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Postgraduate Diplomain Public Health

School of Public HealthUniversity of the Western Cape

SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary Health Care Approach I – Module Introduction

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Population Health and Development: A Primary Health Care Approach I

Module Guide

Population Health and Development: A Primary Health Care Approach IUWC Module Registration Number: SPH 732First published: 2010

Writing Team: Lungiswa Tsolekile, David Sanders, Barbara Hutton

Editor/s: Lungiswa Tsolekile, David Sanders, Barbara Hutton. With editorial assistance from Dawn Daniels.Copyright © 2010, SOPH School of Public Health, UWC.

License:

Except where otherwise noted, this work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License [http://creativecommons.org/licenses/by-nc/4.0/]

Your use of this material constitutes acceptance of the above license and the conditions of use of materials on this site. Use of these materials is permitted only in accordance with license rights granted. Material is provided “AS IS”; no representations or warranties are provided. Users assume all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy. The module may contain materials owned by others, all of which are acknowledged. The user is responsible for obtaining permissions for use from third parties as neededReadings: Reading material is listed at the end of the Module Introduction. They were compiled for registered students in one or two Readers. Copyright permission was sought and paid for per reading per student annually. Readings are not included but their sources are indicated in the Module Guide.Credit value of module: 20 (200 notional learning hours).Study Materials for this module: Module Guide Target group: Health and allied health and welfare professionals with a four or more year degree (MPH)Course delivery: This module was offered as a distance learning module with optional contact sessions.

Design & layout: Cheryl Ontong, MultiTask


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http://creativecommons.org/licenses/by-nc/4.0/



CONTENTS

CONTENTS PAGE

Module Introduction i

Unit 1 The burden, distribution and pattern of ill-health in the world

1

Session 1 Burden of disease in Africa and the world3

Session 2Distribution of ill-health in the world and in developing countries

13

Session 3Patterns of ill-health in developed, developing and underdeveloped countries

29

Session 4 Situational analysis43

Unit 2 The causes of ill-health in the world: The political, social and economic context of health and disease

59

Session 1Causes of ill-health and their classification 61

Session 2The social determinants of health 75

Session 3Social equality, equity and health status 97

Unit 3 Introduction to health, development and Primary Health Care

117


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Session 1The impact of colonialism, capitalism and underdevelopment on health care

119

Session 2The declaration of Alma Ata and the health care approach

133

Unit 4 The Primary Health Care approach 143

Session 1The implementation of the Primary Health Care approach

145

Session 2Application of the Alma Ata principles and the Comprehensive Primary Health Care approach

161

Session 3The vehicle for implementing Primary Health Care: The District Health System

169

Session 4Community participation and community health workers

185


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I MODULE INTRODUCTION

1 LETTER OF WELCOME

School of Public HealthUniversity of the Western CapePrivate Bag X17Bellville7535South Africa

Dear colleague

Welcome to your second module, “Population Health and Development: A Primary Health Care Approach I”.

The main purpose of this module is to introduce you to the Comprehensive Primary Health Care Approach: its origins, rationale, philosophy, theory, concepts and practices. It aims to equip you with a basic understanding of how a Comprehensive Primary Health Care Approach could be applied to the health system in your own country.

Most of you are likely to be working in the public health sector, be it as part of your country’s national department of public health, a non-governmental organization or a sector which has some linkage with public health. This means that you have valuable experience to bring to your studies as well as to the overall field or discipline of Public Health and the practice of Primary Health Care.

In this module we also help you to develop the academic learning skills required for studying more effectively at this level. These skills are developed alongside the Primary Health Care content. For instance, many activities and tasks which focus Primary Health Care content also help you develop the reading, writing, listening and other skills needed to cope with the demands of academic study.

As far as is possible, we plan to engage you in active learning, even though you are studying at a distance, and to this end you will be required to write two assignments, and to prepare a portfolio. The assignments must be submitted during the course of this module; the portfolio must be submitted by the end of your PG Diploma programme which may be at the end of Year 1 or 2 of study, depending on your chosen pace of study. You need to work consistently on the portfolio, as it is an important component of your learning, but will hopefully also provide you with a helpful addition to your curriculum vitae. There is more about the portfolio in this section.

By reading through this Module Introduction you will get a clearer picture of the topics that will be covered, the activities you will engage in, the assignments and portfolio requirements of the module and the outcomes we hope you will achieve. It will therefore be of great benefit to you to read through it carefully. As a distance learner, this is our main way of orientating you: if you skip over it, you will probably be lost. In


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addition, acquaint yourself with the contents of the SOPH Programme Handbook straight away. In it you will find all the information you need regarding, contacting us, assessment, library usage, student support, and Summer and Winter Schools. We have prepared this for your support: the onus is on you to find out how we operate.

Having explored these resources, if you still have questions, please get in touch with us – we are there to help and we often find that it is the students who ask questions and make demands, who succeed best.

All the contact information that you may need is contained in this introduction. You will also find a Student Details Update Form in your SOPH Programme Handbook. If your contact details change, please inform the Student Administrators at the School of Public Health straight away as well as the UWC administration (details in Programme Handbook).

We hope that you will give us feedback on your experience of the study sessions in this module. An evaluation form will be sent to you on completion of your final assignment.

We hope you enjoy your studies.

Best wishes

Module Convenor


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2 INFORMATION ABOUT THIS MODULE

2.1 Module Aims and Rationale

This overview introduces you to the content and the structure of the module. You will also explore aspects of academic learning and practice some ways of learning more effectively. You will examine the meanings of different basic concepts which underpin the entire module and the readings.

2.2 Learning Outcomes

Here we present the intended learning outcomes of this module so that you can see what competences you are expected to have developed by the end of the module.

By the end of this module, you are expected to be able to:

Conduct a situational analysis of a local environment. Analyse the burden and distribution of ill-health in selected contexts. Discuss how physical, social, political, economic and environmental factors affect

health in a local setting (i.e. social determinants of health). Apply this knowledge to analysing factors which affect Public Health practice in

your local environment. Identify Public Health problems, explore their contexts, analyse their immediate,

underlying and root (IUR) causes and risk factors, and rank their priority using selected models.

Discuss how the legacy of colonial health systems has impacted on Africa. Explore how development can impact on the health status of the population. Describe the origins, evolution and main features of Primary Health Care (PHC)

(and particularly Comprehensive Primary Health Care). Discuss key current debates in relation to Primary Health Care (PHC). Plan how to apply a Comprehensive Primary Health Care Approach to address a

local health problem.

Academic learning skills:

Apply a range of strategies to the reading of academic texts

Preview: To look quickly through a text to find out what it is about before reading it in detail

Skim: To quickly read the headings, illustrations, first and last paragraphs of sections, the first sentences of paragraphs, and key words in the text

Predict: To anticipate, foretell


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2.3 Module Outline

The main topics covered in this module are: Unit 1: The burden, distribution and pattern of ill-health in the world

Unit 2: The causes of ill-health in the world: The political, social and economic context of disease

Unit 3: Introduction to health development and Primary Health Care

Unit 4: The Primary Health Care Approach

2.4 The Module Guide

This Module Guide is organised into four units. Each unit is divided into a number of study sessions, each of which is about 5–6 hours of study time. The first page of a study session provides an overview of the session, including a brief introduction, the contents of the session, the learning outcomes (public health content and academic learning content), and the main readings.

Each study session has a combination of input (content), tasks, and feedback for the tasks. By doing the tasks, you should achieve the outcomes of the study session.

TASK 1 - Preview the Module Guide1. Look quickly at the cover of this Module Guide. Then read the content page.

2. Skim through the pages of the Guide for a few minutes. Look at the main headings of each unit, and the main headings of each study session.

3. Unit 1 is called, The burden, distribution and pattern of ill-health in the world. What does this mean? What do the words, ‘burden’, ‘distribution’, and ‘pattern’ mean?

4. Unit 2 is called, The causes of ill-health in the world: The political, social and economic context of health and disease. What does this mean? What do the words, ‘political’, ‘social’ and ‘economic’ mean?

5. Unit 3 is called, Introduction to health, development and Primary Health Care. What does this mean? What do the words, ‘health’, ‘development’ and ‘primary health care’ mean?

6. Unit 4 is called, The Primary Health Care approach. How do you think the four units are linked?

7. Skim through the Guide and find the pages which introduce the four units. Read these pages to find out what the units are about.

8. What do you think you will learn about in this Module? What are your first impressions of the content of the Module Guide? For example, does it seem interesting, challenging or too easy?

FEEDBACKSOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary

Health Care Approach I – Module Introductionvi

Burden of disease refers to a problem of ill-health, how serious it is, how many people get sick or die.

Distribution refers to how ill-health is shared, which people get ill and die before their time, e.g. children in poor countries.

Pattern refers to the most common diseases in a population, e.g. infectious diseases, chronic diseases.

Political is concerned with who has power and authority to control or to influence the way in which society functions and the way in which resources and power are shared.

Social refers to how people live and organise themselves. Economic is concerned with resources such as money, land, jobs and food.

The four units are linked as follows:

Unit 1 examines the problem of ill-health in the world: who is mostly affected; which diseases are the most serious, and the main causes of ill-health.

Unit 2 examines factors which have had a positive or a negative impact on the situation of health and disease in the world.

Unit 3 examines the relationship between health, development and Primary Health Care from a historical perspective.

Unit 4 describes the development of the Primary Health Care Approach (PHC) – its origins, principles, theories and implementation (which resulted in the Comprehensive and Selective approaches). The Unit also looks at the District Health System, case studies and at community involvement in health. The PHC Approach responds to our findings around the burden, distribution and pattern of ill-health the world, as well as the social, political and economic context of ill-health.

TASK 2 - Examine tasks

1. Skim through the Module Guide again. Look quickly at the names of the tasks. What kinds of thinking skills do they encourage you to use?

2. Read some examples of Feedback given for tasks. Why do we provide feedback? How does this help you? What are possible disadvantages of providing you with feedback?

FEEDBACK

1. Task headings usually use words such as analyse, evaluate, compare, extract information, clarify, identify, preview, summarise, plan, and think about. These tasks encourage you to practise and to develop these thinking skills. Tasks replace a lecturer. They guide and support you as you grapple with new ideas and learn. They are the most important part of the Module Guide. No-one will see your answers, unless you want them to, so feel free to scribble notes and to try different ways of answering questions.


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2. Feedback provides answers to tasks and enables you to check if you are on track and to work out where you went wrong. Feedback also helps you to assess yourself and to judge your progress, in an informal way. When you succeed you can congratulate yourself; when you struggle you can go back to the task and try again. Tasks followed by feedback help to develop important skills for successful distance learning. However, there is a danger that you might skip the task and just read the feedback, in which case you would not benefit as much from the Module.

3 THE PORTFOLIO: INTRODUCTION

Preparation for the portfolio

For the PG Diploma in Public Health, you are required to prepare an electronic portfolio – a file in electronic form – of tasks and documents produced in the course of your studies. This portfolio serves to strengthen your learning as you study and allows you to reflect on your progress and growth across the whole course, as well as the challenges you have experienced. Through the Portfolio we are also trying to encourage you to link and integrate the content of the six modules into a coherent whole. At the same time, the portfolio should be seen as a collection of evidence of your competence in the field of Public Health.

Some of you will have experience of portfolios providing evidence of learning in a particular field or course. Parts of the portfolio could also serve to demonstrate your competence in Public Health to current or prospective employers in furthering your career.

The Portfolio should be developed across the duration of your PG Diploma in Public Health programme, but the written report should only be completed as you are finishing your last module - Health Promotion for Public Health I module, i.e. towards the end of your studies. A study diary kept over the duration of your studies is therefore a good idea. These guidelines are included so that you can prepare yourself.

Keep a study diaryWhile engaged in all modules, be sure to write regular notes on your learning and achievements in a section of your study diary. It would be wise to write notes at the end of each unit. This will help you in the end to develop your portfolio report as you may not be able to recall everything that happened during the year (or two years) when you reach the end of the programme.

These are the instructions for the Assignment you will be asked to complete at the end of your programme as part of your assignment submission for the Health Promotion module.


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COMPILE AN ELECTRONIC PORTFOLIOThe portfolio contains two parts and should not be more than 25 pages. It should include:

Part I: A careful selection of your work compiled as you work through the six modules. This may comprise of between six – eight (6-8) samples of your work as evidence of your experience and growth; relevant items undertaken alongside the programme for your work role may be part of the 6-8 samples; and

Part II: A reflective report in which you comment on your experience and growth using the samples as evidence of this growth.

The portfolio should have a contents page listing the selection of work (Part 1) and Reflective Report (Part 2). Each of the components of your portfolio should be clearly labelled with Initial and Surname, Name of the component, and the number corresponding with contents page, e.g. L Mdaka IPH Work Sample 1.1.

Part I: Selection of your work to provide evidence of your experience and growthGuidance on what should be included You have to select between six and eight samples of your work that demonstrate your experience and growth within this postgraduate programme. Be aware that you are required to be selective – so show your best evidence, rather than include everything you have. LESS IS MORE. Your selection of samples should be from the following two sources: any assignments or tasks with the portfolio symbol and any other samples of work produced since commencement of the PGD course.

1. Assignments or tasks from your module that are marked with the symbol on the right, mean that it must be included in the portfolio. There are only three assignments or tasks marked with the symbol and these are in the first three modules of the course.

1.1 Introduction to Public Health Module: Assignment 2 Question 1: CHW PPT.

Pretend you are a trainer from the Ministry of Health seeking to train a group of Community Health Workers (CHWs). Develop a powerpoint presentation on a communicable or a non-communicable disease aimed at training CHWs on this disease and its prevention. The presentation must be made up of 8 - 10 slides excluding the title slide and list of References. Focus your attention particularly on the items which have been underlined but include all items. Remember that the aim is prevention, so select accordingly.

Disease description Prevalence of this health problem within your district (Choose one of

your districts) Mode of transmission (agents, vectors, reservoir) and incubation period Risk factors Symptoms Susceptibility Treatment


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Consequences and burden on the population Prevention/Methods of control Reference List .

1.2 Primary Health Care Module: Assignment 2 Part 2: Reflect on your own practice/ programme or projects that you have been involved in. How comprehensive or selective have these programmes or projects been? How has this Module changed the way you think about the Primary Health Care Approach? Write a 3-page reflection piece.

1.3 Descriptive Epidemiology: Assignment 1: Compare health status datasets: use the indicators you collected in Assignment 1 to compare your region with another region, or compare last year’s data for your region with this year’s, and then, compare your region’s data with the national policy goals.

1.4 Other samples of your work which show evidence of your learning and growth over time. These samples could be selected from the following:

Any part of an assignment or task from the remaining three Postgraduate Diploma modules (Strategies for Management, Health Promotion I, Monitoring and Evaluation I).

1.5 Your portfolio may also include items developed in the course of your professional work since you embarked on your studies, e.g. reports or proposals you have written, training reports, audio recordings of your input, course notes from anything you have taught, posters presented at conferences … in fact anything that you consider evidence of your competence and growth, e.g. a letter of appreciation from your employees, or any similar item.

Part 2: Writing Your Reflective Report

This report constitutes 40 marks of Assignment 2 of Health Promotion for Public Health I.Write a reflective report in NO MORE than 1000 words, 1.5 spacing 12 pt Times New Roman on your experience of the PG Diploma course. Your report should include the following items:

1. A discussion of what you have learned and whether or how it influenced your work. Use the evidence you provided in your list of samples in Part 1.

2. A diagram could be used to show how you see the different modules fitting together.

3. Highlights and challenges you have experienced in the PG Diploma course.4. Reflections on your own professional, personal or academic growth over

the period of this course.5. Changes in your view of your role in Public Health.6. Gaps in your capacity as a Public Health practitioner.7. Goals for future learning in any area relevant to this course.

What is meant by reflection?

In the course of the first semester, we will send you some guidance on writing reflective reports and their potential purpose, as a means of learning.SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary

Health Care Approach I – Module Introductionx

Tips on submission

Since this is an electronic portfolio, you will need to label your files clearly, and send them in one (or two) emails to the Student Administrator with any special instructions for printing out. Numbering and labelling pages is important.

Assessment Criteria for the Portfolio (Assignment 2B – Health Promotion for Public Health)

Marks

i. Demonstrates insight into the field of Public Health 10

ii. Insightful reflections on own growth and development, with appropriate selection of examples demonstrating this growth (incl. strengths and weaknesses); has the student linked samples with the statements made in the reflection report?

20

iii. Selection of samples shows evidence of professional growth 5

iv. Evidence of future learning goals 3

v. Presentation: clarity of organisation of the report 2

Total 40

4 ASSESSMENT

4.1 Information about assessment

There are TWO compulsory assignments in the Module. You must submit both, on deadline. You will receive assignment deadlines from the SOPH Student Administrator. Consider it your responsibility to ensure that you know the deadlines when the semester starts. In addition, you are required to keep a diary of your reflections on this Module, and all your Modules, in preparation for developing a Portfolio of your work across the Postgraduate Diploma in Public Health. (See Portfolio Development at the end of the Module Introduction).

The module is weighted as follows:Assignment 1: 40%Assignment 2: 60%

To pass the module: You are required to pass both assignments with a minimum of 50%. You must have a minimum aggregate of 50% or more for the module. If you get below 50% in Assignment 1, you may repeat it once only. If you do not pass it second time around, you cannot proceed to Assignment 2 and

must repeat the module the following year.


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If you do not achieve 50% in Assignment 2, you repeat the entire module the following year.

IMPORTANT:The following section contains the assignments for the module. Please read questions and instructions carefully. There is important information about assessment in the SOPH Programme Handbook, be sure to refer it before submitting your assignment.

4.2 Your Assignments for Population Health and Development: A Primary Health Care Approach I

Assignment 1 – Situational analysis (100 marks) Weighted at 40% of your Module result; you will need to reach the end of Unit 1 to undertake this assignment.

ASSIGNMENT 1:

TB has been identified as one of the top 10 causes of death in your district. You are therefore assigned to design an intervention to try and curb this problem. However, before designing such an intervention, it is necessary to conduct a situational analysis. For the purpose of this assignment you will be required to collect qualitative data as part of the situational analysis.

For the situational analysis you are required to do the following:

1. Interview seven stakeholders namely, health facility personnel (2), community leaders (2) and community members (3). The interview should focus on: The perceived causes of TB; TB interventions that are present in the community; Attitudes towards those with TB; and Beliefs about TB.

2. Use any classification of causes from Unit 2 Session 1 to classify the causes that have been highlighted by the interviewees.

3. Answer this question: What are the effects of TB on individuals and families?

Guidance on doing the assignment

Produce a mini report on your findings. The report should contain the following information:

1. Introduction (include relevant literature review on TB prevalence, TB attitudes, beliefs and practices and stigma)


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2. Classification of causes3. Effects of TB on the individual and family.4. Description of interviewees (such as age, level of education, etc).5. What were the advantages of using interviews to gather the information and what

were the disadvantages? What other data collection methods would have been useful? Explain why?

6. Summary of findings (include transcripts or notes gathered during the interviews)7. Conclusion (which summarises the main causes and effects)8. References (Harvard style)

The assignment must not exceed 15 pages, excluding the references.

Assessment Criteria for Assignment 1 Marks

i) Selection of information based on literature: evidence of reading (8 marks for each concept)

/20

ii) Citation and referencing (Harvard style) /5

iii) Appropriate classification of causes using an appropriate framework

/20

iv) Identify the effects of TB on the individual and family /10

v) Description of interviewees /10

vi) Motivation on why a different data collection could have been appropriate

/10

vii) Clear summary of the main findings /15

vii) Clear summary of the main causes and effects of TB /10

TOTAL /100

Assignment 2 – Comprehensive Primary Health Care (100 marks) Weighted at 60% of your result; you will undertake Question 1 as you work through Unit 3; you will need to reach the end of Unit 4 to undertake this assignment.

Select a health programme in your district or a project that you are working on. It must be one that is designed to address the problem of TB.

1. Describe the key strategies used in this programme (in other words, the various activities that are implemented to address the problem).

2. Then, critically assess to what extent the programme is an example of a CPHC programme: What is present? What is missing (gaps)? What needs to be done to


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make this programme or project more comprehensive and contain more PHC principles?

3. What resources could you utilise or would you need to make the programme more comprehensive; and why do you need these resources (motivation)? For example, would you reorganise current resources, retrain staff, and link to other departments or sectors? Would you need additional inputs – and if so, what will they be?

4. What key challenges would you face in implementing such a comprehensive PHC programme in the district?

Assessment Criteria for Assignment 1 Marks

i) Description of the key strategies used in the programme/project /15

ii) Critical assessment of the programme - identification of gaps, application of PHC principles to improve the comprehensiveness of the programme/project

/25

iii) Identification and description of resources /10

iv) Clear reasons are given to motivate for resources /15

v) Description of the challenges in implementing a comprehensive primary health care programme

/15

TOTAL /80

You may want to rework this question for your Portfolio at the end of your course. Read the information in Section 3 of this Module Introduction.

In this Module you have learnt about the elements of PHC, CPHC and SPHC. Reflect on your own practice/ programme or projects that you have been involved in. How comprehensive or selective have these programmes or projects been? How has this Module changed the way you think about the Primary Health Care Approach? Write a 3-page reflection piece.

Guidance on doing the portfolio

A personal reflection is a self-evaluation of your own learning progress or growth, the challenges you have or are facing, your feelings about the content you have been exposed to, your perspectives, your attitude and further needs at a particular time.

When writing your portfolio, refer to some of the key concepts you have explored in the Module.


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Assessment Criteria for the Portfolio (part of Assignment 2 – Population Health and Development: A Primary Health Care Approach 1)

Marks

i) Demonstrates insight into the Primary Health Care Approach 5

ii) Insightful reflections on own growth and development with exemplification (including strengths and weaknesses)

15

TOTAL 20

4.3 Submitting Assignments

Read the SOPH Programme Handbook before submitting: Section 8 contains instructions you must make sure to follow before submitting any assignment. There is crucial information regarding referencing and plagiarism in Section 8.3. These guidelines must be followed exactly every time you submit an assignment. Getting this wrong wastes our time, and we WILL return the assignment to you to correct. You may send assignments by email, fax or post. (Email and fax save time). Keep

a copy of everything you have sent. If you post, use fast mail or courier. Send assignments to the Student Administrators, not the lecturer. When you submit your assignment, you will receive acknowledgement that it has

been received. If you don’t, check that it has been received. Type your assignment on A4 paper, in 1,5 line spacing, in 12 pt Times New

Roman, and leave normal margins for the lecturer’s comments. Handwritten assignments will not be accepted. Keep to the recommended length. Excessively long assignments may be

penalised. Number ALL pages. Include the Assignment Cover Sheet (completed fully) as the first page of the

assignment, i.e. the cover sheet and the assignment must be one document. Always put your name on every file you send, and label the file correctly, using

these instructions as a guideline if submitting by e-mail: Your Name (Surname, Initial) e.g. Mambwe R Module abbreviation (see Programme Handbook for Core module

abbreviations). Use CAPITALS, e.g. PHC I Assignment number, e.g. 1 or 2, and Draft or Final The year, e.g. 2015

e.g. Mambwe R, PHC I Asn 1 Final 2015; Mambwe R, PHC I Asn 1 Draft 2015.


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4.4 Assignment Deadlines

Assignments must be submitted by the due date, preferably by e-mail, but fax or post are accepted if dated on or before the due date. You will receive assignment deadlines from the Student Administrator once you have selected your modules.

PLEASE NOTE: Late submission of assignments will impact on the time you have available for the next assignment, disrupt your lecturers’ schedules and result in late submission of marks into the UWC marks administration system; should that happen, you will have to repeat the entire module. It is therefore in your interests to manage your time as effectively as possible. Section 4 in this Module Introduction offers some general guidance and a blank work plan for you to work out your schedule for the semester. Should you require more guidance, try the SOPH Academic Handbook.

Assignment Extensions Under special circumstances, extensions may be granted. Even so, the extension will not normally be longer than two weeks. To request an extension, contact the Student Administrator (not the lecturer or Module Convenor) as soon as a problem arises. No extensions will be given for Draft Assignments, and no late assignments will be accepted in Semester 2.

4.5 Draft Assignments: Please read this section carefully

Lecturers will give you valuable feedback on your assignment if you send a draft. However, Drafts will ONLY be reviewed if they are received TWO OR MORE weeks before the final submission date; no extensions will be given for drafts.

If you want to submit a draft, do not submit a complete assignment. Select sections with which you are having difficulty, or submit an outline of the whole, but not the whole assignment.

Lecturers will make every effort to respond to submitted drafts timeously, but if they run late, they will give you a full week to return the final assignment.

Over the page is the Cover Sheet for the assignments. Please note that it has been included on the CD and sent to you by email.


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4.6 ASSIGNMENT COVER SHEET

School Public Health – University of the Western Cape

An Assignment Cover Sheet needs to be copied into the same file as every e-mailed assignment. If you courier or fax your assignments, attach one to the front of your assignment.

Full name: ______________________________________________________

E-mail address: ______________________________________________________

Postal address: ______________________________________________________

Student number:

Convenor:

Module name: ______________________________________________________

If faxed, state the total number of pages sent including this page: ________________

Student’s comments to tutor

________________________________________________________________________

________________________________________________________________________

Declaration by student

I understand what plagiarism is. This assignment is my own work, and all sources of

information have been acknowledged. I have taken care to cite/reference all sources as

set out in the SOPH Academic Handbook.

Signed by the student: _________________________

The tutor’s comments are on the reverse of this form

------------------------------------------------------------------------------------------------------Office Use

Date received

Assessment/Grade Tutor Recorded & dispatched


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Assignment1 (DRAFT) 2 (DRAFT) Please

Tick1 (FINAL) 2 (FINAL)

5 WORKLOAD AND SUGGESTED WORK PLAN

There are 13 sessions in this module. Because the sessions vary in length, we suggest you set your own goals for when to complete each Study Session, using the work plan provided (this will be posted to you during the course of studying this Module). Keep track of the time it takes you to study so that you can plan your schedule more accurately.

Remember that your draft assignment must be sent at least two weeks before the due date. Assignment 1 requires you to complete Unit 1 and; Assignment 2 requires you to complete Units 2, 3 and 4.

Planning processUse these steps to develop your own work plan:

Review the suggested work plan. Identify the weeks when you will be under other pressures. Fill in fewer Study Sessions for those weeks.

Note the Discussion Group dates.

Spread the units across the time available. This means completing at least two Study Sessions per week.

Reserve time for completing the draft and final assignment.

Write the Study Sessions you plan to complete in the final column in pencil, and adjust the schedule if it becomes necessary.


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WORK PLAN FOR Population Health and Development IWEEK STARTING

DATEUNIT & SESSION

YOUR OWN WORKPLAN

1

2

3

4

5

6

7

8

9

10

11

12

13

14


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6 EXPLORE ACADEMIC LEARNING

Academic learning skills are special reading, writing and other skills and attitudes needed in order to study successfully in an academic context. Reading and writing are the two skills most crucial to your studies at this level.

Reading skillsTable 1 sets out a process that we strongly recommend you use each time you need to read a text. This process helps you to read with meaning, understand what you are reading about, take notes while you are reading, and draw conclusions.

Table 1: Reading skills

How you preview texts What we learn from this Read the cover (title, author) Read the imprint page (author,

source/publisher, date of publication)

Read the notes about the author and the text on the back cover

The main purpose of the text. The perspective of the author and/or

the institution to which they are attached.If the text contains up-to-date or outdated information.To read the text more critically.

Read the contents page. An overview of what the text covers – this helps us to prepare our minds so that we know what to expect from the text.

Think about how the text links to the study session, unit and Module.

To read actively and to make connections between ideas.

Skim the headings, illustrations, first and last paragraphs of chapters or sections, the first sentences of paragraphs, keywords in the text.

To direct our thoughts in preparation for reading the text in detail.

To understand how the text is structured, so as to have a framework in our minds into which we can fit new information that we read.

To have a clear sense of the whole before reading in detail.

To predict the main ideas or arguments and how they are linked.

To understand the text and to remember the ideas more easily.


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What is involved in thinking or reading ‘critically’?

TASK 3 – Examine what critical thinking or reading means

1. Think about this family of words: critic, criticise, criticism, critical, critique, critically. Jot down as many meanings of these words as you can think of.

2. In a learning context, what is a ‘critical’ reader or thinker? How would you expect the person to deal with information or ideas?

3. Imagine reading an author’s definition of what ‘health’ means. What kinds of critical questions might you ask about this?

FEEDBACK

1. critic – someone who commentates, judges or reviews somethingcriticise – to make a judgement about something, to look for the strengths and weaknessescriticism – the judgement, evaluation or disapproval offered by a criticcritical – urgent or serious

2. A critical reader or thinker usually wants to get to the root causes or the essence of something. They tend to question ideas rather than just accept and repeat them as presented. They think deeply about something and look for inconsistencies, flaws, gaps or missing information, aspects that do not add up or make sense.

3. You might ask:

Who is the author? How does his/her position affect his/her view of health?

How universally accepted is this definition?

Is this the only possible definition of health?

What does ‘health’ mean to me?

Who else has defined health? How do they support or argue their definitions?

What are the essential, most important features of the concept of health?

How has its meaning changed over time?

What are some of the main debates or controversies around this concept?


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The writing processWhen you need to write an essay or assignment, we recommend that you follow the writing process in the diagram below. The stages of the writing process follow each other logically, like a cycle.

You begin by analysing the assignment or question and what it requires. This involves looking carefully at the wording of the task and analysing the instructions or the actual words. The second stage is to brainstorm ideas on the topic, asking yourself what you already know about this topic and how you might approach it. Thirdly, you read and make notes, always bearing your question in mind. Once you have done this, you can plan your answer. This is the fourth stage. The fifth stage is to write a first draft. You then read over it, or ask a fellow learner to read it and evaluate your answer. This is the sixth stage. The final stage is to rewrite the assignment or exam answer.

You can repeat the process as many times as you would like until you are satisfied with the final text. However, you do not have to strictly follow the sequence of stages in the cycle. In fact it is quite usual for a writer to alternate between the different stages. For instance, when you draft sections of the assignment in Stage 5, you might find that you want to go back to Stage 3 to collect more information, or to Stage 4 to revise the plan. So the writing process cycle is flexible.


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These next tasks are designed to help you to identify other important academic learning skills, and to clarify the meaning of the terms 'concept', 'theory', ‘evidence’ and 'argument’.

Identify academic learning skills

TASK 4 - List academic learning skills

1. In the diagram below, jot down very quickly some examples of academic learning skills. Do not stop to think about them.

2. What do we call these kinds of diagram and how can they help us learn?


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TASK 5 - Identify academic learning tasks

1. Skim the Module. Find three or four tasks that you particularly like, which you think will help you develop academic learning skills. List the skills that these tasks will help you develop.

2. Why have we included the development of academic learning skills in this Module?

3. What academic learning skills do you feel you could improve or develop further?

FEEDBACK

1. A checklist of the main academic learning skills developed in this Module is provided near the beginning of the Module Guide.

2. Academic learning skills are developed in this Module to assist those learners who are unsure about some aspects of academic learning, especially if English is not their first language. Even learners who feel confident about these skills could try some of the tasks. This may heighten their awareness of what academic learning entails, and what their strengths and weaknesses are. Also, some learners may discover new ways of learning such as the ‘writing process cycle’ which they can incorporate into their set of academic learning skills.

3. Keep the list of skills that you want to develop further. We discuss these later.

What are concepts?

You have probably noticed that the term 'concept' is used a great deal in academic study. People also talk about 'conceptualising' and even 'reconceptualising'. But what do they really mean? Most people find a concept difficult to define because it is an abstract, general idea rather than a concrete or material object which we can see.

Concepts direct our thoughts and actions. We are often not aware of our concepts, although they underlie the terms or names that we give to things, e.g. the world, history, health, disease, war, poverty. If we examine the meaning or the definition of these terms we find that they embody concepts or abstract notions.

Concept: A general, abstract idea or set of ideas.

Often we have a shared, common understanding of the concept underlying terms. Here is a simple example. Think about the term, 'a doctor'. What concept underlies this term?


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Check the definition in a dictionary. You will probably discover very different concepts of a medical doctor. Below are just a few.


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* A trained, licensed professional expert

* A healer of people's physical ailments* A person responsible for curing and preventing disease and promoting the all-

round health of people.

Often people use very different underlying concepts for the same term because they see the main characteristics and functions in different ways. For some people, for example, a doctor is a specialist, trained and licensed professional, an expert who cures them. For others a doctor is responsible for the whole physical, emotional and psychological well-being of people. Yet we all employ the same term and rarely explain exactly what we mean when we refer to a 'doctor'. These contrasting views have developed as a result of our life experiences, beliefs, values and attitudes. Our understanding of these terms can also change as we experience new things which alter our knowledge, beliefs and attitudes. Because terms are not easily defined and competing or contradictory definitions exist, this can create confusion, misunderstandings and even conflict between people.

Terms and their embedded concepts are important in our daily lives as much as in academic study because they help us to think, and to describe and explain aspects of the world and of our experience. They help us to organise our thoughts, to classify random ideas, to objectify, to reflect on ideas, and to analyse and examine them critically. As such, concepts are essential tools in helping us to understand and to make sense of the world in which we live.

However, in academic study we strive to get to the truth, which means that concepts become extremely important and the focus of intensive debate. For instance, most of the concepts employed by social scientists are defined in different ways by different thinkers who see the world in different ways. Social scientists argue constantly about whether the concepts or their definitions are accurate and can be used to adequately describe reality. Concepts are also important in that they form the basis for generating theory.

Concept terms:Terms which embody or represent concepts.

What is theory?

A theory is a set of statements about reality or an aspect of it. It seeks to explain why things are the way they are. These statements are in turn, based on concepts. When you put together several concepts you build a theory or an explanation of why the world is like it is, or why people behave in the way they do. Theories help us to explain and to make sense of the world around us. But theories are only possible explanations. They are often very difficult to prove. SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary

Health Care Approach I – Module Introductionxxvi

There are three other points to note about theories:

1. Much academic work is concerned with testing theory and deciding whether reality fits the theory or not. If there is a poor 'fit' between theory and reality, if the theory does not explain reality or the aspect of it that is being studied, it is usually rejected or re-worked.

2. Theories should enable us to predict. If the world is the way the theory describes it, then it should be possible to say that when x happens, y follows. For example, the theory of gravity states that the earth pulls objects towards it. On the basis of this theory we can predict that if we throw a stone from a building it will fall downwards. If it does not, it means our theory has been challenged, and we need to rethink it.

3. All academic texts use evidence of various kinds to support their arguments or their theories. The stronger the evidence, the less likely it is to be challenged. If the writer does not provide solid evidence, people respond critically to the theory, which can lead to much debate.

What is evidence?Evidence to support theories or arguments is drawn from different sources. For instance, historical evidence can be verbal, such as eye-witness accounts or accounts that have been passed down through the generations, or written, such as official records, newspaper reports, or physical artifacts, such as bones and remains of crockery and jewellery. However, providing evidence means being selective and rejecting some evidence in favour of other evidence.

Therefore the process of selecting evidence is always subjective or partial. It is influenced by our viewpoint or our perspective on what we think is important, as much as by what is available. For example, the feminist critique of much history is that it is the history of important men. Women and women's contribution to society have been ignored. Further, many black scholars would argue that much historical analysis is centred on the history of important white men and ignores the achievements and contributions of other people and African societies in particular.

Because evidence is selected, it is important to cite the source of the evidence used to support a theory. This allows other researchers to check:

whether the evidence has been properly understood

whether all the available evidence has been reviewed before a selection was made.

Let us look at some ways in which we can challenge theory.

TASK 6 - Identify ways in which we challenge theories

1. Based on what you know about theories, how do people challenge them? On what grounds do they challenge theories?


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FEEDBACK

1. Theories can be challenged in different ways:

a) People challenge the concepts that make up theories. For example, someone could argue that the concept of language' as used in a particular theory of how people learn language is incorrect. This casts doubt on the theory itself.

b) Theories are challenged empirically. This simply means that the theory is shown not to fit the reality it says it describes. When theories are challenged empirically, evidence is presented to show that the theory is inadequate.

c) Theories can also be based on emotional and/or irrational belief. When people argue theories that are not true, it is very difficult to respond rationally.

As mentioned, arguments are often presented in a theory.

What is an argument?

'Argument' is yet another term which is used a great deal in academic study.

We usually use arguments:

to convince or to persuade someone of something

to share views and ideas, so as to reach a solution

In some ways an academic argument is similar to a written or verbal argument we might have with a friend. Our purpose is often the same and we try to present our case in the best possible way in order to win the argument. However, in the academic world, an argument refers to a particular way of presenting a case for something, or opposing another argument, by providing reasons, examples and evidence.

We can present an argument verbally, face-to-face as in a discussion, or we can present an argument in a written text. In a written argument, the writer uses special language to link ideas together to create a coherent, persuasive text.

The language of arguments

When we present or structure an argument, we often: describe something (e.g. It shows/ indicates/ appears ...) give examples (e.g. For example ... For instance ... e.g. ...) compare and contrast two things (On the one hand... on the other hand…) give arguments for and against a point of view discuss the cause and effects of something (e.g. The main cause is… / The

effects are…) draw conclusions (e.g. in conclusion…)


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The use of graphsGraphs help show numbers and statistics. There are many different kinds of graphs, but all have number scales and labels to identify the data.

Pie charts

A pie chart is a circle graph that is divided into sectors. Each sector represents or illustrates a percentage in relation to the whole. Together, the sectors create a full circle that represents 100%. The strength of this type of chart or graph is that it clearly shows how the parts relate to the whole.

A. African children B. White children


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Bar graphs

A bar graph is a chart with rectangular bars, with lengths proportional to the values that they represent. Bar graphs are used for comparing two or more values that were taken over time or on different conditions, usually on small data sets. The trait used to sort the data on a bar graph is usually indicated on the horizontal axis. The count is usually shown on the vertical axis.

Under-5 mortality rates by wealth quintile Namibia, DHS 2000

Note: rate for 10-year period preceding the surveySource: DHS 2000

Under-5 mortality: Age-specific mortality ratesNamibia , DHS 1992, DHS 2000

Note: rate for 5 years preceding the surveySource: DHS 1992, DHS 2000


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http://en.wikipedia.org/wiki/Length

http://en.wikipedia.org/wiki/Rectangle

http://en.wikipedia.org/wiki/Chart

Line graphs

A line graph has two separate scales of numbers that organise the data – one along the horizontal axis and one along the vertical axis. The line graph helps us make counts, compare frequencies, determine highs and lows, and look for data patterns. It is also used to show change over time.

Under-5 mortality: Estimated trend and MDG goal Namibia, 1980-2004

Source: i) WHO mortality database ii) World Health Statistics 2006

In addition to understanding abstract terms such as 'concept', 'theory' and 'argument', academic learning also entails using effective learning strategies. This is the focus of our last activity.

Develop Academic Learning StrategiesLearning strategies refer to the special habits, techniques or behaviours we use in order to learn. These cover a range of things, such as, planning study time, organising notes, discussing ideas with others, consulting reference books, time management, writing notes and drawing mind-maps.

TASK 7 - Choose your preferred learning strategies

1. Think about your previous experiences of academic learning. Look at the list of learning strategies below. Select and rank the top six on the list according to how helpful you have found them to be in the past.

2. Then add as many new learning strategies as you can to the list.

3. Which strategies on your list develop general learning abilities and which develop specific language skills? Which strategies develop both these skills? Tick the appropriate column/s.


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Preferred Academic Learning StrategiesAcademic Learning Strategy Skills developed

Rank I like: General Language Both

studying on my own

studying in a group or with another student

previewing texts before I read them in detail

asking questions as I read

summarising in my own words what I have read

writing notes in the margin of the text as I read

keeping a personal dictionary of new words

discussing any learning difficulties with a good friend

planning a text before writing it

editing and rewriting texts

keeping a diary of my thoughts about learning

thinking about how to apply what I am learning in my workidentifying the main argument in texts

checking my progress regularly

practising and applying new ways of learning

drawing diagrams to explain or to summarise ideas

identifying my weaknesses and strengths

looking up words in a dictionary

thinking of ways to remember unknown words

asking for help or finding more resources when I do not understand something


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POPULATION HEALTH AND DEVELOPMENT: A PRIMARY HEALTH CARE APPROACH 1 – READING LIST

When you want to quote a text from this reading list, use the details (including page numbers) under “Publication Details”. All sources are gratefully acknowledged.

Author/s Publication details

Cunningham, P., Popenhoe. D. & Boult ,B. (Eds.)

(1997) Chapter 11 – Health and Health Care. In Sociology. South Africa: Prentice-Hall: 223–227.

Epstein, H. & Julia, K.

(2007). AIDS and the Power of Women. In New York Review, February 15

Janovsky, K./ WHO

(1988) The Challenge of Implementation - District Health Systems for Primary Health Care. Geneva: WHO: 9 – 16; 65-67

Marmot, M. (2005). Social determinants of health inequalities. Lancet; 365: 1099–1104

Milne, S. (2010) Haiti's suffering is a result of calculated impoverishment. From guardian.co.uk, Wednesday 20 January 2010

Monekosso, G.L. / WHO

(1994). District Health Management: From mediocrity to excellence in health care. Geneva: WHO: 20 – 27

Pronyk, P.M., Hargreaves, J.R., Kim ,J.C., Morison, L.A., Phetla, G., Watts, C. Busza, J. & Porter, J.D.H.

(2006). Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet, 368: 1973–83.

Sanders, D. & Carver, R.

(1985) .Chapter 3 - Health, Population and Underdevelopment. In The Struggle for Health. London: Macmillan: 54-70.

Sanders D & Carver R (1985). Chapter 6 - Changing Medicine, Changing Society. In The Struggle

for Health. London: Macmillan: 185-193 and 204-213.

Schaay, N. & Sanders, D.

(2008). International Perspective on Primary Health Care Over the Past 30 Years. In: P. Barron, J. Roma-Reardon (Eds). South African Health Review 2008. Durban: Health Systems Trust.

Schaible, U.E. & Kaufmann, S.H.E.

(2007) .Malnutrition and Infection: Complex Mechanisms and Global Impacts. PLoS Medicine, 4(5): 0806-0812.

Wagstaff, A. (2002). Poverty and health sector inequalities. Bulletin of the World Health Organization, 80 (2): 97-105.

Walt, G. & Vaughan, P.

(1981). Introduction. In An introduction to the primary health care approach in developing countries, London: Ross Institute of Tropical Hygiene: 1 -12.


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http://www.guardian.co.uk/

Werner, D. & Sanders, D.

(1997) .Chapter 1 - The Life and Death of One Child: Rakku’s Story. In Questioning the solution: The politics of Primary health care and Child Survival. Palo Alto: HealthWrights: 11-12.


(1997). Chapter 2 - The Historical Failures and Accomplishments of the Western Medical Model in the Third World. In Questioning the Solution: The Politics of Primary Health Care and Child Survival. Palo Alto: HealthWrights: 13-17.


(1997). Chapter 3 - Alma Ata and the institutionalization of Primary Health Care. In Questioning the Solution: The Politics of Primary Health Care and Child Survival. Palo Alto: HealthWrights: 18-22.


(1997). Chapter 4 - The Demise of Primary Health Care and the Rise of the Child Survival Revolution. In Questioning the Solution: The Politics of Primary Health Care and Child Survival. Palo Alto: Healthwrights: 23-25.


(1997). Chapter 5 –Health Care as if People Mattered. In Questioning the Solution: The Politics of Primary Health Care and Child Survival, Palo Alto: Healthwrights: 23-25.


(1997). Chapter 11 - Health Status in Different Lands at Different Times in History, A Comparative Perspective. In Questioning the Solution: The Politics of Primary Health Care and Child Survival. Palo Alto: HealthWrights: 75-86.


(1997). Chapter 14 - A look at the situation today: Equity as a determinant of Health. In Questioning the Solution: The Politics of Primary Health Care and Child Survival. Palo Alto: HealthWrights: 108-120.]


(1997). Chapter 18 - Zimbabwe’s National Children’s Supplementary Feeding Program. In Questioning the Solution: The Politics of Primary Health Care and Child Survival. Palo Alto: Healthwrights: 138-141.

World Health Organization

(2007). Community health workers: What do we know about them? Policy Brief. WHO: Geneva.

World Health Organization

(1998). Decentralization and Health Systems Change in Africa: Case study Summaries. Prepared for the Regional Meeting on Decentralization in the Context of Health Sector Reform in Africa. Geneva: WHO: 1-5 & 57-61.


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Documents

Introduction to PH - Outcomes€¦ · Web viewIntroduction to health, development and Primary Health Care 11 7 Session 1 The impact of colonialism, capitalism and underdevelopment