The recent trends in the spread of HIV infection have been recognized by the World Health Organization as one of the most life threatening news. The epidemic is witnessed across the globe causing major distractions to individual, community, and even the entire national peace. The rate of morbidity as well as mortality has greatly risen in most places, continues to rise, and is projected to continue rising in the future, despite the various research activities being conducted by medical doctors and researchers in laboratories across the globe. Baltimore as a city is one of the places struck by the pandemic and has made various attempts to curb it. Nonetheless, human beings have used their intelligence and creativity in ensuring that however much the treatment may remain impossible, the rate of spread is minimized through conducting educational programs to boost the level of awareness by the public as well as provide various aids such as free condoms to curb the spread.
Morbidity and mortality rates are terms that are used in the health sciences or in the domain of public health to show the magnitude of the risks associated with a particular infection. The morbidity and mortality rates often determine the next course of action by the victims. It has been the concern of every individual to lower both morbidity and mortality. This paper develops a strategy that ensures a reduction of the morbidity and mortality rates in the Maryland state. The strategies developed to promote awareness include public education in both private sectors and public institutions. Other strategies include proper housing as well as the development of social platforms. The second part of the paper assumes a practical case where an individual in a leadership position would plan, organize, finance, regulate, and assure quality in the program. Using the policy process and political strategies, the second part of the paper indicates that a leader would work with existing public policies or advocate for new policies and deal with stakeholder opposition to assure the success of the program developed.
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The World Health Organization (WHO) defines morbidity as the number of times a disease or an epidemic occurs within a given population of people over a given period of time. In most insurance companies, the morbidity rates are applied in the determination of the relevant amounts of premiums charged on the customers. Similarly, insurance companies also use the morbidity rates to predict the possibility and frequency by which a customer may undergo. On the other hand, mortality rate refers to the rate or the likelihood of an occurrence of death in the event of a disease (Rehm et.al., 2003). This paper presents a program that is used to reduce the morbidity as well as the mortality for Baltimore, a Maryland county.
Epidemiological Basis for the Program
Epidemiology refers to the scientific study that deals with the cause patterns of attack as well as the causes of various diseases in a given population of people (Hoshino & Kapikian, 2011). In the domain of public health, epidemiological studies form the cornerstone since they basically not only focuse on the causes and distribution of various diseases, but also focuse on the formulation of ways of preventing any further occurrence of such diseases. The discipline stands as a pivot in world’s attempts to curb the spread of diseases since the major epidemiological reports often elaborate on the origin of various diseases, the mode of spreading as well as possible preventive measures (Hoshino & Kapikian, 2000).
Despite the various strategies that have been advocated in the attempts to control the spread of HIV infection in Baltimore over the last three decades, the data from the World Health Organization still show that the city is among the leading 10 urban areas in the country with respect to the level of HIV prevalence. For example, in 2009, the World Health Organization’s morbidity and mortality data showed that approximately 13,048 people were tested positive for the HIV virus (Tang et.al., 2000). Among the population tested positive for the virus in Baltimore City, 12, 809 individuals were adults including the adolescents aging above 13 years. 5620 individuals out of the total number of those tested positive were living with HIV, while the remaining 7189 were patients whose virus had developed into the advanced stage of AIDS (Tang et.al., 2000). Such epidemiological data therefore are vital for managers who plan to develop programs to help in the prevention of further spread of the virus. Curbing or reducing the number of people infected with the virus will greatly boost the attempts to lower the morbidity as well as the mortality rate in Baltimore.
Cultural Diversity and the Spread of HIV
The variation in the nature of cultural practices in Baltimore as a city has a great role to play in the general morbidity and mortality rates. The majority of cultural studies that have been conducted in the past have revealed that the types of cultural activities, which a particular group of people practices, influences greatly the rate of spread of various infectious diseases in such places (Parker, 2001). Cultural practices therefore are determinants of the morbidity and mortality rates for various diseases in many places.
For instance, in Baltimore, it is hypothesized that the great rate of HIV infection is a result of the increasing trend of irresponsible sexual behavior in the city. A number of city residents interviewed both in open and private forums have admitted to have engaged in unprotected sexual intercourses with multiple partners, but still expressed no fear or guilt in the practice (Barin et al., 1997). This trend therefore implies that there exists a general culture of acceptance to such sexual practices within the city. This culture has greatly exposed the city population to the risks of HIV infections. This increasing risk of HIV infection, which offers a breakthrough for other opportunistic infections among the city inhabitants, has therefore increased both morbidity and mortality rates, hence needs to be addressed. In addition, there is a culture that attaches little value to the dignity associated with proper housing (Barin et al., 1997). Poor housing conditions are also a major threat that has contributed to the high rates of morbidity and mortality within the city (Barin et al., 1997). The following strategies have been developed to help keep a check on the extraordinarily increasing rate of morbidity and mortality within the city of Baltimore.
The concerns about housing and how it influences the rate of morbidity and mortality within the city of Baltimore cut across various aspects of life. Other than being a cultural issue, the influence of housing within the city is also a matter of social justice as well as a health concern. The culture of a particular group of people determines the nature of the houses in which they live. This strategy aims to offer adequate support and stable housing system that ensures proper and affordable housing for the residents of the city (Mann et al., 1999).
The establishment of a stable housing system is one of the most efficient programs that can aid in the reduction of the morbidity and mortality related to HIV. The scarcity of the proper and affordable housing within the city has been identified as a root cause of residential segregation, failure of access to health care as well as school failure and dropouts (Mann et al., 1999). In order to curb such challenges heightening the morbidity and mortality related to HIV, there should be an expansion of various federal programs such as Housing Opportunities for Persons With AIDS (HOPWA). This program shall help to minimize homelessness and promote access to health care as well.
Reducing the Impacts of Incarceration
The impacts of incarceration are one of the new drivers for HIV infections across the world, including Baltimore. The impacts can therefore be reduced through the provision of regular voluntary testing to the confined class (Mann et al., 1999). These include the prisoners who should receive such tests both during entry and exit from the prison centers. This testing policy would help in facilitating treatment plans to those infected as well as boost the efforts of preventing further spread within prisons and the community at large. In addition to the tests conducted, the government through the city council would participate in HIV prevention through the provision of free condoms within prison facilities (Barin et al., 1997).
Provision of condoms for the prisoners in prisons would not only lower the HIV associated morbidity and mortality in prisons, but also in the greater communities into which they shall be released (Barin et al., 1997). The reduction of the impacts of incarceration as a method of lowering the morbidity and mortality within the city also involves the expansion of re-entry programs. These programs would work towards a smooth transition of formerly incarcerated individuals back into the societies. The expansion can be majorly achieved through educational programs, which equip the prisoners with basic skills requisite for qualification in the employment market. This strategy makes them more useful, hence being able to address HIV infection issues, drug and substance abuse, housing concerns as well as mental health before they are released from prisons.
Expansion of Substance Abuse Prevention Programs
The recent studies conducted with regards to the morbidity and mortality rates associated with HIV have revealed that 19% of the total new infections of HIV are related to drug injection techniques of drug abuse. In order to help the active drug users, programs that promote clean needle use should be established in order to curb the risks of infection through needle sharing (Barin et al., 1997). However, educational programs about drug and substance abuse should be conducted to inspire the city residents against the total use of drugs. Alongside discouraging the frequent drug users from continuing through various exchange programs, there should be a parallel program that administers special drugs to the perpetual addicts to help them recover from the addiction. Healthy lifestyles therefore would greatly boost efforts for lowering the morbidity and mortality rate (Mann et al., 1999).
Social Justice Platform
In addition to the programs elaborated above, a further step in the reduction of morbidity and mortality rates in Baltimore is the development of the social justice platform. In this regard therefore, there would be a movement known as “Kick AIDS Out of Baltimore” (KAOB), which shall be operated on the main purpose of carrying out activities aimed at reducing the number of new HIV infections within the city (Hoshino & Kapikian, 2000). The movement (KAOB) proposes that all stakeholders such as larger organizations and individuals working in various capacities in the HIV prevention plans review the progress of such strategies so as to ensure that the national target of reducing the rate of HIV infection by 25% in the year 2015 is fully achieved. The movement shall assume a conclusive remedy that will ensure a positive and a popular approach in the efforts to lower the morbidity and mortality associated with HIV within the city.
The strategy must be fully implemented to reduce morbidity and mortality in Maryland state. So that the strategy can be fully implemented, it calls for sound management of the process. This process of strategy implementation involves the following stages or sub-processes, which the management or the leadership in charge of the strategy implementation has to conduct. These stages include: planning; organizing: financing; regulation and quality assurance of the program.
It involves coming up with a sound chronological order of how the strategy is to be implemented and run. A plan, which is a list of activities, is drafted on how the whole process is to be undertaken within a particular period of time (Stock & Lambert, 2001). Planning takes into consideration aspects such as what are the strategic needs for it to be fully implemented, the cost to be incurred, the implications of strategy implementation, both positive implications or benefits and also negative implications or consequences, and the time limits within which the strategy ought to be implemented (Stock & Lambert, 2001).
The aspect of what the strategy needs so that it can be implemented deals with first identifying what is really needed in terms of resources and materials such as medical equipment for carrying out tests and experiments, vehicles for movement. The remuneration and allowances of the staff to be involved are also considered together with the materials they need to carry out the tasks that will be assigned to them (Stock & Lambert, 2001). Personnel to involve depends on the expertise and skills needed because of the strategy to be properly and fully implemented, it needs the input of different experts. These experts include the following: doctors, policy analysts, research experts, managers, accountants, and scientists.
Stakeholders to be involved in the process are also identified depending on the role they will play in the strategy. Some of these stakeholders may hail from the public sector such as government ministries, in this case giving more regard for the Ministry of public health. Government parastatals, especially those that deal with health issues, can also form a part of the stakeholders together with public-owned corporations. The stakeholders can also hail from the private sector as it can play a very critical role in the implementation of the strategy by offering helpful suggestions and recommendations for the better implementation of the strategy.
The NGOs (non-governmental organizations), especially in the field of health and related disciplines, can also be very instrumental in the strategy implementation in terms of facilitation, idea generation, and screening for purposes of the process and hence should be a part of the stakeholders (Devanna et.al., 2006). The list the stakeholders can also include the following: donors, officers, or staff from international bodies such as the World Health Organization (WHO)
The cost to be involved in the whole process is also pre-determined or approximated in the planning stage. This is properly done through the preparation of a budget so as to determine the total cost to be involved in the process. The budget is an approximation of the expected cost in monetary value, though it is not expected to be very accurate as it may deviate from the actual cost that will finally be used (Devanna et.al., 2006).
The implications of full implementation of the strategy are also determined, and in case of any negative implications or consequences as a result of the strategy, then it is determined how these negative implications will be dealt with. The positive ones or the benefits are also determined as well as the value they will add to the humanity as compared to the cost incurred and whether the prime objective of formulating the strategy will be achieved, which in our case is ‘reducing morbidity and mortality in the state of Maryland.
After planning, financial, physical, and human resources are arranged or placed in a logical order so as to move a notch higher in implementing the strategy. To start with, the identified human capital or personnel in the planning stage are placed in an orderly manner through assigning them different positions, roles or tasks, and responsibilities. This ensures the possibility of performing all the activities related to the implementation process as it is easier to co-ordinate the whole process when the duties are segregated (Devanna et.al., 2006). Also, one is accorded a task according to his or her own expertise or skills, thus ensuring efficiency and effectiveness. The physical resources and space are also arranged in such a way as to facilitate the performance of the activities involved (Austin et.al., 2003). The so-far gathered financial resources are also synchronized, put together, and each activity to be carried out is apportioned a certain percentage of the financial resources so as to ensure that these activities are carried out logically (Stock & Lambert, 2001).
Financing the Strategy
Financing deals with the provision of timely, cost effective, and secure financial resources for the implementation and actualization of the strategy (Stock & Lambert, 2001). The strategy cannot be implemented without finances and therefore getting the financial resources is a key step in achieving the strategy (Stock & Lambert, 2001). The sources of these funds may include: funds from donors, grants from the government, loans, careful spending, money from the general public through special events and campaigns, earned income from tenders and sales, and investments. After the funds are availed, it is determined what is needed and how to use the money for the achievement of the desired objective.
Regulation and Assurance Program Quality
After proper planning and organizing, regulation and assurance of the program quality will be easy since the implements will easily note where things are not working well. It will therefore be easy to regulate the implementation process and finally ensure that quality results are realized and thus the morbidity and mortality rates are reduced.
The strategy is expected to work in harmony with the majority of existing public policies, though to a certain extent it is expected to bring changes in the way things are done in the state of Maryland by its residents and also by the leadership of the state. These changes in terms of policy change through the formulation of better policies and advocating for behavioral change are unavoidable (Stock & Lambert, 2001). This is because it is through such that the desired objective of reduced morbidity and mortality in the state will be realized. The new formulated policies though meant to bring much good may affect some other parties negatively and therefore they might not welcome them, but may instead oppose them.
It is also clearly known that the majority of people are quite reluctant to change in especially behavioral aspects, despite the much better they may bring to them if they are affected. The political class is another group that needs to be very well convinced that the new strategy will work quite well for the good of all (Stock & Lambert, 2001). The above class needs to be fully convinced about the strategy, so that they can believe, embrace, enact it to a law in case it requires so, and promote it for adoption by everyone else in the state. Failure to get the support of the political class coupled with the general tendency of people`s reluctance to change will be very much detrimental for the strategy of implementation.
Since the objective of the strategy that is reducing morbidity and mortality in the state needs to be achieved based on its significance, it is best to assure the success of the strategy or program (Mayhew et.al., 1998). The above can be achieved by dealing with the stakeholder’s opposition in the following ways:
- Involving all stakeholders right away from the initial stages of the program or strategy formulation so as to take their views, opinions, and ideas into consideration and thus avoid future opposition by the same stakeholders.
- Creating public awareness of the positive impact that will be brought about by the program that is about reducing morbidity and mortality rates and making it well-known that the program is good for everyone.
- Clearly highlighting the objective of the program in a well understood manner by everyone to reduce misunderstanding and reluctance to change.
- Ensuring that critical stakeholders embrace the program, so that they can assist in reaching out to others to make them embrace the program, for example, if the leadership embraces the program, it can assist in reaching out to the residents to also embrace it.
- Increasing mass media campaigns through television, newspapers and radios.
- Bringing to the knowledge of people the significance of reducing morbidity and mortality levels.
- Educating the people on the consequences of refusing to change behaviors that increase morbidity and mortality and encouraging behavioral change by doing so.
In conclusion, the morbidity and mortality rates can be reduced in the state of Maryland through proper formulation of the correct strategy or program and by bringing into place better policies. Also, it may be beneficial to do away with some few policies that may not help in reducing morbidity and mortality and advocate for behavior change amongst all the residents of Maryland State.