as educational policy-regulatory,
infrastructural, community organizational and managerial interventions
in municipal health plans supported by human resources for
implementation

3.2 Incorporation of public health core actions (promotive,
preventive, protective, control and encouragement for early
detection and treatment of diseases) and intervention, such as
educational policy-regulatory, infrastructural, community
organizational and managerial interventions in municipal
health plans supported by human resources for implementation

Public health core actions
ASSESSMENT
The regular collection, analysis, and sharing of information about
health conditions, risks, and resources in a community. Assessment
identifies trends in illness, injury and death and the factors which may
cause these events.
POLICY DEVELOPMENT
Information gathered from assessment activities is used to develop
local and state health policies. This process includes information
sharing, citizen participation, compromise, and consensus. Policy
development includes consideration of political, organizational and
community values and foster shared ownership of policy decisions.
ASSURANCE
Assurance means making sure that needed health services are
available. Assurance focuses on maintaining the capacity of public
health agencies to manage day-to-day operations and provide the core
public health functions. This function also requires monitoring the
quality of health services provided in both public and private sectors.

Promotive, preventive, protective, control and
encouragement for early detection and treatment
of diseases
The natural history of a disease classifies into five stages: underlying,
susceptible, subclinical, clinical, and recovery/disability/death.
Primordial Prevention: earliest prevention modality
Primary Prevention: consists of measures aimed at a susceptible
population or individual.
Secondary Prevention: emphasizes early disease detection
Tertiary Prevention: clinical and outcome stages of a disease
Quaternary Prevention: action taken to identify patients at risk of
overmedicalization, to protect him from new medical invasion, and to
suggest to him interventions, which are ethically acceptable

Interventions in municipal health plans

5/26/2022
Primary health care services shall be delivered according to the
following three streams:
• Municipality-based clinical specialist support teams supporting delivery of
priority health care programmes at a municipality
• School-based Primary Health Care services
• Municipal Ward-based Primary Health Care Agents
Interventions in municipal health plans
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5/26/2022
School health services
• Delivered by a team that is headed by a professional nurse
• Services will include health promotion, prevention and
curative health services that address the health needs of
school-going children, including those children who have
missed the opportunity to access services such as child
immunization services during their pre-school years
Ashok Pandey 25

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Municipal ward-based primary health care agents
• A team of PHC agents must be deployed in every municipal ward
• Technical and capacitated HR must be deployed per ward.
• Each team will be headed by a health professional depending on availability
• Each member of the team will be allocated a certain number of families
• The teams will collectively facilitate community involvement and participation
in:
•Identifying health problems and behaviours that place individuals at risk of
disease or injury
•Vulnerable individuals and groups
•Implementing appropriate interventions from the service package to address the
behaviours or health problems Ashok Pandey 26

Goal
Goal 1. A healthy, safe and resilient community:
• Improved social and emotional wellbeing
• Increased healthy eating
• Increased active lifestyles
• Increased adaptation to the health impacts from climate change
• Reduced injury and harm
• Prevention of family violence
Goal 2. A connected and inclusive community:
• Increased connection to and engagement in community life

In developing these priority areas,
municiplity has included consideration of
• Across the life course – Looked at the lifespan of community
from infants, children and young people to older adults, to
understand the impacts on health and wellbeing at different life
stages
• Community groups –Identified the needs and priorities of people
from multicultural communities, the LGBTQIA+ community,
First Nations peoples, carers and people with disability
• Genders – Assessed how all genders and intersectionality, which
are attributes other than gender such as age, disability or sexual
orientation, may be impacted by a range of health issues

Implementing the Strategy/plan
• Organized an emergency Aware Program
• Construction of Parks and recreational facilities within health center
• Planned Parenting Seminar Series
• Plan the skills 4 the Future
• Local Alliance Group for specific program (Safe motherhood, Health
insurance, Immunisation, etc)
• Unite for Safety and Respect Project

Addressing Challenges
• Lack of funding
• Need for a clear statement
• Legally who is responsible to pay and place
• Rollout strategies
• Involvement of private sector and other govt. Dept’s
• Brain drain
• Trust
• Climate change
• Migrated population

National and provincial govt. Intervention
• Resources and tools of trade office.
• Accommodation and transport to health workers
• fully participate in the budgeting processes of municipality
• national and provincial govt. Intervention
• Proper communication
• co-operative governance

Mobilization of local clubs and organizations
Community Mobilization: A capacity-building process through which
individuals, groups, or organizations plan, carry out, and evaluate
activities on a participatory and sustained basis to improve their health
and other needs, either on their own initiative or stimulated by others.
Community mobilization aims to mobilize and engage community
members to address a particular cause. Engagement of community
mobilizers needs to happen early and individuals need to be involved
from the definition of the problem through to the generation of adequate
solutions.

Mobilizing Communities for
Development and Social Change

Why Community Mobilization?
• Decentralization and democratization require increased
community level decision-making
• Communities have different needs and problems, different
cultures, beliefs and practices--one message may not fit all
• Builds mechanisms and systems to sustain health
improvements
• Brings additional resources that may not be
available to health system alone
• Communities can apply political pressure to
improve services.

Contd..
• Empowering CM approaches can strengthen community
members’ skills and capacity to address the underlying
causes of health problems and reduce barriers to access of
information and services.
• Social structures and norms may need to be changed if
true access to information and services is to be achieved
by those who need them most. CM can help to facilitate
these changes.
• CM can increase community members’ awareness of their
right to decent treatment and can strengthen members’
ability to claim this right.

Benefits of Community Participation
• Increased ownership, support and responsibility
• More likelihood of, and sustainability for, behavior change
• More cost-effective programming
• Better response to community needs and concerns
• Community Participation not only increases ownership, but it also instills a sense
of greater responsibility for the program & for FP in general.
• Due to community support, enabling environment & role models Behavior change
is more likely & more likely to be sustained.
• Programming is more cost-effective b/c project resources are often supplemented
by community
• Community members participate in problem identification, prioritization &
decision-making, the program can respond better to their needs & concerns.

Contd..
• More culturally appropriate strategies and messages
• Increased coverage and access to information and services
• Increased demand
• Increased advocacy for service and policy change
• Increased success (results and sustainability)
• FP program strategies & messages are often more culturally
appropriate & acceptable.

Examples of Stakeholders
• MOH (National, Provincial/Regional, District)
• Donors,
• Associations
• NGO/CBO partners
• Health Facility ( service providers, support staff, outreach workers)
• Community (chiefs, religious leaders, women leaders, community
group leaders, community resource persons and traditional health
workers)

List of community mobilization activities
• Community meetings to discuss an issue with community leaders, which
may include traditional, religious and local political leaders, among others.
• Public debates in which community members question leaders on a
specific, predetermined topic. These debates can be recorded on the radio
and then broadcast.
• Puppet shows and participatory theatre where audiences are encouraged
to participate by developing alternative scenarios that would lead to better
outcomes.
• Village literacy fairs where information about a predetermined topic is
shared.
• Dance and concerts conveying key messages. The events can be recorded
and screened through cinema units or made to go viral on the Internet.

Contd..
• Mobile cinema units screening short films addressing a specific topic and followed by
discussions and questions/answer sessions. Sporting events and competitions where
messages are conveyed before and after the games and at halftime.
• Listening groups to listen to and discuss a particular radio program.
• Quiz competitions between teams addressing knowledge of a specific topic.
• Print media such as leaflets and cartoon strips for distribution in the community.
• Community coalitions made up of people who practice desired behaviors, or who have
survived the outbreak and can act as positive role models and decrease stigma.
• Door-to-door sessions where mobilizers enter household to discuss the outbreak and
protective practices in privacy.
• Storytelling in which a narrator recounts a pertinent story which may be real or fictional,
to highlight key messages and the importance of protective behaviors.

Mobilization of local clubs and organizations
A Community is a set of people living together with common interest” We all live in
a community. There are different things that bind us together. Let us try to identify
them.
• Beliefs
• Values
• Language
• Territory
• Religion
• Culture
• Occupation
Community mobilization is a capacity building process through which community
individuals, groups, or organizations PLAN, CARRY OUT, and EVALUATE
activities on a participatory and sustained basis to improve their health and other
needs, either on their own initiative or stimulated by others.

Why mobilization of local clubs and
organizations
1. Creating demand for interventions
2. Increasing access to services
3. Scaling up interventions
• Increasing effectiveness and efficiency of interventions
• Contributing additional resources to the response
• Reaching the most vulnerable
• Addressing the underlying causes of Education: gender disparities, lack of
awareness etc.
• Increasing community ownership and sustainability.
Resource mobilization is actually a process of raising different types of
support for your organization.

Benefits of Community Mobilization
• Increase community, individual, and group capacity to identify and
satisfy their needs
• Improve program design
• Improve program quality
• Improve program results
• Improve program evaluation
• Cost effective way to achieve sustainable results
• Increase community ownership of the program

Key Task involved in Community Mobilization
• Developing an on-going dialogue between community members
• Creating or strengthening community organizations (Committees etc.)
• Creating an environment in which individuals can empower themselves to
address their own and their community’s health needs
• Promoting community members’ participation
• Working in partnership with community members
• Identifying and supporting the creative potential of communities to develop
a variety of strategies and approaches
• Assisting in linking communities with external resources
• Committing enough time to work with communities, or with a partner who
works with them

Local club and organisation
Involving all Stakeholders
• Identification of Deprived/Neglected Group What do you think, who are deprived and
neglected people in your community?
• Why are they neglected?
• How can you enhance their participation?
Deprived people
Why are they deprived?
How can their participation be enhanced?
Economically deprived group (Poor)
Women
Tribal/indigenous people
Disable people
Minority Groups
Others Examples Identify marginalized groups in your community

Inter-organizational coordination, cooperation
and resource mobilization
• “As an individual I could do nothing. As a group we could find a way
to solve each other’s problems”.

The process concerned with mobilizing human and
financial resources through five main approaches.
1. Political mobilization
2. Community mobilization
3. Government mobilization
4. Corporate mobilization
5. Beneficiary mobilization

Degree of Community Participation
Co-option: Token involvement of local people, Representatives are chosen, but have
no real input or power
Compliance: Tasks are assigned, with INCENTIVES, Outsiders decide the agenda
and direct the process
Consultation: Local opinions are asked, Outsiders analyze and decide on a course of
action
Cooperation: Local people work together with outsiders to determine priorities,
Responsibility remains with outsiders for directing the process
Co-learning: Local people and outsiders share their knowledge to create new
understanding, Local people and outsiders work together to form action plans with
outsiders facilitation

Excessive use of local (specifically in rural setting)
and mass media (specifically in urban setting)
Overconsumption describes a situation where the use of a renewable
natural resource exceeds its capacity to regenerate.
A prolonged pattern of overconsumption leads to the eventual loss of
resource bases.

Mass media is an effective means of following things:
• Expressing views, opinions, and ideas
• Sharing views, opinions, and ideas
• Communication
• Spread information
• Advertising
• Marketing

Ashok Pandey
The Definition of Media
• Broadly, what enables communication to take place
• May be interpersonal and one on one( speech, writing, facial gesture)
• Specifically, a technological development that extends the channel,
range of speed of communication among large groups of people
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Ashok Pandey
Mass Communication
• Communication from one person, group or institution through a
transmission system or medium to large audiences or markets
• From one ( or few) to many
• Implies concept of gatekeeper: controller of transmission/message
design
• Implies concept of effectiveness and efficiency: is messaging achieving
what it intended?
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Ashok Pandey
Characteristics of Mass Communication
1. Message produced in complex organizations
2. Message fixed in some form with information and symbolic content (
either in digital bits or commodity form)
3. Message is sent/transmitted or diffused widely via a technological medium
Newspaper, magazine, CD or videocassette, radio, television, satellite or
Internet
4. Message is delivered rapidly over great space
5. Message reaches large groups of different people simultaneously or within a
short period of time
6. Message is primarily one-way, not two way
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Ashok Pandey
Media of “Mass” Communication
• Print
• Newspapers
• Magazines
• Books
• Audio
• Radio
• Music/Sound Recording
• Visual
• Film
• TV
• Videogames
• Digital
• Internet
5/26/2022 55

Rural areas
• FM/Radio
• Poster
• Pictorial diagram
• Pamphlets
• Internet and mobile, are often called collectively as digital media &
radio and TV, as broadcast media

Urban areas
• Newspaper
• Magazine ( general & public interest)
• Journals
• Books
• Other are leaflets, circular letters, newsletters, folders, banners, and
wall newspapers.

Establishment of public health service centers at wards
1. Situation analysis
2. Take a land
3. Make a design
4. Construct the infrastructure
5. Establish and make it functional

Special roles and functions of public health practitioners at
the local health and medical service centers in the rural
and urban settings
• Creating Awareness.
• Monitoring Community Health.
• Identifying the Prevailing Health Issues in the Community.
• Initiating Educational Programs.
• Designing Health Service Delivery System.
• Making Policies and Regulatory Initiatives.
• Conducting Community Wellness Programs

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