JA-CHRODIS Work Package 7 Diabetes: a case study on...

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JA-CHRODISWorkPackage7

Diabetes:acasestudyonstrengtheninghealth

careforpeoplewithchronicdiseases

SWOTANALYSISOVERVIEW

OFNATIONALORSUBNATIONALPOLICIESANDPROGRAMS

ONPREVENTIONANDMANAGEMENTOFDIABETES

Successful strategiesus

Successfulstrategies


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Table of Contents

Executivesummary 3

Acknowledgements 4

Introduction 5

TheSWOTanalysis 6

Methods 8

Results 9

References 14

APPENDIX-SWOTAnalysisform 15


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ExecutiveSummaryIntheframeoftheJA-CHRODIS,diabetesisconsideredacasestudyonstrengtheninghealthcareforpeoplewithchronicdiseases.Theworkpackageondiabetes(WP7)focusesonallthemajor aspects of a serious disease like diabetes: identification of people at high risk,preventionandearlydiagnosis,healthpromotion inpeoplewithdiabetes,comprehensivemultifactorial care, prevention of complications, educational strategies for people withdiabetesandtrainingforhealthprofessionals.TheWP7teamconductedasurveytoprovidea structuredoverviewabout current programs, and a SWOTanalysis to give a qualitativeoverview,byCountry,ofthecurrentpoliciesandprograms,includingsuccessfulstrategies.TheSWOTanalysisisastrategicplanningtoolusedtoevaluatetheStrengths,Weaknesses,Opportunities,andThreatsofapolicy,aprogram,aprojectoranintervention.

ThisReportdescribes the resultsof theSWOTanalysis relative to theexpertoverviewonsuccessfulstrategiesandstrengths.

A totalof fifty-three stakeholders in12Countries contributed to theSWOTreportingandanalysing 39 policies. The texts of the SWOT, has been coded inductively, building up aninterpretativemodelbasedonemergingcategoriesclassifiedinthreethemes:approaches,features,capacitybuilding.

To be a "success", a policy or a program needs to be dynamic, bottom up, flexible,integrated, multi-intersectoral, and equity oriented. External communication anddisseminationisakeypointforsuccess,andthepartnershipamongstakeholdersshouldbekeptactivethroughouttheprocess.

According to the responders, a strong scientific background is considered a key point.StrategiesshouldbecomprehensiveandaddressthemostcommonriskfactorsofthemainNCDs. A clear description of the care pathways is needed supported by an informationsystematnational,subnationalandlocallevel.Planninganddefinitionofsoundobjectiveson Integrated Care, is leading starting point Regular monitoring and evaluation, with adefined and shared set of outcomes and indicators, are important drivers for programsimplementation.Astrongandefficientleadershipisneeded.

Capacitybuilding is intendedas thedevelopment and strengtheningof human resources,focusing on people with diabetes and professionals. Good educational models and carestrategiesareessentialandneedtobesharedwiththepersonswithdiabetes.


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Acknowledgements

Thefollowingexpertsdesignedthestudy,performedthedataanalysisandpreparedthereport:

AngelaGiusti,BrunoCaffari,FlaviaLombardo,MarinaMaggini(ISS)ThefollowingpartnersandexpertscontributedtothedatacollectionfortheSWOTanalysis:AustriaBrigitteDomittner,SabineHöfler(GÖG).IlanaVentura,RobertMoschitz,PetraLehner,StephanieStürzenbecher,GerhardHofer,EvaKernstock,RobertGriebler.BelgiumValentinaStrammiello(EPF).VivianedeLaveleye,StijndeCeukelier.FinlandJaanaLindström,KatjaWikström(THL).AuliPölönen,HeikkiOksa.FranceAlainBrunot(MoH)GermanyAndreaIcks,UlrikeRotheGreeceTheodoreVontetsianos(YPE)ItalyMarinaMaggini,AngelaGiusti,BrunoCaffari,FlaviaLombardo,FlaviaPricci(ISS),MassimoMassiBenedetti(HIRS),RobertoD'Elia,PaolaPisanti(MINSAL).AlbinoBottazzo,RitaStaraLithuaniaZydruneVisockiene(VUKSK)NorwayMonicaSørensen(HOD)PortugalJoséManuelBoavida,CristinaPortugal(DGS)SloveniaJelkaZaletel(NIJZ)SpainVendulaBlayaNováková,MaríadelMarPolodeSantos,AntonioSarríaSantamera(ISCIII)EIWHPeggyMaguire,MaeveCusackEWMAAlbertoPiaggesi


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Introduction

The challenge facing decision-makers and leaders in health care, is how to strengthenchronic disease prevention and control efforts, and how re-design health care system tobetter meet complex needs of persons with chronic diseases like diabetes. In 2011, theGeneralAssemblyoftheUnitedNations,withEUsupport,adoptedapoliticaldeclarationonthe Prevention and control of non-communicable diseases. World leaders committedthemselvestostrengtheninternationalcooperation,includingcollaborativepartnershipsinsupport of national, regional, and global plans for the prevention and control of non-communicable diseases, through the exchange of best practices in the areas of healthpromotion, legislation, regulation and health systems strengthening, training of healthpersonnel,anddevelopmentofappropriatehealth-careinfrastructure.

The European summit on chronic diseases (Brussels, 2014) stressed the need for jointefforts, at European level, to optimize resources and energy to address major chronicdiseasesacknowledgingtheneedforacoalitionacrosssocietytopreventchronicdiseases,preserving the best state of health and sustainability of a modern health system, withobjective of maximizing the years of healthy life of European citizens.(ec.europa.eu/health/major_chronic_diseases/events/ev_20140403_en.htm).

The launch, in 2014, of the European Joint Action on Chronic Diseases and PromotingHealthyAgeingacrosstheLifeCycle(JA-CHRODIS),isaresponsetotheobjectivessetbytheUnitedNationsand theEuropeanCommission.Thegoalof the JA-CHRODIS is topromoteand facilitate a process of exchange and transfer of good practices among countries andregions, for effective action against chronic diseases, with a specific focus on healthpromotionandchronicdiseaseprevention,onco-morbidityanddiabetes.

IntheframeoftheJA-CHRODIS,diabetesisconsideredacasestudyonstrengtheninghealthcareforpeoplewithchronicdiseases.Theworkpackageondiabetes(WP7)focusesonallthemajor aspects of a serious disease like diabetes: identification of people at high risk,preventionandearlydiagnosis,healthpromotion inpeoplewithdiabetes,comprehensivemultifactorial care, prevention of complications, educational strategies for people withdiabetesandtrainingforhealthprofessionals.JA-CHRODISisnotaresearchproject,thusitsmain objective is to use the knowledge already available, to improve coordination andcooperationamongcountriestoactondiabetes,includingtheexchangeofgoodpractices,andtocreategroundfor innovativeapproachestoreducetheburdenofchronicdiseases.SpecialemphasisisalsogiventosupportthedevelopmentandimplementationofNationalDiabetesPlans.

Toprovideanoverviewonpracticesforpreventionandmanagementoftype2diabetes,theWP7 team conducted a survey to provide a structured overview about current programs(interventions, initiatives, approaches or equivalents) that focus on aspects of primary


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preventionofdiabetes, identificationofpeopleathigh risk,earlydiagnosis,preventionofcomplications of diabetes, comprehensive multifactorial care, education programs forpersonswithdiabetesandtrainingforprofessionals.Theresultsofthesurveyarepresentedin the Report "Survey on practices for prevention and management of diabetes"(www.chrodis.eu/wp-content/uploads/2016/01/Report-prevention-and-management-diabetes-Final.pdf)

To complement this quantitative analysis, a SWOT analysis was conducted to give aqualitativeoverview,byCountry,ofthecurrentpoliciesandprograms,includingsuccessfulstrategies.Theaim is tooffer insights, fromthePartnerspointofview,onwhatmakesapolicy/program applicable, sustainable, and effective from a public health and from thestakeholders’ perspectives, what are the necessary preconditions for its implementationand what are the lessons learnt from the experience. It also provides a backgroundperspectiveofthesettingwheregoodpracticesaredeveloped.

TheSWOTanalysis

TheSWOTanalysisisastrategicplanningtoolusedtoevaluatetheStrengths,Weaknesses,Opportunities,andThreatsofapolicy,aprogram,aprojectoranintervention.Althoughthemethodhasbeendeveloped in theareaofbusinessand industry, ithasbeenextensivelyused in community development programs, health and education. The strengths of thismethod are its simplicity and applicability to different contexts and levels of analysis,includingpoliciesandprograms'implementationandevaluation.

The purpose of performing a SWOT is to reveal positive forces that work together, andpotential problems that need to be recognized and possibly addressed.It also enablesparticipants to make a judgment and share their vision on the four aspects mentionedaboveinordertoenrichthecommonperception.

TheSWOTanalysisalsooffersasimplewayofcommunicatinginaglanceaboutinitiativesorprograms. In a SWOT analysis (Fig.1) both internal attributes and external conditions aredescribed:

• Strengthsareinternalattributesofthepolicy• Weaknessesareinternalattributesofthepolicythatneedtobeaddressed• Opportunitiesareexternalconditionsthatmayfacilitatethepolicyimplementation• Threatsareexternalconditionsthatmaystandinthewayofthepolicyimplementation.

The analysis addresses and highlights all the characteristics, relationships and synergiesamonginternalandwithexternalvariablesofaphenomena(i.e.policyorprogram).Forthisreason, the stakeholders involved in the analysismust have a specific knowledge of thetopicandhaveanoverviewofthecontext.Theanalysiscanbeperformedaccordingtotwo


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differentapproaches:basingonthesingleexperts'pointofviews,collectedbyaresearcher,or inaparticipatoryway,throughfocusgroups,metaplanorotherparticipatorymethods.Thissecondapproachprovidessharedscenarios, taking intoaccounttheexpertaswellasotherstakeholders'perspective(i.e.specificpopulationgroups,associations).

ThetimingoftheSWOTvariesdependingontheobjectives.Theanalysiscanbe

• ex-ante,toimproveplanningandintegrationofaprograminitscontext,i.e.toevaluatethepreconditionsfortheprogramimplementation;

• intermediate,todeterminewhether,inrelationtothechangesinthecontext,thelineofactionsidentifiedarestillrelevant;inthisphase,itcanprovideelementstodecidechangesintheprogram;

• ex-post,forevaluationpurpose.

Oncetheinternal(S&W)andexternal(O&T)attributesofthetopichavebeendescribedindepth,somestrategicactions, thatcan leverageonS&OinordertoaddressW&T,canbeidentified bymaking a cross analysis of internal and external factorswith themicro andmacro environments of the program. It is also possible to set lines of actions to beimplemented (intermediate), to describe the story of success and to producerecommendationsbasedon lesson learnt (final). Furthermore, themethodologyallows tomake a cross analysis of internal and external factors with the micro and macroenvironmentsoftheprogram.

Figure 1. Structure of a SWOT analysis


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MethodsThemethodologywaspresented,discussedandagreedduringthe3rdmeetingoftheWP7,heldinRomeonJuly2-3,2015.Duringthemeeting,apilotanalysishasbeenconductedbythe Partners. A SWOT analysis form (Appendix) has then been sent to all WP7 Partnersthrough the WP7 web based Community of Practice (http://www.iss-cnesps.it/course/index.php?categoryid=2).

StartingfromwhatalreadyreportedintheWP7questionnaires,thePartnerswereaskedtoinclude in the analysis five main current policies/programs on prevention and care ofdiabetesasstandalonepolicies/programsoraspartofamorecomprehensivenationalplan(chronicdiseasesprogram,…).Inthecontextofthisanalysis,weconsideredasapolicythestated principles that guide the actions of government. The partners, and participatingexperts,werealsoaskedtodescribethesuccessfulstrategiesandthelessonslearnt.

Apublicpolicy isapurposiveandconsistentcourseofactionproducedasa responsetoaperceivedproblemofaconstituency,formulatedbyaspecificpoliticalprocess,andadopted,implemented,andenforcedbyapublicagency.ANationalProgramusually,butnotalways,followsandtranslatesintoactionaNationalPolicy.

Thosepartnerswhorepresentassociations/organizationsconductedtheSWOTconsideringpolicies on specific arguments. The level of analysis has been national/federal or subnational. If no policies were available in a Country, the analysis addressed the externalfactors that could make the policy/program feasible and sustainable or that might beconsideredasexternalthreats.

Figure 2. SWOT analysis: the options


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IntheSWOTanalysisdifferentdimensionscouldbeexplored,includingdifferentaspectsofthepoliciesandprograms thatweredeemed relevant suchas:planning,endorsementbypolicy makers and stakeholders, implementation, organizational changes, partnerships,intersectorality, management, aspects relating to human resources, technology andinformationsystems,coordinationofcare(i.e.interdisciplinarity),funding,integrationwithother policies/programs, supported by laws or regulations, leadership, empowerment,capacitybuilding,monitoringandevaluation,internalandexternalcommunication.

Thestepsforthetextanalysiswere:qualitativecontentanalysis,inductivedevelopmentofcategoriesanddeductiveapplicationofcategories.TheanalysiswasconductedusingNVivo10.0softwareforqualitativedataanalysis.

ResultsByNovember2015,14SWOTanalyseshadbeensenttotheWP7coordinationteam.ElevenCountry SWOT with policies and programs analysis were conducted by: Austria, Finland,France,Germany,Greece,Italy,Lithuania,Norway,Portugal,Slovenia,Spain.Inadditiontothe Country analyses, EWMA, EIWH and EPF/IDF made analysis of policies on differenttopics:

- EPF/IDFEurope-->Patients’perspectiveofnationalpoliciesinBelgium- EIWH (European Institute of Women Health)à Gender perspective of national

policiesandprogramsonpreventionandmanagementofdiabetes- EWMA(EuropeanWoundManagementAssociation)àManagementofthediabetic

footandeducationofprofessionals:ageneraloverviewacrosstheEU.

A totalof fifty-three stakeholders in12Countries contributed to theSWOTreportingandanalysing39policies(Tab.1,Fig.3).

Table 1. Figure 3. Countries contributing to

the SWOT

N.stakeholdersinvolved 53meanperSWOT 3.7(1-10)

N.policiesincluded 39meanperSWOT 2.8(0-6)

Methodsofparticipation email 10/22

meeting 9/22groupvideocall 2/22individualcall 1/22


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Figure 4. Mind map of successful strategies representing the emerging themes and categories

AllthetextsoftheSWOT,hasbeencodedinductively,buildingupaninterpretativemodelbased on the emerging categories, as described by the partners (Fig.4). The successfulstrategies have been derived from the "Strengths" and "Successful Strategies" items(Appendix).ThecategoriesemergingfromtheSWOTanalysishavebeenclassifiedinthreethemes:approaches,features,capacitybuilding.

Approaches

Tobea"success",apolicyoraprogramneedtobebuiltonabottomupapproachandtheprocessshouldbedynamic,beingadaptedonaregularbasis,with"theconstantinputandfeedback by the stakeholders and involved organizations". The programs should also beflexibleenoughtogiveageneral frameworkforactivities,which"facilitatesrelativelyfreeconduct of the project by different partners". As a result, newmodels and practices aredevelopedbottomup,basedon localneeds,resourcesand initiatives. Inthesameway,anational scalediseasemanagementprogramcanprovidea general frame,while the sub-national levels can develop their own structured diabetes programs, which "take intoaccount regional differences, geographic distances in some less populated regions", andotherspecificcharacteristicsofthelocalcontext.

The integration of different policies and programs is a key point, cited by 9 partners.Diabetes prevention and treatment can be successfully integrated within other chronicdiseases and health promotion programs, comprising primary, occupational, specializedhealth care and cross-sectional interventions. Moreover, "the consistency between the


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different National Health Programs and Plans", produces a synergy of actions at sub-national level, where actions and interventions are to be locally developed. Beyond thehealthsector,aparticipatory"healthinallpolicies"approach"supportstheimplementationofa strategy,assists in intersectoral cooperationand therefore leads towin-win solutionsforcomplexproblems".

Accordingtothepartners,anintersectoralapproach:"maximizesthehealthco-benefitsofother sectors" (i.e. municipalities, NGOs, national and local scale patient's associations,educationandsocialsector,privatesector,food,drugandequipmentindustry,marketing,media, universities and research institutes, political decision makers); enhances thenetworking and the concerted action; supports shared commitment and ownership,reducing the solo-thinking that is distinctive of themono-sectoral approach. All partnersand stakeholders, both nationally and locally, should be "involved and engaged alreadyfrom the very beginning of the planning", and the partnership should be kept activethroughouttheprocess.Withinthehealthsector,particularlyimportantisthepartnershipof"theregionalandnationalmedicalassociations".

TheactiveengagementofNGOsandAssociations isdeemed fundamental to improve thegeneralawarenessonspecifictopics, i.e.thegenderperspectiveandthecomplexdiabeticfoot disease. When the collaboration among different partners from different sectorsbecamesystematic,thenetworkingmaycontinueevenaftertheendoftheproject.Inorderto promote a successful intersectoral approach, it is important to demonstrate "how thegoalsof theprogrampromoteandcomplement theenforcementof themission"ofeverystakeholder/organization.

All partners have highlighted the key role of the Associations of people with chronicconditions, whose actions and advocacy are described as "strong and proactive". In onecase, the program "was enabled by the initiative by a strong and distinguished patientorganization and further facilitated by strong support by national authorities and localdecisionmakers".

The multi and interdisciplinary approach is another successful strategy, aimed to anintegrationofskillsandknowledgeatalllevelsofthehealthsector,andseemstoimprovequalityofpreventionandtreatment"withoutnecessarilyincreasingitstotalcost".

Health equity intended as "equality of opportunities for all" is, in some case, specificallyreferredtolowsocioeconomicandminoritygroups.Fromagenderperspective,apartfrompregnancy,thereseemstobenospecificattentiontowomen'shealth.Theissueofgender"shouldbe consideredonbothnationalandEU levels" ofpoliciesandprograms.Partnersrefer a favourable reimbursement system of diabetes treatment, and the universalaccessibilityofcare,asasuccessfulstrategytoaddresshealthequity.

External communication and dissemination is another key point for success to creategeneral public awareness, media visibility, and to increase the knowledge of and theparticipation in theprograms.Communicationexpertsshouldwork"inclosecollaboration


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withthehealthcareprofessionalsintheprogram";aspecificcommunicationunitshouldbeestablished to define the communication plans and to coordinate the activities: mediacampaigns,pressconferences,newsletterstopartnersandmedia,pressreleases.Thesamegroup should coordinate the production of reports, information sheets, counselingmaterialsandothermaterialsforinternalpurposes.

Features

Accordingtotheresponders,astrongscientificbackgroundisconsideredakeypoint.Theguidance supporting the national and local programsmust be evidence-based, providingdataontheexpectedhealthoutcomes(i.e.reductionofincidenceofulcersoramputationrates), diabetes prevention possibilities and risk scores. Evidence-based guidelines andspecific prescription criteria and protocols for the management of diabetes are alsoprovided.Insomecases,theguidelineembracestype2diabetesprevention,earlydetectionandcare,type1diabetesinchildhoodandadolescence,gestationaldiabetesanddiabetesprevention in childhood and adolescence. It is highlighted that the strategy is "not onlyevidence-based,butalsoaresultofaconsensusbetweenalltheparties".Strategiesshouldbe comprehensive and address the most common risk factors of the four main NCDs(cancer,COPD,CVDanddiabetes),asmostofthepersonswithchronicdiseases"sufferfrommore than one NCD and will benefit from disease prevention initiatives cut across thespecificdiseases".Thus,strategiesshouldbebothdiseasespecificandunspecific.Diabetesprograms should "be proactive rather than reactive". Attention has to be paid toprevention, promotion of healthy lifestyles and early detection of new cases, as well aspreventionofcomplications.

From the organizational point of view, a successful strategy include the definition of theneededpositions(e.g.diabetesnurses,podiatrists,psychologists,dieticians)andastrategiccontinuityofcareatalllevelsofthesystemofcare.Acleardescriptionofthecarepathwaysisneeded,addressing specific groups (differentages,pregnancy), and theareasofhealthpromotion, diabetes prevention and treatment, included specialist and intra hospitalreferral.Insomecases,thecarepathwaysaredefinedatnationallevelandsupportedbyaninformation system at national, sub national and local level. Remote consultation andsharedmedicalelectronicrecordfacilitatesaccesstotheindividualdatabypersonitselfandby thehealthcareprofessionalsworkingondifferenthealthcare levels.Earlydetectionofnewcasesofpatientdecompensationsmaybehandledthroughanautomaticalarmsystemimplementedthroughthe integratedelectronicmedical record.Aperformant informationsystemandtheofferofe-servicescanreducetheattendanceinoutpatientclinics,decreasetheaverageresponsetimeforhospitalreferralandreducethehospitalconsultation.

Regular monitoring and evaluation, with a defined and shared set of outcomes andindicators,areimportantdriversforfurtherprogramsimplementation.Both"quantitative-whathappened-andqualitative-whyandhowithappened-evaluationmethods"canbefruitfully applied. Successful strategies include also "population-level evaluation and asystematicmediafollow-up",includingpopulationawarenessondiabetesandotherchronic


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conditions. An efficient monitoring system makes it possible to measure patients'outcomes,quality,effectivenessandcostoftheinterventionsonprimarycareandhospitallevel.

Fromtheplanningpointofview,dividingtheprogramintosub-programshasfacilitatedtheefficientandcoordinatedconductofthewholetask.ThedefinitionofsoundobjectivesonIntegratedCare, sharedamongnationalandsubnational levelhasbeena leadingstartingpoint.Astrongandefficientleadershipisneeded,atgovernmentallevel(forpolicyaction)aswell as subnational and local level. The key elements of the leadership described are:shared values as the basis of the program, multi-disciplinarity and multi-sectorality,centralized and shared coordination, at national, sub-national and local level, efficientplanning,reportingandcommunicating,experiencedgroup,politicalsupport,supportandownershipbyprofessionals,adequatefunding,proactivecommunication,socialdemandfortheaction.

Internalcommunicationisanotherkeypoint,includingtheactiveinvolvementofdoctorsintheirownpractice,especiallyduring the implementationphase.PracticeoutreachvisitofGeneral practitioners by the diabetes teams seems to be a successful strategy. Internalcommunicationcanbebasedonmarketing strategies, inorder toenrol in theprogramalargenumberofphysicians.Email,newsletters,reports,aswellasface-to-facemeetingandseminars can ensure efficient internal communication. Information and communicationtechnologiesarereportedasdeterminantforaneffectiveinternalcommunication.

Althoughastructuredandcontinuedfundingisdifficult,differentsourcescanbeinvolved.Insomecases,themunicipalitiesandorganizationsinvestedalsotheirownfunds,engagingthemintotheprogram.FinancialincentivesforgoodpracticesofdiabetesfollowupbyGPshave been undertaken in some cases. In any case, budget allocations are needed for aneffectiveimplementationoftheprograms.

Capacitybuilding

In this analysis, capacity building is intended as the development and strengthening ofhuman resources, focusing on peoplewith diabetes and professionals. Good educationalmodels and care strategies are essential and need to be shared with the persons withdiabetes,"toensuresuccessfulmanagementof the illnessandagoodqualityof life".Thetheoreticalknowledgenecessarytodevelopconsistent,up-to-dateeducationalreadyexistsas well as structured curriculum, basic and advanced courses and other educationalinitiatives (e.g. people at high risk, newly diagnosedpeople,management of thediabeticfoot),includedindividualandgroupmodelsandpeergroups.Differenteducationalmodelshavebeentestedandevaluatedandcanbeeffectivelyusedandadaptedtospecificneedsand contexts. Still, the specific educational needs have to be identified and the demandanswered,developingtoolstoraiseawarenessandhealthliteracy,tosupportself-efficacy,self-management and patient-centered care, and to promote individual and groupempowerment.


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Inthesameway,effective,up-to-dateandevidence-basedtrainingfortheprofessionalsisimportant.Starting fromthe identificationof thetrainingneeds, thedemand isansweredand this increases the knowledge of health care professionals and improves theirengagement. A successful strategy in the training of the health care professionals is thechangeoftheeducationparadigmandshifttowardscoaching,insteadofteaching,andtheimproving awareness of the importance of counselling skills and self-managementeducationandtheunderstandingofthechangeprocess,itscharacteristicsandchallenges.Thus, new tools and techniques in prevention and care are adopted, such as solution-centeredcounselling,motivational interviewing,empowerment-basedapproachesandthehealthcareprofessionals trainingcurriculaarechangedaccording to theneweducationalneeds.

ReferencesPopeC,MaysN.QualitativeResearch:Reachingthepartsothermethodscannotreach:anintroductiontoqualitativemethodsinhealthandhealthservicesresearch.BMJ1995;311:42.

PopeC,ZieblandS,MaysN.Analysingqualitativedata.BMJ:BritishMedicalJournal.2000;320(7227):114-116.

PopeC,MaysN.Qualitativeresearchinhealthcare.July2006,BMJBooks.

Wikipedia,thefreeencyclopedia.SWOTanalysis.https://en.wikipedia.org/wiki/SWOT_analysis(lastaccessDec29th2015).


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APPENDIX

SWOTANALYSISFORM


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SWOT ANALYSIS

Country__________________________________ Date: ______________ Partner: __________________________________

Name of responder: _________________________________________________________________

Partners/Stakeholders involved in the analysis: _________________________________________________________________

_________________________________________________________________ _________________________________________________________________

Method of participation: ¨ Email¨ Meeting,workshop¨ Groupcall(skype,hangoutorother)¨ Other,pleasespecify__________________________________________

Included policies and programs: 1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

5. _____________________________________________________________________


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Strengths Weaknesses • …• …• …

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Opportunities Threats • …• …• …

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Successful strategies:

Lessons learnt:

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