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Objective orientated project planning (ZOPP)
Mark L Wahlqvist
International Health and Development Unit, Monash University, Melbourne, Australia

S A J Clin Nutr 2000 February Vol 13 No 1

Supplement
The imperative for identification and evaluation of effective intervention for health is growing. Evidence-based health care is increasingly the order of the day. The problem is that it is increasingly predicated on randomised double-blind clinical trials, which favour single factor, especially pharmaceutical, interventions for health (usually medical) management. The greatest potential for health advancement, however, resides in community-based interventions of a health promotional kind or ones to address widespread medical problems like low birth weight, HIV positivity, atherosclerotic vascular disease, mood disorders, obesity and age-related cognitive impairment - these are complex problems with genetic, lifestyle and societal contributors. For major reduction in incidence or prevalence, they require interventions which themselves may need to be multifactorial, albeit definable, sets of variables. The best chance for evidence acquisition here is likely to be the establishment of a model which would predict health outcomes in the same way as happens in the engineering sciences (e.g. predicting that an aircraft will in every instance fly without catastrophe to its required destination, a phenomenon not amenable to a clinical trial in the usual sense of the design).

Successful project planning in the government, non-government organisation (NGO) and corporate sectors is now becoming more and more relevant to the public health sector. One of the best examples is that developed by the German government and promoted by GTZ (the German Ministry of Science) in its aid projects. It is known as ZOPP (Ziel Orientierte Projekt Planung). First, it requires core problem definition, then with the enumeration of its consequences follows cause and effect analysis which offers various scenarios for intervention. Possible interventions are assigned priority on a probability-of-success analysis, along with assessment of affordability and resource requirement. Indicators are agreed, as are means of verification, and assumptions are defined. The ZOPPmethodology is now being used in public health nutrition to provide the evidence for nutrition programmes. It has the capacity to make a major impact in the clinical sector as well.

In some ways ZOPPfinds support from anthropologists who have developed RAP(rapid assessment procedures) and PRA (participatory rapid approaches), 1,2 which assess situations in cost-effective fashion where there are pressing health problems. The more familiar hypothesis testing approach, made more holistic, is reflected in the SHARP (Structured, Holistic Approach for a Research Proposal) methodology. 3

Unless human nutrition scientists embrace this kind of methodology, more affordable than many a pharmacological development with clinical trials, lifestyle and societal approaches to human health advancement may be overwhelmed by ones which are inappropriately simplistic less cohesive and more costly. Evidence-based nutrition is in need of this emergent field of scholarship.

1. Scrimshaw SCM, Hurtado E. Rapid Assessment Procedures for Nutrition and Primary Health Care. Tokyo: United Nations University, 1987.
2. McGranahan G, Leitman J, Surjadi C. Green grass and brown roots: Understanding environmental problems in deprived neighbourhoods. Journal of Environmental planning and Management 1998; 41: 505-518.
3. Gross R, Karyadi D, Sastroamidjojo S, Schultink W. Guidelines for the development of research proposals following a Structured, Holistic Approach for a Research Proposal (SHARP). Food and Nutrition Bulletin 1998; 19: 268-282.