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Assessing Health Status & Health Needs

Assessing health status & health needs

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Page 1: Assessing health status & health needs

Assessing Health Status & Health Needs

Page 2: Assessing health status & health needs

What is Health Status Assessment?

• A health status assessment of a population establishes whether particular health problems exist in a given population, characterizes the problems and identifies the potential for avoidable mortality and morbidity.

• It can be used to support health needs assessment, for example, describe patterns of disease in a population and compare it other populations.

• It can also be used in policy making, aiding planning (e.g. resource allocation and target setting), evaluation and to identify areas for further research.

Page 3: Assessing health status & health needs

Reasons

• To conduct health needs assessment• To audit equitable distribution of resources• To assist in conducting review of existing

policy• To enable setting of targets for achievement• To evaluate existing/proposed health

service/intervention and for research purpose as well

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Steps in Health Status Assessment1. Define the purpose2. Define the population3. Define the aspects of health to be considered4. Review the available data5. Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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Steps in Health Status Assessment

1.Define the purpose2. Define the population3. Define the aspects of health to be considered4. Review the available data5. Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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1. Clearly define the purpose

• The starting point of the health assessment, defining the purpose, is very

important. Many a times, a tendency to have an extensive unfocused list of objectives as well as the temptation to examine interesting but irrelevant issues may arise. These must be resisted.

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Steps in Health Status Assessment1. Define the purpose

2. Define the population3. Define the aspects of health to be considered4. Review the available data5. Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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2. Define the Population

• Defining the population to be assessed is extremely important.

• Population size, structure and the period of observation can have major effects on the numbers of cases of disease or disability observed.

• The data is therefore usually expressed as proportions (e.g. the number of children aged under five per thousand population at a particular point of time) or rates (the number of new cases of tuberculosis per thousand population per year).

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Steps in Health Status Assessment1. Define the purpose2. Define the population

3. Define the aspects of health to be considered4. Review the available data5. Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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3. Define the aspects of health to be considered

• Health can have a variety of meanings which can range from the lofty definition of World Health Organization having physical, emotional and social dimensions.

• In practice a more restrictive definition should be used which can be easily measured, for example a particular group of diseases or certain summary measures of population health.

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Steps in Health Status Assessment1. Define the purpose2. Define the population3. Define the aspects of health to be considered

4. Review the available data5. Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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4. Review the available data

• Comprehensive population health assessments are based on a wide range of data of different types.

- Local data – health service providers at local level

- National Data- Census

- International Data- WHO

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Steps in Health Status Assessment1. Define the purpose2. Define the population3. Define the aspects of health to be considered4. Review the available data

5.Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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5. Select Data Carefully• At first sight there may seem to be so many data available

that assessing health should not be much of a challenge.• Finagle’s law The information you have is not what you want; the

information you want is not what you need; the information you need is not what you can get; the information you can get costs more than you want to pay.

• When the data source proposed to be used has been identified the following aspects of the data should be considered before utilizing it :

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• Validity of data for assessment-

-data must be relevant to the issue-data items should have been defined-data should be relevant to the defined population

• Technical quality of data- -data should have been properly recorded according to the specified definitions-complete in all aspects -be free from classification or selection biases -appropriate for the assessment planned

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• Quality of the analytic methods The data should be adjusted for the population

structure, e.g. age, sex, social group or ethnic composition and the numbers should be big enough to allow a statistically adequate and precise estimate of the aspects being considered

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Steps in Health Status Assessment1. Define the purpose2. Define the population3. Define the aspects of health to be considered4. Review the available data5. Select data carefully

6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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6. Analyze & Interpret Data• In progressing from data to information, the purpose of the assessment will

determine the nature of the analyses chosen.• The results of the health assessment need to be communicated to the

concerned people with the following usual aspects:Comparison of findings on health aspects of the

population Describing the relative heath of groups of the

population (based on defined areas or social groups)

and identifying inequalities. Comparing the health trends over timeDescribing the impact of health problems in terms of

people’s experience of health problems.

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Steps in Health Status Assessment1. Define the purpose2. Define the population3. Define the aspects of health to be considered4. Review the available data5. Select data carefully6. Analyze and interpret data

7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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7. Carry out a local study, If Necessary

• The health aspect planned to be assessed can be sufficiently important and the available local data so limited that a case may exist for conducting a fresh data collection.

• Conduct of special survey is however usually constrained by the cost involved.

• At the local level, a special survey or longitudinal study should only be carried out if time is available and the value of the data likely to be provided justifies the cost.

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Steps in Health Status Assessment1. Define the purpose2. Define the population3. Define the aspects of health to be considered4. Review the available data5. Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary

8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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8. Consider the use of comparators

• Assessing the health of a population may be undertaken to assess what is the actual extent of a health problem and also to determine how it compares with previous years, other areas and other social groupings.

• For example in examining the need for initiatives to reduce smoking, all that may be required is the number of deaths and extent of ill health associated with smoking locally.

Page 23: Assessing health status & health needs

Steps in Health Status Assessment1. Define the purpose2. Define the population3. Define the aspects of health to be considered4. Review the available data5. Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators

9. Address issues of confidentiality & disclosure10. Communicate results effectively11. Evaluate health status assessment

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9. Address issues of confidentiality & disclosure

• Assessing the health status of a population, especially at a small area level, increases the risk of inappropriate and unnecessary disclosure of personal data.

• For example, the assessment of the HIV positive status of commercial sex workers in a particular area. Social and other discrimination besides loss of clients may result from the publication of the survey results.

• Informed consent of the participating subjects is an essential pre-requisite to their inclusion in the assessment process.

Page 25: Assessing health status & health needs

Steps in Health Status Assessment1. Define the purpose2. Define the population3. Define the aspects of health to be considered4. Review the available data5. Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure

10. Communicate results effectively11. Evaluate health status assessment

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10. Communicate results effectively

• The result needs to be communicated to a general audience.• Key points about health status analyses to consider in a written or oral

communication are :Think through its purpose. Don’t leave it to the reader to relevant points from a mass of

data-quote specific data to make a point. Ensure confidentiality for participants in survey and ensure

this is made clear to everyone.

Don’t be too sophisticated-many people in the target audience will not have that much background knowledge of the issue.

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Steps in Health Status Assessment1. Define the purpose2. Define the population3. Define the aspects of health to be considered4. Review the available data5. Select data carefully6. Analyze and interpret data7. Carry out local study, If Necessary8. Consider the use of comparators9. Address issues of confidentiality & disclosure10. Communicate results effectively

11. Evaluate health status assessment

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11. Evaluate Health Status Assessment

• Those who are engaged in public health need to emphasize the importance of assessment to others.

• It is important that our work is assessed using correct tools such as audit.

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Now Let’s move on to ASSESSING HEALTH NEEDS

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What is health needs assessment?• a systematic method of identifying the unmet health and

health-care needs of a population and making changes to meet these unmet needs.

• Doctors- assessing the health needs of individual patients by professional training and clinical experiences- a systematic approach

• Such systematic approach has often been missing in assessing the health needs of local population

• Case studies have revealed the importance of conducting scientific “health needs assessment” before planning appropriate interventions in society.

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Need

• Need, implies the capacity to benefit from an intervention.

• ‘To speak of a need is to imply a goal, a measurable deficiency from the goal and a means of achieving the goal. ’

• Health needs assessment is not the same as population health status assessment.

• It incorporates the concept of a capacity to benefit from an intervention.

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• Two broad categories Normative or professionally assessed needs

the needs which the expert health care providers think should be addressed

Felt Needs the needs which the community feels to be

important.

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Approaches to Needs Assessment

• Epidemiological based approach • Comparison of the levels of service receipt

between different populations.• Determining the demands and wishes of

professionals, patients, politicians and other interested parties

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Assessing of health needs provides the opportunity for :

• Assessing the population’s health status in terms of the patterns of disease or disorders in the local population and the differences from district, regional, or national disease patterns.

• Learning more about the needs and priorities of patients and the local population.

• Highlighting areas of unmet needs and working towards meeting these needs.

• Influencing government policy, inter-sector collaboration, as well as research and development priorities.

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Steps for Health Needs Assessment

1. Identify the health problem to be addressed in the defined population.

2. Carry out a health status assessment -for the population, covering the relevant areas of ill-health and/or potential health to determine what is the size and nature of the problem.

3. Identify the existing services and interventions being delivered, including, where relevant, the service targeting, quality, effectiveness and efficiency.

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4. Identify the interventions by determining what patients, professionals and other stakeholders want.

5. Identify interventions by reviewing the scientific knowledge and determine the most appropriate and cost effective solutions.

6. Determine the resource implications. It may require to choose between competing ways of meeting needs (competing interventions) and decide on competing priorities – resources are always limited.

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7. Enunciate the recommendations and the plan for implementation.

8. Determine whether assessing need is likely to lead to appropriate change by identifying expected health gains.

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Needs Assessment Requires Careful Preparation

• The process of needs assessment involves identifying the right issues,

By defining objectives as clear, simple and focused as possible.

• using the right technical methods• and managing the process effectively.

Good leadership effective communication

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Identify the Health Problem or Issue

• health problem should be clearly identified• many sources for identification

the results of a population health status assessment

input from patients or stakeholdersmedia reports scientific and professional literaturegovernment priority setting reports of public health professional bodies

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Dimension of the Problem

• be desirable to be able to estimate the likely number of beneficiaries of the planned interventions

• the assessment process should be able to establish the following :

– How many people in the studied population are likely to be suffering from the target condition or conditions ?

– What their socio-demographic and other characteristics are?

– To what extent they are already receiving appropriate interventions.

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Availability of Services

• several sources of data on healthcare in locality• Hospital Data provides information on-

OPD attendance, Hospital Admission, patient characteristics to some extent length of stay

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Determining the most Appropriate and Cost-EffectiveInterventions

• Essential part of a health needs assessment is the review of the clinical effectiveness and cost-effectiveness of interventions that can address the identified health needs.

• Evidence about the effectiveness of health interventions can be found in databases of good-quality systematic reviews such as the Cochrane Library, or peer reviewed publications.

*The Cochrane Library is a collection of high-quality, independent evidence to inform healthcare decision-making.

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Resource Implications• Determining how resources are currently being spent

(programme budgeting)• Defining options for change by suggesting alternatives : (a) identify potential services which require more

resources (b) identify services which could be provided

at the same level of effectiveness but at reduced cost.

(c) identify services which are less cost-effective than those identified.

• Assessing the costs and benefits of the principal options.

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Implementation of Recommendations

• Building agreement to a practical implementation plan for meeting the unmet needs is an essential part of needs assessment.

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Summary• Assessing health status of a community is a challenging

process required – to conduct a health needs assessment – to enable setting of targets for achievement

• methodology varies depending on objective• Needs implies the capacity to benefit from an intervention. a. Felt Needs- what people consider they need

b. expressed needs- needs expressed by action c. and normative needs- what health professionals define as need

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• Health Needs Assessment is a systematic method of identifying the unmet health and health care needs of a population and making changes to meet these unmet needs.

• Health needs are not static and therefore any assessment will only provide snapshot of current needs of population concerned.

• Thus health need assessment is a continuous process which is to be reviewed, updated and evaluate concurrently.

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Reference

"Assessing Health Status and Health Needs." Text Book of Public Heath and Community Medicine. Ed. Rajvir Bhalwar. First ed. N.p.: Department of Community Medicine, 2009. 354-59. Print.

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