Planning Health Education Programmes:

Introduction
Careful planning is essential to the success of all health education activities. This study session is
the first of two sessions that will help you to learn about ways in which you can plan your health
education activities. In this study session, you will learn about the purpose of planning health
education interventions, the basic concepts of planning, and what steps to take when you are
planning. The study session will focus in particular on needs assessment, which is the first step in
planning health education and promotion. You will learn about categories of needs and
techniques that you can use when carrying out needs assessment.

You may have covered some aspects of planning in other modules such as the Health
Management, Ethics and Research Module. However, planning in this study session refers
specifically to the health education planning process (Figure 12.1).

Figure 12.1  All health education messages require a lot of

planning before they are delivered. (Photo: I-TECH/Julia
Sherburne)

Learning Outcomes for Study Session 12

When you have studied this session, you should be able to:
12.1  Define and use correctly all of the key words printed in bold. (SAQs 12.1 and 12.2)
12.2  Explaiin the purpose of planning health education activities. (SAQ 12.2)
12.3  List the principles of planning in health education practice. (SAQ 12.2)
12.4  Describe the six steps of planning health education interventions. (SAQ 12.3)
12.5  Describe the main categories of needs assessment. (SAQs 12.4 and 12.5)
12.5  Discuss some of the techniques of needs assessment. (SAQs 12.4 and 12.6)

12.1  Planning health education activities

Before you can begin planning your health education activities, you need to have a clear
understanding of what planning means. Planning is the process of making thoughtful and
systematic decisions about what needs to be done, how it has to be done, by whom, and with
what resources. Planning is central to health education and health promotion activities (Box
12.1). If you do not have a plan, it will not be clear to you how and when you are going to carry
out necessary tasks. Everyone makes plans — for looking after their family, for cooking, and so
on. You can build on experience you already have in planning, and apply it to health education.
 Box 12.1  Key questions to ask when planning
 What will be done?

 When will it be done?
 Where will it be done?
 Who will do it?
 What resources are required?

12.2  The purpose of planning in health education

There are several benefits to planning your activities. Firstly, planning enables you to match your
resources to the problem you intend to solve (Figure 12.2). Secondly, planning helps you to use
resources more efficiently so you can ensure the best use of scarce resources. Thirdly, it can help
avoid duplication of activities. For example, you wouldn’t offer health education to households
on the same topic at every visit. Fourthly, planning helps you prioritise needs and activities. This
is useful because your community may have a lot of problems, but not the resources or the
capacity to solve all these problems at the same time. Finally, planning enables you to think
about how to develop the best methods with which to solve a problem.

Figure 12.2  Every village in Ethiopia is different. Planning is

required so the health messages are tailored to the specific
conditions. (Photo: UNICEF Ethiopia/Indrias Getachew)
 Haimonot is a
Haimonot is doing health education activities — but not
planning them. How would you convince her that planning
health education activities would be helpful? What points would you want to talk about? Use the
paragraph above to help you plan what you want to say.

12.3  Principles of planning in health education

In this section you will learn about the principles you should apply when planning any activity in
the community. Planning is not haphazard — that means there is a principle, or a rule, which you
should take into account when developing your health education plans. You should always
consider the principles shown in Box 12.2 when you plan a piece of work.

Box 12.2  Six principles of planning in health education

1. It is important that plans are made with the needs and context of the community in
mind. You should try to understand what is currently happening in the community
you work in.
2. Consider the basic needs and interests of the community. If you do not consider the
local needs and interests, your plans will not be effective.
 3. Plan with the people involved in the implementation of an activity. If you include
people they will be more likely to participate, and the plan will be more likely to
succeed.
4. Identify and use all relevant community resources.
5. Planning should be flexible, not rigid. You can modify your plans when necessary.
For example, you would have to change your priorities if a new problem, needing an
urgent response, arose.
6. The planned activity should be achievable, and take into consideration the financial,
personnel, and time constraints on the resources you have available. You should not
plan unachievable activities.
 Meserete is a Health Extension Practitioner. Some time ago she developed a health education
programme for her community. At the beginning, she identified some important health problems
that were occurring in her community. Local people were recruited to identify their own health
problems, and to look for a solution appropriate to their setting. Meserete also identified local
resources that would be helpful for her health education activities. Finally, she developed a plan
to meet the needs of the community and started to implement it. However, she faced a shortage
of resources to carry out all of the items in her plan, so she prioritised the items and modified her
plan according to the resources that were available. Look at Box 12.2 above, and work out which
principles of planning you think Meserete used.

12.4  Steps involved in planning health education activities

Planning is a continuous process. It doesn’t just
happen at the start of a project. If you are
involved in improving and promoting individual,
family and community health, you should make
sure that you plan your activities. Planning can
be thought of as a cycle that has six steps (Figure
12.3). In this section, you will learn the basic
steps to take when planning your health
education activities.

View larger image

Figure 12.3  Steps in planning health education
activities. (Source: Henk van Stokkom)
12.5  Needs assessment
Conducting a needs assessment is the first, and probably the most important, step in any
successful planning process. Sufficient time should be given for each needs assessment. The
amount of time required for a needs assessment will depend on the time you have available to
address the problem, and the nature and urgency of the problem being assessed.

Needs assessment is the process of identifying and understanding the health problems of the
community, and their possible causes (Figure 12.4). The problems are then analysed so that
priorities can be set for any necessary interventions. The information you collect during a needs
assessment will serve as a baseline for monitoring and evaluation at a later stage.

Figure 12.4  You may find out that conditions such as goitre are
common in your locality. (Photo: Henk van Stokkom)
Before you begin a needs assessment, it is important to become
familiar with the community you are working in. This involves
identifying and talking with the key community members such
as the kebele leaders, as well as religious and idir leaders.
Ideally, you would involve key community members throughout
the planning process, and in the implementation and evaluation
of your health education activities.

There are various categories of needs assessment. In order to

develop a workable and appropriate plan, several types of needs
should be identified, including health needs and resource needs,
which are outlined below.

12.5.1  Health needs assessment

In a health needs assessment, you identify health problems prevalent in your community. In
other words, you look into any local health conditions which are associated with morbidity,
mortality and disability. The local problems may include malaria, TB, HIV/AIDS, diarrhoea, or
other conditions arising from the local context, such as goitre caused by lack of iodine in the diet.

Having identified the problems, you need to think about the extent to which local health
conditions are a result of insufficient education. For example, are people lacking in knowledge
about malaria, or HIV, or diarrhoea? Are they aware that some of their behaviours may be part of
the problem?

12.5.2  Resource needs assessment

A resource needs assessment identifies the resources needed to tackle the identified health
problems in your community. You should consider whether there is a lack of resources or
materials that is preventing the community from practising healthy behaviours. For example, a
mother may have good knowledge about malaria and its prevention methods, and want to use
Insecticide Treated Bed Nets (ITNs). However, if ITNs are not available, it may not be possible
for her to avoid malaria. Therefore, a bed net is a resource which is required to bring about
behaviour change. Similarly, a woman may intend to use contraception. However, if
contraceptive services are not available in her locality, she remains at risk of unplanned
pregnancies. In order to facilitate behaviour change, you should identify ways of addressing this
lack of contraceptive resources.

Be aware too that education is in itself one of the great resources you can call on. An education
needs assessment should also be part of you plan.

12.5.3  Community resources

First read Case Study 12.1 to help you think about community needs.

During a needs assessment, you also need to identify the resources available in the community,
such as labour power. This would include finding out about the help that community leaders and
volunteers could give, and the local materials and spaces in which to conduct health education
sessions. When looking at community resources, you should include local information such as
the number of people in each household, their ages and their economic characteristics. You
would also include information on community groups and their impact on local health activities
and communication networks.

12.6  Assessment techniques
Data related to the health needs of the community can be obtained from two main sources —
these are called primary and secondary sources. Primary sources are data which you collect
during a needs assessment, using techniques such as observation, in-depth interviews, key
informant interviews, and focus group discussions. Secondary sources are data that were
collected and documented for other purposes, including health centre and health post records,
activity reports, and research reports. You may also be able to review data which has already
been collected by other people to identify local health problems.

Various techniques can be used to collect data from the community. These include observation,
in-depth interviews, key informant interviews, and focus group discussions — which we describe
next.

12.6.1  Observation

To carry out an observation, you watch and record events as they are happening. Box 12.3
outlines some situations where observation can be a useful method of collecting relevant data.
Box 12.3  Observation is useful to understand
 Community cultures, norms and values in their social context.

 Human behaviour that may be complex and hidden.

When you are observing households, individuals, or more general practice or behaviour in your
community, you may find it useful to use a checklist. For example, you could prepare a checklist
to keep a detailed record of household practice and environmental hygiene. Following your
checklist might help you to be more systematic about the things you are observing. You cannot
observe everything at the same time, so the checklist will help you prioritise what to observe, and
how to record what you have seen. A checklist is a very helpful tool for observation, and more
generally with planning. There is an example of a checklist in Box 12.4.

Box 12.4  Checklist to organise observations

A Health Extension Practitioner has prepared a checklist to help organise her observations when
she visits pregnant mothers in her community to put up new insecticide-treated mosquito nets
(ITNs).

The checklist includes the following points:

 Is the net hung above the bed?  Yes/No

 Has it been tied at all four angles above the bed?  Yes/No
 Is the net tucked under the mattress?  Yes/No
 Does the net have a hole anywhere where an insect might get in?  Yes/No
You have probably already gathered a lot of information by using observation within your
community. If you keep alert to all the things that are happening around you, you will be able to
gather a lot of very useful information. Systematically observing and recording what you see is
an important technique that you can use to identify health problems and their possible causes
(Figure 12.5).

Figure 12.5  Make sure you take notes of your observations as

you plan your health education activities. (Photo: Yesim Tozan)

12.6.2  Interviews
The in-depth interview is another important method of data collection. This technique can be
used when you want to explore individual beliefs, practices, experiences and attitudes in greater
detail. It is usually conducted as a direct personal interview with one person — a single
respondent. Using in-depth interviews as a Health Extension Practitioner, you can discover an
individual’s motivations, beliefs, attitudes and feelings about health and illness. For example,
you may want to explore a mother’s attitudes to — and use of — contraception.

It is a good idea to use open-ended questions to encourage the respondent to talk, rather than
closed questions that just require a yes or no answer.

An in-depth interview can take around 30–90 minutes. Box 12.5 lists the steps you should take
when conducting an in-depth interview.

Box 12.5  Conducting an in-depth interview

 Identify an individual with whom you are going to conduct an in-depth interview, obtain
their consent and arrange a time.
 Prepare your interview guide — this is a list of questions you can use to guide you during
the interview. You can generate more questions during the interview if other issues arise
that you want to follow up.
 Write down the responses as accurately as you can. You can also use a tape recorder to
record the responses. However, you should ask permission from the respondent to use a
tape recorder.
 After the interview is completed, review your notes or listen to the tape and prepare a
detailed report of what you have learned.

Figure 12.6  In-depth interviews can help you gather a lot of

information that will help you plan your health education
activities. (Photo: UNICEF Ethiopia/Indrias Getachew)
Perhaps you could practise inventing open-ended questions. Try
it out on your family and friends until it becomes easy to do. A
closed question goes like this: Do you like vegetables? The
person can only really say yes or no. An open question goes like this: Tell me something about
how vegetables fit into your diet? Then the person can start talking about vegetables much more
— and you will get a lot more information.

A good time to do an in-depth interview is when the subject matter is sensitive; for example,
gathering data from women regarding their feelings about sexuality and family planning, or if the
woman has had an abortion. This is a useful technique when you need to explore an individual’s
experiences, beliefs and attitudes in greater detail.

12.6.3  Key informants
Key informants are people who have first-hand knowledge about the community. They include
community leaders, cultural leaders, religious leaders, and other people with lots of experience in
the community. These community experts, with their particular knowledge and understanding,
represent the views of an important sector of the community. They can provide you with detailed
information about the community, its health beliefs, cultural practices, and other relevant
information that might help you in your work. How do you feel about talking to leaders and
people with lots of experience? Do you ask them different sorts of questions from those you ask
of other people? Although beliefs and attitudes apply to key informants too, you also have a
chance to find out some answers to questions about ‘the bigger picture’ of your community when
people are public figures.

12.6.4  Focus group discussions

Focus group discussions are group discussions where around 6 to 12 people meet to discuss

health problems in detail. The discussion is led by a person known as a ‘facilitator’. Box 12.6
describes the steps to use if you want to conduct a focus group discussion.

Box 12.6  Conducting a focus group discussion

 Select 6–12 participants for your focus group discussion. For the discussion of some
sensitive issues, it might be necessary to lead one focus group of men only (Figure 12.7),
and another of women only. For other issues, a mixed group could lead to interesting and
informative discussions.
 Prepare a focus group discussion guide. This is a set of questions which are used to
facilitate the discussion. While the discussion is going, you can also generate more
questions to ask the participants.
 There should be one person who facilitates the discussion, and another person who takes
notes during the discussion. If possible, it is also useful to record the discussion using a tape
recorder, so that you can listen and analyse it later.
You may find it useful to use focus group discussions in the following situations:

 When group interaction might produce better quality data. Interaction between the
participants can stimulate richer responses, and allow new and valuable issues to emerge.
 Where resources and time are limited. Focus groups can be done more quickly, and are
generally less expensive than a series of in-depth interviews.
Figure 12.7  Focus groups can be the source of a lot of useful information about local health
conditions. (Photo: AMREF)
In this study session, you have learnt four techniques that will help you to conduct needs
assessments. You can either select one technique which best fits the aims of your needs
assessment, or use a combination of more than one technique to build a more complete picture of
the issues you need more information about.

Summary of Study Session 12

In Study Session 12, you have learned that:

1. Planning is the process of making thoughtful and systematic decisions about what
needs to be done, how it has to be done, by whom, and with what resources.
2. Planning health education activities has several advantages. It enables you to
prioritise problems, use your resources efficiently, avoid duplication of activities, and
develop the most effective methods to solve community health problems.
3. Planning should be based on your local situation, and take into account all the
interests and needs of the community.
4. A needs assessment is the usual starting point for the health planning process. There
are a variety of techniques you can use for this, including observation, interviews and
focus group discussions.
5. No matter what techniques are used to conduct your health and resource needs
assessments, the basic concept is to find out more about health problems in your
community, and gather information about their underlying causes.