Integrating Health

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Integrating Health In Local Government
Grace Blau, Nick Matteo, Angela Vindigni
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Aim

• Share the learning from three Metro Councils
  about the introduction of integrated planning
• Identify challenges for municipal public health
  planning
• Raise possibilities to progress integrated
  planning in local government

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Health Incorporated Moonee Valley City
Council Angela Vindigni Health Promotion Officer
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Organisational Structure
CEO
Organisation Strategy
City Services
Organisation Strategy
Community Development
Social Development
Community Well Being
Health Promotion Officer
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Health Incorporated
Project Aim Increase organisational capacity for
health promotion

• Map relationships between council department
  functions and their impact on health
• Increase understanding of Health Promotion
  Principles
• Integrate health promotion principles into
  Council planning processes
• Develop a Health Promotion Policy
• Develop KPIs for health in department service
  planning

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Health Incorporated
Leading the Way MAV/VicHealth health planning
resource tool
Moonee Valley Corporate/Council Plan
Health Incorporated Project
Review MPHP 2000-2003
Moonee Valley MPHP 2003-2006
Moonee Valley MSS
Project outcomes
MVM PCP Community Health Plan
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Health Incorporated
Project Description Phase 1
Education and knowledge development

• Questionnaires
• Workshops
• Mapping of department functions within the
  health promotion (Ottawa Charter) framework
• Leading the way with Councillors and Senior
  Managers
• Adopting Environments for Health Framework
• Provision of education and information across
  the organisation
• Reviewing Municipal Public Health Plan
• Redeveloping the Municipal Public Health Plan

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Health Incorporated
Project Description Phase 2
Integration

• Bring together information from Phase 1 of the
  project into the MPHP implementation (Developing
  KPIs)
• Develop detail and structure to support the
  integration
• Development of the health promotion tool

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Health Incorporated
Project Description Phase 3
Evaluation

• Re-test staff knowledge through questionnaire
• Review implementation tool
• Review Service Plans
• Review changes in practice

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Health Incorporated
Achievements

• Staff induction program
• Common framework (Environments For Health)
• Closer relationships and partnerships developed
  with departments
• Integrated overview of organisational functions

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Health Incorporated
Next steps

• Continuation of previous education
• Implementation planning for MPHP
• Establish of structures to support and review
  integration of health and well being in the
  organisation
• Implementation of the evaluation plan and
• Resource development

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Health Incorporated
What have we learnt?

• Need to maintain commitment across all levels of
  management
• Need to maintain communication and interest
  throughout the project
• Seek opportunities to shape practice around
  theory
• It take time

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Integrating Public Health into the Business of
Local GovernmentGrace BlauHealth Projects
Coordinator
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Objectives

• To develop structures and implement processes
  that ensure integrated planning
• To educate and train council officers and
  managers in the use of these structures and
  processes

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Organisational Structure
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Outline of Project

• Establish internal Project Reference Group
• Raise awareness of social model of health
• Conduct internal public health audits
• Propose recommendations

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Recommendations

• Futures Forum
• Workshop series
• Corporate training modules
• TBL reporting tools
• City indicators

• Responsibility for MPHP - strategic planning unit
  and public health planning unit
• Horizontally integrated planning group

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What have we achieved?

• Public health is now on the agenda
• Strategic planners and public health planners
  have now made contact
• There is an increased understanding of the
  plethora of planning frameworks being promoted in
  local government

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What is yet to be achieved?

• Obtain definitive commitment for collaboration
  between strategic planners and public health
  planners
• Develop structures and implement processes to
  ensure integrated planning
• Educate and train council officers and managers

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What have we learnt?

• Organisational priorities matter
• Position of MPHP is important
• Commitment to MPHP is vital
• Marketing the value of MPHP takes time
• Introducing integrated planning needs change
  leaders and change drivers

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Where to from here?

• External consultant engaged to conduct workshop
  series (mind mapping, open space, convergence)
• Strategic planners meeting with public health
  planners next week
• New committee structure has been proposed - City
  Safety and Health

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City of Yarra

• Municipal Public Health Plan
• 2003 2005
• Draft Framework and Action Plan

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Background
Council Resolution MPHP Framework Based on the
Social Model for Health.

• Interdependence of physical, economic, social,
  environmental and cultural factors
• Active citizen engagement
• Balance of universal and targeted services
• Focus on wellness rather than illness

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Broad Aim of MPHP

• Yarra Community to reach a state of complete
  physical, social and mental well-being so that
  they can realise their aspirations, satisfy needs
  and participate fully in community life
• Ongoing and long-term approach
• Influence rather than provide (no with MPHP)

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Specific Aims of MPHP 2003-2005

• Preparation for the future
• Universal platform of strategic communication
  including active citizen engagement
• Strong democratic and corporate governance
  structures (Council and community)
• Value add to other plans and strategies
  services that deal with specific health issues
• Increase knowledge/evidence

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Specific Aims of MPHP 2003-2005

• Engaging, communicating and working with
  complexity (shared understanding of the Yarra
  Community)
• Service development (flexibility, relevance and
  responsiveness
• Integrated planning and policy
• Measuring progress - Community indicators
• Advocacy

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Rationale for Proposed Framework

• Communicating, Engaging and Working with
  Complexity
• Data analysis, contextualized information,
  research emerging as an increasing core
  function of Council (governance/leadership/steward
  ship)
• High population mobility and high rate of change
  - ABS trends over time and a more sophisticated
  approach is needed
• Strong network of community-based agencies and
  high levels of social capital

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Rationale for Proposed Framework

• Service development ( Flexibility, relevance and
  responsiveness)
• Federal and State Governments constant reform
  process
• Public investment in Yarra is at its peak (except
  for one-off kick start)
• Any growth funds to rural, growth corridors and
  politically strategic regions
• Retreat by Federal and State Governments from
  universal services
• Increased user pays

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Rationale for Proposed Framework

• Emerging need to reprioritize, reconfigure and
  other resource sharing arrangements (need more
  sophisticated data)
• Need to protect public resources by acting as a
  single organism (vagaries of micro-economic
  reform, setting up parallel primary care systems
• Perhaps more formal partnership arrangements

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Rationale for Proposed Framework

• Emerging issues require joined up solutions
  including joined up resources
• No for MPHP. Need to resource planning where
  decisions are made

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Rationale for Proposed Framework

• Active Citizen Engagement
• Increasingly traditional services provided at
  arms length, ordinary citizens feeling
  increasingly powerless
• Building trust, connectedness, respect for
  community assets and a protective factor
• Shift toward true power sharing
• Encourages citizens forming social networks
• Active citizen commitment to seek involvement in
  all areas of Council activities

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Rationale for Proposed Framework

• Active Citizen Engagement
• Inform Councils advocacy role
• Structure for initiating community action
• Provides strong bottom up processes
• Provides greater transparency and accountability

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Rationale for Proposed Framework

• Measuring Progress Community Indicators
• Values and aspirations of community, not just as
  service users
• Provides a shared view of what is important to
  community
• Provides a baseline so we can measure progress

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Rationale for Proposed Framework

• Integrated Planning and Policy
• Paradox need to improve integrated planning and
  policy but also need to reduce the planning
  effort
• Emerging needs require whole of governments,
  whole of community approaches
• Good policy and planning occurs at many levels
• Recognises interdependence of many factors
  (Social model for health)
• Optimises and strengthens service delivery
• Gives additional weight to funding submissions

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Summary

• What about health?
• This framework not sexy
• Paradoxically social model for health makes role
  and relevence of MPHP less clear

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Common Learning
1. Evolution of Municipal Public Health
Planning 2. Is the MPHP a plan or a
process? 3. What are the expectations of the
MPHP?
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1. Evolution of Municipal Public Health Planning

• Current legislation does not reflect contemporary
  Municipal Public Health Planning
• Tensions between many planning frameworks within
  local government - Different frameworks -
  Statutory with no funding - Strategic with
  funding - PCP Community Health Plans

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Health Act 1958, Section 29B
1. Every council must, in consultation with the
Secretary, prepare at three-year intervals a
municipal public health plan. 2. A municipal
public health plan must (a) identify and assess
actual and potential public health dangers
affecting the municipal district and (b)
Outline programs and strategies which the council
intends to pursues to (i) prevent or minimise
those dangers (ii) enable people living in the
municipal district to achieve maximum
wellbeing(c)provide for periodic evaluation of
programs and strategies. 3. Every council must
review its municipal public health plan annually
and, if appropriate, amend the plan
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2. MPHP a Plan or a process?

• Procedure
• Course
• Route
• Method
• Means
• Manner
• Practice

• Map
• Diagram
• Scheme
• Strategy
• Proposal
• Idea
• Design

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• What value does the MPHP add to an
  organisation? (The glue or the coat - hanger)
• Is it the way we do business a process we
  undertake?
• Is it the guide to direct our business a plan
  we follow?
• Is it an amalgam of all our other plans?
• Where does leadership in decision-making exist
  in the organisation?

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3. Expectations

• The Community - Health service providers -
  PCP - Residents - Business community
• The organisation - Capital city vs metro vs
  rural
• The Officer - EHO vs Health Planner vs Social
  Planner
• DHS - Accountability structures

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Conclusion

• Change takes time
• Need for organisational support
• Value of informal opportunities