دکتر ناهید جعفری، متخصص پزشکی اجتماعی مدیر گروه مدیریت خدمات و برنامه‌های سلامت

 تعریف برنامه سلامت  طراحی برنامه سلامت  اجرا  پایش و ارزشیابی  ادغام برنامه های سلامت

مشكل سلامتي مجموعه فعاليتهايي است كه براي حل يک مشكل سلامتي در يك گروه هدف يا كليه افراد جامعه، طراحي و اجرا مي گردد. هر برنامه از مجموعه‌اي فعاليت‌هاي به هم پيـوسته تشكيل شده كه در سطوح مختلف نظام ارائه خدمات در حال اجرا است.

هر عامل تهديد کننده سلامتي افراد و جامعه يك مشكل سلامتي است. بيماريها و حوادث عوامل خطر با توجه به محدود بودن منابع، مشكلاتي كه سهم بيشتري در به خطر انداختن سلامتي داشته باشند از اولويت بيشتري براي مقابله برخوردارند. لذا نظام سلامتي پس از شناسايي مشكلات بايد اقدام به اولويت‌بندي آنها نمايد.

The Logic Model process is a tool that has been used by program managers and evaluators. The model describes logical linkages among program resources, activities, outputs, audiences, and short, intermediate, and long term outcomes related to a specific problem or situation.

SITUATION ANALYSIS What we Invest ! Time Money Partners Equipment Facilities What we Do! Workshops Publications Service Long Change in situation: Environment Social conditions Economic conditions Political conditions What we Reach ! Customers Participants OUTPUTSINPUTSOUTCOME Medium Change in: Behaviors Practices Policies Procedures Short Change in: Knowledge Skills Attitude Motivation Awareness External Influences, Environmental, Related Programs

Situation Analysis Priority Setting Problem Definition Goal Setting Organization Implementation Monitoring & Evaluation

 Organizational landscape  Trend in health indicators  Burden of disease/ risk factor  National or international commitment  …….

 Burden of disease/ risk factor  Incidence, prevalence and other related indicators  Health need and health problems (based on health surveys, epidemiologic estimation, ….)

 Current situation (in IRAN, region and world)  Cost of ……  Predisposing and enabling factors  Current intervention  …..

Primary Prevention Health promotion Secondary Prevention Screening & treatment Tertiary Prevention Rehabilitation Healthy people Non diagnosed/ Early disease/ Patients Complication & Non fatal outcome Invulnerable to disease Reversible Vulnerable to disease Irreversible Natural History of Diseases / Disorders

 Goal  Objectives  Strategies

Primary Prevention Health promotion Secondary Prevention Screening & treatment Tertiary Prevention Rehabilitation Healthy people Non diagnosed/ Early disease/ Patients Complication & Non fatal outcome Invulnerable to disease Reversible Vulnerable to disease Irreversible Community risk assessment/ management Individual risk assessment / management Inter sectoral collaboration Community intervention Health promotion interventions …….. Natural History of Diseases / Disorders

Primary Prevention Health promotion Secondary Prevention Screening & treatment Tertiary Prevention Rehabilitation Healthy people Non diagnosed/ Early disease/ Patients Complication & Non fatal outcome Invulnerable to disease Reversible Vulnerable to disease Irreversible Mass screening High risk population screening Early detection Appropriate and timely treatment Diagnostic test Prevention of complication ……………….. Natural History of Diseases / Disorders

Primary Prevention Health promotion Secondary Prevention Screening & treatment Tertiary Prevention Rehabilitation Healthy people Non diagnosed/ Early disease/ Patients Complication & Non fatal outcome Invulnerable to disease Reversible Vulnerable to disease Irreversible Prevention of disability Rehabilitation ………. Natural History of Diseases / Disorders

 Process definition  Target group  Health provider (knowledge & skills)  Time of services  Kind of services  Standard of services  ………………..

 Resource estimation (manpower, money, material, time, information)  Resource preparation  Resource allocation

 Pilot study  Feasibility study  Time study  Cost utility/ cost benefit analysis  Evaluation

 Review based on pilot study result  Regional or national development

 Monitoring  Continuous review of the degree to which program activities are completed and targets are met  Evaluation  Periodic analysis of progress toward meeting established objectives and goals, providing feedback on performance and direction for future plans

SITUATION ANALYSIS What we Invest ! Time Money Partners Equipment Facilities What we Do! Workshops Publications Service Long Change in situation: Environment Social conditions Economic conditions Political conditions OUTPUTSINPUTSOUTCOME Medium Change in: Behaviors Practices Policies Procedures Short Change in: Knowledge Skills Attitude Motivation Awareness Evaluation Study: Measurement of process indicators — measurement of outcome indicators

 The word ‘integration’ stems from the Latin verb integer, that is, ‘to complete.’ The adjective ‘integrated’ means ‘organic part of a whole,’ or ‘reunited parts of a whole.’  It is mostly used to express the bringing together or merging of elements or components that were formerly separate

 Health care integration generally means: the ‘‘bringing together of inputs, delivery, management and organization of services as a means of improving access, quality, user satisfaction and efficiency.’’  Integration allows for greater efficiency and effectiveness, less duplication and waste, more flexible service provision, and better co-ordination and continuity.

 In resources  In health provider  In target group

Health Problems Un Healthy Diet Ischemic Heart Disease Asthma Cancer Diabetes Smoking

Health Problems Un Healthy Diet Ischemic Heart Disease Asthma Cancer Integrated Care for Child Health Breast Feeding Growth Monitoring Parent Education for Healthy Life Style Diabetes Parent Education for Healthy Behavior Prevention of Over Weight/ Obesity Smoking

Health Problems Un Healthy Diet Ischemic Heart Disease Asthma Cancer Integrated Care for Child Health Parent Education for Healthy Life Style Diabetes Parent Education for Healthy Behavior Healthy Diet Parenting Smoking

Health Problems Un Healthy Diet Ischemic Heart Disease Asthma Cancer Breast Feeding Growth Monitoring Diabetes Parent Education for Healthy Behavior Prevention of Over Weight/ Obesity High Risk Family Management Healthy Diet Smoking Integrated Care for Child Health

Health Problems Un Healthy Diet Ischemic Heart Disease Asthma Cancer Breast Feeding Growth Monitoring Parent Education for Healthy Life Style Diabetes Parent Education for Healthy Behavior Prevention of Over Weight/ Obesity High Risk Family Management Healthy Diet Parenting Smoking Integrated Care for Child Health

Health Problems Un Healthy Diet Ischemic Heart Disease Asthma Cancer Integrated Care for Youth Health Appropriate Physical Activity Tobacco Use Prevention Education for Healthy Life Style Diabetes Education for Healthy Behavior (drug abuse, unsafe sex, tobacco use, …) Prevention/ Management of Over Weight/ Obesity High Risk Family Management Healthy Diet Life Skills Smoking

Health Problems Un Healthy Diet Ischemic Heart Disease Asthma Cancer Integrated Care for Adult Health Appropriate Physical Activity Smoking Cessation Education for Healthy Life Style Diabetes Education for Healthy Behavior (drug abuse, unsafe sex, tobacco use, …) Prevention/ Management of Over Weight/ Obesity High Risk Population Screening Healthy Diet Life Skills Smoking

Health Problems Health Program Integrated Care for Child Health Integrated Care for Youth Health Integrated Care for Adult Health Integrated Care for Old People Health Integrated Care for Maternal Health Health Program Age Specific Care