University Of Gondar

College Of Medicine and Health Sciences

Institute Of Public Health

Department of Health promotion and behavioral science

Individual Assignment on

Planning Health Promotion on one prioritized Health problem Using

PRECEDE-PROCEED Model

On Post natal care service utilization at Setit Humera Health Center, Humera Town
S/n Full name ID Department
1 Redatey Mamay Temalew GUE/00014/16 Nutrition

Submitted to: Proffecer Telake

Sep 2024

Gondar, Ethiopia
 Acknowledgement
I would like to express my deepest gratitude to My Instructor Proffecer Telake for his valuable
teaching, welcoming personality and for giving me this opportunity to prepare this planning
health promotion program on one prioritized health problem using precede - proceed model.
Also I would like to express my deepest gratitude for Setit Humera Health center staffs and
Humera town health office and kebele administrative staffs.

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 Table of content

Contents
Acknowledgement ......................................................................................................................................... i
Table of content ............................................................................................................................................ ii
List of Tables ............................................................................................................................................... iii
Abbreviations ............................................................................................................................................... iv
1. Introduction to Health promotion and Education.................................................................................. 1
2. Introduction to the PRECEDE-PROCEED Model ............................................................................... 1
3. Background information about the health center .................................................................................. 2
4. Planning of the health promotion and education program on one prioritized health problem using the
PRECEDE PROCEED model....................................................................................................................... 3
4.1. Social diagnosis ................................................................................................................................. 4
4.2. Epidemiological diagnosis ............................................................................................................ 5
4.3. Behavioral and environmental diagnosis ........................................................................................... 7
4.3.1. Behavioral factor ......................................................................................................................... 7
4.3.2. Environmental factors ................................................................................................................. 8
4.4. Educational and organizational factor................................................................................................ 8
4.4.1. Predisposing factors .................................................................................................................... 8
4.4.2. Enabling factors .......................................................................................................................... 8
4.4.3. Reinforcing factors ...................................................................................................................... 9
4.5. Administrative and policy diagnosis .................................................................................................. 9
4.6. Action plan ....................................................................................................................................... 10
4.7. Implementation ................................................................................................................................ 11
4.8. Process Evaluation ......................................................................................................................... 11
4.9. Impact evaluation ............................................................................................................................. 11
4.10. Outcome evaluation ....................................................................................................................... 12
5. Recommendation .................................................................................................................................... 12
6. Reference ................................................................................................................................................ 13

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 List of Tables
Page

Table 1: Work force of Setite Humera health center staff profile 2023/2024……………….…. 2

Table 2: Nine top diseases of the health Center above 5 years category of the fourth quarter…………. 5

Table 3: 4th quarter MCH Service utilization achievement, 2016 E.C………………….………6

Table 4: Health problem priority ranking using 5-point scale …………………………….…… 6

Table 5: Behavioral prioritization matrix……………………………………………….………. 7

Table 6: Environmental prioritization matrix …………………………………………………...8

Table7: Health education action plan in SHHC 2016 E.C. ……………………………………10

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 Abbreviations
ANC: Ante Natal Care

BCC: Behavioral Change Communication

BSC: Bachelor of Science

EC: Ethiopian Calendars

EFY: Ethiopian Fiscal Year

HE: Health Education

HEWs: Health extension workers

HEHP: Health Education and Health Promotion
HIT: Health Informatics Technician
HSM: Health Service Management
IEC: Information, Education and Communication
MCH: Maternal and Child Health
PMTCT: Preventing Mother to Child Transmission

PNC: Post Natal Care

SHHC: Setit Humera health center

SMART: Specific, measurable, affordable, realistic, and time bounded

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 1. Introduction to Health promotion and Education
Health Education is a part of health care concerned with promoting healthy behaviors. Since
individual’s behavior can be the main causes of health problems, and it can also be the main
solution. Through health education we help peoples to understand their behaviors and how it
affects their health and encourage them to make their own choices for healthy life, without any
coercion. Health education as aimed at bringing about behavioral changes in individuals, groups,
and larger populations from behaviors that are presumed to be detrimental to health, to behaviors
that are conducive to present and future health. Health education covers the continuum from
disease prevention and promotion of optimal health to the detection of illness to treatment,
rehabilitation, and long-term care. It includes infectious and chronic diseases, as well as attention
to environmental issues.

Health promotion is any planned combination of educational, political, environmental,

regulatory, or organizational mechanisms that support actions and conditions of living conducive
to the health of individuals, groups, and communities.

2. Introduction to the PRECEDE-PROCEED Model

The PRECEDE–PROCEED model proposed in 1974 by Lawrence W. Green that can help health
program planners, policy makers and other evaluators analyze situations and design health
programs efficiently. It provides a comprehensive structure for assessing health and quality of
life needs, and for designing, implementing and evaluating health promotion and other public
health programs to meet those needs. One purpose and guiding principle of the PRECEDE–
PROCEED model is to direct initial attention to outcomes, rather than inputs. It guides planners
through a process that starts with desired outcomes and then works backwards in the causal chain
to identify a mix of strategies for achieving those objectives. A fundamental assumption of the
model is the active participation of its intended audience — that is, that the participants
("consumers") will take an active part in defining their own problems, establishing their goals
and developing their solutions.

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In this framework, health behavior is regarded as being influenced by both individual and
environmental factors, and hence has two distinct parts. First is an "educational diagnosis" –
PRECEDE, an acronym for Predisposing, Reinforcing and Enabling Constructs in Educational
Diagnosis and Evaluation. Second is an "ecological diagnosis" – PROCEED, for Policy,
Regulatory, and Organizational Constructs in Educational and Environmental Development.

The model is multidimensional and is founded in the social/behavioral sciences, epidemiology,

administration, and education. The systematic use of the framework in a series of clinical and
field trials confirmed the utility and predictive validity of the model as a planning tool. So, our
planning of health education using the PRECEDE–PROCEED model is as follows with its steps.

3. Background information about the health center

Humera town is the capital city of Welkayt Tegede Setit Humera zone which is located 975km
away from Addis Ababa, the capital city of Ethiopia and 424km from Bahirdar, the capital city
of Amhara regional state. The town has an elevation of 585 meters above sea level. Its climate is
hot semi-arid the overall climate throughout the year is mild and dry. The annual rainfall ranges
between 400 and 600mm, with most of the rain falling in the rainy season. With annual mean
temperature of 37.6c0 . The city Administration has 4 kebeles. Based on Setit Humera city
administration health office annual report 2016, Humera town has a total population of 20,934 of
whom 10258 are men and 10676 are women. There is one public hospital, one health centers,
and 8 private clinics in which all of the institutions provide different services based on the
standards of health delivery systems in the city. Setit Humera health center is the only health
centers that provides services for 20,934 population in the given catchment area and it contains 4
kebeles,
Table 1. Work force of Setit Humera health center staff profile 2023/2024

S.N Types of profession Total No Male female

1 General practitioner 1 1 0
2 Health officer 2 2 0
3 BSc Nurse 5 4 1
4 Clinical nurse 7 4 3
5 Clinical Midwives 4 2 2

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 6 Pharmacy Technician 3 2 1
7 Pharmacist 1 1 0
8 Laboratory Technician 2 1 1
9 Laboratory technologist 1 1 0
10 BSc Midwives 2 1 1
11 health extension worker 8 0 8
12 HIT 1 1 0
13 Environmental health 1 1 0
14 Biomedical technician 0 0 0
15 Supporting staff 27 8 19
Total 65 29 36

4. Planning of the health promotion and education program on one prioritized

health problem using the PRECEDE PROCEED model
My visit was conducted at Setit Humera health center on the date of Sep 1, 2024 G.C. The
objective of the visit was to assess the health promotion and education situation at the health
center for the partial fulfillment of the course, by asking different responsible professionals in the
health center about the health education and promotion plan using the following question listed
below so as to develop Health Education and promotion plan on one prioritized problem using
PRECEDE—PROCEED model.

 Questions for different responsible professionals in the health center,

 Do you have a plan for health promotion and education program at your facility?
 If yes how the program was planned?
 Did you conduct community need assessment during planning?
And we were assessing their objectives either it is SMART or not and how do they monitor and
evaluate the health education and promotion program.

Setit Humera health center has diverse health workforce including General practitioner, Health
officer, BSc Nurse, Clinical Nurse, BSc Midwife, Midwife technician, Environmental health,
Pharmacy technologist, Pharmacy technician, Laboratory, HIT, HEWs and other supportive

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staffs, but it has no integrated and coordinated health education plan, there is irregular health
education without specified focal person.

The health education they are giving is not based on community need assessment, or community
involvement and environmental intervention, simply by looking at the Top ten diseases.
Moreover, their health education and promotion program has no incorporated clear strategic
objective, which is the direct reflection of shared vision of the health center. They do not receive
feedback from clients. The health center conduct health education by using leaflets, posters but
they do not use audio records and video plays unless during campaign time. There is poor
recording and documentation after conducting health education. Also, they have no monitoring
and evaluation methods for health education and promotion program.

VISION

To see that all postpartum mothers in Setit Humera catchment area utilizing PNC service.

MISSION

BY providing routine, planned health education and promotion program through community mobilization
increasing mothers PNC service utilization seeking behavior by participating of all stakeholders in Setit
Humera catchment area.

GOAL

To increase post-natal care service utilization in Setit Humera catchment area.

OBJECTIVE

To increase the utilization of post-natal care among mothers who give birth from 5.7% to 50% in
catchment area of Setit Humera health center by the end of Nov 2017 E.C.

4.1. Social diagnosis

On 01/09/2024 G.C, I was visited Setit Humera health center maternal and child health
attendants on the situation of PNC in mothers who give birth. The diagnosis was conducted to
assess the community perception, knowledge, beliefs about PNC as well as on health education
& promotion program and to determine the quality of life by using face to face interview of
health facility attendants. In addition to this we were trying to meet community leaders in order

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to hear their concern about their major health problems. According to the interview and
community meetings, Community leaders and Clients who attend Setit Humera health center
explained that:

☞ Most health workers are poor communicator and do not respect properly

☞ The health center provides poor services like shortage of clean and safe water supply

☞ There is prolonged waiting time to get the required service

☞ There is large problems of environmental sanitation

☞ High cost of living/inflation

4.2. Epidemiological diagnosis

As I reviewed the fourth quarter recorded report of the Setit Humera health center, the major
health problems are the following. It was conducted at two service categories namely outpatient
and maternal & child health services respectively.

Table 2: Nine top diseases of Setit Humera Health Center above 5 years category of Annual
report, 2016

S.N Disease Achievement

1 Pneumonia 1308
2 Malaria(PF) 907
3 Malaria(PV) 677
4 Typhoid fever 676
5 Urinary tract infection 577
6 Upper respiratory tract infection 565
7 Acute Tonsillitis 545
8 Diarrhea 396
9 conjunctivitis 343

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Table 3: Annual report of Setit Humera Health center MCH Service utilization achievement,
2016 E.C.

S.N Service category Achievement

1 Syphilis 28.4
2 Family planning 36.3
3 ANC4 18.5
4 PNC 5.7
5 Institutional delivery by skilled birth attendant 6.4

Identifying health problems and prioritizing

Table4. Health problem priority ranking using 5-point scale

Service Magnit Severity Feasibility Community Governmen Total Rank

utilization ude concern tal concern
Family planning 5 2 5 2 4 18 4th

ANC 4 4 5 3 3 4 19 3rd
2nd
Institutional 5 5 4 3 5 22
delivery by
skilled birth
attendant
1st
PNC 5 4 5 4 5 23

environmental 5 2 2 5 3 17 5th
sanitation

☞ Therefore: The prioritized health problem is low post natal care coverage.

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 4.3. Behavioral and environmental diagnosis
4.3.1. Behavioral factor
 Low educational level
 Giving birth outside health care facilities
 Lack of awareness about obstetric related danger signs
 Lack of awareness about PNC services
 Self-referral to Humera General Hospital
Table 5: Behavioral prioritization matrix

More important Less important

More changeable  Poor communication

of health care provider
 Disrespect of health
provider to clients

Less changeable ☞ Negative attitude of

health providers to the
health center

☞ Therefore: The Behavioral objective is: To enable the health care to provide
compassionate and respectful care workers in Setit Humera health center by the end of
Nov 2017 EFY.

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 4.3.2. Environmental factors
 Lack affordable transport system(lack of ambulance in the health center)
 Irregular health education session in health center and the community
Table 6: Environmental prioritization matrix

More important Less important

More changeable Shortage of clean water

Less changeable Lack of affordable transport

system

☞ Therefore the environmental objective is to increase clean and safe water supply in
Setit Humera health center for quality health service in second quarter of 2017 EFY.

4.4. Educational and organizational factor

4.4.1. Predisposing factors
 Positive predisposing factor
 Positive attitude towards PNC service
 Believing PNC service is used to prevent complication both for the neonates and
mothers
 Negative predisposing factor
 Lack of awareness about obstetric related danger signs
 Lack of awareness about PNC service
 Negative attitude towards health provider

4.4.2. Enabling factors

 Positive Enabling factor
o Adequate number of staff
o Presence of HEWS
o Presence of skilled health provider
 Negative Enabling factor
 Poor transport system and road

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  Irregular health education session

4.4.3. Reinforcing factors

 Positive reinforcing factors

☞ Giving reward for those who follow the service

☞ Appreciate and giving reward for those community religious leaders who gave health
education and participated in social mobilization
 Negative reinforcing factor
 Absence of policy that punish those who do not attend the PNC service

4.5. Administrative and policy diagnosis

I focused on identifying resources, polices, supports, and facilities needed for implementing and
evaluating the health education program. I assessed a place and timetable for activities,
budgeting, personnel, organizational barriers, facilitators, policies and coordination’s for
implementing educational interventions. We assessed different barriers like:

☞ Weak supportive supervision

☞ No access of water supply

☞ Poor access of transport

☞ Poor recording and documentation of health information

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 4.6. Action plan
Table7: Health education and promotion Action plan in Setit Humera health center 2016 E.C.

Problem Objective Strategies Activities Indicators Responsible Resource Time bound

body

Low To increase Awareness Identify No of HEW and Module, Oct to Nov

coverage PNC creation postpartum postpartum health poster and
of PNC coverage about PNC mothers in the mothers professionals radio
from 5.7% catchment area
identified message
to 85% by and give
the end of Health
2017 E.C. education
in Setit Establish Create common No of PNC Health care Guidelines Oct to Nov
Humera collaboration understanding coverage providers
health with about the -Head of the
center importance of
stakeholders health center
PNC
-kebele
leader
Provide Provide Health care Medical Oct to Nov
quality PNC Compassionate, provider supply
services respectful care -Supporting
-doing routine staffs
Review the No of Head of HC, Allocate Oct to Nov
program review health care budgets
meeting provider and for review
conducted
head of meeting
kebele

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 4.7. Implementation
 I will provide HE for community by religious leaders about the importance of PNC
Service
 I will create and post different posters on different sites where community can get them
easily.
 I will create and disseminate radio spot message related to PNC service.
 I will engage in coordination of potential stakeholders for Capacity building for health
worker and community
 I will recommend the concerned body to provide MCC training to all staffs

4.8. Process Evaluation

All activities during implementation will be evaluated in order to achieve the intended result with
the intended time period such as the community and religious leader training will be followed,
preparation of radio spot, we avail required resource and materials used for health education;

- Preparation for Health education training to the community and religious leaders starting
from Oct 10 to 15/2017 E.C.
- Follow up of all activities daily, weekly, monthly and quarterly
- Strengthen supportive supervision for health extension workers and women health
developmental army
- I will continue my evaluation during provision of until Nov 21/2017.
- Two times weekly Development of radio spot and dissemination
- Creation and posting of poster from Oct 5 -Nov 21 2017.

4.9. Impact evaluation

I will evaluate the immediate outcome or change on personal and environmental behaviors after
the end of each activity like;

 Increase PNC coverage

 Awareness about the importance of PNC service utilization.
 Awareness about the complications of post-natal period.
 Positive attitude towards health provider.
 Having plan for health education.

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 4.10. Outcome evaluation
I will evaluate the outcome of our intervention i.e. the long term change among beneficiaries of
the service by measuring increased utilization of PNC service and improved quality of life such
as:

 Decrease new born morbidity and mortality

 Decrease maternal morbidity and mortality

5. Recommendation
I will recommend Setit Humera health center:
- To have health education plan and good implementation
- To have integrated and coordinated health education and promotion schedule
- To assign health education and promotion focal person
- Monitor and evaluate their health education plan regularly
- Fellow and review the outcome and impact of the Health promotion and Education
program

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 6. Reference
1. Setit Humera city administration health office annual report, 2016
2. Setit Humera Health center 2016 DHIS2 Annual Report
3. Planning, Implementing, and Evaluating Health promotion programs six edition James
F.McKenzie., Brad L.Neiger& Rosemary Thackeray
4. Planning Health Promotion programs first edition L.kay Bartholomew, Guy S.parcel,
Gerjokok& Nell H.Gottlieb

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