Cholera is a highly contagious disease. It could cause death and widespread human suffering as manifested during the 2012 cholera outbreak in Sierra Leone, where thousands of people lost their lives and many more were infected in the latest outbreak to ravage the country (World Health Organization, 2012). Owing to the devastating nature of the epidemic, many health agencies (public and private) collaborated to introduce new interventions to manage the disease (World Health Organization, 2012). Some of these interventions included improving access to fresh water, improving sanitation facilities, and improving access to health care facilities. Most of these interventions were emergency responses to the epidemic, while others provided a long-term solution to the public health crisis (World Health Organization, 2012). The proposed study strives to investigate the efficacy of these interventions, with the goal of improving the country’s response to another disaster.
Justification of Public Health Issue
Every day, key decision makers in the public health practice seek new information to improve the efficacy of their public health programs. An article by Mandelblatt, Fryback, Weinstein, Russell, and Gold (1997) argues that funders and practitioners seek the same information because they want to have adequate information to underpin their decision-making processes. In line with this understanding, Waters et al. (2006) affirm that research information which relates to public health issues are not isolated to the evidence underpinning the effectiveness of public health interventions. In this regard, Mandelblatt et al. (1997) recommend that public health researchers need to evaluate the effectiveness of public health interventions. Alternatively, an article by the Medical Research Council (2012) shows that, evaluating existing public health interventions is important in developing and implementing complex interventions in public health. It affirms this view through the advancement of the “2000 MRC Framework for the Development and Evaluation of RCTs for Complex Interventions to Improve Health” (Medical Research Council, 2012, p. 4). Although both research articles (mentioned above) highlight the importance of evaluating public health interventions differently, they both cite economic, health, and public accountability reasons as the main motivations for doing so. Each of the articles described above speak to policy and advocacy gaps because they both show the importance of seeking new information about existing public health interventions to improve the efficacy of public health interventions.
What Interventions are being used to Address the Public Health Issue
Rychetnik, Frommer, Hawe, and Shiell (2002) recognize the complexity of identifying an effective tool for evaluating public health interventions because most of them require multiple, flexible and community-driven instruments for assessing the quality of public health interventions. Rychetnik et al. (2002) also say that the systematic review of randomized control trials (RCT) is one way that most researchers could evaluate the efficacy of public health interventions. This method uses the concept of levels of evidence to establish whether a public health intervention is appropriate for clinical practice, or not. The biggest limitation leveled against the adoption of the RCT is its inability to accommodate the flexibility and complexity of public health interventions. Comparatively, the Medical Research Council (2012) says that observational studies outline a different way of evaluating public health interventions. Many researchers believe that observational studies could produce findings that have the same level of accuracy as RCT trials, but few of them agree that they could reach this level of accuracy without additional evidence to justify it (Rychetnik et al., 2002). While this method has been widely appraised by many researchers, some of them believe that it is highly prone to bias (Mandelblatt et al., 1997).
Impacts of the above Interventions
The RCT and observational studies have had a profound impact on the quality of research data obtained from public health programs because they provide meaning and context to public health interventions (Schwartz et al., 2014). For example, they could explain whether public health interventions succeed or fail, depending on the community context. Furthermore, both techniques are strong on validity and in-depth understanding of public health interventions (Rychetnik et al., 2002). This way, it is easy to understand the purpose and implementation techniques of public health programs.
Alternative Intervention that could Address the Public Health Issue
Program accountability is an alternative intervention that could address the public health issue. Schwartz, Price, Deber, Manson, & Scott (2014) propose it as a framework for demonstrating accountability to several stakeholders who may be involved in implementing a public health program. Such stakeholders may include funders, policy makers, community members, state health agencies and non-governmental organizations (Rychetnik et al., 2002). Depending on existing health needs, stakeholders may require that public health officials demonstrate how their public health programs reduce mobility and morbidity. The same stakeholders may require that the officials demonstrate that they use money efficiently or that increased support would lead to improved health outcomes (Rychetnik et al., 2002). By making sure there is accountability to program stakeholders this way, it is easy to identify effective public health interventions, maintain them and discontinue those interventions that do not add value to the shareholders’ goals. If we extrapolate this narrative to the proposed study, we find that, program accountability would help us to know which public health interventions align with the goals of the stakeholders and which ones misalign with the same. Those that are misaligned are possible contenders for discontinuation, while those that align with stakeholders’ goals are potential candidates for continuation.
Potential Strength and Challenges
Improved efficiency is the main strength associated with program accountability. Since many public health activities are government-sponsored, it is easy to tolerate inefficiencies (Schwartz et al., 2014). Program accountability helps to reduce this flaw by making sure that the health programs meet stakeholder goals. The main challenge of program accountability is its reliance on structure and processes. Therefore, public health interventions that lack such structures and processes are vulnerable to poor adoption of the intervention. Collectively, the above-mentioned issues highlight the greatest strengths and weaknesses of program accountability.
Overall Impact of this Intervention
The overall impact of program accountability to the public health practice is widespread. While some experts believe that it would improve the effectiveness of public health interventions, others see it as a complication for the implementation of public health practice. For example, Schwartz et al. (2014) say that, program accountability could complicate the implementation of public health programs by presenting challenges relating to governance and funding arrangements. In line with this assertion, Schwartz et al. (2014) say adopting program accountability would create multiple accountability pressures, and encourage the introduction of interventions that are measured over a long time. Collectively, these factors show that, program accountability could affect the types of health interventions introduced in public health crises.
References
Mandelblatt, J., Fryback, D., Weinstein, M., Russell, L., & Gold, M. (1997). Assessing the Effectiveness of Health Interventions for Cost-Effectiveness Analysis. J Gen Intern Med, 12(9), 551–558.
Medical Research Council. (2012). Developing and evaluating complex interventions: new guidance. Web.
Rychetnik, L., Frommer, M., Hawe, P., & Shiell, A. (2002). Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health, 56(1), 119-127.
Schwartz, R., Price, A., Deber, R., Manson, H., & Scott, F. (2014). Hopes and Realities of Public Health Accountability Policies. Healthcare Policy, 10(1), 79-89.
Waters, E., Doyle, J., Jackson, N., Howes, F., Brunton, G., & Oakley, A. (2006). Evaluating the effectiveness of public health interventions: the role and activities of the Cochrane Collaboration. J Epidemiol Community Health, 60(4), 285–289.
World Health Organization. (2012). Cholera in Sierra Leone: the case study of an outbreak. Web.