Local Health Goals and Integration: Using policy research to guide practice

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Local Health Goals and Integration Using
policy research to guide practice

• Julia Abelson, Ph.D.
• Centre for Health Economics and Policy Analysis,
  McMaster University
• Presentation to alPHa
• June 12, 2001, Brantford, ON

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Regionalization, Integration and Health Goals in
Ontario

• regionalization and devolution considered the
  model through which improved service integration,
  coordination and rationalization can occur
  (tailored to local needs)
• Ontario decides against establishment of RHAs in
  late 80s and early 90s
• formal integration has been on and off (and on
  again) the policy agenda (i.e., IHSs and IHDSs)
• regionalization is a well-known feature of
  Ontarios health system (e.g.,DHCs, CCACs, RCCs)

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Ontario context (contd)

• shift from provincial health goals focus of early
  90s (e.g., Premiers Health Council) to health
  care and hospital restructuring
• absence of formal institutional structures to
  pursue broader health agenda provincially and
  locally

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How does Ontario compare to other jurisdictions?

• Institutional structures
• integrated health and social services at the
  provincial and regional level in PEI, Quebec
• provincial health council with mandate for health
  goals development in NS
• provincial health goals in NS, BC
• community health boards/councils in NS, BC and
  Manitoba

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Other jurisdictions (contd)

• Nova Scotia Provincial Health Council (1990-1995
  re-established in 1997)
• Mission
• to listen and respond to Nova Scotians
• to guide and monitor government decision making
  on all aspects of healthy public policy
• to promote the use of the NS Health Goals as an
  essential tool to achieve health and well being
  for Nova Scotians and their communities

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Nova Scotia (contd)

• Community Health Boards
• - first established in early 1990s legislated
  into formal existence in 2000
• - members initially appointed by district health
  authorities with provision for elections
• A community health board shall
• (a) foster community development that encourages
  the public to actively participate in health
  planning and service delivery

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NS Community Health Boards (contd)

• (b) construct a community profile that identifies
  the deficiencies and strengths of the community
  with respect to factors that affect health,
  including income and social status, social
  support networks, education, employment, physical
  environments, inherited factors, personal health
  practices and coping skills, child development
  and health services in the community

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To whom are board members accountable?

• most board members consider themselves most
  accountable to all residents of their
  district/municipality
• some perceive themselves as accountable to
• ward residents only (for elected reps)
• provincial minister of health
• local health care providers/organizations

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How do board members perceive their
representative roles?

• SK board members thought their role was most
• like that of
• School board member (25)
• Hospital board member (23)
• Member of legislature (14)
• Member of Crown corporation (12)
• NGO member (11)
• (Lewis, Kouri, Estabrooks et al., 2001)

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What are the governance structures that define
boards?

• is it appointed, elected or a mix?
• what difference does this make to decision
  making?
• democratically elected board members confer
  locally generated legitimacy
• appointed and elected members dont behave that
  differently over time is this still a goal
  worth pursuing?

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Involving the Community in the Development of
Local Health Goals

• Need to consider the following
• Who to involve?
• In what?
• How?
• Why?

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Who to involve?

• How to achieve a balance between
• Citizens/public (service users, caregivers,
  taxpayers, community members)
• Experts (lay, technical, provider, non-provider)
• Stakeholders (those with an interest)
• Elected officials
• Who should be involved?
• Who wants to be involved?
• Who does get involved?

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In what?

• Need to consider who to involve in what roles
• users/caregivers need to provide information
  about needs, values and preferences
• citizens/taxpayers should also have a say in
  setting priorities and making choices
• need to balance provider and technical expertise
  against provider dominance (especially in health
  care sector)

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HOW?

• Voice or choice?
• Voice consultation providing input without
  conferring control over final decision (e.g.,
  surveys, town halls)
• Choice responsibility conferring some control
  over the final decision (e.g., representation,
  voting, referenda)

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What are the objectives?

• to inform, educate and build an active, engaged
  citizenry
• to obtain views, ideas, values
• to conduct a fair and legitimate process
• to achieve/influence outcome

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Challenges

• People get involved in issues that directly
  affect them (e.g., hospital closures, NIMBY
  issues)
• Challenge is to convince them that thinking about
  and acting on health goals is important and
  directly affects them localizing these
  initiatives will help!

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Challenges (contd)

• the public is looking for meaningful involvement
  that will make a difference and wants
  accountable consultation
• local health goals initiatives may generate
  expectations that local community cant meet be
  clear about deliverables!!

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How local factors can influence change

• Communities may have pre-disposing
  characteristics that facilitate or impede health
  goals and local integration
• Some examples
• historical, cultural traditions such as
  inter-agency collaboration or competition
  elite-driven vs. grass-roots decision making
• resistance to change or commitment to innovation
• strong local identity/coherent community values
• volunteer base, density of networks of local
  organizations (i.e., community capacity)

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Local factors (contd)

• Local institutions can act as enablers
• Examples
• local government
• media
• community groups
• health organizations
• local leadership (credible, enthusiastic leaders)

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Some final reflections

• local health goals and system integration offer
  exciting opportunities for Ontario communities
• clearly articulated health goals need to be
  linked to local solutions that are concrete and
  achievable to show people how they can make a
  difference
• begin with those that have greatest potential to
  succeed and build on early successes to engage
  the community