The Municipal Public Health and Wellbeing Plan (MPHWP) Benchmarking Project

Transcription

1 The Municipal Public Health and Wellbeing Plan (MPHWP) Benchmarking Project Report A report by the Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne For North Metro and West Metro Health, Department of Health and Human Services (DHHS) August 2016

2 Acknowledgments Researcher: Dr. Helen Jordan (Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne) Research Assistants: Geoff Browne and Louise Freijser (Melbourne School of Population and Global Health, The University of Melbourne) Department of Health and Human Services: Adrienne Campbell Steve Ballard Iain Butterworth Mark Lee Monica Kelly Maria Drakopoulos Tim Fry Members of the North and West Metro Regional Health and Wellbeing Advisory Group (NMWR); North and West Regional Management Forum, and most importantly local council directors, managers and planners for their enthusiasm and participation in the project. Local Councils include: Banyule City Council Brimbank City Council Darebin City Council Hobsons Bay City Council Hume City Council Maribyrnong City Council City of Melbourne Melton City Council City of Moonee Valley Moreland City Council Nillumbik Shire Council Whittlesea City Council Wyndham City Council City of Yarra While supportive of this research, the views expressed in the report do not necessarily represent the views of the Department of Health and Human Services (DHHS). 2

3 Table Of Contents ACKNOWLEDGMENTS 2 KEY FINDINGS 4 EXECUTIVE SUMMARY 5 TABLE 1: SUMMARY OF RECOMMENDATIONS 8 INTRODUCTION 14 PROJECT BRIEF 15 PROJECT METHODS 15 STAGE 1: ESTABLISHING GOVERNANCE AND STAKEHOLDER ENGAGEMENT 15 STAGE 2: CONTENT ANALYSIS OF PLANS 16 STAGE 3: CONSULTATION WITH COUNCIL STAKEHOLDERS 16 ETHICS CLEARANCE 16 RECRUITING LOCAL COUNCILS 17 DETERMINING SUCCESS OF ACTIONS WITHIN PLANS 17 INTERVIEWS 18 WORKSHOP 18 STAGE 4: INDICATORS 19 RESULTS 19 MPHWP CONTENT ANALYSIS 19 TARGET GROUP 19 POLICY/ISSUE AREA 20 TYPE OF ACTION 22 STATUS OF IMPLEMENTATION 22 STAKEHOLDER CONSULTATION: INTERVIEWS 25 FACTORS INFLUENCING SUCCESSFUL IMPLEMENTATION 25 STAKEHOLDER CONSULTATION: WORKSHOP 42 RESOURCING OF MPHWP ACTIONS 42 CAPACITY BUILDING STRATEGIES 43 MONITORING AND EVALUATION 43 DISCUSSION 45 PARTNERSHIPS 45 RESOURCING 46 EVALUATION 47 INFORMATION SHARING 49 RMF/ COUNCIL COMMUNICATION CHANNELS 49 EVIDENCE 49 TARGET GROUPS 50 APPENDICES 52 3

4 Key Findings The key findings of this report are as follows: 1) The majority of actions across the 14 ( ) Municipal Public Health and Wellbeing Plans (MPHWPs) targeted the community in general. Fewer focused on individual target groups, including Aboriginal and Torres Strait Islander populations, CALD groups, new arrivals, or people with low socio economic status. 2) The majority policy/issue areas being addressed by the actions focussed on the social determinants with fewer focussing on individual health and behaviours or access to health and social services for particular target groups. 3) A large proportion of MPHWP actions had no data on implementation. Hence progress on these actions was unknown. This was largely due to three Councils that had not evaluated or could not easily retrieve evaluation or performance related data. Of the 10 Councils that did provide evaluation/reporting data, seven provided close to 100% coverage of their MPHWP actions. 4) A range of factors was identified during the interviews as having influenced the successful implementation of MPHWP actions. These include the degree of integration with other planning processes, strength of partnerships, resourcing, support, timing and visibility. 5) Strategies to promote the enabling factors or address the barriers to implementation, and to enhance evaluation capacity among planners were identified during the interviews, workshop and with further analysis. These are summarised in Table 1 of the Executive Summary. The Appendix includes a suggested set of indicators/tools for consideration by planners. The set of indicators should be considered in conjunction with other outcome related indicators including those that are currently being developed to measure progress towards achieving the outcomes of the Victorian Public Health and Wellbeing Plan. In addition, a number of recommendations have been developed for consideration by Councils, networks such as the Local Government Health Planners Network, North Metro and West Metro Health (DHHS), central office (DHHS), and Regional Management Forums, among others. 4

5 Executive Summary The MPHWP Benchmarking Project is a joint initiative of the Department of Health and Human Services (North Metro and West Metro Health) and The Melbourne School of Population and Global Health. Information gained from this project will inform future planning, implementation and evaluation processes, ultimately leading to a stronger coordinated and effective public health response within and across local councils areas in the North Metro and West Metro Health region. The project aims were to identify: 1) the nature and the success of the priorities and actions in the round of MPHWPs and the factors that contributed to their success or otherwise (selected to enable retrospective analysis); 2) indicators that can be used to determine success and track progress across selected action types included in the plans, and governance strategies that would increase the likelihood that these actions are implemented successfully; and 3) key strategies and actions that will enhance successful implementation of current and future MPHWPs plans. The methods used to fulfil these aims included stakeholder engagement, content analysis of the 14 MPHWPs ( ) and one place-based plan (Braybrook Revitalisation Project), interviews, and a workshop involving Council planners. Of all actions across the 14 MPHWPs the majority, 74% targeted the community in general. Actions focused equally on young people (8%), people of low socioeconomic status/disadvantaged/homeless (8%), and internal local government operations (6%). Fewer focused inclusively or exclusively on the groups defined by gender/sexual orientation, Aboriginal and Torres Strait Islanders, the aged, CALD groups, disease based population groups, health services (non-target group specific), new arrivals and people with disability. Artists were included as a target group in five MPHWPs. This inclusion may reflect the role that councils can play in providing spaces and opportunities for leisure and cultural related participation. 5

6 The majority of policy/issue areas being addressed focussed on the broader determinants of health e.g. natural environment and resource efficiency (9%), leisure and culture (sports and arts) (9%), crime and safety (9%), public open space and facilities (8%), education and employment (6%), transport (5%), housing (3%) and economic development (2%). Actions that focussed on social cohesion and democracy (12%) included such activities as representation on committees, developing partnerships, building community capacity etc. This is likely to be a reflection of the efforts by DHHS over the past decade on promoting the importance of the Environments for Health Framework in Municipal Public Health Planning. Fewer focussed on individual health and behaviours (17% in total) or access to health and social services (8%) for particular target groups. Of these actions most focussed on physical activity (30%), and healthy eating (30%), followed by drug and alcohol use (17%), gambling (12%), and tobacco use (5%). In terms of type of actions, the predominant category was delivering a new program or service (23%). This was followed, by the development or implementation of a strategic plan, reorientation of existing services or service improvement, and continuing or expanding on an existing service/program, advocacy, and research (8-16%). A large proportion of MPHWP actions had no data on implementation. Hence progress on these actions was unknown. This was largely due to three Councils that had not evaluated or could not easily retrieve evaluation or performance related data due to: 1) no evaluation/performance reporting undertaken or 2) change of staff and lost data due to inadequate data storage and retrieval systems. Of these three Councils, the progress of ~300 MPHWP actions were unaccounted for (98% of the MPHWP actions for these Councils). Of the 10 Councils that did provide evaluation/reporting data, seven provided close to 100% coverage of their MPHWP actions. Of the remaining three Councils, data was not available for approximately 50/270 (18.5%) of the MPHWP actions. Of those actions for which data was available 52% have been implemented fully and were completed by the end of the MPHWP period. A further 19% were fully implemented and were ongoing at time of interview. Some action types that stand out in terms of progression include those that were partially implemented and ongoing or no longer continuing. Of those actions that were advocacy-based, 17% and 13% 6

7 were only partially implemented and were continuing or had been discontinued at time of interview, respectively. Almost a third of all actions concerning the development or implementation of a strategic plan were partially implemented or continuing at time of interview. These strategic plans tend to have a life span of three-four years, and continued implementation beyond the term of the MPHWP is not unexpected, though it would have been expected that all had been developed. While 54% of actions requiring the reorientation of services or service improvement were fully implemented and completed, one quarter was only partially implemented and ongoing at time of interview. A number of factors were identified during the interviews as having influenced the successful implementation of MPHWP actions. These include: Implementation being the responsibility of Council/Unit Partnerships Clarity and visibility of the action Interest in the topic Whether the action was incorporated in a wider Council plan Councillor/regional and central government support Resourcing/budget/ external funding opportunities Timing or being opportunistic/readiness Alignment/line of sight with priorities Feasibility/Realistic nature of the action Strategies to promote the enabling factors or address the barriers to implementation, and ways in which evaluation of MPHWPs could be enhanced, were informed by the interviews and workshop. These are summarised in Table 1 below. They are provided for consideration by Councils, networks such as the Local Government Health Planners Network, North Metro and West Metro Health (DHHS), central office (DHHS), and relevant RMFs. The Appendix includes a suggested set of indicators. These should be considered in conjunction with other outcome related indicators including those that DHHS (central office) is leading the development on - to measure the progress towards achieving the outcomes of the Victorian Public Health and Wellbeing Plan (VPHWP). The main body of this report summarises the findings from the content analysis, interviews and workshop, which together, informed the development of these recommendations. 7

8 Table 1: Summary of recommendations Factor Aim Recommendation Page Implementation the responsibility of Council/Unit within Council To ensure that internal/external partnerships are not a barrier to implementation 27, 28, That partnerships have an agreed area of focus that is relevant to all partners 1.2 That there are clear lines of responsibility for all partners (external and internal) 1.3 That the nature of the responsibility for each organisation/unit is agreed upon and outlined in a partnership agreement 1.4 That the efforts towards building and maintaining relationships are recognised and factored in when determining resource requirements. 1.5 Stakeholder analysis is undertaken by Councils to prioritise partnership development and maintenance opportunities 1.6 Council units evaluate their own capability as an effective partner and identify areas in need of strengthening Clarity of action for all To ensure actions are clear 2.1 That health planners consult on the wording and use of terms associated with MPHWP actions that are to be promoted for cross Council action/inclusion in the plan Interest in the topic Visibility of the action To make clear how an action relates to the objectives of another unit/organisation To ensure all preparatory and capacity building work 3.1 Demonstrate the relevance of MPHWP actions to the primary objectives of other organisations/units 3.2 Encourage a broadening of the primary objectives of nonhealth sectors (broader determinants) within and external to Council to capture all health associated benefits (e.g., Health in All Policies) by strengthening the line of sight between an action on determinants and improvement in health. 4.1 To report on the activities that are normally unseen or appreciated, to demonstrate the amount of effort and

9 Factor Aim Recommendation Page is visible and valued consequently, resources, that are required in their implementation o Using the suggested set of indicators in Appendix 2 might help to increase the visibility of some key planning related activities Action incorporated in the Council/Community Plan To build on the reported enabling effect of incorporating MPHWP actions in the Council or Community Plan 5.1 For MPHWPs that are standalone: o Build and make visible linkages with the Council/Community Plan o Engage with Councillors in the process of planning the MPHWP o Link evaluation of the Council/Community Plan to the evaluation of the MPHWP 5.2 For MPHWPs embedded in the Council/Community Plan make clear the health and wellbeing benefits of the actions or 30 Resourcing/budgets To have resources allocated to core actions and build in flexibility for others flag MPHWP related objectives/actions 6.1 Actions that make flexible use of existing resources are likely to be implemented over new or novel activities. Where possible, and where effectiveness will not be compromised, prioritise the re-design of existing programs/services over the development of new untested programs/services. 6.2 For potentially successful strategies for which resources are not currently available, maintain a level of readiness, to utilise opportunities that might later present themselves (related to timing and being opportunistic) 6.3 Agree to the allocation of a budget against an identified set of key initiatives to ensure availability of resources throughout the life of a plan (over the entire four years). 6.4 Allow for the inclusion of a set of aspirational deliverables as 31, 42, 46 9

10 Factor Aim Recommendation Page a way of introducing issues which could be later targeted depending on the eventuation of early trends, availability of data, funds, further research, or opportunities for capacity building. External funding opportunities Alignment/line of sight with priorities Feasibility/realistic actions To provide more external funding opportunities To more strongly align actions with existing priorities To ensure actions in MPHWPs are feasible and realistic 7.1 To pursue funding opportunities to instigate novel and ground breaking health and wellbeing related actions across all Councils; and for evaluation efforts, lessons learnt, and tools to be shared equally across all Councils (those funded and non-funded) 8.1 To consider National, State and regional level priorities when determining Council level priorities and to improve line of sight by making these linkages visible 9.1 To undertake a situation assessment, prior to confirming an action, and in doing so, consult those who are expected to be involved in planning and implementation (partners), identify existing resources and the level of commitment, and determine what is required to ensure the action be successfully implemented and the outcomes achieved. o Actions for which this is particularly relevant include those suggested for inclusion in the MPHWP without any link to available data on need/effectiveness; those that do not seem straightforward; and/or those for which there is doubt about an action s likelihood of implementation or effectiveness. o In doing the above, it is important to consider the overall resources available for implementation, monitoring and evaluation of the actions in the MPHWP (as a whole) and hence, the number of actions within the plan ,

11 Factor Aim Recommendation Page Evaluation, Monitoring and Reporting Evaluation, Monitoring and Reporting cont. To enable monitoring and evaluation of MPHWPs 10.1 For all local Councils to determine, on an annual basis, those actions that have not progressed, the reason for the lack of progression, whether efforts should continue to support these actions, and the nature of this support That the degree of evaluative activity (e.g. progress indicators or full evaluation) and timing (year) be determined for each activity early in the planning cycle That actions within the MPHWP be flagged for type of data to be reported (e.g. process/outcome data) and that indicators be mapped against the actions/objectives earlier in the planning cycle That a set of indicators on activities that are not normally measured and hence valued be provided for consideration. See a set of indicators for possible use in Appendix That the Local Government Health Planners Network map shared activities based on issue area, action type, and target group across North and West Metro Health region That informal networks, possibly as subsets of the Local Government Health Planners Network, and based on topic areas be considered for development. These networks can share key lessons, develop common sets of indicators, and identify efficiencies in effort and ways in which RMFs and DHHS can assist to promote strategies on common issues (e.g. advocacy efforts) That a reporting format for evaluation be offered to health planners for use in the recording of their monitoring and evaluation. This would encourage the consistent use of terminology and practices and the sharing of data. 33, 43, 44, 47 11

12 Factor Aim Recommendation Page 10.8 That a flexible portal for Councils to maintain, append, communicate, and share resources on particular strategic areas of importance be considered for development. This initiative could be facilitated by the Local Government Health Planners Network, PCP, or wider state-wide level agency MPHWP planners work with their Councils social planning unit to identify relevant indicators and evaluation data that are available and opportunities for inclusion of questions/items in existing data collection tools (e.g. adding items to community/council staff survey instruments) That reporting of actions be saved on a shared drive for general accessibility when staff responsible for the data move to other positions/organisations. Regional Management Forum (RMF) To ensure MPHWP health planners have the opportunity to voice their suggestions to the RMF 11.1 Council Chief Executive Officers as members of RMFs ensure they have an understanding of the MPHWP and the needs and priority areas that underpin the plan That Clear lines of communication from the RMF to the health planner (e.g. via their Manager, or directly via the Chief Executive Officer) are strengthened The health planner via the Manager has the opportunity to provide suggestions for joint and integrated action on particular issues among RMF members. Those actions that target the social determinants of health and rely on the nonhealth sector are particularly relevant to this recommendation The heath planner receives a report back on RMF meeting outcomes via their Manager , 49 12

13 Factor Aim Recommendation Page Evidence To ensure Council health planners have access to the latest peer reviewed journals and evidence on programs relevant to their communities needs 12.1 That the issue concerning the low accessibly and use of peer reviewed journal articles particularly regarding the effectiveness and appropriateness of interventions be recognised. This issue concerns all sectors of government and associated agencies That the availability and use of PubMed, a freely available bibliographic resource, be promoted as a useful resource for access to peer-reviewed journal articles related to public health and medicine related research That networks such as the Local Government Health Planners Network consider ways in which existing evidence can be promoted and shared, and skills in accessing evidence 49 Target Groups Skills To ensure actions address the target groups determined to be most in need. To develop skills in planning, implementation and evaluation. promoted That health planners consider ways in which they can make more visible the resourcing assigned to different target groups. o An example of a basic template is provided in the Appendix That the Local Government Health Planners Network with other relevant health planner networks, communities of practice and PCPs, identify plan and coordinate opportunities for the development of key skills required to plan, implement and evaluate public health plans (e.g. community engagement, partnership development, indicator development, evaluation etc.) 50 13

14 Introduction The Municipal Public Health and Wellbeing Plan (MPHWP) Benchmarking Project is a joint initiative of the Department of Health and Human Services (North Metro and West Metro Health) and the University of Melbourne. This project was endorsed by the North and West Metropolitan Region (NWMR) Health and Wellbeing Advisory Committee, the Northern Region Human Services' Directors Group, Western Human Services Directors Group, Northern and Western Regional Management Forums and has been designed in consultation with local government representatives overseeing the MPHWP process. At the commencement of this project, the NWMR was part of the Department of Health. It later became the North Metro and West Metro Health, Department of Health and Human Services (DHHS). This did not change the health region boundary still capturing the same 14 local government catchment areas (See Figure 1 below). Figure 1: Map of the North Metro and West Metro Health Region Source: North and West Metropolitan Region 14

15 Project Brief This project explored the nature, success and influential factors of the actions of the MPHWPs within the North Metro and West Metro Health region, and one place based plan Revitalisation Braybrook, to compare the different drivers/supports. This project established benchmarks against which to measure change over time in terms of the action, policy type, priority area, success, and the structures in place to promote success. Project Aims 1) To identify a) the nature and the b) success of the priorities and actions in the previous round of MPHWPs ( ) and the factors that contributed to their success or otherwise. 2) To identify a) indicators that can be used to determine success and track progress for selected action types included in the plans, and b) the governance strategies that are designed to increase the likelihood that these actions are implemented successfully. 3) To identify key strategies and actions that will enhance successful implementation of current MPHWPs and future plans Project Methods The methods are divided into four stages. The first involving stakeholder engagement, the second: content analysis, the third interviews and the fourth, development of a draft set of potential indicators for use by Councils. Stage 1: Establishing Governance and Stakeholder Engagement Mechanisms for project governance and informing key stakeholders of the proposed project to gain sector engagement and buy-in from each Council were identified and implemented. The researcher, Helen Jordan, presented the project proposal at the Northern Region Human Services' Directors meeting (October 2014) and the Regional Health and Wellbeing Advisory Group for feedback and endorsement. An update was presented to the Regional Health and Wellbeing Advisory Group in early The project also progressed under the auspice of both the Northern and Western Regional Management Forum (RMF) via the 15

16 North Metro and West Metro Health DHHS representative Steve Ballard. Regular meetings were held with North Metro and West Metro Health (DHHS) managers to discuss project progress. Stage 2: Content Analysis of Plans MPHWPs are public documents. The plans for all 14 Councils in the North Metro and West Metro Health (DHHS), sourced previously for a separate project, were added to NVivo as PDF files. These were used to identify key actions within the plans and to map them against previously developed criteria according to policy area, action type, target group, and focus of responsibility. A coding book was developed to ensure consistency in the coding. The coder tested the codebook on a sample of actions. The main researcher repeated the coding of the sample, discussed and reconciled any discrepancies with the coder, and amended the codebook to address the discrepancy. While there was one main coder for this project, the main researcher checked all the actions within the coded categories and cleaned the data before analysis. The criteria and rationale for their selection are listed in Appendix 1. The plans that were analysed included: standalone MPHWPs, Council Plans or Community Plans that incorporated MPHWPs, and the Braybrook Revitalising Project (place based plan). Some MPHWPs are strategic in nature and are underpinned by separate action plans. Annual evaluation reports of these plans were explored to determine success in some instances. For some MPHWPs some of the actions were focused on the development of sub-level strategic plans. These subplans were not analysed (e.g. Disability and Inclusion plans, Community Safety Plans). Consequently, any indications of success in relation to an action in the parent plans were focussed on the nature of that action (e.g. to develop a strategic plan, to engage with community to identify priorities for a strategic plan etc.). Stage 3: Consultation with Council Stakeholders Ethics Clearance Ethics clearance was sought and received from the Melbourne School of Population and Global Health s Human Ethics Advisory Group (The University of Melbourne). The project was deemed minimal risk and received support to go ahead (ID ). 16

17 Recruiting Local Councils Directors of the Health and Wellbeing portfolio in Councils were all sent a letter of invitation with a study information sheet inviting their Council to participate in the study. They were initially asked to provide contact details of the health and wellbeing officers/managers responsible for the MPHWPs and for permission to follow-up with these people for collection of relevant documents and an interview. On acceptance by the Director (13 of 14 Councils accepted the invitation, 1 declined), the person(s) for whom contact details were provided were ed an invitation to participate in the study, a study information sheet and consent form to be interviewed at a later date. A separate letter of invitation was sent to Directors and Health Planners or Managers asking them to participate in the workshop at the end of the study. Determining Success of Actions within Plans Evaluation/monitoring reports associated with each of the MPHWPs of participating Councils were obtained from websites or planners directly, if they were available. Some planners were not present during the implementation of the previous MPHWP and found it difficult to source any relevant documents. However, documentation of varying degrees of quality and completeness were generally made available. For one Council, the planner reported on the success of each of the actions within the plan directly. A template was developed and used by the researcher to determine whether each action had 1) been implemented and 2) whether outcomes were reported. Process indicators dominated. Outcomes were reported against very few actions. Once the researcher completed the reporting template for a plan, it was ed to the Health and Wellbeing Coordinator of each participating Council to verify the categorization of implementation status for each action. In a few cases, some of the recorded outputs were modified on further discussion and the provision of additional information from the coordinator. Once confirmed, each action was coded according to its categorized status of implementation. It needs to be noted, that success (in terms of implementation and outcomes) is not the sole responsibility of local government but also, the system of governance, commitments and strategic plans expected to support planning (e.g. regional structures, Victorian Public Health and Wellbeing Plan). It is understood that these governance structures may 17

18 change over time, and that any success or weaknesses in these arrangements have the potential to be reflected in the MPHWPs, in particular, the nature of the planning, the actions embedded in the plans, implementation, and outcomes. Interviews Invitation letters were sent to all Directors responsible for MPHWPs. Of 14 Council Directors, 13 agreed to participate. Directors agreeing to participate provided contact details of staff involved in the MPHWP or health planners involved in the current MPHWP if no one was available. Invitations to participate were ed, along with study information sheets and consent forms, to the contacts provided by the Directors, asking them if they would like to participate in a face-to-face interview individually or in a group with colleagues. One interview occurred for each of the 13 Councils. Of these interviews, six involved one participant, four involved two, and three involved three. Participants included health promotion officers (18) or team leaders/managers (5). During the interviews of key MPHWP personnel a summary of data from the content analysis of MPHWPs was presented, at the individual LG level (data provided for own Council only) and in aggregate, at the regional level. The researcher and interviewees discussed patterns, and the factors that contributed to the success or otherwise of each action type. Strategies that could increase the likelihood that similar actions in current and future plans will be successfully implemented were also discussed. Interviews were taped from which written transcripts were obtained for later analysis. Workshop The workshop was held 11th December 2015 and included 15 Council representatives from 12 Councils, and 5 DHHS staff. During this workshop, a summary of the preliminary findings (for all Councils combined) was presented and aspects of the findings workshopped to identify possible reasons for patterns observed and strategies to facilitate the enablers presented. 18

19 Stage 4: Indicators Participants of the workshop expressed an interest in the use of shared indicators for the evaluation and monitoring of particular common actions within their MPHWPs. A set of potentially relevant and common indicators is listed in Appendix 2. Results MPHWP Content Analysis The total number of actions across the fourteen MPHWPs was 811 (range: ). The average number of actions per plan was 58, or 37 excluding two MPHPWs with the highest number of actions (204 and 173). The number of actions in the Braybrook Revitalisation Plan was 86. The actions across all 14 MPHWPs are presented below according to target group, issue area, action type, and status of implementation. Target Group Of approximately 811 actions across the 14 MPHWPs, 74% (599) targeted the community in general, 7% (55) young people, 7% (53) people of low socioeconomic status/disadvantaged/homeless, and 6% (51) internal local government operations. Between 1-4% (8-31) of the actions focused inclusively or exclusively on groups defined by gender/sexual orientation, Aboriginal and Torres Strait islanders, artists, CALD groups, disease based population groups, health service operations (non-target group specific), new arrivals and people with disability (See Figure 1 below). The Braybrook Revitalisation Plan was remarkably similar in the proportion of target groups listed in the pie graph in Figure 1 below. It had a greater proportion of actions targeting young people (22% compared with 7%) and people of specific gender or sexual orientation (6% compared with 3%). While only 1% of actions explicitly stated that it was targeting those of low SES and the disadvantaged, it could be argued that 100% of its actions were targeting these populations. Braybrook is targeted specifically by the Revitalisation project because it is a suburb with high levels of disadvantage. 19

20 Figure 1: Target Groups of MPHWP actions Policy/Issue Area Of the issue areas addressed by the actions across the 14 MPHWPs, the majority focussed on traditional health sector aligned activities e.g. individual health and behaviours (18%) or health and social services (8%), for the particular target group selected. It was interesting to note the high proportion of actions focussing on the social determinants of health e.g. natural environment and resource efficiency (10%), leisure and culture (sports and arts) (8%), crime and safety (9%), public open space and facilities (8%), education and employment (5%), transport (4%), housing (3%) and economic development (2%). Actions that focussed on social cohesion and democracy showed a large presence (13%) and included such activities as representation on committees, 20

21 developing partnerships, building community capacity etc. See Figure 2 below. Figure 2: Issue Areas covered by 14 MPHWP actions ( ). Of the actions that addressed individual health and behaviours (144), 45 (31%) focussed on physical activity, 36 (25%) healthy eating, 25 (17%) drug and alcohol use, 17 (12%) gambling, and 7(5%) tobacco use. None focused on sexual practices. Twenty-four referred to other that did not have sufficient sub-categories of any one type (e.g. SunSmart) or were non-specific. These issue areas were selected as they aligned with the health promoting priorities of the Victorian Public Health and Wellbeing Plan. See Figure 3 below. 21

22 Figure 3: Number of individual health and behaviour related actions in 14 MPHWPs ( ). Type of Action Of the type of MPHWP actions, the predominant categories were delivering a new program or service (23%), development or implementation of a strategic plan (16%), reorientation of existing services or service improvement (13%), continue or expand an existing service/program (12.3%), advocacy (9.8%), infrastructure or facilities (9%), and research (8.2%). See Figure 4 below. The Braybrook Revitalisation Plan was similar for each of the above except for developing a new program or service (33%), infrastructure or facilities (21%). Status of Implementation A large proportion of MPHWP actions had no data on implementation. Hence progress on these actions was unknown. This was largely attributable to 3 Councils that had not evaluated, or could not easily 22

23 retrieve evaluation or performance related data. The latter was due to 1) a change of staff and hence loss in knowledge about past practices, and 2) inadequate data storage and retrieval systems in place. Figure 4: Number of MPHWP actions by type across 14 MPHWPs. Of these 3 Councils the progress of ~300 MPWHP actions were unaccounted for (98% of the MPHWP actions for these 3 Councils). Of the Councils that did provide evaluation/reporting data (n=10: one Council did not participate), seven provided close to 100% coverage of their MPHWP actions. Of the remaining three Councils, data was available for approximately 220/270 (81.5%) actions. (Figure 5 shows the proportion of actions for which status of implementation is known and the status where known). 23

24 Figure 5: Status of implementation (%) of MPHWP actions at end of four years Unknown Not commenced Partially implemented and not continuing Partially implemented and ongoing Fully implemented and ongoing Fully implemented and completed % of Actions Of all the 13 MPHWPs participating in this component of the study, 29% of all actions were fully implemented and completed and 9% fully implemented and ongoing by the end of the MPHWP period. Three percent had not commenced. Of those that were partially completed at the end of the planning period, 9% were continuing while 5% had discontinued. The proportion with missing data was 45%. Of the actions within the Braybrook Revitalisation Project that were fully implemented, 45% were completed and 30% ongoing at the end of the planning period. Four percent had not commenced. Of those that were partially completed, 15% were continuing while 6% were no longer continuing. Evaluation data was available for 100% of the actions. Evaluation and reporting data is presented against MPHWP actions according to the type of action. These are presented in Table 2 below. An average of 52% of actions for which data is available, by action type, have been fully implemented and were completed by the end of the MPHWP period. A further 19% were fully implemented and were ongoing at time of interview. Some action types that stand out in terms of progression include those that are partially implemented and ongoing 24

25 or no longer continuing. Seventeen and 13% of advocacy-based actions were only partially implemented and were continuing or had been discontinued at time of interview, respectively. It is feasible that almost a third of all actions concerning the development or implementation of a strategic plan were partially implemented or continuing at time of interview. These strategic plans tend to have a life span of 3-4 years, if not longer. One quarter of actions requiring the reorientation of services or service improvement were only partially implemented and ongoing. This was unexpected given the high proportion (54%) that were fully implemented and completed at time of interview. Perhaps the nature of the reorientation and improvement for these actions require a fair degree of engagement and negotiation across Council areas, explaining this delay. This could also explain the similar pattern observed for actions that required infrastructure or facilities to be built. Adequacy of resourcing may be a factor. It can be difficult to plan and hence budget for time and resources over a 4-year period, particularly for actions that are heavily resource dependent. Stakeholder Consultation: Interviews Factors influencing successful implementation The following is a list of factors that influence the degree of implementation of actions within the MPHWP as reported during interviews with Council staff. Implementation the responsibility of Council/Unit Partnerships Clarity of action for all Interest/Visibility/line of sight Part of wider Council plan Councillor/Leadership support Resourcing/budgets External funding opportunities Flexible use of existing resources Timing or being opportunistic/readiness Alignment with priorities External factors beyond control Feasibility/Realistic Regional/central DHHS support These are described below. 25

26 Table 2: Implementation status against type of actions for which evaluation information was available from (13) MPHWPs plus the Braybrook Revitalisation Plan. Nonspecific N (%) Advocacy N (%) Continue with or expand an existing program or service N (%) Delivering a new program or service N (%) Development or implementation of a strategic plan N (%) Infrastructure or facilities N (%) Partnership development or engagement N (%) Reorient services or Research service N (%) improve N (%) Total Fully implemented and completed 5 (50) 24 (43) 28 (57) 71 (57) 35 (42) 35 (57) 20 (51) 34 (54) 19 (53) 271 (52) Fully implemented and ongoing 1 (10) 15 (26) 14 (29) 29 (23) 14 (17) 9 (15) 9 (23) 3 (5) 3 (8) 97 (19) Not commenced 0 1 (2) 3 (6) 7 (6) 5 (6) 1 (2) 1 (3) 5 (8) 3 (8) 26 (5) Partially implemented and not continuing Partially implemented and ongoing 2 (20) 7 (13) 4 (8) 11 (9) 7 (8) 4 (7) 2 (5) 5 (8) 4 (11) 46 (9) 2 (20) 9 (16) 0 7 (6) 23 (27) 12 (20) 7 (18) 16 (25) 7 (19) 83 (16) Total 10 (100) 56 (100) 49 (100) 125 (100) 84 (100) 61 (100) 39 (100) 63 (100) 36 (100) 523 (100) 26

27 Implementation the responsibility of Council One factor that was reported to enable implementation of MPHWP actions was Council having a clear line of responsibility for an action and not relying on other organisations or services to implement that action. This was supported by the content analysis where it was shown that those actions where Council had sole responsibility for its implementation were more likely to be implemented. As one interviewee stated: Things that are easiest to succeed are already within Councils control and authority,... [it is] harder when you are influencing rather than controlling. And from another: Lots of things we can do internally, but externally is hard. One interviewee was concerned with the inclusion of any action within the MPHWP that relied on others outside of Council: This is our plan we should only put in what we can achieve or what the Councillors want to achieve [this] is what we have done or said we want to do. We have partnerships but reliance is another thing. Reliance on them would be a different thing. Control and authority can also differ internally, within Councils. One interviewee felt that those actions that were within the Community and Wellbeing Unit s responsibility were more likely to be implemented, compared with those that required input from other Council units. I think it was things that were within the more traditional community and wellbeing role, [where we] can deliver without much prodding things [that] were most successful were where we held responsibility - the unit. Council can more easily influence some factors over others. Those factors that are outside the control of Council, particularly those for which implementation is State government and external authority dependent, were reported to be particularly difficult. This was the experience of at least one Council: We had an action in the previous plan which was delayed and delayed [the action was eventually] transferred to the next MPHWP factors [were] beyond our control. 27

28 Partnerships A few interviewees referred to the importance of strong partnerships when asked what factors contributed to the successful implementation of actions within an MPHWP. Certainly there are a lot of actions [that] would involve external partners. Clearly we can t have an impact on homelessness without strong relationships with key service providers in the municipality. One interviewee highlighted the importance of partners being able to see the value in their contribution. This has implications for buy-in. When asked which factors contributed to successful implementation, the respondent answered: Where partnerships and collaborations were developed and where there was that buy-in (internally and externally) - that they had something to contribute as well and it wasn t just Council s responsibility. And from another: In terms of those [actions] that worked well - [they] had clearly defined owners/partnerships and a clear role for local government or community health. Others referred to the resources required to build and maintain partnerships. For one Council, building the readiness of partners was seen to be a prerequisite for programs. Another interviewee suggested spending more time working on the strategies for partnership development and maintenance. I would like us to develop a smaller action plan around how we work with our partners. Clarity of action for all/line of sight Another factor that was reported to influence successful implementation of an action was whether the action was written in a way that was clear to relevant stakeholders (internal or external). One interviewee gave an example: a social capital [action] framed around a social audit wasn t compelling to anyone across the organisation it was academic the language of it, but now in the current plan we have a community building strategy that is meaningful to everyone and they understand that 28

29 Topic Interest Another factor that was reported to influence the successful implementation of MPHWP actions was whether there was a wide-ranging level of interest in the policy area being addressed by that action. As one interviewee stated: It s always easier to get things done if the energy and motivation is behind everybody; it is harder when energy and flavour of the month have moved on. And from another: If Councillors interest creates interest internally (i.e. potential staff time, resources, interest at a senior level of the organisation), getting Councillor interest is a big thing particularly if the MPHWP is linked to the Council Plan. Interest may depend on perceptions of relevance or whether there is a clear line of sight for that action. One interviewee raised the concern that if the topic area seemed too health oriented then other sectors within Council may not see its relevance to their own work functions, and be less likely to be involved in its implementation. There was a tendency in this plan [ ] to have actions that focussed on protective risk factors and this led to a bit less engagement across the organisation because they [the risk factors] were seen to be more health oriented. Another interviewee said that they were going to try to generate a better understanding of the linkages to health and wellbeing. Realistically from next calendar year [our] work [is] to set the groundwork on the why. A new iteration - to have a resourcing component encouraging people to consider the health plans They will be put through a process where they will be asked to consider the relevance to their work. Visibility of action Interest in the action could perhaps be influenced by its degree of visibility, particularly for those actions that involve building evidence, advocacy, developing partnerships. We have always known our work is invisible. I have to communicate it to our manager and to colleagues, our work is building the evidence, 29

30 partnerships and mobilising internal stakeholders and partnerships externally, but it is really long term it is that work at the beginning that builds the momentum. Embedded in Council/Community Plan Two factors reported above Interest in the Action and Visibility of Action are likely to be met if the actions are part of a Council plan, as these are likely to have gained Councillor and Council leadership support. Councillors are very involved in the Council plan so they have a lot of interest, a lot of influence of what goes in and what doesn t. They have their platform of what they stand for and what they were elected on, what can happen. Even with the best research and best data, if this works contrary to what a Councillor wants to achieve that can be hard going. Certainly [for] those objectives/actions that were successful there is a political will behind them. One interviewee stated that this might also have to do with the expectation that the progress of all actions within the Council plan is to be reported. [The] fact that part of the Council plan means we have to report on them. More accountability around them. One interviewee reported on the different requirements in the Public Health and Wellbeing Act (PHWA) (relevant to the MPHWP) compared with the LG Act (relevant to the Council Plan). The PHWA requires different things to the LG Act so [the Council Plan and MPHWP were] split off own engagement The PHWA has a few more loops. This view led to the same Council adapting how they merged the two processes. So the process for [involved] two separate processes [they then] merged, but [for] the plan, we kind of worked as one and broke up to do our own thing - then came back together. One interviewee felt that embedding the MPHWP into the Community Plan (rather than the Council plan) would more strongly influences the potential for an action within the plan to be implemented. 30

31 Resourcing/funding Adequate resourcing of an action was reported to be a factor raised by almost all interviewees. In relation to an action that was not implemented, one interviewee reported: It couldn t be resourced We don t have a budget we have staff two staff allocated to the HP and a few thousand dollars and if we want to progress anything we have to have it driven through the departments and put a budget bid for it and there are increasing restraints [rate capping will be one of these]. Others referred to specific aspects of resourcing. These are reported under the relevant subheadings below. External funding opportunities Access to external funding opportunities was raised as an influencing factor of successful implementation of MPHWP actions. Healthy Communities and Healthy Together Victoria were two funding sources often raised during the interviews. However, with the ending of these initiatives and no others in sight, Council staff signalled the need for additional sources of funding for initiatives. This factor of resourcing also relates with the next. Flexible use of existing resources A number of interviewees referred to the cap on Council rates (from the start of the financial year), and it s likely impact on the provision of resources in the future. While most of those referring to the cap were fairly pessimistic, one interviewee said that while this might impact on the number of new services or programs, there was scope to focus planning efforts on existing programs and services by re-orienting them to ensure they are better targeted, efficient and effective. The interviewee argued that those actions that make flexible use of existing resources are likely to be implemented over new or novel activities particularly: If people can see it helps them do their job better not asking them to do extra, but slight modifications to do their job better. Timing or being opportunistic One interviewee reported the benefit of timing and being opportunistic when it came to the availability of resources. Council planners might have a list of community needs and strategies for which resources are not currently available, however, if they waited, in readiness, an opportunity might later present itself. 31