Overview of the Solihull Sexual Health Strategic Plan - Assignment Example

CRITICALLY ANALYSE AN IDENTIFIED PUBLIC HEALTH STRATEGY Overview of the Solihull Sexual Health Strategic Plan Even on a global scale, sexual healthissues remain one of the most important health issues that confront us as people. It is against this backdrop that various countries have put in efforts to advance in their quest to promoting effective sexual health among their populace. Most of these efforts are guided by the World Health Organisation’s programs on sexual and reproductive health (Department of Health, 2005). But due to the complexity of sexual and reproductive health issues and the peculiarity of these issues to various countries, each country tries to have its own sexual health program. Again, due to the need to decentralize the effective advancement of sexual and reproductive health, countries including the United Kingdom have set up several localized sexual health projects. One of such is found in Solihull. With a population of 94,753, Solihull is faced with a number of sexual and reproductive health issues including high sexually transmitted infection rate and high rate of unplanned conception. As it is commonly said, if you do not know where you are going, any road takes you there. This means that for major project such as the sexual and repreoductive health program of Solihull, it is important to have a strategic agenda that guides the implementation of the project. It is in light of this that the Solihull Sexual Health Strategic Plan 2008 – 2013 has been designed as a policy context for dealing with the many issues of sexual and reproductive health that confront Solihull. Sexual health needs of the population The population of Solihull suffers from three major sexual and reproductive health needs, which form the basis for the sexual and health strategic plan 2008 to 2013. The first of these has to do with a sudden high rate of teenage conception in the last 3 years. It has been observed that unlike what existed earlier where the national rates of teenage conception for England was higher than what existed in Solihull, there has been a sudden turn around whereby the teenage conception rates have gone higher within the population than what existed before (Wanless, 2004). Even though the rates are currently not above the national rates, they remain higher than they were before. In the graph below, the rate of teenage pregnancy in women aged 15 to 17 in 2009 and 2011 are compared between England and Solihull. Source: The Guardian (2012) From the graph, it can be seen that the rate of teenage pregnancy and for that matter unplanned conception in Solihull keeps increasing with increasing national rates. The second sexual health need that confronts the region has to do with higher average rates of sexually transmitted infections. Quite strangely, Solihull is currently plagued with rates of sexually transmitted infections that are higher than the national average. A recent screening program that was undertaken in 20 locations for instance identified an infection rate of 10% amongst people under the age of 25 (Solihull NHS Care Trust, 2008, p. 19). Meanwhile, this population represents one of the healthiest and most productive groups. The third need identified could directly be linked as the cause of the second as there are insufficient sexual and reproductive public health centers. A typical scenario is the fact that there is no local Genito-Urinary Medicine (GUM) clinic within the population. Even though there is a contraception service and sexual health service, these are not captured under the capacity in specialized contraception (CASH) and so there is no well matched geographic integration of the sexual and reproductive health needs within the population. Aims and Strategic Objectives of the Strategic Plan One of the most unique features of the Solihull Sexual Health Strategic Plan 2008 – 2013 is that the plan has clearly been defined along the lines of aims and objectives. It would be noted that aims are often generalized goals that broad in nature. To this end, they require specific and smaller tasks to aid in their achievement. It is in this sense that the need for specific objectives arises. As far as aims are concerned, the strategic plan is aimed at improving the sexual health of the Solihull population (Solihull NHS Care Trust, 2008, p. 13). The plan is also aimed at reducing the sexual health inequalities that exists between geographical or socially disadvantaged groups (Solihull NHS Care Trust, 2008, p. 13). Some of the specific objectives that are aimed at achieving the aims are paraphrased from the Solihull Sexual Health Strategic Plan 2008 – 2013 document as follows 1. Cut down on the occurrence of STIs 2. Reduce the transmission of HIV and STIs 3. Decrease incidences of unplanned preganacies, especially in people under the age of 18 4. Improve the health, support and care given to people living with HIV 5. Decrease incidence of stigma against people infected with HIV 6. Provide rapid access to safe, legal, high quality and equitable NHS funded termination of pregnancy services 7. Provide needed support to teenage mothers and their children 8. Increase the skill and training of personnel and workers delivering sexual and reproductive health services Rationale for the Strategic Plan Even though the sexual health and reproductive needs of Solihull has been mentioned as one of the prevalent in the whole of England, policy makers say the rates do not cause an alarming need for the present strategic plan as the existence of inequalities within the region as far as sexual and reproductive health are concerned. The inequality actually forms the basis and rationale for what has come to be known as the Solihull Sexual Health Strategy 2008 – 2013 (House of Commons Health Committee, 2003). Statistics actually has it that there are more reports of sexual health morbidity in northern Solihull than there are in the south. This is a condition that calls for urgent attention if we really want to believe in the call for equal rights and justice. In the north, there are higher rates of sexually transmitted infections and teenage pregnancy keeps going up than in the south. The rationale was therefore to bridge the gap and bring about some levels of equality and sanctity. Technically also, the disparity represented a bleak future for the Borough as it meant that at any point in time there could be a spread of the poor sexual and reproductive health conditions to the entire Borough. Application of international strategies/policies Due to the need of ensuring that the Sexual Health Strategy 2008 – 2013 conformed to international and global standards, policy makers considered a number of international strategies and policies in the formulation of the strategic plan. These international strategies and policies were adapted directly from the World Health Organization and the European Union. For example it would be noted that the World Health Organization holds it as a policy to make access to healthcare a universal right. What this means is that primary health care must reach all people without discrimination and inequality (NICE Guidelines, 2005). In relation to this policy or strategy, the current strategic plan included sexual health as part of its primary health care agenda. What this means is that by the time the entire plan is rolled out at the end of 2013, no member within the population will be left behind in receiving quality sexual and reproductive health care. What is more, the preparation of the strategy 2008 – 2013 considered what has come to be known as the WHO European regional strategy on sexual and reproductive health in the preparation of strategy objectives. This is because the 5 point objectives of the WHO European regional strategy on sexual and reproductive health were critically considered in drafting the objectives of the present strategic plan. Application of national strategies/policies At the national level also, a lot of considerations were made in ensuring that Sexual Health Strategy 2008 – 2013 conformed to national provisions. It is for this reason that a number of national strategies and policies on sexual health service were considered in making the present strategic plan. Some of the national policies driving change in sexual health service that were considered include the National Strategy for Sexual Health and HIV and the Teenage Pregnancy Strategy (Solihull NHS Care Trust, 2008, p. 6). Mention can also be made of “Tackling Health Inequalities – a programme for action” and “Our Health, Our Care, Our Say” white paper. Basically, these have served as guiding principles for the strategic plan in ensuring that Solihull is not treated as an island within a larger nation in terms of the provision of sexual and reproductive health needs of the populace. If for nothing at all, the usefulness of having the national policies as a driving force in the current was to ensure that at every point in time, there would be a comparative basis for measuring the effectiveness of the strategy. For example if national levels of teenage pregnancy are rising with falling rates in Solihull, the Solihull Strategy can then be judged as a successful one. Localization of the strategy The localization of the strategy was motivated by the need to decentralize the existing national campaign policies on sexual and reproductive health. It has often been argued that once sexual and reproductive health policies are implemented at the national level and using a centralized approach, the impact that it has on indigenous people does not become as effective as what is felt when the programs are decentralized (Health Institute for Health and Clinical Excellence, 2007). A couple of reasons could be assigned for this including the fact that a centralized sexual and reproductive health program has a larger sample size and thus makes evaluation and monitoring very difficult. Again, with a centralized policy, there is an over-generalization of variables and so it is always difficult to target the core and immediate needs of indigeneous people. For instance in cases where levels of say HIV may be higher than the national levels, the national levels will be used as the yardstick for the implementation of interventions and so eventual interventions may not be suitable for the people for whom they are meant for. It is in light of this that it became necessary to localize or decentralize the strategy to have a better view and picture of the sexual health needs of the people within Solihull. If for nothing at all, with the present localized strategy, the people will have it easy identifying stakeholders to speak to when they are in need of any assistance and help. Identified stakeholders and their Roles For a strategic plan of this nature that takes its inspiration from not just what is happening within a local setting but from a national and international perspective, it is always important to have a number of stakeholders whose roles will be clearly defined in the context of the scope of the strategic plan. From this perspective, three major stakeholders are identified to include policy makers, sexual and reproductive health workers, and community populace. A hierarchical representation can be given to these three stakeholders using the network idea of input, processing and output. This is briefly presented below. From the graphical representation given above, the policy makers are identified as having the role of putting into the strategic plan, every needed logistic and resource that can start off the implementation process. In the first place, these policy makers are identified along two major lines, which are governmental and local. At the national level, government is obliged to be the larger facilitator of the sexual health strategy through operations from the ministry of health. Then at the local level also, the local assembly has a role to play by ensuring that there is an enforcement of the enactments that are done at the national level. Some of the specific tasks and activities that are expected to be undertaken by the policy makers include the drafting of the strategic plan as we now have it as the Sexual Health Strategy 2008 – 2013. They are also responsible for budgeting and the drafting of all legal documentations that would back the enactment of the plan. Furthermore, policy makers are expected to make sure that enough resources are sourced for the successful and smooth take off of the plan. Once the policy makers get their house in other and undertake the enactment of the strategic plan, the health workers become identified as stakeholders whose major role is to ensure for the implementation of the plan. Indeed, it is largely accepted that implementation is the law and not the enactment of it therefore (Orpwood and Barnett, 1997). What this means is that the measure of the success of any given policy or strategic plan like this should be judged by how best the program is implemented and not by how beautiful the enactment of the program is. To this end, once policy makers make all resources and logistics available to the local health directorate, it is expected that sexual and reproductive health personnel within the town will dispatch and carry out their functions effectively to ensure that the people receive the needed sexual and reproductive health care they deserve. Consequently, the sexual and reproductive health worker could be described as the service provider who is obliged to ensure that quality and effective sexual health care reaches the doorstep of the ordinary populace. Some of the means by which the sexual health worker can process or implement the inputs made by the policy maker includes the conduct of community based sexual health awareness campaigns and the organization of institution based sexual health seminars (Resnick, 2007). Finally, the community members who would be at the receiving end of the policy are also identified and recognized as key stakeholders. If for nothing at all, the measure of the level of success of the strategic plan rests with them. This is because as the output, it is expected that the levels of sexual health improvement that will be seen in them should be a measure of the outcome of the strategy. A failed strategic plan for instance should result in a falling standard of sexual and reproductive health among community members whiles as a successful strategy should manifest in an improved sexual and reproductive health of the local people. Due to the uniqueness of the role expected to be played by the community members as stakeholders for measuring the impact or level of success of the strategy, they may well be described as service users (Mahar, 2009). Despite the luxurious role given to community members as service users, they still have a couple of assisting roles to play to ensuring the success of the strategy. For example it is expected that these community members will be as corporative to health workers as possible when it comes to adherence to basic rules and instructions given to them on their sexual and reproductive health. Analysis of Action Plan The action plan for the Sexual Health Strategy 2008 – 2013 may be analysed along three major themes even though there are ten (10) action plans in all. This means that some of the action plans shall be inbedded into others. The first of the themes under the action plan has to do with reduction of prevalence rates of STIs and unplanned pregnancy. As far as this action plan is concerned, the strategic plan looks at a number of specific tasks to undertake in achieving it. For instance it has been said that there will an improvement in the intake of Chlamydia screening, introduction of opt-out screening, triaging patients according to their sexual health needs, promoting voluntary testing and counselling, among others (Redman, 2003). These are indeed very useful tasks and objectives that have been assigned to the action plan. What is commendable is that most of these actions for achieving the goal of reducing prevalence rates are patient-centred. That is, they focus on the needs of the patient and also take sexual health care to the doorstep of the patient. According to the action plan, most of the tasks and objectives should kick start in 2009 and they will be measured by the levels of infections in STIs, HIV and unplanned pregnancies. The second theme of action plan has to do with the improvement of care given to people already infected with STIs, HIV and unplanned pregnancies. This is also very useful as it is necessary that as preventive measures are taken, curative measures would also not be abandoned (Stanton, 2005). What makes this theme a necessity is that once the affected people are abandoned, there are chances that they will be re-infested or they will affect unaffected people (Moynihan and Henry, 2006). It has planned that one of the ways in achieving this action plan shall be through the development and resourcing of HIV service specifications to meet the social needs of infected people. It has also been planned that campaigns on the need to avoid stigmatization against affected people will be increased. What is more, care shall be given to both teenage mothers and their babies to ensure that they live healthily. Whiles most of these actions are ongoing, a lot more of them have been targeted to start by September 2008. The means of measurement of the success of this theme shall be the level of social welfare and satisfaction expressed by affected people. It will also be judged on the rate of improvement on the health status of affected person to be sure that their health is improving rather than deteriorating (Tombak, 2012). The final theme touches on the issue of raising the commission in charge of the Sexual Health Strategy 2008 – 2013 to higher and expected standards. This plan will be achieved through a number of actions and tasks that are aimed at the commission as an institution and also on the personnel in-charge of service delivery (Wolinsky, 2005). For instance it is part of the plan to ensure that sexual health providers are equipped with necessary capabilities to make them host integrated levels of services. Funding to the commission shall also be increased to ensure that logistics and resources needed for service providers to carry out their roles and duties effectively are made readily available. The training and education of sexual health providers shall also be enhanced. The latter shall be started from a point where a standard is set for all sexual health and reproductive service providers to meet a national criteria or qualification (Solihull NHS Care Trust, 2008, p. 36). The lead agency to carry out this third theme is identified as the sexual health coordinator who shall have a mandate, which is ongoing. The measure of rate or levels of success and achievement of this particular plan shall be based on the assessment results of the quality control service delivery. Major Challenges faced in the implementation of the Strategic Plan Clearly, the enactment and implementation of the strategic plan has not taken place without a number of thriving challenges. One of the core challenges identified by stakeholders has to be with a non-adherence to strategic innovations (Resnick, 2009). What this means is that even though the action plan has been accepted as a very worthy and credible tool for facilitating sexual health to the people of Solihull, not much of the primary tasks taking place are based on them. This is a major challenge because it is only when the actions taking place on the ground are based on the action plan that success rate and measure of the plan can be based on the strategic plan. The second challenge identified has to do with financial constraints. In some quarters, it is argued that this second problem of financial constraint is the cause of the first one. This is because once the needed financial supports are cut short, chances are that things are going to be done based on improvisation rather than on the strategic plan. Finally, there has been a bitter complain of the continuing widening gap between the north and the south in terms of inequality and disparity in sexual health issues. Once this disparity continues to exists, the task of the commission becomes very difficult (Sparks and Hirsh, 1997). This is because as they make improvement in one section of the Borough, statistics from the other section also worsens (Thornton and Bley, 1994). Recommendations relating to Chesterfield In relation to the case that has been studied about Solihull, a number of recommendations are being made for utilization within the strategic plan for Chesterfield, Derbyshire, England. In the first place, it is suggested that the strategic plan for this local area should accommodate some of the key policy areas of an international and national strategic plan on sexual and reproductive health. This way, the plan will not be working in isolation from global standards for improving the sexual and reproductive health of the people. Indeed, if there is going to be a any better yardstick for measuring the impact of the strategic plan of Chesterfield, it should be in accordance with how well the plan sticks to the wider international and national policy. What is more, a people based approach to sexual and reproductive health is suggested as the most ideal intervention for handling the cases of sexual and reproductive health within the local area. By a people-based approach, reference is being made to the use of campaign strategies including house-to-house education, institutional seminars, school-based advocacy programs and a generalized integration of sexual and reproductive health in the educational curriculums of schools. Finally, it is suggested that an external peer review quality assurance mechanism be devised to check the strategy for its quality. This peer review quality assurance could be made up of stakeholders from other local areas where similar strategies have taken place so that there will be the sharing of ideas as to how carried out their own program and things about their program that can be integrated into what exists at Chesterfield. REFERENCE LIST Department of Health. 2005. You’re Welcome Quality Criteria: Making Health Service Young People Friendly. London: Department of Health. Health Institute for Health and Clinical Excellence. 2007.One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. London: NICE. House of Commons Health Committee. 2003.Sexual Health: Third Report of Session 2002-2003. Volume 1. London: The Stationary Office. Mahar, M. (2009). The Real Reason Health Care Costs So Much Medical Care. Money-Driven Medicine: 41(1): 142-52. Moynihan R and Henry D (2006) The Fight against Disease Mongering: Generating Knowledge for Action. PLoS Med 3(4): e191. doi:10.1371/journal.pmed.0030191 NICE Guidelines: 2005. Long Acting Contraception. National Institute for Health and Clinical Excellence Orpwood, G. and Barnett, J. (1997) ‘Science in the National Curriculum: an international perspective’. The Curriculum Journal 8(3): 331–49. Redman, B.K. (2003). Measurement Tools in Patient Education. New York: Springer. Resnick, L. B. (2007). Education and learning to think. Washington, DC: National Academy Press. Resnick, L. B. (2009). Developing scientific knowledge. American Psychologist, 44, 162-169. Solihull NHS Care Trust, 2008, Sexual Health Strategy 2008-2013, [Online] http://www.solihull.gov.uk/Attachments/Sexual_Health_Strategy.pdf [February 4, 2013] Sparks, D. and S. Hirsh. (1997). A New Vision for Staff Development. Alexandria, Va: Association for Supervision and Curriculum Development. Stanton, M. (2005). 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