PLANNING IN ORAL HEALTH

PLANNING IN ORAL HEALTH II

SUBMITTED BYVISHNU JGUIDED BYDr. MAHAMOOD MUTHEDATH Dr. ASEELA AHMED1

1INDEXINTRODUCTIONDEFENITIONWHY PLAN?WHO IS A PLANNER?IMPORTANCE OF PLANNINGUSES OF PLANNINGINFORMATION REQUIREMENTS FOR PLANNINGTYPES OF PLANNINGSTAGES OF PLANNINGPLANNING DENTAL CARE FOR INDIVIDUALPLANNING A SCHOOL DENTAL HEALTH PROGRAMMEPLANNING FOR COMMUNITY DENTAL PROGRAMME2PLANNING CYCLENEEDS ASSESSMENTCOLLECTION OF DATAANALYSIS OF DATADETERMINING PRIORITIESDEVELOPMENT OF PROGRAM GOALS,OBJECTIVES AND ACTIVITIESRESOURSES IDENTIFICATIONIDENTIFYING CONSTRAINTSALTERNATIVE STRATEGIESDEVELOP IMPLEMENTING STRATEGYIMPLEMENTATIONMONITORINGEVALUATION

3RATIONAL PLANNING MODELCOMPARISON OF PLANNING DENTAL CARE FOR A PRIVATE PATIENT AND A COMMUNITYCONCLUSSIONREFERENCE4IDENTIFY THE PROBLEMCONDUCT A NEEDS ASSESSMENTANALYSE THE DATADETERMINING PRIORITIESDEVELOP PROGRAM GOALS ,OBJECTIVES AND ACTIVITIESCOLLECT THE DATAIDENTIFY AVAILABLE RESOURSESIDENTIFY CONSTRAINTSIDENTIFY ALTERNATE STRATERGIESGIVEN THE RESOURSE AND CONST-RAINTS, CHOOSE THOSE ACTIVITIES THAT WILL BE MOST EFFECTIVE5DEVELOP IMPLEMENTATION STRATEGYIMPLEMENT, MONITOR,EVALUATE AND REVISEONGOING PHASE6

NEEDS ASSESSMENTFIRST STEP IN PLANNING PROCESSThe reasons for conducting a need assessments are:-To ascertain causes of problemTo evaluate the effectiveness of the problemTo define the problem and to identify its extend and severity7The information helps in developing appropriate goals and objectives.It also involves identifying potential health problems and health promotion needs.It is important to consider what type of information is needed and how it should be obtained. Data can be obtained by survey, questionnaire or clinical examinations or more informally through personal communication based on the population to be examined.

8Data for needs assessment should essentially includePopulation profile and general information on a populationEpidemiological data on patterns and distribution of dental diseasesHistory and current status of dental programs in the communityMode of development of policies and decisionsType of resources available to the community (funds, facilities, and labors)9

COLLECTION OF DATAData can be collected by conducting a survey with various techniques and also from local state and central agencies and private organizations. Other sources for obtaining such data use research studies and investigation reports.10ANALYSIS OF DATAIt is important to first look into the socioeconomic structure of the community and determine the type of employment exists. It indicate whether or not they might be able to afford dental care through their job.The age distribution tells what the target groups are, and thus steps up priority for planning.Educational status i) It tells the educational level obtained by majority of community members ii) It may give an understanding about the community and values towards obtaining an educationKnowing the median income of the community helps in determining the populations access to the health care.Health care facilities indicate types of services being provided the amount of services and the cost of receiving those services.11A look into the communitys public transport system provides the information regarding the populations access to health care services.The labor data(health resources) give information about the number of dentist : population ratio,types of services provided, the cost, and the availability of services.Knowing the fluoride status of a community is also essential for dental planning.Educational system provides an insight into number of schools and enrollment and distribution of children among schools within the community. This information can assist in developing school based program for the community.12

In most cases, the political affairs of the community will determine the direction of the program taken. Each local governments policies may vary in the methods of instituting new programs, allocating funds, hiring personnel, or setting priorities. In addition, the politics of the state government will also shape the overall direction taken by the communities within the state.If the planner is designing a dental treatment program for specific population, the survey data can be converted into specific resource requirements (time, labor, facility) for treating the population13D) DETERMINING PRIORITIESAs per Spiegel priority determination is a method of imposing peoples values and judgement of what is important onto the raw data.When resources are limited, it becomes necessary to establish priorities to allow the most efficient allocation of resources. If priorities are not determined, the programs may not sense those individuals or group who need the care most.A health task force or advisory committee formed by consumers, community leaders and providers should be established to aid in the development of policies and priorities. Planning with community representation helps in the program implementation and acceptance. 14

Factors affecting priorities Population: disease affecting large number of people is preferred over the disease affecting smaller number of people.Eg : dental caries is preferred over attrition Disease: The more prevalent acute disease gets preference over the chronic disease.Serious disease gets preference over non-serious diseaseEg: dental caries is preferred over mild gingivitis15

Risk groups: the group of people in which there is a high risk of disease get priorities over the group of people on which the disease are less likely to occur.Eg: For dental diseases, the following group of people gets priorities.Preschool and school going childrenExpectant mothersMedically compromised peopleMentally and physically handicapped personsElderly peopleLow income minority groups16

E) DEVELOPMENT OF PROGRAM GOALS, OBJECTIVES AND ACTIVITIESProgram goals are broad statements on the overall purpose of a program to meet a defined problem such as to improve the oral health of the school aged children in the community while program objectives are more specific and describe in a measurable way in the desired end result of program activities.The objective should specify the nature and extend of the situation or condition to be attained(what), the target group or portion of environment(who) and the geographical area(where), if the program and also the time(when) by which the desired situation or the condition is intended to exist.17Program objectives may be(2 types) outcome objectives or process objectives based on the way they are started. Outcome objectives provide a means of measuring quantitatively the outcome of the specific objectives whenever. Process objective states a specific process by which a public health problem can be reduced and prevented.Next step is to state how to bring about the desired results. This area is referred to as program activities and it describes how the objectives will be accomplished. It includes What is going to be done?Who will be doing it?When will it be done?

18F) RESOURCE IDENTIFICATIONThe available resources and finances are identified to carry out the project. The resources besides finances also include skilled and unskilled man power, materials, knowledge, and techniques required for the dental health program.The resources must have the following prioritiesAdequacy extend to which resources would complete the jobAppropriateness most suitable resources to get the job done 3. Effectiveness how capable the resources are to complete the jobEfficiency the cost in terms of money and the amount of time expanded to complete the job19

G) IDENTIFICATION OF CONSTRAINTSWhen planning any programs, there are usually many constraints or difficulties. The reasons of constraints may beLimitation of resourcesPolicies of the organizationSocial customs of the communityLack of fundsAttitudes of social organizationsLack of skilled and unskilled powerg) Socioeconomic status By identifying these constraints easily in the planning stages one can modify the design of the program and there by create a more practical and realistic plan. A group that is familiar with local politics and community structures can not only identify constraints but also offer alternative strategies.20

H) ALTERNATIVE STRATEGIESIt is important to generate a sufficient number of alternatives so that at least one may be considered acceptable. With limited resources, the planner needs to consider the anticipated costs and effectiveness of each alternative.If the preventive measures were considered to be cost effective as well as practical to implement, then select that measure as the best of the alternatives.21

I) DEVELOP IMPLEMENTATION STRATEGYAn implementation strategy for each activity involves addressing various aspects related to the program such as the effects of the objectives to be achieved, the activities required to achieve the objective, individuals responsible for each activity, chronological sequence activities, materials, media methods and techniques to be used, and the government estimate of materials, and time.To develop an implementation strategy the planner must know what specific activities they want to do. Once stated the planner may specify what activities must be undertaken to implement the activity.22

J) IMPLEMENTATIONThe process of putting the plan into operation is referred to as the implementation phase. This phase is ongoing in situations where close supervision and evaluation of program ensures effective operations.Integrating all the external variables to achieve comprehensive planning and implementation require an etiological approach (Bruts, 1972). Only through team work between the individual and the environment can be implementation be successful.23Phases of implementation Health programs can be divided in to four phases of implementation which should focus in sequence:Pilot phaseControlled phaseActualization phaseOperational phaseIn the pilot phase, the program proceeds on trial and error base, while in controlled phase the program runs under regulated conditions to judge the effectiveness. In actualization phase, the program is subjected to realistic operating conditions whereas, in the operational phase, the program becomes an ongoing part of structure. Each phase has different objectives to met.

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K) MONITORING Monitoring refers to the maintenance of an ongoing watch over the activities of a health service. Once it has been implemented, the program requires continuous surveillances of all activities. The program success is determined by monitoring , in terms of program objectives met, individuals job efficiency, equipment functioning, and appropriateness and adequacy of facilities only so as to avoid problems and adjustments are made as and when necessary. 25L) EVALUATION Evaluation is defined as the collection and analysis of information to determine program performance. Evaluation, both informal and formal, is a necessary and important aspect of program.It helps to measure the program and effectiveness of each activity.To solve the problemTo identify the problems in carrying out the problems.To tackle unsolved problems, revision and modification of the plan of the project.To periodically check and measure the success of the projectTo identify ; ascertain and total the cost of the project.Evaluation should be done to examine the quality and quantity of the work achieved during the project

268. The attitudes of the beneficiaries of the project should be evaluated to determine if the project was accepted by them.9. A detailed report is prepared and submitted 27RATIONAL PLANNING MODELWithin the community and hospital dental services the rational planning model is used certain extend. Rational planning model provides a basic guide to the planning process (McCarthy 1982) and involves the following stepsAssessment of need : identification of oral health problems and concerns of populationIdentifying priorities : agreeing the target areas of actionDeveloping aims and objectives : aim is the overall goal to be achieved where as objectives are the steps needed to reach the aimAssessing resources : identifying the range of resources available to facilitate implementation of the plan by personnel, material and equipmentImplementation : turning the plan into actionEvaluation : measuring the changes resulting from a plan2829OPTIONSDECISION OF POLICYAVAILABLE RESOURCESIMPLEMENTATIONEVALUATIONIDENTIFICATION OF NEEDSCOMPARISON OF PLANNING A DENTAL CARE FOR A PRIVATE PATIENT AND A COMMUNITYPRIVATE PATIENTCOMMUNITYDentist conducts a dental and medical history and a clinical examination of a patientDentist diagnoses the oral health of a patientDentist develops a treatment plan based on diagnosis, priorities, patients attitude and the method of payment for services

The dentist obtains patient consent for treatmentThe planner conducts a survey of the communitys structure and dental statusThe planner analyses the survey data of the communityThe planner develops a program plan based on analysis of survey data , priorities and alternatives, the communitys attitude and the resources available.The planner obtains community approved of plan30The dentist selects the appropriate personnel to provide the care: dentist, specialist, laboratory technician, dental hygienist and dental assistant

The dentist selects the appropriate dental service for the patient

The dentist evaluates the treatment rendered to the patient. Clinical examination, radiograph and patient satisfactionThe planner selects the appropriate labour to implement the program: dentist, dental hygienist, dental assistant, dental technician, nutritionist, health educator, school teacher, social worker, health aids and public health nursesThe planner selects the appropriate activities for the community : community water fluoridation and school based fluoride rinse programsThe planner evaluates the community program. comparison of baseline survey with subsequent survey, attainment of goals and objectives, cost effectiveness of activities, appropriateness of activities and community satisfaction31CONCLUSIONA plan can play a vital role in helping to avoid mistakes or recognize hidden opportunities. It helps in preparing a set of decision for action in the future, enables priorities to be set, taking into account situation involved to reach the desired outcome within the limited resources. It aids in the decision making in a rational way rather than constantly reacting to pressure and demands and must precede development and change in any organization. Planning is meaningful only if changes is seen to be necessarily and if the plans are capable of being implemented in a given social and political environment. Different types of planning exist and must be tailored according to needs. 32REFERENCESCOMMUNITY DENTAL HEALTH ANTHONY W JONGTEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY S S HIREMATHESSENTIALS OF PREVENTIVE AND COMMUNITY DENTISTRY SOBEN PETERESSENTIAL DENTAL PUBLIC HEALTH BLANDID PALY, RICHARD WATT, PAUL BATCHELOR, ELIZABETH TREASURETEXTBOOK OF COMMUNITY DENTISTRY SATHEES CHANDRA, SALEEN CHANDRA3334