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Discussion 2: Sustainability

Which of the following programs is more sustainable?

  1. A funder gives money to groups that will buy food and distribute it to low-income families.
  2. A funder gives money to groups that will create community gardens with resident participants in low-income neighborhoods who will continue the program in years to come.

Given the realities of international financial volatility, funding for public health programs may be abruptly discontinued, leaving programs unfinished and participants underserved. Public health professionals need to anticipate how a program will be sustained when the funding or program term ends. Not only is this better for the program itself, but it provides more lasting benefits for society.

For this Discussion, review the media titled

Empowering Women.

Consider how the program executives raise funds to sustain their program despite a small operating budget. Also, consider some of the serious ramifications for social change in Belize if the program was not sustainable.

Read the following scenario: My program is Child Obesity Prevention Program focus and implementation in school setting and focus on African American Children.


You receive funding for your program ( child obesity prevention program implemented in school )After 3 years, the funding ends. Consider how you can sustain your program past the initial funding of your program, and determine the long-term impact it might have on the community.

By Day 4


Post

an explanation of the importance of sustainability to your chosen public health program (SPP). Then, explain the strategies you might incorporate into your program to ensure sustainability in post-funding years. Finally, explain how your public health program, if implemented, could promote long-term social change.

?Empowering Women?
Program Transcript
NARRATOR: Abuse knows no boundaries. It does not discriminate by class,
geography, or race. Domestic violence is a serious public health issue around the
world, and Belize is no exception.
ANNA SILVA: The reason why domestic violence is such a problem in Belize, I
have a few. It can be cultural. You have women who, when trying to leave their
relationship, because of our culture, maybe their parents or family will tell them,
well you need to go back. That’s your relationship. A statement that is used often
is, you make your bed and you must lie in it. So, then that woman goes back to
her relationship.
Other than that, financially, it’s a problem because of lack of employment, not
only for women, but also for men for are known to be the breadwinners of the
family. So, that, again is an issue.
NARRATOR: Thanks to the grassroots efforts of two women, families in Belize
have a welcome safe haven at Mary Open Doors. In a small office perched
above the city of San Ignacio near the border of Guatemala, Mary Open Doors is
situated in the Cayo District a mountainous area home to ancient Maya ruins.
Here, Anna Silva and Carmen Concha work out of this three-room space.
They meet with clients, coordinate safety efforts, and raise funds with the help of
a small group of volunteers. In the Cayo District, 70% of women surveyed
reported experiencing some form of domestic violence.
AMANDA MORALES: There’s only two domestic violence shelters in the whole
country. It’s a small country, but, especially because there’s so many villages and
bush out there, the resources aren’t available to all women. So it’s definitely hard.
There’s no transportation to get to places here. So, a lot of times, if there’s a
domestic violence call, police won’t go out into the villages, because it’s too
expensive, gas is too much money. So women are forced try to find other ways
to get by, and there’s just minimal options at this point for women.
NARRATOR: Not only do women face logistical challenges to getting help, they
also must contend with deeply ingrained, patriarchal dominance.
NATASHA BANI-SADR: There’s this idea of male dominance that’s sort of
inherent, just in the gender roles here. I know from what I’ve seen, there are a lot
of women who actually– it’s ingrained in them as well, that they should be
submissive to their husbands. There’s an idea, I guess, that things like marital
rape don’t exist. There’s this duty that women have to their husbands. And that’s,
? 2012 Laureate Education, Inc.
1
I think, of the main source of that. And possibly, in general, the social problems-just with the judicial system and social services– is a problem as well.
NARRATOR: In an undisclosed location, Mary Open Doors has a safe-house
shelter, for women and families seeking asylum from domestic abuse. Working
with a minuscule budget, Anna and Carmen network with dozens of local and
international agencies to support abused women, finding them shelter, health
resources, work, and legal counsel.
NATASHA BANI-SADR: L think part of the reason that it is such an issue here-networking and trying to raise awareness of Mary Open Doors and other
domestic violence shelters– is that there are only two of them in the country. It’s
a fairly small, country only 350,000 people. But at the same time, I think two
shelters is inadequate, especially considering the geographic diversity and range.
People are spread out across the entire country, and they have problems
traveling, aside from just hearing about them in the first place. So that’s one of
things that our program aims to do, is to bring knowledge of these shelters to
villages and rural areas in Belize.
NARRATOR: For both Anna and Carmen, the calling is not merely professional.
It is profoundly personal.
ANNA SILVA: I am a survivor of domestic violence, so I have walked in their
shoes. And knowing that I could give back what I got from family members and
people who supported me, I felt I had to do that. I had to do make that
commitment, and fortunately, God willing, I did.
CARMEN CONCHA: I was in a domestic violence abuse for 16 years. I was a
businesswoman with my husband. But because I wanted to hold that
relationship, and we say this culture of one husband and one wife, I stand with
that for a period of time. But I didn’t know that that was affecting my child. She
was so quiet, she’d never say much words to me. But as she grew up, it did
affect her, when she was in her teens. I realized that I must do something.
I just asked God to help me, to show me how to deal with the situation here. And
I get in touch with Mary Open Doors, and they really supported me. When a child
is in that situation, I used to be ashamed of it, but now I am not. Because, you
know what, I put her into drawing, music, singing, and that helped her a lot. So
now, she has so many drawings that heal her. And I could see that’s her first
drawing– there used to be sad drawings. And now, it’s not. It’s something more
nature, more nicer for her, and we communicate a lot.
And the thing that really touched me with my daughter, for many years after I left
my husband, she told me like a month ago, she said, you know why I am so
distant to you? Because you spent your time mostly on dad, and you never, you
? 2012 Laureate Education, Inc.
2
spent no time with us. And says, you were all [INAUDIBLE] for dad, and this is
why I distanced myself from you. This is why I did all of this.
And then, she was crying her heart out, and I got out of bed and I said, OK, all
right. I couldn’t cry at that moment, but she was crying, saying, mom, forgive me.
I know you’re a good mom, I know you did everything for me, but this is what
happened, why I’m so distant from you. And she says, but I’m learning, and I’m
learning to communicate it to you. And it really touched me.
Women, we feel like being in a relationship with our husband, to make them have
a father, sometimes you make the wrong mistake. Because that was my desire,
to help one husband, the children have one father. But, no, it’s not what we want.
It’s the happiness for our children. So today, now, we are more better, we
communicate more better. She can say she loves me, and I can say I love her,
and I can say thanks, and thank God, and thank Mary that I can hold my child in
my hand. We can laugh, we can go on nature walk, we can go running now
together, we can do so many things.
It’s just because I did go to that organization. I felt a little embarrassed to go to
the organization, and I believe many women are in that same condition, too. But I
would say, don’t. Go. Save a child. Give your child a life.
NARRATOR: Working for Mary Open Doors has not only empowered Anna and
Carmine to change their situations, they also are working every day to empower
the lives of other women.
CARMEN CONCHA: It was so hard for me to bring up my experience. But I know
it will help others, because I did go back to San Pedro High School, and we did
that three-day workshop, and that was my first time for me to see what happened
to my daughter. And after what I said, there were four more students that came
up and said that they’re happy that’s what I said.
Because, I mean, I told them from being there, I said, if my daughter only knew
what I’m saying here, she will kill me. But I told my daughter, because it’s not
nice– you have a future for your daughter. You plan a life for them. And you don’t
know– the life you’re living with your husband, you don’t know that’s affecting
them and turning their dreams to something destructive.
So, women, I said, if you need to get out, get out. Don’t care what who says. Just
get out. You need to live a life, because we are vulnerable. We are so precious.
But when we’re in a relationship, we don’t believe that we are precious, and we’re
worth something. We’re worth a dime, gem, whatever. So, this is what I would
like to say to you all, that I am happy.
Continue courage. Thank you, miss Anna.
? 2012 Laureate Education, Inc.
3
?Empowering Women?
Program Transcript
NARRATOR: Abuse knows no boundaries. It does not discriminate by class,
geography, or race. Domestic violence is a serious public health issue around the
world, and Belize is no exception.
ANNA SILVA: The reason why domestic violence is such a problem in Belize, I
have a few. It can be cultural. You have women who, when trying to leave their
relationship, because of our culture, maybe their parents or family will tell them,
well you need to go back. That’s your relationship. A statement that is used often
is, you make your bed and you must lie in it. So, then that woman goes back to
her relationship.
Other than that, financially, it’s a problem because of lack of employment, not
only for women, but also for men for are known to be the breadwinners of the
family. So, that, again is an issue.
NARRATOR: Thanks to the grassroots efforts of two women, families in Belize
have a welcome safe haven at Mary Open Doors. In a small office perched
above the city of San Ignacio near the border of Guatemala, Mary Open Doors is
situated in the Cayo District a mountainous area home to ancient Maya ruins.
Here, Anna Silva and Carmen Concha work out of this three-room space.
They meet with clients, coordinate safety efforts, and raise funds with the help of
a small group of volunteers. In the Cayo District, 70% of women surveyed
reported experiencing some form of domestic violence.
AMANDA MORALES: There’s only two domestic violence shelters in the whole
country. It’s a small country, but, especially because there’s so many villages and
bush out there, the resources aren’t available to all women. So it’s definitely hard.
There’s no transportation to get to places here. So, a lot of times, if there’s a
domestic violence call, police won’t go out into the villages, because it’s too
expensive, gas is too much money. So women are forced try to find other ways
to get by, and there’s just minimal options at this point for women.
NARRATOR: Not only do women face logistical challenges to getting help, they
also must contend with deeply ingrained, patriarchal dominance.
NATASHA BANI-SADR: There’s this idea of male dominance that’s sort of
inherent, just in the gender roles here. I know from what I’ve seen, there are a lot
of women who actually– it’s ingrained in them as well, that they should be
submissive to their husbands. There’s an idea, I guess, that things like marital
rape don’t exist. There’s this duty that women have to their husbands. And that’s,
? 2012 Laureate Education, Inc.
1
I think, of the main source of that. And possibly, in general, the social problems-just with the judicial system and social services– is a problem as well.
NARRATOR: In an undisclosed location, Mary Open Doors has a safe-house
shelter, for women and families seeking asylum from domestic abuse. Working
with a minuscule budget, Anna and Carmen network with dozens of local and
international agencies to support abused women, finding them shelter, health
resources, work, and legal counsel.
NATASHA BANI-SADR: L think part of the reason that it is such an issue here-networking and trying to raise awareness of Mary Open Doors and other
domestic violence shelters– is that there are only two of them in the country. It’s
a fairly small, country only 350,000 people. But at the same time, I think two
shelters is inadequate, especially considering the geographic diversity and range.
People are spread out across the entire country, and they have problems
traveling, aside from just hearing about them in the first place. So that’s one of
things that our program aims to do, is to bring knowledge of these shelters to
villages and rural areas in Belize.
NARRATOR: For both Anna and Carmen, the calling is not merely professional.
It is profoundly personal.
ANNA SILVA: I am a survivor of domestic violence, so I have walked in their
shoes. And knowing that I could give back what I got from family members and
people who supported me, I felt I had to do that. I had to do make that
commitment, and fortunately, God willing, I did.
CARMEN CONCHA: I was in a domestic violence abuse for 16 years. I was a
businesswoman with my husband. But because I wanted to hold that
relationship, and we say this culture of one husband and one wife, I stand with
that for a period of time. But I didn’t know that that was affecting my child. She
was so quiet, she’d never say much words to me. But as she grew up, it did
affect her, when she was in her teens. I realized that I must do something.
I just asked God to help me, to show me how to deal with the situation here. And
I get in touch with Mary Open Doors, and they really supported me. When a child
is in that situation, I used to be ashamed of it, but now I am not. Because, you
know what, I put her into drawing, music, singing, and that helped her a lot. So
now, she has so many drawings that heal her. And I could see that’s her first
drawing– there used to be sad drawings. And now, it’s not. It’s something more
nature, more nicer for her, and we communicate a lot.
And the thing that really touched me with my daughter, for many years after I left
my husband, she told me like a month ago, she said, you know why I am so
distant to you? Because you spent your time mostly on dad, and you never, you
? 2012 Laureate Education, Inc.
2
spent no time with us. And says, you were all [INAUDIBLE] for dad, and this is
why I distanced myself from you. This is why I did all of this.
And then, she was crying her heart out, and I got out of bed and I said, OK, all
right. I couldn’t cry at that moment, but she was crying, saying, mom, forgive me.
I know you’re a good mom, I know you did everything for me, but this is what
happened, why I’m so distant from you. And she says, but I’m learning, and I’m
learning to communicate it to you. And it really touched me.
Women, we feel like being in a relationship with our husband, to make them have
a father, sometimes you make the wrong mistake. Because that was my desire,
to help one husband, the children have one father. But, no, it’s not what we want.
It’s the happiness for our children. So today, now, we are more better, we
communicate more better. She can say she loves me, and I can say I love her,
and I can say thanks, and thank God, and thank Mary that I can hold my child in
my hand. We can laugh, we can go on nature walk, we can go running now
together, we can do so many things.
It’s just because I did go to that organization. I felt a little embarrassed to go to
the organization, and I believe many women are in that same condition, too. But I
would say, don’t. Go. Save a child. Give your child a life.
NARRATOR: Working for Mary Open Doors has not only empowered Anna and
Carmine to change their situations, they also are working every day to empower
the lives of other women.
CARMEN CONCHA: It was so hard for me to bring up my experience. But I know
it will help others, because I did go back to San Pedro High School, and we did
that three-day workshop, and that was my first time for me to see what happened
to my daughter. And after what I said, there were four more students that came
up and said that they’re happy that’s what I said.
Because, I mean, I told them from being there, I said, if my daughter only knew
what I’m saying here, she will kill me. But I told my daughter, because it’s not
nice– you have a future for your daughter. You plan a life for them. And you don’t
know– the life you’re living with your husband, you don’t know that’s affecting
them and turning their dreams to something destructive.
So, women, I said, if you need to get out, get out. Don’t care what who says. Just
get out. You need to live a life, because we are vulnerable. We are so precious.
But when we’re in a relationship, we don’t believe that we are precious, and we’re
worth something. We’re worth a dime, gem, whatever. So, this is what I would
like to say to you all, that I am happy.
Continue courage. Thank you, miss Anna.
? 2012 Laureate Education, Inc.
3
Types of evaluation
There are different forms of program evaluation, which includes formative, process,
impact, and outcome assessment (Gafoor, 2013).
Formative Evaluation
This type of evaluation guarantees that initiative is achieving activities that are planned and
appropriate for the implementation of the program (CDC, n.d). It is used by evaluators to
develop and modify existing program or adopting a new activity. Thus, this will be crucial to
attain the goals of child obesity program and guarantee its success. Formative evaluation asses
the quality of the implementation and the initiative delivery. This step ensures the success of the
program and captures any issues that need to be modified before full implementation. To make
formative evaluation quantitative and qualitative data is collected throughout the duration of the
program and assessments are done to inform stakeholders and make any necessary changes. This
data is collected from surveys and discussion groups with parents and children before and after
each step of the implementation to check feedback and make improvements and get better
results. These data are useful in analyzing achievement trends. Evaluators can use exploratory
and open-ended questions in the group discussion or distribute surveys to determine program
progress as well as identifying weak parts of the program. Quantitative data reveals if resources
allocation is convenient and used as intended.
Process Evaluation
Process evaluation reveals if program initiative and activities are coherent with the
program plan and will lead to the set goals and outcomes (CDC, n.d.). Process evaluation will
keep track of progress and determine if plan and activities meet the goals and are culturally
accepted by diverse children included in the program and their parents and if the initiative
accessible to them as well. Parents should be able to be in awareness sessions one per month and
make monthly surveys to monitor behavioral and physical progress as well as increase in
knowledge. Also, children should have access to healthy food and have transportation mean to
take them home after free physical training offered after school. Quantitative data will reveal
how funds are used and resources allocated and number of participants and change in BMI value
in children. Whereas qualitative data reveals behavioral and attitude progress and focus groups
can provide feedback.
Impact Evaluation
Impact evaluation focused on the impact of the end on results of the initiative that was
implemented whether they were intended or not intended (Issel &Wells, 2017). It will thus reveal
if initiative results in decreasing child obesity and achieving the goal in Dayton, Ohio. This
evaluation depends on quantitative data from community using surveys. It reveals the impact of
the initiative on the community and not only the school where the program setting will have most
of its focus. The stakeholders will be WIC, CDC in Ohio , pediatric clinics collated with the
program and the school board.
Outcome Evaluation
Its focus is to achieve both the short as well as the long-term program goals. Outcome
evaluation detects the progress in life quality and health, and behavioral change. This evaluation
will seek to check if child obesity rates are decreased in Dayton community. This will be done in
community meeting assisted by leaders and focus groups in schools to get some feedback. It will
use both quantitative and qualitative ways to collect data to have view of the program?s goal.
Results will reveal the success of the program implementation in community and thus success in
school settings as well and how well were the goals achieved.
1. Evaluation Goals
Table 1. Evaluation Goals
Type of Evaluation
Evaluation Goal
Formative Evaluation
The evaluation seeks to achieving the program goals and
improving the program during program development and
implementation (RHIhub, 2018 ).
Process Evaluation
The evaluation tests the early results of the program and check if is
on track with the plan, what challenges are faced during
implementation and plan modification needed to reach the goal. It
describes various procedures, activities, and policies of the
program (JBA, 2007).
Impact Evaluation
Impact evaluation measures the effectiveness of the program on
target population. It measures modification in awareness,
knowledge attitudes, behaviors, etc. (RHIhub, 2018 ).
Outcome Evaluation
Outcome evaluation focuses if long and short team goals are met.
It measures change in quality of life and behaviors (RHIhub,
2018)
2. Data Collection
Table 2. Evaluation Data Collection Strategy
Evaluation
Evaluation
Measures/Indicators
Purpose
Question
Formative
Evaluation
Does in school
intervention show
any change in
BMI of children
and their
behavior?
Elements that can be
observed are BMI and
total weight. Also,
attitudes and behavioral
changes can be detected
if kids were asked to
plan their own weekly
Data Collection Method
Data can be collected by
making surveys, group
discussion, assigning tasks for
the children as asking them to
plan their own weekly diet,
pack their own lunch box,
planning their workout at home
diet and we offered
some options on the
assessment and asked
to pack their own lunch
box or at least choose
what they want to pack
for school. Also, time
per week spent in
workout and screen
hours can give a clear
idea of the short- and
long-term results of the
program.
routine and duration. This can
be done on small group of the
total target population
monitored by public health
educator and no statistical
analysis is necessary.
Process evaluation
intends to check is
program progress
is on track or
challenges forced
changes in the
plan. It specifies
services offered in
the program and
the target
population and it
relies on
stakeholders?
perception of the
program
It is a progress indicator
that is observable and
measurable. In this case
we measure the kids?
weight and BMI to
check change every
month to check kids?
progress.
Nutritionist will check
children?s BMI and public
health educator and teacher will
monitor and report number of
healthy meals they have and the
number of hours they work out
per week.
It studies the
impact of the
program on target
Impact indicators
include changes in
Is there reduction
in screen time
accompanied with
increase of
physical activity?
Written
assessment does it
reveal that
children have
better
understanding of
nourishing food
and why it is
important to stay
away from high
sugar food and
soda drinks.
Are results
indicating that the
short-term goals
are met?
Process
Evaluation
Impact
Evaluation
Observe any
modification in
adopting healthy
behaviors such as how
many healthy meals
and snacks kids eat in
school every week, and
how many hours they
practice.
This evaluation depends on
quantitative data from
community using surveys filled
Outcome
Evaluation
population and
stakeholders.
Impact evaluation
reveals not only
the result but also
the modifications
due to these
results.
awareness, knowledge
by community members and
and skills (RHIhub, 2018) children?s parents.
Its focus is to
achieve both the
short as well as the
long-term program
goals. Outcome
evaluation detects
the progress in life
quality and health,
and behavioral
change.
Outcome Evaluation
measures program
effects in the target
population by assessing
the progress in the
outcomes.
Data can be collected from
nutritionist, psychiatrist,
pediatric clinic, surveys and
focus groups to determine all
qualitative and quantitative
aspects of this program.
Increased mental and
physical wellbeing and
increased knowledge
are major indicators.
Quantitative information will
include BMI, weight, hours of
workout per week.
Qualitative data will include
behavioral, attitude and quality
of health and life.

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