Causal-Web Analysis

A Model Approach to Joint Programme Planning

Cheap cigarettes Social habits/ lack of awareness Poor detection by medical care Lack of hazardous waste Smoking Food/water contamination Chemical exposure in foods Weak enforcement Weak health education programmes

Cultural habits beetle nut chewing Alcohol use/ abuse

Illicit availability

Cancer

Low funding

UV radiation

Chemical exposure in workplace Lack of prorammes

Lack of policy/ weak policy

Ozone depletion

Chemical exposure in air pollution

Weak political will or lack of priority

Prevailing bias on economic development

Lack of or no use of evidence

SEA-EH-550 Distribution: General

Causal-Web Analysis
A Model Approach to Joint Programme Planning

WHO Project: ICP/SCC/200

 World Health Organization (2005) This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors.

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Causal-Web Analysis A Model Approach to Joint Programme Planning

Contents
Introduction ......................................................................... v 1 2 Background .................................................................... 1 Logistics Getting the Act Together ................................ 4
2.1 Collecting and Collating Background Information ....................... 4 2.2 Identifying the Stakeholders ........................................................ 5 2.3 Finding a Venue for the Exercise ................................................. 6 2.4 Logistics of Enabling Smooth Conduct of the Workshop ......................................................................... 6 2.5 Other Resource Needs ............................................................... 6

Participatory Consultation/Dialogue ................................ 7

3.1 Problem Analysis / Problem Perception Brainstorming ................. 7 3.2 Defining Environmental Issue as a Disease Concern .................... 8 3.3 Preparing the Causal-web Diagram ............................................. 9 3.4 Causal-web analysis: Prioritizing for Action ................................................................ 10 3.5 Defining Problem Reduction Intervention Objectives ................ 11 3.6 Charting Out Actions/Interventions ........................................... 12 3.7 Charting the Plan in Matrix form ................................................ 13

The Next Phase ............................................................ 14

4.1 Operational or Implementation Planning (next phase of the managerial process) .................................................................. 14

References ......................................................................... 16 Annexes

1 2 Flow of process of Joint-Planning .............................................. 17 Joint Programme Planning, Sri Lanka 2006-2007 ...................... 21

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Abbreviations used in the document

CHP SEARO FCH POA SDE Country Health Planning South-East Asia Regional Office Department of Family and Community Health in the SEA Regional Office Plan of Action Department of Sustainable Development and Healthy Environments, South-East Asia Regional Office Regional Expected Results Office-Specific Expected Results Causal-Web Analysis Primary Health Care Ministry of Health Country Cooperation Strategy United Nations Environmental Health Specific, Measurable, Achievable, Relevant, Time-bound: Objectives writing algorithm Programme Evaluation Review Technique Country Expected Results Colombo Municipal Council

RER OSER CWA PHC MOH CCS UN EH SMART PERT CER CMC

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Causal-Web Analysis A Model Approach to Joint Programme Planning

Introduction
The Regional Director, Dr Samlee Plianbangchang, in his reform process for the SEA Regional Office, undertook as a major prong of his vision strategy, decentralization of authority and responsibility to the country level, thus signifying greater accountability for programme implementation by country offices. Having 75 % of the regional budget at country level, and this devolution of managerial responsibility meant a congruent need for a thorough and technically sound process of joint planning among regional and national counterparts. In executing the planning effort for the 2006-2007 biennium, this new engagement was to be charted through three processes that were mutually supportive. One focused on programmme managers of a technical department being brought to the Regional Office for consultation and planning together for preparing the departmental PoA (effort piloted by the FCH department). The second approach was for a departmental staff member (one or two Regional Advisers) to visit the country and jointly plan the departmental PoA with a team of several national counterpart agencies that had relevance to the risk-factor issues being considered for problem reduction (effort piloted by the SDE Department). The third and perhaps the most pervasive is the country days approach where three or four persons (the WR, one or two of his programme planning staff, and one or two national programme counterparts) visit the Regional Office for consultation and joint planning with each of the departments (this was the lead action promoted by the central planning unit in the Regional Office). The first two approaches complemented the third as these provided very specific and focused content to the country days process by the fact that a good deal of consensus on country needs would be already had by the time the country team arrived for the country days event.

Causal-Web Analysis A Model Approach to Joint Programme Planning

The expected results (particularly OSERs) were the main focus as these would highlight the needs of countries. At the end of each session in every case, there would be a resulting matrix of OSERS out of which the Regional Expected Results (RERs) were then crafted by the respective technical departments, in a way that harmonized several of the OSERs. All these would be combined finally to generate a regional PoA, in which country needs are fully articulated and integrated into a regional plan of action (a consolidation of national plans of action). The following model process was what the SDE Department used (the second approach) in the cases of Sri Lanka, Indonesia and Nepal, for carrying out the initial phase of the joint exercise in the Region for planning for the 2006-2007 biennium. The causal-web analysis (CWA) helps us to see the broad picture of causal elements and their linkage processes. CWA also brings key players to the planning table and shows the need to work together within comprehensive programmes rather than in those fragmented along the lines of technical disciplines. It would help thus to promote sustainable health programmes.

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1
Background
A good plan of action is a necessary tool to effectively address any problem reduction objective. A plan being a road map on how to negotiate an issue, is necessary for knowing the way forward, what resources would we need, what achievements may be targeted, and what time-frames may be applied. It is only in the past 30 years or so that the systems approach to health service delivery has gained currency particularly since the advent of PHC and within this organic perspective, an acceptance of the holistic notion of health1. Given this new paradigm of health, WHO has gradually turned to joint planning as a mechanism to develop its country support agenda2. The joint planning process has evolved over the years from being a mere

1 Morris Schaefer, The management of environmental health programs: A systems view, WHO, 1979. 2 Country Health Planning (CHP) was an important element in the managerial process very seriously undertaken by WHO in the formative work of the PHC Initiative from 1978.

Causal-Web Analysis A Model Approach to Joint Programme Planning

consultation by the WHO country office technical staff with their counterparts in the Ministry of Health to more rigorous processes of having substantive discussions and dialogue. However, few instances use a clear and systematic technical process for perceiving issues the basis of the planning process for everything else flows from the rationality of this first step. Thus, these actions are often ad hoc and the resulting issues, unrealistic and lacking relevance to the needs of the country. Consequently, bad plans beget bad outputs. Joint planning can happen only in an environment that demands and provides the enabling conditions for it. Thus, a need for time and resources; so are good processes and procedures that are rational and systematic. Often, bureaucratic and command and control type of organizations and systems use top-down processes of planning, while those that are more horizontally oriented and more participatory in their decision-making employ joint-planning. WHO has, as more countries have gained in their national health expertise, increasingly used joint planning together with national counterparts. Planning may be described as an orderly process of defining a problem through analysis, identifying the unmet needs and demands that constitute the problem, establishing realistic and feasible goals, deciding on their priority, surveying the resources needed to achieve them, and projecting administrative actions based on the weighing of alternative intervention strategies for solving the problem. Thus, planning is a process that constitutes many steps, and results in a product called a plan. (Schaefer, 1974: administration of environmental health programmes, a systems view) The planning stage is the first of four elements in the health managerial process. Others are implementation, monitoring and evaluation each with its specific and scientific technical processes.

Causal-Web Analysis A Model Approach to Joint Programme Planning

The content of this paper is a model of how to carry out this first stage of planning simply yet rigorously with good participation of stakeholders relevant to the issues at hand. The scope of the effort was that of identifying the problems, their causes, priorities and needed actions. The process3 of this joint planning is in two phases. Phase one would be that of logistics getting the resources (people and materials) together. The second phase is that of preparing the plan through a participatory event consultation among the partners. Each event could be staggered depending on time and resource availability.

See Process flow chart of joint-planning in the Annex.

Causal-Web Analysis A Model Approach to Joint Programme Planning

2
Logistics Getting the Act Together
Before we can get to the group work required for the planning exercise, several antecedent activities need to be completed. These would be identifying needed information and stakeholders, seeking a venue for doing the exercise, actual conduct of the meeting, gathering materials for workshop support, and other resources (people and funds).

2.1 Collecting and Collating Background Information

Every problem-solving domain would require different sets of information to understand the terrain, so, in this case of environmental health planning for WHO country support, the following sets of information may be required: The WHO Country Corporation Strategy (CCS), which sets out the priority areas and inputs that WHO would use in country support. This would be both a technical and managerial guide to frame the actions we plan for within the limits of the WHO mandate.

Causal-Web Analysis A Model Approach to Joint Programme Planning

The national health plan of the country. This will guide us on what the national priorities are. Major donor (bilateral and multilateral) development programme input to the country. This helps in seeing WHO input in the context of overall external support so that we are aware of possible efficiencies in charting our actions to filling the gaps, avoiding redundancies and parallel action. The WHO action plan for country support of the previous biennium and reviews and assessments made on it, and a review of the present status of implementation of the ongoing biennial actions.

2.2 Identifying the Stakeholders

It is very important to select the right set of people for the meeting. The quality of discussion and, consequently, the quality of the dialogue and the resulting relevance of the intervention strategies chosen would depend on the quality of the participants. Obviously, different groups of people perceive and define problems in different ways, depending not only on their respective personal values but also on their culture, level of education, and involvement in the practice of environmental health whether in the government or private sector. For reviewing environmental concerns, there is quite a wide variety of expertise to choose from given the multi-disciplinary and multisectoral nature of health issues. A judicious balance of partnership is the objective so that the discussions adequately reflect the comprehensiveness of environmental health. The urban and rural water boards, MOH (staff both from environment and epidemiology), WHO office staff (environment and other related disciplines), laboratory, university and research institutes, major EH programme-related donor agencies, municipal authority, related UN agencies, representatives of civil society, etc. The main protagonists find a rational way of selecting participants. In the case of WHO, as in the selection of participants

Causal-Web Analysis A Model Approach to Joint Programme Planning

for most WHO meetings, MoH is a partner, and thus its views are entertained in the selection4.

2.3 Finding a Venue for the Exercise

This is important because of the nature of the discussions. Ideas flow easier when we are in an unconstrained environment or at least are perceived to be so. Thus a retreat setting outside the usual office space is desirable5.

2.4 Logistics of Enabling Smooth Conduct of the Workshop

We need to make good logistics planning for the meeting. Commuting comfortably to and from the venue for the participants, non-intimidating table arrangements for discussion, adequate stationery and other support items for writing and noting discussion, audiovisual support such as projectors, flipcharts, etc, and refreshments supplied in a way that makes for efficient use of time.

2.5 Other Resource Needs

Funds for the meeting, and a good meeting facilitator who does not prescribe ideas but helps to generate the wealth of ideas in the room by facilitating active participation and involvement in the discussions and dialogue of the meeting. This step deals with the conduct of the meeting/workshop/retreat once the people and materials are together. It signifies a collective process of consultation and dialogue that will help the participants feel a sense of ownership of the product that comes out of this collective thinking (a set of actions to address defined national health issues).

4 This can work both ways as help or a constraint, depending on the interest and involvement of the counterpart programme manager to get the right participants. No constraints were faced in the cases in Sri Lanka, Nepal and Indonesia. WHO programme staff in the Regional Office and the country office dialogued to select the participants based on their relevance to programmerelated knowledge base and the past implementation involvement. We also selected some who were perceived to be very relevant but not had the chance to be involved in WHO programmes in the past (academia, NGOs, municipal authorities etc.). 5 In the case of Sri Lanka and Indonesia, the venue was WR office conference room; in Nepal we used a city hotel as retreat.

Causal-Web Analysis A Model Approach to Joint Programme Planning

3
Participatory Consultation/ Dialogue
3.1 Problem Analysis / Problem Perception Brainstorming
This initial step is a critical one that will identify environmental issues with which the country grapples. We used a brainstorming approach to lay out with abandon the various issues that are perceived as environmental issues. There is no critical analysis of these expressions at this stage as doing so would impede free and frank flow of thoughts. Everyone is encouraged by the facilitator to give as much expression to the thoughts that come to mind. This discussion results in a long listing of items of environmental relevance (to note on white board or paper). Using cards to note ideas and put up on a board is an alternative method if the participants consider that to be a more comfortable process of initial venting of their ideas. Whichever the case, the next step is to analyse these ideas/inputs for clarity and relevance as problem statements, and classify these into categories of similar risk factors.

Causal-Web Analysis A Model Approach to Joint Programme Planning

For example, those relating to water quality, solid waste, personal hygiene, chemical hazards, occupational hazards, pollution namely air, water, soil, safety, supply and security of food, etc. These will help define the many disparate thoughts that emerged from the group brainstorming into a classification of environmental concerns, for use in initiating the construction of the causal web. (see examples in Annex 1). Environmental risk factors have been the backbone of pubic health disciplines in our academic programmes. Engineers deal with water and sanitation mostly looking at operations and maintenance of systems. The solid wastes types deal with personal hygiene and with keeping vermin away from people so that these vectors do not carry harmful germs to humans thus the discipline of sanitarians. The occupational and chemical hazards discipline deals with risk reduction from a very epidemiological perspective that separates them from the kind of input that engineers or sanitarians provide. And food safety experts deal in so many fronts laboratory, health education, food technology, food security, nutrition etc. that their discipline is even more fragmented. Thus, each of these disciplines has demarcated its professional boundaries to the extent that it becomes a breach of professional conduct to partner with others lest the dominance of the discipline is jeopardized. Such is the status of cooperation among those who deal in environmental health, and thus to find a common ground where everyone6 will see issues coherently would be to frame our environmental health problem in a different way, for example, as diseases outcomes.

3.2 Defining Environmental Issue as a Disease Concern

In health services delivery, whatever the specialized health intervention input to it maybe, the common converging goal

WHO technical staff in different departments.

Causal-Web Analysis A Model Approach to Joint Programme Planning

remains the control or elimination of diseases. Thus, defining environmental interventions also as addressing disease reduction helps in gaining this increased coherence with it also the potential for engendering the cooperation of other health colleagues. The WHO environmental health programme managers have been increasingly leaning towards this view lately7. Given this perspective and after presenting the above to the participants, they were encouraged to think of the diseases that related to the list of environmental concerns that emerged from the initial brainstorming and classified into major environmental concerns/areas (about 4-5 areas). Not unexpectedly, the following issue/disease pairings emerged:8 Unsafe water, sanitation and food to diarrhoeal and enteric diseases; vector borne diseases Unsafe use of chemicals to poisoning, CVDs and cancers Unsafe work environment to injuries and accidents Air pollution to respiratory infections

3.3 Preparing the Causal-Web Diagram

This is the crux of the meeting. Good causal-web analysis9 would help in seeing the broad picture away from the narrow confines of tunnel-vision that many experts have that focuses all solutions within the confines of their own disciplines. The participants were then divided randomly into four or five groups for exhaustive discussion on risk factors for these diseases. The random assignment

7 WHO Environmental Health Programme Directors Meeting in Kobe in 2004 decided to use this disease approach for seeking more involvement from other WHO inhouse expertise for EH programme planning and implementation. 8 There could be other disease outcomes also if the group identified more esoteric aspects of environment such as social environment, animal/vector-man contact environment etc. resulting in disease concerns such as TB, HIV/AIDS, malaria, dengue, kala-azar, trachoma, schistosomiasis, SARS, avian flu etc. 9 See in the Annex two for sample causal-web diagrams resulting from the country workshops.

Causal-Web Analysis A Model Approach to Joint Programme Planning

of participants to the groups was for a good reason. Aggregating people with similar disciplines into the same group would bias the discussions to risk factors to those that they most identified with. Further, pooling people of different expertise and experience into a group would be a better learning experience for all too. The participants use a white board or flip chart to work out a diagram or flow chart of the risk factors (or causes) that relate to the given disease. The thought process used is that the participants think through a hierarchy of objectives from proximate determinants to more distal ones through a process of sitting around and articulating those that comes to mind, while someone writes these down on a flip chart. Cross-dialogue is maintained to get clarity of what causes are mentioned but not critically analysing or questioning any one of these for the moment, as this would stymie input from the shy participants. The resulting picture would be a messy noodle diagram (a causal-web) as shown in Annex 1. However, as messy as this may look, the diagram prepared together would have helped the participants to become aware of the bigger picture that influences the affliction of the given disease. It would be a clear depiction that the causes of disease are multidimensional, multi-level, multi-disciplinary, and multisectoral.

3.4 Causal-Web Analysis: Prioritizing for Action

This step of analysing the diagram helps to pick out the right10 problem reduction intervention. Each group leader then presents the individual group work to a plenary of the session participants. Thus, everyone is made aware of the larger array of environmental issues that we face daily and the myriad pathways that are before us for addressing them. For example, we see that we may address diarrhoeal diseases through health education, provision of clean

10 right would mean those actions that are possible financially, politically, culturally, and also administratively.

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Causal-Web Analysis A Model Approach to Joint Programme Planning

water, food hygiene, personal hygiene practices, control of flies and other vermin, case management, and also various combinations of these. The participants then select the causes that are most plausible (priority) for addressing, given the enabling conditions of the context, the technical expertise available, and political exigencies. The selections made cannot be perfect as all the information needed for making the optimal decision is never fully available. However, even with this limitation, the choices would seem to be rational and because these are made in collaboration and partnership, the potential for team effort implementation more real.

3.5 Defining Problem Reduction Intervention Objectives

While the causes specified in the web diagrams were written out as clauses that refer to the deficiency of a condition, these would now have to be written out as a problem reduction objective a desired state. For example, the lack of safe water supply to households is a depiction of deficiency; we can state the problem objective as to promote the availability of safe water to households11. This will help in charting out in the next step, the hierarchy of actions needed to carry out this action. This is the next step: that of defining the set of actions to achieve the availability of safe water to households. A necessary component of this step of identifying problem reduction objectives is that of constraint analysis. There are always both external (exogenous), and internal (endogenous) constraints to any open system12 that shape it, bound it, and serve to determine its direction. The practicality of selecting and using a particular intervention depends on several assumptions (constraints) of

A more rigorously stated objective would need to be more specific using the SMART principle (specific, measurable, achievable, relevant and with a scheduled time-frame).
11 12 For an explanation of an open system and closed system in the environmental context, see Morris Schaefer, 1979.

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socioeconomic, political and cultural considerations of the milieu in which the system operates. Furthermore, endogenous factors within the administrative system of the programme in such forms as its history, its values, ways of working and internal manifestations of external influences (civil service rules, professional society attitudes, etc.) also influence decisions as to the practicality of selecting a given intervention or strategy to address the problem at hand.

3.6 Charting Out Actions/Interventions

With problem reduction objectives clearly defined, we can move to the next step of charting out actions and interventions. The participants do this by using a decision-tree model. This is an inverted tree type of diagram (see figure). The group members, through dialogue, chart this listing and agree on the activities13. Figure: The decision-tree for improving water quality surveillance

13 This can be as elaborate as the participants want it to be. In the case of WHO, we focus on our mandated responsibility limits and thus the simple set of outputs as in diagram (in this case for improving water quality surveillance derived from the WHO workshop for 2006-2007 biennial planning in Sri Lanka in December, 2004)

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Causal-Web Analysis A Model Approach to Joint Programme Planning

3.7 Charting the Plan in Matrix form

This essence is an abridged set of activity statements put in matrix form for easy reference (other ways to make activity statements are narrative statements with illustrations as may be necessary, summaries of techniques and typical work schedules. (activity patterns can be expressed as flow charts also). The activity statements (Annex 2) would generally consist of: what is to be done, by whom it is to be done, where it is to be done, when it is to be done, and how it is to be done. In the WHO planning parlance, these would be similar to the following: What is to be done expected result, product, and activities (indicators also may be noted within this element as these describe an indication of the tangible output) By whom responsible staff member Where it is to be done the location where the WHO action is to be in a given country When it is to be done time-frame How it is to be done the activity description/definition statement (SMART).

The specification of these elements, together with the quantitative targets expressed in programme and operational objectives will help the manager to determine most of the resource requirements for the proposed programme of action. The major step of developing the programme budget may be best undertaken at this stage of management planning when the activities are reasonably clear and so possible to make a rational costing.

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4
The Next Phase
4.1 Operational or Implementation Planning
(next phase of the managerial process)
Once the actions are delineated, implementation begins with assigning roles and responsibilities to various players. Defining focal responsibilities will help in the next stage of operational or implementation planning for the team leader to develop a project approach, (with well-defined quantitative product targets, nature and scope of the benefits-recipient population, ways of delivery and time-frames). Further elaboration on operational planning are the preparations of managerial review/monitoring tools such as Gantt Charts, and PERT(programme evaluation and review technique) charts which would help project managers to efficiently manage time by being aware of the constraints of time in scheduling the many activities that collectively constitute the achievement of an objective.

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Causal-Web Analysis A Model Approach to Joint Programme Planning

Budgeting
Clear set of actions needed for addressing the problem reduction objective helps to rationally pursue the process of costing tasks and contributing to a well-planned budget that reflect true costs not just rounded unrealistic estimates.

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References
Schaefer, Morris, The Management of Environmental Health Programmes: A Systems View, WHO, 1979 Lewis, James, P How to Build and Manage a Winning Project ., Team, Amacom, WHO, 1993 Managerial Framework for Optimal Use of WHOs Resources in Direct Support of Member States, WHO, March 1983, 1985 Operational Planning Guidelines: Budget and Management Reform, WHO, November 1999

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Causal-Web Analysis A Model Approach to Joint Programme Planning

Annex 1

Flow of Process of Joint-Planning

Free flow brainstorming on perceived environmental issues in the country

Classify/collapse the perceived issues into broad environmental concerns /risk factors (eg. water/sanitation, solid waste, food safety, chemical safety, occupational etc.

For each category agree on the main disease outcome of major importance. This way we can relate EH to disease and raise interest of medical care givers also

Divide into groups where each group develops a web-ofcauses for each disease category

From the Decision Tree diagrams prepare the WHO matrix POA (CERs, Products or detailed CERs, and subordinate activities

For each of the selected determinant risk factors, prepare a Decision Tree diagram. This will help to analyse the task into practical action points.

From the causal-web, select a few proximate determinant risk factors (e.g. awareness, lack of programme, policy, data, surveillance, etc)

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Causal-Web for Cancer

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Causal-Web Analysis A Model Approach to Joint Programme Planning

Causal-Web for Cancer

Causal-Web Analysis A Model Approach to Joint Programme Planning

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Causal-Web for Poisoning

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Causal-Web Analysis A Model Approach to Joint Programme Planning

Annex 2

Joint Programme Planning, Sri Lanka 2006-2007

Proposed Office-Specific Expected Results (OSER), Products and Activities October 2004
OSER Products Product Description Activities Responsibility Lead/Partners

1) An information Water management quality system in surveillance place system piloted

Presently there is a need for a comprehensive information management system that has a focal point and is able to collect and collate information from all other related agencies and to generate evidence for decisionmaking. It is expected that the focal point in the ministry of health will collect and collate the data and generate evidence for advocacy. Field-level testing needs to be done to keep track of emerging scenarios. With some supplies and training, a pilot (s) could be tried out. Existing labs are not of good quality and needs strengthening if a good programme is to be built.

Identify focal point Identify mechanisms for collecting information and mapping Training

2)A mechanism for field level water quality testing piloted

Rapid diagnostic test kits/ residual chlorine Training/Management Training of staff Provision of S&E Management procedures

3) Capacity of three regional water quality testing laboratories built

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OSER

Products

Product Description

Activities

Responsibility Lead/Partners

Food safety surveillance system established on pilot settings

1) Strengthened implementation of food safety regulation in pilot settings

A team approach needs to be built around a food safety programme and thus central and district-level partnerships need to be developed. This is best done in a couple of pilot healthy district settings where this partnership effectiveness can be demonstrated Sampling of food for quality capacity in both district and urban settings need strengthening. The Colombo Municipal Council will be an active partner in the urban setting of Colombo. This pilot in one province and in Colombo will help demonstrate effectiveness

Review and revise regulations Training of PHI & FDI on implementation Training MOHs on monitoring and supervision in relation to food regulation Consumer education Human resource Training Rapid diagnostic test kits Sampling kits Mobility

2) Sampling and analytical skills of PHII and FDII enhanced in one province and CMC as part of food quality partnership

3) Staff of food laboratories provided with competencies related to food analysis (Anuradhapura / Kalutara/MRI,/ CMC, Kandy)

Training Three settings: Anuradhapura, Kalutara S&E and Kandy labs are the focus as settings. Also the MRI and the capacity of CMC can help to improve overall competency at the urban level.

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OSER

Products

Product Description

Activities

Responsibility Lead/Partners

Capacity of stakeholders for addressing health hazards in informal workplaces developed

1) An evidence base on occupational health hazards established nationally

Steering group MoH would decide the content of the data to collect in the context of informal workplaces. Achievement of this product will be organized and coordinated by the University of Colombo where it will set up the database. Identify and communicate more information on health effects of hazards from specific industries and other exposure topics, develop educational materials for training ToTs. Focus on awareness to those affected i.e. workers and the local community The focus of training is on health staff on how to address the implementation of control programmes.

Develop database Train selected users S and E

2) Awareness programme for workers and community piloted

Awareness material development. Training of trainers Set up a pilot intervention study in work setting

3) The peripheral health staff of one province trained on identifying and control of occupational safety hazards

Training material preparation. Training sessions. Apply knowledge in a work setting intervention

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OSER

Products

Product Description

Activities

Responsibility Lead/Partners

Approaches 1) Policy for to poisoning chemical and hazard safety, management management developed coordination developed

Coordination of programmes on chemicals management in industry, agriculture and homes is weak. Safety programme are inadequately conceived and executed. Better skills and coordination are needed among partner institutes Lack of effective case management at the first point of contract can save lives and limit infirmity. Some hospitals at this first point of contact to be thus strengthened with methods, protocol, supplies and training. Pilot settings envisaged. Web site through which the data base could be accessed for research

Coordination method developed. Roles assigned to partners. Training.

2) Standardized patient management practices (poison related) established at first point of contact in selected hospitals 3) Information management and sharing capabilities of the national poison information centre enhanced

Protocols S&E Treatment Algorithm Research Training

Existing data system review and Information Establish a web sharing to be undertaken site Information sharing meeting annually

Review of present functions of NPIC

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Causal-Web Analysis A Model Approach to Joint Programme Planning

OSER

Products

Product Description

Activities

Responsibility Lead/Partners

National 1) Evidence Infobase on air on air pollutionpollutionrelated health related effects health collected and effects collated established 2) Research on selected issues of air pollution commissioned to bridge the knowledge gaps

Research in selected urban and estate sectors, and survey on chronic lead poisoning among children

Survey Intervention studies- urban /rural

Rural and even urban communities use firewood extensively still. Promotion of smokeless stoves that UNICEF is developing. The government will demonstrate the effectiveness in pilot settings operational research. Many studies have been done earlier and this information needs to be captured and used along with new data to be collected. So the need for an information base.

Survey study to assess main issues (primary and secondary data). Awareness building Demonstrations

3) A computerized infobase established

Info base development. Training for use by selected users.

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