Public health Planning for hearing Impairment (pre-conference course) Dr Daksha Patel Improving health worldwide www.lshtm.ac.uk
Public health Planning for
hearing Impairment (pre-conference course)
Dr Daksha Patel
Improving health worldwide
www.lshtm.ac.uk
Learning objective
By the end of this session you should be able :
Discuss the key challenges and barriers within health
systems to deliver ear and hearing care services , with
reference to low and middle income countries
360 million people
have disabling hearing
loss, globally 328 million
adults
32 million children
Clinical vs. Public health approaches
Clinical approach
Individual Patient
Public health approach
Population needs
• Take a history
• Examination and Diagnose
• Treat
• Counsel/ follow up
• Survey population need / service gaps • Plan – 1
0,2
0,3
0prevention strategy,
training, technology• Strengthen Health system- Policy • Monitor & Evaluate
What does this means for
health systems?
How people, resources and
their actions are organised
to promote, maintain and
restore health.
Health Systems approach
Governance Responsibility and leadership
Health personnel Ear & hearing health team + ???
Health financing Income and expenditure mgt.
Medicines, technology Infrastructure, consumables etc
Information systems Need, utilisation, monitoring,
evaluation
Service delivery Equitable, excellent, economically OK
Health systems approachGovernan
ceServicedelivery
Information
systems
Medicines,
technology
Health financing
Health personnel
Health systems
360 Million 360 Million
PrebycususPrebycusus
HEARING AIDS ? HEARING AIDS ?
CongenitalCongenital
? COCHLEAR IMPLANTS
HEARING AIDS
? COCHLEAR IMPLANTS
HEARING AIDS
MEASLES / MUMPS / MENINGITIS
MEASLES / MUMPS / MENINGITIS
IMMUNISATION IMMUNISATION
OTOTOXICITY OTOTOXICITY
AWARENESS / GOVERNANCE AWARENESS / GOVERNANCE
CSOMCSOM
EARLY DETECTION AND TREATEMENT
FOCAL
EARLY DETECTION AND TREATEMENT
FOCAL
WAX/ FBWAX/ FB
TREATMENT TREATMENT
CausesCauses
LIMITED PREVENTION
NEEDS AUDIOLOGICAL REHAB
PRIMARY PREVENTION
POSSIBLE
Services required
How do you eat an elephant?
Human
resources
Model for District Level services
PATIENTS
Equipment
Supplies (£)Leadership
Information
Management
Practical approach
I million population I million population
ServicesServices
Primary
Secondary
Tertiary
Primary
Secondary
Tertiary
Where are they Where are they
Data and information
Data and information
Survey Data
Monitoring data
Survey Data
Monitoring data
TechnologyTechnology
Types
Availability
Repair and maintaining
Types
Availability
Repair and maintaining
Is there enough ? Is there enough ?
Finances Finances
Sources
sustainability
Sources
sustainability
Human resources
Human resources
Training
Distribution
Range of Cadres
Training
Distribution
Range of Cadres
How many ? How many ?
GovernanceGovernance
National guideline
National programme
Leadership
National guideline
National programme
Leadership
5.3% hearing impaired = 53,0005.3% hearing impaired = 53,000
HEALTH SYSTEM HEALTH SYSTEM
UNIVERSAL HEALTH COVERAGE
No change
Number of HI will increase :
• Population growth
• Ageing population
CHANGE
• Identify what must be
changed.
• Strengthen each of the
Health systems blocks
• Universal health – equity
and excellence
What are the options?
Health systems - universal health coverage
Universal health – to ensure that all people obtain health services they
need without suffering financial hardship.
EQITABLE – EXCELLENCE- ECONOMIC
Health systems strengthening blocks
GOVERANCE Leadership, National plans etc
PERSONNEL Ear Care Team
FINANCING Income + expenditure management
MEDICINES, TECHNOLOGY Infrastructure, consumables,
Equipment, etc
INFORMATION SYSTEM Need, utilisation , monitoring performance
SERVICE DELIVERY Equitable , excellent , economic
Challenges
HSS BLOCK Challenge
GOVERANCE Leadership, National plans
PERSONNEL Ear Care Team Defining roles and cadres
FINANCING Income + expenditure
management
investment – vertical and
integrated
MEDICINES,
TECHNOLOGY
Infrastructure, consumables,
Equipment, etc
hearing aids ?
Cochlear implants
Diagnostic challenges
INFORMATION SYSTEM Need, utilisation , monitoring
performance
Local data and targets
SERVICE DELIVERY Equitable , excellent ,
economic
setting local priorities
Health services
Community level
District / secondary level
Tertiary level
Ministry of Health National Planning / targets / finances
Local data, research, training
Prevention and treatment
Prevention, early detection,
Rehabilitation, inclusion etc.
Khayelitsha
Question: How do we deal with
hearing loss in situations like this?
Or this?
Human resources
Community level
District / secondary level
Tertiary level
Centers of excellence- university
Primary health workers
Community Rehabilitation workers
ENT Nurse / clinical officers
Audiology technicians
ENT surgeons , ENT Nurses, audiologists,
, speech therapists
ENT surgeons, sub speciality consultants,
ENT Nurses, audiologists,
speech therapists, health systems planners
( research capacity , policy advisor)
How many required per million populations for each cadre?
Human resources ENT / million population
Audiologists / million population
Speech therapists / million population
Take corrective
action: revise plan
Monitor progress
of implementation
Implement the
programMonitor progress of
implementation
Identify
problems and solutions
Midterm review of
implementation
Assess the .
needs in the community
Identify relevant
strategies for primary,
secondary and tertiary
prevention
Assess resources
already available at each level of
delivery
Identify gaps
in current provision
Determine
priorities for action
Convert strategies into a plan of
action with clear objectives and
targets; indicators;
Wh
ere
d
o w
e w
an
t to
be
?
Secure resources start
the program
Manage the program
(money, material,
manpower etc.)
Evaluate the program
Determine if the program can be scaled up elsewhere
End of program
Program planning and management cycle
STEP 1 STEP 2
STEP 3
STEP 4Set priorties ,
Budget and timetable
STEP 5
STEP 6
WHERE ARE WE NOW?
SWOT situation analysis ( one of many tools )
StrengthsStrengths WeaknessWeakness
OpportunitiesOpportunities Threats Threats
Internal factors
External Factors
Positive Negative
The “leaky can” • I Million Population
Prevalence ( Backlog)=
Number of people that
need services
Number treated / habilitated/ provided support
Mortality
New cases? INCIDENCE
Reduce = prevention programme
What resources are available and
being used at present
Local needs
+
Global support SELECTING REGIONAL
PARTNERS
INTER INSTITIUTIONAL
AGREEMENTS
FUNDING
LOCAL FACULTY AND
ADMINISTRATION
Capacity Building Strategy
Epidemiology
Public health strategy for HI
HI children: health & education
Health system challenges
National programmes
Primary ear& hearing health
Planning skills and tools
Developing a local plan –
district level
Monitoring and
evaluation
Advocacy
Online Network-DEAPH
Partner mentoring- 3 years
Local linkages with public health
Conclusion
• Public health Approach is essential to address the growing burden
of hearing impairment and deafness.
• Public health approach has to be targeted at population level
• Planning is an organised process to maximize the utilization of
available resources efficiently and effectively
• Key steps to planning include :
Know the problem – and solution
Know what you have
Know where you want to go and how – Aim and Objectives
Define a logical priority order of activities and timetable – Strategy
Implement – Monitor
Did you get there – Evaluate
Situation analysis
Thank You for listening
“If all my possessions were taken
from me with one exception,
I would choose the power of
communication, for by it I would
soon regain it all”Daniel Webster
Thank you for listening
Video - education and inclusion
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