plenary 2: achievement of safe communities over the decades: from lidköping to …….."
TRANSCRIPT
Achievement of Safe Communities over the decades: from Lidköping to …………..
Koustuv Dalal, PhD Professor in Public Health Science (Health Economist)
Chair: International Safe Hospital Director, Centre for Injury Prevention and Safety Promotion
Örebro University, Sweden Academic Editor, PLOS ONE
Safe Communities around the world
Safe Communities year-wise
Evaluation
Outcome evaluation
Economic evaluation
What have we done?
What can we scientifically think?
What can we socially -economically think?
Do we need any more safe community?
Safe Communities 1. Australia 2. Austria 3. Bosnia and Herzegovina 4. Canada 5. Chile 6. China 7. Taiwan 8. China, Hong-Kong 9. Croatia 10. Czech Republic 11. Denmark 12. Estonia 13. Finland 14. Germany 15. Iran (Islamic Republic of) 16. Ireland
Safe Communities 17. Israel 18. Japan 19. Mexico 20. New Zealand 21. Norway 22. Peru 23. Poland 24. Republic of Korea 25. Serbia 26. South Africa 27. Sweden 28. Thailand 29. Turkey 30. United Kingdom 31. United States of America 32. Viet Nam
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starting year 1989 till 2015
EVALUATION DOMAINS
Polic
y
Science
Practice
Planning & Evaluation
Evaluation has two arms: 1. Data gathering 2. Contextualizing results
TYPES OF EVALUATIONS
Process evaluation
Qualitative evaluation
Formative evaluation
Evaluation Research
Program evaluation Outcome
Economic
Program Evaluation:“Program evaluation is the use of social research procedures to systematically investigate the effectiveness of … programs.” (Rossi, Freeman and Lipsey)
Also called impact, dissemination, and summative evaluation
Assumes efficacy has been confirmed by evaluation research
Concerned with both internal and external validity
Program evaluation typically involves assessment of one or more of the five program domains:
1. The need for the program
2. Design of the program
3. Program implementation and service delivery
4. Program impact or outcomes
5. Program efficiency
Outcome evaluation: Gauges the extent to which a program produces the intended improvements it addresses
Addresses effectiveness, goal attainment and unintended outcomes
Is critical in quality improvement
Outcomes can be initial, intermediate or longer-term
Outcomes can be measured at the patient-, provider-, organization or system level.
Why economic evaluation?
Injuries, illnesses are significant economic burden
=> Established need for economic analysis
Provides framework for comparison of
intervention options and effectiveness
Adds a transparency to decision making process
Economic Evaluations (EE) put values Motivating a re-allocation of resources
Cost-effectiveness or cost-benefit
Economic Analysis is used to test economic theories and to predict changes made in response to resource re-allocation
EE: Applied analytic methods to: Identify, Measure, Value, and Compare
Health Economic evaluation“The comparative analysis of alternative courses of action in
terms of both their costs and consequences”
Related to social choice
Choice
A
B
Is A better than, as good as,
or worse than B?
All Economic Evaluation: assessment of both use of resources & health benefits of the Health Care Program
] Optimum use of scarce resources
What have we done?
Evaluated all
SC reports
SC scientific articles
To know what Safe Communities have done (outcome)
To know what Safe Community Certifiers have done (process)
To know what Safe Community Program ( The World Health Organization initiated program) has delivered by economic point of view
The evaluation was conducted independently
being loyal to science
being loyal to research profession
So the evaluation is actual representation of ‘facts and figures’ without any bias
as this evaluation is subject to anonymous review for high-impact scientific publication for future reference
Output
Inputs
Productivity
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Designation: starting year 1989 till 2015
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Re-Designation: 2002 - 2015
SC reports
Effectiveness of Safe Communities Overall injury reduction†: 22 - 33% Minor injuries 41% Use of bed-days due to injuries reduced by 39% Health care treatments due to injuries reduced by 15%
Childhood injuries reduced significantly Elderly injuries reduced
† could not test significance yet
Several scientific publications (>150) RTI Elderly Child injury Violence ……………….
More than 20 PhDs
SC program
Cost effectiveness 1.3 million USD intervention cost 2.7 million USD SAVINGS of societal costs
Cost-benefit ratio 1 : 10
Injury frequencies reduced Significant difference between reports at
intra-country & inter-countries
Lack of consistencies reporting inter-system evaluation (certification process)
Heterogenous approach of the system Methodological inconsistencies
Global macro social factorsNational / Regional macro social factors
Community
Friends RelativesHOSTAgent / vehicleH o m E
NeighborhoodNational / Regional Physical environment
Global physical environment
Social env.
Physicalenv.Lense
Telescope
Forward looking: intervention, determinant, injury=> outcome in a life stage
PreviousGeneration
Childhood AdultNext
Generation
Olderage
Adolescent
Fetal
development Adolescent
Fetal
development
Fetal
development
Fetal
develop-ment
NextGeneration
Hosking et al, 2011
Lense-Telescope Model
Backward looking: injury prevention in a life stage
Economies of Scale and Economies of Scope
Economies of scale exist when average cost is declining. Important to distinguish between long-run vs. short-run
Short-run economies of scale: affect operating decisions and relevant to post-entry stage
Long-run economies of scale: impact whole structure only relevant in the pre-entry stage.
Economies of scope: cost savings associated with a broadening of scope of activities (e.g. multi-country). Economies of scope arise from “complementarities” in the mechanism of production or distribution of Safe Community services
Economies of scope for SC:
Excess capacity utilization (grossly missing)
Utilization of specific and dedicated networking through carefully planned publicity (lacking)
Deliverable of ‘safe Community’ brand identity (why society should buy it?)
SC should implicitly focus on
leveraging core competencies
competing on capabilities
mobilizing resource, human
when Safe Community program is in transition phase we should be very CAREFUL to choose between short-run and long-run goals
We should consider and re-consider whole SC structure to emphasise on
either pre-entry level
or post-entry level
Can we emphasise on both?
Safe Communities are Successful to reduce injuries
Effective in both Social and Economic perspectives
Remember the Cost : Benefit ratio = 1: 10
Do we have any other social program(WHO initiated) that provides such cost benefit? No
Do we care for our children as future of our society?
Do we care for our money?
Do we like to be cost-effective?
YES
SC gives usevidence-based injury prevention
community level safety promotion
Cost-effectiveness (all most 50% savings in cost)
Cost-benefit = 1: 10
Lens -Telescope model:
what are we providing for next generation?
Is it just a WHO logo we should think for?
Is it: “just you thinking of ‘you and your bragging -business’?
OR
Is it: “we think for our society and do our best to build up sustainable Safe Communities”?
Is it: “we create a safer community for our next generation”?
Thanks for your valuable time!