• Chapter 1: Introduction to Program Planning

    • Chapter 1: Introduction to Program Planning

    Introduction 


    Welcome, new professionals, to the beginning of your journey in learning some of the most fundamental skills used in any public health career. In our first hypothetical situation, you are training as a local health education specialist, and your supervisor has assigned you to a major project, which will include the following requirements:


    In the road map below, you can see that there are some major stops along your journey. Each of these stops is a major skill that will be utilized in the program planning process, during which you will be given room to learn about and practice using each of these skills. There are also some minor stops in the map; these are equally important aspects and act as tools to help us with our program planning. Let’s briefly look at each stop so that you know where this is all going.


    1. Choose a location: Because all students are from different locations, the first thing that you will have to do is choose a location for your project. 

      • For example, you could say that you live in Rexburg, Idaho, in the United States of America, and that you are currently working for the Eastern Idaho Public Health Department.

      • Where do you live? Do you have health districts? Do you have a ministry of health? You will want to have a specific location in mind for your project that covers a fairly small geographic location like a city or county. 

    3. Planning Models: As one might imagine, it is a major task to plan, create, and implement a program of this scale. Over the years, many people have created systematic planning models that create step-by-step processes to help you accomplish your work. The generalized planning model helps us understand the pieces that all the different planning models have in common.

    4. Needs Assessment: The first major step is to identify the health needs within the community. We need to collect empirical data to show us the most important issues; it isn’t professional to just choose which health issues we think are most important. Each individual’s needs will not be the same, but we can identify more prevalent needs, to make significant health improvements for the community. This data will traditionally come from both primary and secondary data collection. In this class, you will only use secondary data—that is data that other people have collected already. 


    5. Needs Assessment: Once the most pressing health issues in your community have been identified, you will need to break each one down into the underlying causes to help you prioritize. When prioritizing, two things need to be determined: firstly, how much is each health issue impacting your target population, and secondly, how changeable the issue is. Will the health promotion program being made have the capability to make a change on this health issue?

    6. Goals and objectives: Now that we know which health issue we are going to target with our program, it is important to decide which changes need to be made. Setting specific goals and objectives will help you measure if we are successful or not. 

    7. Theory-driving interventions and adopt or adapt: Most of the time you don’t create a program from scratch to bring about the change. There are many programs that have already been created that have evidence to indicate how successful they have been. In public health, evidence-based practices are most effective, majorly increasing our chances of having a successful program. These other programs will be based on sound behavior change theories that helped them construct their programs using a theoretical foundation. Once the specific needs of your community have been identified, you can search for an evidence-based program that fits those needs. Then, that program can be either adopted or adapted to fit the needs of your community. 

    8. Budget: Now that you have identified the program you will use, you can start the administrative duties associated with running that program. The first step is to create a budget. You have been given $100,000 to run your program over the course of the year. Where is that money going to go? Will that be sufficient? You won’t know until you create a budget allotting all of that money to the personnel, supplies, and equipment that will be needed. 

    9. Marketing 4 Ps—Segmentation: The next administrative step is to market the program. Advertising is what we typically think about with marketing, and this is very important. However, marketing is just one part of advertising. Take caution; this is one of the most challenging areas in public health. 

    10. Implementation: Implementation is a critical step. Before the program is started, you have to determine how you are going to run it. Who will be in charge of the program? Who will hire, train, and manage the staff? Where will you hold the program? These are critical questions that have to be answered during the planning phase, not while running your program. 

    11. Evaluation: One of the last steps is to evaluate the program and determine how successful your program has been. If the goals and objectives have been created correctly, you should already have a great understanding of what you want to measure. During the planning phase, you need to determine how the data will be collected to measure these things. 

    Conclusion 

    This all sounds like a lot to do. Luckily, all of these steps will be broken down, allowing us to do them one at a time over the course of the next few months of the course. Although these are foundational public health skills, depending on your career choice, you may not be doing all of these things day-to-day. However, no matter which career you eventually choose, these skills will be vital.


    Program Planning

    One exciting part of public health is making changes that will improve health and make the world a better place. Accomplishing this requires careful planning, including following these steps:

    1. Location: where will your intervention happen?

    2. Planning model: follow an established pattern for developing the plan.

    3. Needs Assessment: find data about the most pressing health needs of the targeted area

    4. Goals & Objectives: set specific, measurable goals for what will be accomplished

    5. Budget: know how much you have to spend and how it will be allocated

    6. Marketing: publicize your intervention

    7. Implementation: carry out the plans

    8. Evaluation: assess if you have met your goals and how effective are the results


    Health Promotion

    The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, n.d.-a)

    (World Health Organization, n.d.-b)

    Public health work involves promoting the health of individuals and communities. Health promotion aims to empower communities to improve their health outcomes not just through focusing on individual behaviors, but also through addressing social and environmental forces. Health promotion accomplishes this through building healthy public policies, creating supportive environments, and strengthening community action and individual skills.

    The WHO has set Health Promotion priorities in these four areas:

    Health Education

    (Rural Health Information Hub, n.d.)

    One basic public health strategy to improve health is to educate the public by using classes or informal workshops. A good example are Community Health Workers who know the local people and work effectively with them. They are especially valuable in understanding cultural differences of the target groups.

    According to the National Commission for Health Education Credentialing in the US, Health Educators are responsible for eight main roles: (National Commission for Health Education Credentialing, n.d.)


    Settings for Health Promotion

    (World Health Organization, n.d.-c)

    Overview

    "Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love." The Ottawa Charter, 1986.

    Improving health can happen in many different settings. To build on the Ottawa Charter, the WHO presented Healthy Settings, a “Whole System” approach to health promotion, that encourages community participation, partnership, empowerment and equity.

    What is a setting? A setting can be anywhere people actively use and shape the environment. It is also where people create or solve problems relating to health by planning, implementing and evaluating health promotion programs. Examples of settings include schools, work sites, hospitals, cities, and even prisons.


    The History of Public Health

    (Institute of Medicine (US) Committee on Educating Public Health Professionals for the 21st Century, 2003)

    Throughout history, whenever people have lived together, there has been a need for public health. Ancient Romans built aqueducts to supply safe drinking water and dispose of waste. The earliest historical account of public health is in the Bible (Leviticus 11–20) where Moses gave the people rules for food safety.

    Some of the notable public health efforts in more recent centuries were vaccinations. Vaccines were first developed by the Chinese a thousand years ago and later introduced in Europe in 1796 by Edward Jenner for smallpox. In 1854, John Snow investigated a cholera outbreak in London and discovered it was spread by contaminated water. In his now-famous public health intervention, he chained the central pump to prevent use of its water.

    Such actions eventually led to developing public health associations, like in these examples:

    In the last two centuries, public health efforts have been used to:

    In short, public health efforts work to protect against environmental hazards, prevent the spread of disease, encourage healthy behaviors, and respond to disasters.


    Stakeholders in Health Promotion Programs

    (Chapter 7, Section 8. Identifying and Analyzing Stakeholders and Their Interests, n.d.)

    A key element in the health promotion process is the involvement of stakeholders. Any intervention will be more effective if all stakeholders are engaged in the process and all their interests are addressed.

    WHO ARE THE STAKEHOLDERS?

    Stakeholders include all who are affected or have an interest or a “stake” in a program.

    PRIMARY STAKEHOLDERS are beneficiaries, those who stand to gain something from the program. Listed below are some examples of primary stakeholders:

    SECONDARY STAKEHOLDERS are those directly involved with beneficiaries, such as parents and family members, healthcare workers, community volunteers. Listed below are some examples of secondary stakeholders:

     KEY STAKEHOLDERS

    Government officials and policy makers can pass laws and regulations that may either fulfill the goals of the program or cancel them out. From local board members to state and federal agencies or legislators, they can make or break public health efforts. An advisory board of appointed professionals may offer guidance and support.

    Influencers are people that others listen to. They can be in respected positions such as church leaders, doctors, community organizers, and especially the media.

    Others with an interest:

    WHY INVOLVE STAKEHOLDERS?

    In most cases, participation of as many stakeholders as possible and responding to their concerns will bring the greatest chance of success. Some advantages of identifying a wider list of stakeholders:

    WHEN SHOULD YOU INVOLVE STAKEHOLDERS?
    The earlier in the process stakeholders can be involved, the better.

     HOW TO IDENTIFY STAKEHOLDERS

    EVALUATING THE STAKEHOLDER PROCESS
    It is important to monitor how well stakeholders are involved in your effort. The stakeholders themselves should help evaluate what did and didn’t work to recruit and keep them.

    KEEPING STAKEHOLDERS INVOLVED
    New stakeholders may need to be brought in as time goes on. You have to maintain stakeholders’ and supporters’ motivation, keep them informed, and continue to find meaningful work for them to do if you want to keep them involved and active.


    Coalition Building

    (Chapter 5, Section 5. Coalition Building I: Starting a Coalition, n.d., p. 5)

    Whenever community problems are too large for any one agency to solve, the best approach is to put together a coalition of groups and individuals to work together to achieve the goal. A coalition can be a powerful force for positive change in a community.

    Coalitions can work together in the short term, or become permanent organizations with governing bodies and funding. Regardless of their size and structure, they exist to work together to reach specific goals.

    Coalitions are often formed to accomplish goals. Some examples of possible goals are listed below:


    HOW TO FORM A COALITION

    It helps to start with a core group and pull in all necessary stakeholders, as well as opinion leaders, policy makers, and community members. Early in the process, the elements below must be addressed:

    As a coalition forms, it is essential to be inclusive and communicate well with all members. Acknowledge and take advantage of the diversity of coalition members.


    Addressing Social Determinants of Health in Your Community

    (Chapter 2, Section 17. Addressing Social Determinants of Health in Your Community, n.d., p. 2)

    Social determinants of health.

    (U.S. Department of Health and Human Services & Office of Disease Prevention and Health Promotion, n.d.)

    Social determinants of health are the conditions of daily life and the environment that affects the health and well-being of different groups. They are often some of the root causes of health disparities and inequities. These social determinants can either support or limit the health of a community or population. Social determinants of health are grouped into five domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. For example, racial and ethnic minorities may have more health problems due to:

    Many worldwide efforts address social determinants of health. It will require a whole community approach in which different sectors all work together to assure conditions for health. Changes will be required by individuals, communities, and nations. Partnerships will be needed among public health, community organizations, education, government, business, and civil society.

    Social determinants of health (SDOHs) contribute to health disparities. For example, people who don't have access to grocery stores with healthy foods have higher risks of heart disease, diabetes, and obesity — and lower life expectancy.

    Just promoting healthy choices won't eliminate health disparities. Instead, public health needs to take action with partners in education, transportation, and housing to improve the conditions in people's environments. 


    Health equity and health disparities. 

    A basic principle of public health is that all people have a right to health. Health equity results when everyone can attain their full health potential and no one is prevented because of their social position. Health disparities refer to preventable differences in health conditions and health status among groups. Most health disparities affect groups that have been marginalized or excluded. They experience worse health as well as less access to food, good housing, and health services. Health inequities are “avoidable inequalities in health between groups of people within countries and between countries” (Chapter 2, Section 17. Addressing Social Determinants of Health in Your Community, n.d.).


    HOW TO TAKE ACTION TO ADDRESS SOCIAL DETERMINANTS OF HEALTH

    Many health programs intend to change individual behavior: to quit smoking, get more exercise, or eat healthier foods. These efforts don’t address the social determinants that are, at least partially, responsible for health.

    This section presents ideas from the US Centers for Disease Control and Prevention on how to address social determinants of health in your community. It suggests how to influence health and health-related issues by addressing their social determinants. This model also promotes health equity.

    By effectively addressing the social determinants of health, we can create a healthier community, and improve the quality of life for all. The figure below (from the CDC Report) outlines seven phases and related steps in addressing social determinants of health in your community.


     Figure: CDC Phases of a Social Determinants of Health Initiative

    PHASE 1: CREATE YOUR PARTNERSHIP

    The first step toward creating a successful partnership is to assemble a group of interested community members and organizations to discuss ideas and concerns for the community. Invite others to join your efforts, particularly those who have insight into or have experienced harm from the political, social, economic, and environmental conditions in your community.

    Listen to diverse groups in your community and involve relevant sectors (for example, government, education, business, public services, faith, funding agencies).

    Define your community. It could be a geographic area such as a neighborhood or city. Shared experience can also define a community’s employment, ethnicity, or culture.

    Assemble your partnership. Determine who should be included in the partnership. Contact potential partners and convince them to participate. Choose an effective facilitator. Establish guiding principles for the partnership.

    The people and groups identified should reflect the diversity of the community, including gender, race, ethnicity, age, income, sexual preference, and other dimensions of social exclusion. Those who might be included, depending on the initiative, are:

     

    PHASE 2: ASSESS THE SOCIAL DETERMINANTS

    You may start with disparities in health, such as high rates of infant mortality among some groups, and try to determine what social determinants influence them. Or you may start with major social determinants, such as income inequality or education levels, and consider how they affect health. You may choose to address social determinants by eliminating (moderating) negative factors or by increasing (strengthening) positive factors.


    PHASE 3: BUILD COMMUNITY CAPACITY TO ADDRESS SOCIAL DETERMINANTS

    “Community capacity” refers to the resources, infrastructures, relationships, and operations that enable a community to create change and improvement.

    Assess community capacity. Identify existing community strengths that can be mobilized to address social determinants; look at the places (for example, parks, libraries) and organizations where assets are found.

    Build community capacity. Much of the work to increase community capacity relies on processes that you will develop working in and with your community. If your group’s leaders are representative of the community, they will better understand its assets and needs, and will better engage the community to devise solutions that will have broad support.

     

    PHASE 4: SELECT YOUR APPROACH TO CREATE CHANGE

    Choose from among these six strategies for changing community conditions that others have found useful:

    Consciousness raising. People come together to discuss experiences or concerns and the social factors that influence them. This discussion can be useful for a partnership that addresses specific health inequities and their root causes.

    Both insiders and outsiders need to develop a common understanding of issues, which will lead to stimulating discussion and motivating partners to address the issues. This is a good approach when some people in a group do not see how social and structural factors influence health inequities. This approach can bring diverse groups together for action.

    Local community development. Creating community change at the local level involves strengthening social ties, increasing awareness of issues and enhancing community member participation. This requires bringing  individuals together so they can cultivate a shared group identity and develop ways to address their common purpose. Local community development is unique in that those who experience the problem are the leaders in addressing it.

    Social action. This approach focuses on altering social relationships and resources available to address health inequities. For example, a group of community members might join together to light a candle for each person injured by an alcohol-impaired driver in the past five years as a way to encourage the enforcement of impaired driving laws. Social action can be especially useful at the beginning of change efforts since media attention can help get people’s attention. 

    Health promotion. Traditionally, health promotion focuses on changing individuals to encourage behaviors. These efforts may also include policy changes that facilitate positive health outcomes. Addressing social determinants of health may include increasing access to fruits and vegetables with community gardens or reducing exposure to environmental toxins by changing air quality policies. Health promotion efforts may work at the level of individuals, community, or society. For example, an intervention might include educating about the benefits of physical activity. Because the costs of exercise facilities might be a barrier, your health promotion effort might address social determinants by working with a local recreational facility to lower fees for those who cannot afford them.

    Media advocacy. The strategic use of print, broadcast, and social media can encourage social, economic, or environmental change. It is an excellent way to reach large populations and capture the attention of decision makers who influence policy. Mass media campaigns reach people through newspapers, radio, television, and social media. Media advocacy can influence change in norms and policies.

    Policy and environmental change. Changes in policies and environmental conditions require active participation of key decision makers from different sectors. Policy changes can be designed to regulate the behavior of individuals (for example, smoking bans), organizations (for example, flex-time policies in workplaces), or communities (for example, housing codes for minimizing exposure to hazards). Policy changes can also affect the built environment, such as zoning laws.

    Selecting your approach. Consider your specific situation, including your partners and community, to decide which approach is needed. Don’t be afraid to try something new or a combination of approaches. Be willing to modify your approach as you track your successes and challenges.


    PHASE 5: MOVE TO ACTION

    Assemble a planning team. Agree on specific roles and responsibilities for partners and devise a timeline. Develop your action plan. Implement your plan. Some helpful guidelines are listed below:


    PHASE 6: DOCUMENT AND SHARE YOUR WORK

    Keep careful records of the process, impact, and outcomes. Evaluate your efforts by linking your evaluation to your community assessment and action plan. Carefully record what you do. This will enable others to reproduce what has worked. Communicate the findings and lessons learned to others in the field.


    PHASE 7: MAINTAIN MOMENTUM

    To effect real social change, you need to keep at it for the long term. Remain flexible and dynamic. Combat fatigue and burnout. Social change is hard work. It often involves dealing with injustice and human tragedy on a daily basis, and its results may come slowly. People and organizations get tired, and the temptation to quit can grow strong. Sustainability is essential, to enable a program to continue when funding stops. Below are some important ideas for sustainability:


    Ten Essential Public Health Services

    (community tool box, n.d.)

    WHAT ARE THE TEN ESSENTIAL PUBLIC HEALTH SERVICES?

    The Ten Essential Public Health Services were adopted by the US Centers for Disease Control in 1994 and strongly emphasize the theme of prevention. They are worth reviewing as possible priorities while communities assess their public health status.

    Essential Service #1: Assess and monitor population health by collecting and interpreting health related data.

    Essential Service #2: Investigate, diagnose, and address health hazards and root causes, identifying emerging health threats and combating both infectious diseases and patterns of chronic disease and injury.

    Essential Service #3: Communicate effectively to inform and educate, including health promotion and social marketing efforts in your community.

    Essential Service #4: Strengthen, support, and mobilize communities and partnerships. Health professionals join with other community sectors in effective coalitions.

    Essential Service #5: Create, champion, and implement policies, plans, and laws. Review health-related laws and policies and advocate for changes as needed to promote optimal health for all.

    Essential Service #6: Utilize legal and regulatory actions. This may include enforcement of sanitary codes, protection of drinking water and clean air, and monitoring healthcare services and supplies.

    Essential Service #7: Enable equitable access for socially disadvantaged people. This should be done for clinical healthcare as well as culturally appropriate health education.

    Essential Service #8: Build a diverse and skilled workforce with effective training for public health professionals.

    Essential Service #9: Improve and innovate through evaluation, research, and quality improvement of health programs and community initiatives.

    Essential Service #10: Build and maintain a strong organizational infrastructure for public health, including ties with higher learning and research.


    W01 Application Assignment Case Study: 

    CREATING HEALTHY CHILD DEVELOPMENT AT THE MITUMBA INFORMAL SETTLEMENT, NAIROBI, KENYA

    Mary Amuyunzu- Nyamongo, African Institute for Health and Development

    (African Institute for Health and Development, n.d.; Chapter 2, Section 17. Addressing Social Determinants of Health in Your Community, n.d., p. 2)

    Urban informal settlements, more commonly referred to as “slums,” are home to almost one billion people globally, including one-third of those living in cities in developing regions. Such settlements provide some of the harshest conditions found in any collective living arrangement due to overcrowding, poor sanitation, and minimal access to essential resources. These conditions also result in stigmatization, social isolation, and discrimination. In Africa, people in urban settlements experience more morbidity and mortality than rural residents and have less access to health services. Children are hit hardest by these conditions, with five year olds and under mortality being 35% higher among children in Nairobi settlements than among children in rural Kenya.

    Mitumba, a Kiswahili term meaning “second hand” or “used,” is a Nairobi settlement of approximately 18,000 people that was established in 1992. Mitumba is smaller than other Nairobi settlements and, consequently, has received little attention or support from governmental or other organizations. In 2006, the African Institute for Health & Development (AIHD), with support from the U.S. Centers for Disease Control and Prevention, established a partnership with residents of Mitumba to undertake a pilot project to promote healthy child development. AIHD is a Nairobi-based, non-governmental organization (NGO) with a multidisciplinary staff that includes anthropologists, sociologists, economists, and education specialists. It was established in 2004 to conduct research, training, and advocacy on health and development issues.

    The goal of the Mitumba project is to facilitate empowerment processes with mothers of children under the age of five to improve health; these processes include increased access to health information, safety, and early child development opportunities. The project follows general principles of community-based participatory research (CBPR), fully engaging mothers of under-five children, community health workers, and community leaders throughout the entire project period. CBPR goes beyond simply educating people, which usually involves interventions imposed on communities by outsiders, to an approach inspired by the Brazilian community organizer Paulo Freire. In his 1968 work, Pedagogy of the Oppressed, Freire describes a process which actively involves community members and organizations in developing the capacity to improve their own political and economic circumstances, as well as their health and well-being. Communities are encouraged to take control of their situations and to collectively improve them through cycles of planning, action, and evaluative reflection. The rationale is that the beneficiaries must drive the improvement and promotion of their own health with effective and sustainable strategies if significant long-term change is to take place.

    To help all residents and the AIHD gain clarity about living conditions in Mitumba, a 10-day social mapping project was conducted with youth and adults to understand community resources and boundaries. Mothers took part in surveys and focus group discussions to identify community conditions and norms affecting maternal and child health. In interviews, key informants provided insight into community issues and challenges. Participatory processes informed the design of the questionnaires as well as efforts to assure respondents of confidentiality.

    The findings revealed that Mitumba has three narrow roads passable by car during non-rainy seasons, six narrow paths for foot traffic, four churches, one school, and no health facilities. Housing structures are small and crowded: in 68% of the households, 3 to 5 people share a single 10' _ 10' room for both cooking and sleeping; only occasionally does the living space include a toilet. Most houses are made of metal sheeting and plastic, and have dirt floors. Water, available from community taps, is purchased at high prices and is mostly unclean because the vendors who supply the water use low quality pipes. Toilets, constructed by landlords, are shared by large numbers of people, poorly maintained, and often full. Children are not allowed to use them because of these conditions and because the holes are too big, creating safety concerns. Consequently, most children eliminate their waste on the open ground, causing serious sanitation problems. The sole community school in Mitumba has six classrooms, none of which have doors, windows, desks or books. The nearby city council school does not accept children from settlements. Some children attend private schools but most families cannot afford the fees.

    Some 65% of the mothers in Mitumba have received primary education and 35% a secondary education. Most residents engage in casual labor in industrial areas or construction sites. Women work in nearby wealthy households, although more than half were unemployed at the time of the baseline study. Poor economic conditions limit access to safe, affordable child care when mothers work or run errands. Young children (0–3 years) are usually left with neighbors who are not obligated to feed or clean them; older children (3–5 years) are usually left outside of the locked house. Children are often seen looking for food, loitering around neighboring houses, or sleeping on the ground when their mothers are away. Mothers reported that the major concerns facing young children include lack of food (20%) and diseases (42%), including malaria, respiratory infections, and diarrhea and vomiting. Due to lack of access to health services and limited economic resources, mothers stated that when their children are sick they frequently rely on chemists (pharmacies) and drug vendors who often sell inadequate or inappropriate remedies. Thus, 20% of households reported at least one child having died.

    With this information, organizers held a consensus-building forum with mothers to identify and prioritize their needs and to enable them to think of homegrown, practical approaches they could adopt and implement without stretching their scarce resources. The community decided upon three initiatives: establishing a day care center (the core project), soliciting support for the community school, and working with youth to enhance their ongoing activities and to open new horizons for them. Together, these initiatives support the overall goal of improved child health while also increasing skills and capacities among various groups in the community.

    For example, the mothers stated that they wanted their children nurtured in a home environment staffed by older mothers with experience and training in child care and development. They identified two such mothers from the community, potential locations, and determined how much they could afford per child. The community members and AIHD jointly planned the intervention. They included a signed memorandum of understanding that defined roles and responsibilities for each group, in order to develop commitment and to safeguard against potential misunderstandings. They constructed the day care by refurbishing and expanding an existing facility.

    The floors were cemented, fences were added, and walls were painted with bright colors and murals of story book characters. Fifteen mothers attended a training session to learn how to make toys and other items needed for the center. Additional sessions focused on nutrition, developmental needs and health and safety issues. Within a few weeks, the day care center reached full capacity, with 20 children, and the partnership began discussing the development of additional centers.

    Additional Activities

    Community members also stressed the importance of education for the growth of individuals, communities, and the nation at large. Current educational conditions in Mitumba make it difficult for the children to learn and thus fully participate in the world. During meetings with community members, the school chairman, and teachers, the partnership identified the need to construct a fence around the school to ensure safety; obtain access to desks, textbooks, and writing materials; secure windows and doors; and pipe water in for personal hygiene and food preparation. The group developed a proposal to seek city council sponsorship.

    Another serious problem in Mitumba is the lack of employment for youth, which contributes to alcoholism, drug abuse, prostitution, and single parenthood. Using an approach similar to that adopted by the mothers, a partnership was established with Tuff Gong, a community youth group in existence since 2004 that has been involved in environmental cleanliness, HIV and AIDS education, and football activities. Members started monthly cleanups, but no longer have the equipment necessary to continue. The partnership is seeking funds to support their activities. Evaluation activities for the pilot phase of the Mitumba project include review of the registers used to record implementation activities; before-and-after photography; periodic, informal discussions with the community members; and end-of-project surveys.

    (Lightly edited from “Community Interventions on Social Determinants of Health: Focusing the Evidence,” by Marilyn Metzler, Mary Amuyunzu-Nyamongo, Alok Mukhopadhyay, and Ligia de Salazar. In McQueen, D and C. Jones C, editors. Global Perspectives on Health Promotion Effectiveness. New York: Springer, 2007.)


    References


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    Chapter 5, Section 5. Coalition Building I: Starting a Coalition. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/promotion-strategies/start-a-coaltion/main

    Chapter 7, Section 8. Identifying and Analyzing Stakeholders and Their Interests. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/participation/encouraging-involvement/identify-stakeholders/main

    community tool box. (n.d.). Chapter 2, Section 7. Ten Essential Public Health Services. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/ten-essential-public-health-services/main

    Institute of Medicine (US) Committee on Educating Public Health Professionals for the 21st Century. (2003). History and Current Status of Public Health Education in the United States. Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. https://www.ncbi.nlm.nih.gov/books/NBK221176/

    National Commission for Health Education Credentialing. (n.d.). Responsibilities & Competencies. NCHEC. https://www.nchec.org/responsibilities-and-competencies

    Rural Health Information Hub. (n.d.). Health Education. RHIhub. https://www.ruralhealthinfo.org/toolkits/health-promotion/2/strategies/health-education

    U.S. Department of Health and Human Services & Office of Disease Prevention and Health Promotion. (n.d.). Social Determinants of Health. Healthy People 2030. https://health.gov/healthypeople/priority-areas/social-determinants-health

    World Health Organization. (n.d.-a). Health and Well-Being. World Health Organization. https://www.who.int/data/gho/data/major-themes/health-and-well-being

    World Health Organization. (n.d.-b). Health Promotion. World Health Organization. https://www.who.int/westernpacific/about/how-we-work/programmes/health-promotion#:~:text=Health%20promotion%20is%20the%20process,of%20social%20and%20environmental%20interventions

    World Health Organization. (n.d.-c). Healthy Settings. World Health Organization. https://www.who.int/teams/health-promotion/enhanced-well-being/healthy-settings

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