COPAR: Planning, Implementing and Evaluation of Community Health Action Plan

Topic Outline

1. Planning
2. Health Planning Cycle
3. Essential Steps in Planning Process
4. Priority Setting: WHO Special Considerations
5. Formulating Goals and Objectives
6. Implementation: Deciding on Community Interventions/Action Plan
7. Evaluation of Community Health Nursing Interventions

Learning Objectives: After studying this unit, you will be able to:

• Discuss community health planning.

• Describe the steps in planning cycle.
• Describe the different components of program implementation.
• Describe evaluation approaches.

Introduction

After the data has been collected and organized and nursing diagnoses have been formulated comes the
planning phase of the nursing process. If the assessment and diagnosis phase is the compass of the
health care process, planning is its heart and soul since nursing interventions and the implementation
and evaluation of the plan will depend on the expected goals and outcomes that have been set during
the health care process.

Overview

Planning to meet the health needs of the community. Is determining the approach to be used in
assisting the client toward optimal wellness. It is deciding which actions will be used to help solve,
lessen, or minimize the effects of the identified problems, or to prevent potential problems.

Planning is the logical decision-making process used to design an orderly, detailed series of actions for
accomplishing specific goals and objectives. Planning for community health is based on assessment of
the community and the diagnoses formulated, but assessment and diagnosis alone do not prescribe the
specific actions necessary to meet clients’ needs.

Health Planning

Health Planning Cycle

1. Step one – Surveying the Environment – “What is?” – involves gathering extensive information to
determine health profiles and experiences. It is meant to identify current state of the issue under
consideration.
2. Step two – Setting directions – “What ought to be?’ – involves goal settings and objectives to identify
the desirable future state for the issue under consideration.
3. Step three – Problems and challenges – involves identifying and quantifying the shortfalls (pitfalls)
between what is and what ought to be.
4. Step four – Range of solutions – involves identifying the range of solutions to each identified problem
or challenge and often requires creativity since no-off-the-shelf solutions may be available for some
problems and challenges.
5. Step five – Best solutions – involves a choice of solution or set of solutions that should be
implemented to address the problems or challenges identified in step 3.
6. Step six – Implementation – involves implementation of the chosen solutions and often begins with
the development of an implementation plan.
7. Step seven – Evaluation – involves evaluation of the results of implementation to determine whether
solutions are effective in achieving their goals.

Essential Steps in the Planning Process

1. Prioritizing the identified problems/diagnosis

2. Developing goals and outcome statements
3. Planning nursing actions
4. Documentation of the NCP

Planning

In summary, the planning phase involves (a) priority setting, (b) formulating goals and objectives and (c)
deciding on community interventions.

Formulating goals and objectives

Goals and objectives are crucial to planning and should be feasible and specific (Anderson, Guthrie, &
Schirle, 2002). The diagnosis that identifies needs must be translated into goals to give focus and
meaning to the nursing plan.

Goals – broad and not constrained by time and resources; states the ultimate desired end point of all
activities; directed towards solving health status.

For example:
Health need: The group of elderly people has altered coping ability to their fear of crime.
GOAL: Within 6 months, this group of elderly people will be free to walk the streets of their
neighborhood without experiencing any incidents of criminal assault.

Objectives – stated in specific and measurable terms, client-centered and outcome-focused; concerned
with resolution of the health problem itself. An adequate statement of objective specifies both the
criteria as well as the standards of SMART.

For example:
1. By the end of the 1st month, a safety committee will be established to study crime patterns in the
neighborhood.
2. The safety committee will develop strategies for crime reduction and elder protection, which will be
presented to the city councils for approval by the end of third month.
3. By the end of 5th month safety strategies such increase police surveillance, town watch patrols will be
implemented.
4. By the end of 6th month, there will be no reported incidents of criminal assault.
Implementing Plans for Promoting the Health of the Community

Implementation is putting the plan into action. Implementation is often referred to as the action phase
of the health care process. In community health midwifery process, implementation includes not just
nursing action or nursing intervention but collaboration with clients and perhaps other professionals.

Implementation is the most exciting phase for most health workers. It also entails coordination of the
plan with the community and the other members of the health team. Collaboration with other sectors
such as the local government and other agencies may also be necessary. All are partners in
implementation.

Preparation

The actual course of implementation, outlined in the plan, should be easy to follow if goals, expected
outcomes, and planned actions have been designed carefully. Professionals and clients should have a
clear idea of who, what, why, when, where, and how. Who will be involved in carrying out the plan?
What are each person’s responsibilities? Do all understand why and how to do their parts? Do they know
when and where activities will occur? As implementation begins, midwife should review these questions
for themselves, as well as for clients. This is the time to clarify any doubtful areas, thereby facilitating a
smooth implementation phase. Implementation requires flexibility and adaptation to unanticipated
events.

Components of Program Implementation

1. Coordinating the health programs

2. Monitoring health programs
3. Supervising the program staff.

Evaluating Implemented Community Health Midwifery Intervention and Plan

Evaluation is usually seen as the final step, but since the midwifery health care process is cyclic in nature,
the midwife is constantly evaluating throughout the entire process. Evaluation methods must be
addressed “in the planning phase, when goals and measurable objectives are established” and
interventions are identified (Shuster & Groeppinger, 2004, p. 369).

Evaluation refers to measuring and judging the effectiveness of goal or outcome attainment. How
effective was the service? Were client needs truly met? How has health status changed? Professional
practitioners owe it to their clients, themselves, and other health service providers to evaluate a
program fully and effectively. evaluation is an act of appraisal in which one judge’s value in relation to a
standard and a set of criteria. Evaluation requires a stated purpose, specific standards, and criteria by
which to judge, and judgment skills.

Evaluation approaches may be directed towards structure, process and/or outcome.

1. Structure evaluation – looking into manpower and physical resources of the agency responsible for
community health interventions.
2. Process evaluation – examining how the CH midwifery process were undertaken.
3. Outline evaluation – determining the degree of attainment of goals and objectives
4. Ongoing evaluation or monitoring – done during implementation to provide feedback on compliance
to the plan as well as on need for changes in the plan to improve the process and outcomes of
interventions.

Types of Evaluation

To determine the success of their planning and intervention, community health midwife use two main
types of evaluation: formative and summative evaluation.
1. Formative evaluation – focus on the process during the actual interventions. Essentially looks at the
step-by-step process of program implementation.
2. Summative evaluation – focuses on the outcome of the interventions. Examines the effect or degree
to which the outcome objectives have been met, informs the agency or program leader of the program
impact on client’s health.

Standards of Evaluation

1. Utility – value of results

2. Feasibility – answers the questions of whether the plan for evaluation is doable or not considering
available resources
3. Propriety – ethical and legal matters
4. Accuracy – validity and reliability of the results of evaluation.