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Local Government Planning for Health & Wellbeing
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Municipal Public Health Plans
Guidelines For Development
Contents
Introduction
Background
- Functions of Councils
- Municipal Public Health Plans
- Rationale
Preparing a Municipal Health Plan
- Setting up a Steering Committee
- Role
- Membership
- Chairperson
- The Functioning Committee
- Project Manager
- Timeliness
Identifying Scope and Issues
- Choosing the Issues
- Working Groups
- Information Awareness
- Local Networks
- Community Liaison
- Consultation with Department of Human Services
- Collecting Information
Generating Goals, Objectives And Actions
- Context
- Goals, Objectives and Actions
- Action and Strategies
Writing The Strategy
- Words on Paper
- Expression
- Structure
- Decision Making and Approval Process
Producing And Promoting The Finished Document
- Production
- Promotion
Review And Evaluation.
- Reviewing a Plan
- Evaluating a Plan
Appendix 1
Published by the Public Health Division,
Department of Human Services (formerly the Department of Health And Community
Services),
Victoria, Australia.
Graphics and Production by the Promotion Media Unit, Dept. of Human
Services.
For further information regarding this document please contact:
Ron Frew (03) 9616 7484, Municipal Public Health Plans Program,
Department of Human Services (formerly H&CS). email: rfrew@hna.ffh.vic.gov.au
ISBN NUMBER 0 724 124 209
In preparing this manual extensive reference was made to the document:
Looking forward a Guide to Preparing a Conservation Strategy, Ministry
of Planning and Environment 1989.
This manual is a working document and not the definitive statement on MPHPs. While there is a need for some consistency in content and approach across the State, local plans should reflect the conditions and needs of individual communities.
These guidelines are designed to cover key elements which should be included in all MPHPs, while allowing for a high level of flexibility to suit the particular circumstances of each council.
The determinants of ill-health are changing. The public health concerns of the 19th Century such as rats, drains, pure water, sewerage, overcrowding and adulterated food, have largely been met and replaced by modern day hazards. Today, the common causes of illness and death are cardiovascular disease, cancer, respiratory disease, accidents and violence. The aim of public health programs is to create a physical, social, economic and cultural environment which enables people to avoid ill-health and achieve maximum well-being. Public health programs differ from other programs by focusing on prevention through the creation of healthy environments, rather than changing the individual.
In 1988 the Parliament of Victoria enacted a series of major reforms to the state's public health legislation. These changes are designed to bring the law in Victoria into line with the public health concerns of the late 20th Century.
The Health (General Amendment) Act 1988 clarifies and simplifies the law relating to the activities of local government in public health. It removes a number of restrictive regulatory controls and gives councils greater freedom to determine their own priorities.
The new legislation sets out for the first time the long-standing, but previously unwritten, functions of local government. The Act states:
29A. The function of every council under this Act is to seek to prevent diseases, prolong life and promote public health through organised programs including the prevention and control of:-
In order to take account of the dynamic nature of local government and the fact that public health problems and priorities change over time, the Act makes provision for councils to document their major public health activities in a public health plan.
Under the Act:
29B.
MPHP's are intended to serve four related purposes:
Preparing A Municipal Public Health Plan
Since it is not possible to address every actual or potential public health danger affecting a local government area, a planning and priority-setting process has to be undertaken. A strategic planning process ensures that expenditure is targeted to the areas of greatest need and where it is likely to be most effective. Whether explicitly or not every council and health agency is already making these kinds of planning decisions.
MPHPs enable such decisions to be made more systematically and to be documented. They are fundamentally a management tool for helping local councils determine the direction of public health priorities, identifying the key programs and strategies required to accomplish their objectives and evaluating progress.
Most key programs are likely to be in place already; some new programs may replace existing activities so as to respond to changing conditions. A plan will incorporate both maintenance and change strategies.
MPHPs are oriented on practical results which maximises outcomes within available resources. Effective implementation depends largely on the planning process itself. An effective process will include liaison with local communities on the key issues and the action which needs to be taken.
MPHPs represent a vehicle for councils and H&CS to plan public health programs and strategies in partnership. State and regional health policies and priorities establish the context for MPHPs. Improved co-ordination of Public Health planning will be achieved through consultation between council and H&CS in the development of municipal plans.
The information provided by councils in their plans will be used by the department to monitor key public health issues in local areas, to gauge the effectiveness of different strategies and to assist in the sharing of information among councils across the State. In the course of plan preparation, the department will provide feedback and to ensure that State and regional public health objectives are addressed.
Effective planning requires a structured methodology and a team approach. Nowhere is this more clearly true than in the field of public health, which cannot be the preserve of any one agency, sector or level of government, it is the shared responsibility of all. Within individual councils all staff including; community services, engineers, town planners, environmental health officers, medical officers of health, maternal and child health nurses and recreation officers, make decisions and carry out programs which have an impact on public health.
A MPHP is not so much the plan of the City of Healthville, but a plan for the City of Healthville. This recognises that the planning and delivery of public health services should be a partnership between the relevant groups. Planning provides an opportunity to develop a common purpose and sense of direction.
Once a decision has been made to proceed with the preparation of a MPHP, a number of important organisational issues must be addressed.
A steering committee should form the core of the process, although its functions and role will vary from council to council, depending on the particular needs of each municipality.
It is a useful means of bringing together appropriate representatives to oversee the preparation of the municipal public health plan. Its role is to:
The steering committee establishes preliminary objectives and sets limits on the scope and scale of the project to ensure that it remains manageable. For this reason, the group members should have a thorough understanding of the key (not all) public health characteristics, trends and events that may affect the community, as well as management and operational skills.
The steering committee should represent all the main interest groups, such as community health services, hospitals, community agencies and local government. Nevertheless it should not be so large as to be unwieldy. Fifteen members is the recommended maximum; a dozen is preferable. More than fifty percent of the membership should be from the local community, with the balance to include representatives from council and staff.
The committee should be reasonably representative of the community involved, considering socio-economic and ethnic groups, geographic spread (particularly in a large rural shire), women, young people and older residents. If this is not possible on the steering committee, other efforts should be made to ensure that these groups contribute to the strategy.
Interest groups that could be considered for representation on the committee include:
The most direct approach to selecting a committee is to identify and invite potential members. A more equitable approach is to contact all relevant organisations and seek nominations. It may also be worthwhile to advertise in the local newspaper, calling for nominations from individuals with knowledge and interest in health issues.
If a choice has to be made between nominations, individuals who are open minded, constructive and willing to contribute time and effort to the plan are clearly preferable. Ideally they would already be active in local organisations and thereby capable of following through the implementation of some of the proposed action strategies.If some nominees are not selected, they should be thanked for their nomination and invited to contribute to the process in other ways. The council may wish to ratify the proposed membership of the steering committee.
Selecting the steering committee chairperson could be one of the initial steps in setting up the plan, or could be undertaken at the first meeting. In most cases a councillor is the logical choice, in order to maintain close contact between council and the plan. Alternatively, a retired older resident may have the required experience, and more time to devote to the position.
Committee members need opportunities to get to know each other, to develop a team spirit, and to improve their motivation to contribute. For example, having supper after meetings and perhaps a dinner for the first meeting.
It is more efficient to fix committee meeting dates and times well in advance. Monthly meetings will probably be necessary to keep abreast of the plan formulation process. Evening meetings are likely to suit the majority of members but the most convenient time should be discussed at the initial meeting.
The steering committee will determine how formal its meetings will be and how it will make decisions. It may operate on a consensus model or vote on motions. A vote may only be necessary on major or contentious issues.
Meetings should be run in a way that provides plenty of opportunity for discussion and airing of views. The aim is to give fair consideration to all viewpoints and to come to informed and reasoned decisions.
Urgent decisions may need to be taken between steering committee meetings. The power to take these can be delegated to an executive group consisting of the chairperson, community representative and council officer.
It is likely that the steering group will nominate a plan co-ordinator or project manager as responsible for carrying out the work of plan development. (In some larger councils these tasks might be shared among a small working party). However, while this work can be quite demanding, particularly in periods of intensive activity, there is no reason for plan preparation to be the sole or even the major focus of any one officer's work.
The particular person(s) selected for this task will not necessarily come from the same professional group or unit within council. This will depend on local circumstances and organisational structures. However, it is essential that the plan co-ordinator has access to information and advice from key staff responsible for the main public health programs and services provided by council. The person should have strong written and oral communication skills, and be able to relate effectively with external organisations.
A time schedule for the MPHP preparation process needs to be drawn up as one of the initial steps. Realistic estimates of the time required for each stage may be difficult so early in the process, but a schedule is essential to maintain progress towards the end product.
There are a number of factors to be considered in drawing up a schedule . This might include the amount of time of the coordinating officer is able to provide to the steering committee and time allowed for the preparation of information material, its distribution, and dealing with responses received.
It is virtually impossible to schedule for major delays due to, for example, rejection by council of a draft document or major changes to the steering committee. Such unforseen hold ups would require readjustment to the schedule if they should arise.
A sample schedule is presented below as an indicator of the duration of possible steps in the process. The process could be extended further depending on the time the coordinating officer has available per week on the project.
----- ongoing activity for the identified period
* * * Key activity or events throughout development
It is important not to be overly ambitious in setting the scope of the MPHP. Successful completion of a relatively limited undertaking is better than abandonment due to unrealistic targets.
The choice of particular issues to be dealt within the MPHP is up to the people involved. The selection can be made by the steering committee based on discussion with others, a public survey, or a combination of these approaches.
At the first meeting members of the steering committee could be asked to present a brief paper on the issues they see as important. These suggestions would be discussed and combined into a list. In addition, the responsible officer for the MPHP could present a draft list for discussion.
Issues selected should be locally significant now, or likely to be so in the foreseeable future. A local solution to the issues should be possible, or at least a local contribution to resolving a more broad-scale problem, eg, cancer prevention. Consideration should be given to state and federal health priorities in determining priorities, but only as they relate to local issues.
Limit the final choice of issues to a manageable number in relation to the labour available for their investigation and policy development. Closely related issues could be bundled together for the purposes of setting up a working group or writing a section of the MPHP. If some significant issues have to be omitted, these should be noted in the MPHP for future attention.
An effective means of dealing with the issues selected for the MPHP is to set up a working group for each bundle of issues or for categories such as `community safety'. A clear brief and a general set of guidelines, is needed for each group to ensure consistency in output.
Working group members could come from the steering committee only, or they could be co-opted from staff within council and the community. Some issues can only be effectively tackled through co-operation with other agencies in the municipality or an adjoining municipality. It may be appropriate for a working group dealing with such an issue to include representatives from the other municipality.
A range of views should be represented on each working group with all members willing to contribute time and effort to developing that section of the MPHP. Their role could include collecting information, setting objectives, writing policies and/or recommending actions.
One member of each group could be nominated to report back regularly to the steering committee.
The first step is to make the community aware of the fact that a plan is being prepared. Publicity in the local or regional media (newspapers, radio, television) is one means of doing this. Personal contact with the local media people should be made as early as possible, to enlist their co-operation. They will have suggestions on presenting material in a form that they can most readily use. A regular newspaper column or feature articles dealing in turn with each health issue being tackled in the plan would be a very valuable.
Posters, notices and talks to various groups are also effective means of publicising the plan. A display can be mounted at council offices, public libraries, the main shopping centre, and any local festivals. A competition or quiz is a means of stimulating young people. A newsletter to ratepayers provides another opportunity for informing people.
Personal word-of-mouth contact is the best way of getting people involved. Networks of people who are business associates, friends, customers, or colleagues in voluntary organisations, churches and service clubs can be tapped for this purpose.
It is a good idea to make each steering committee member who is representing an interest group or organisation personally responsible for informing members of that group about the plan, and soliciting their views at appropriate stages in the process. This role is particularly important for groups such as community health, whose co-operation and support for aspects of the plan is vital.
Community liaison is important in developing a MPHP. The MPHP will be both more acceptable and more realistic in its proposals if the key players are given an influential role in framing its recommendations. Those included might be community health centres, local hospitals, schools, residents associations, industry/commerce, welfare organisations, and (for specialist advice) statewide and national bodies such as the Anti-Cancer Council and H&CS regional offices. The process of preparing the plan can be as important as the product in creating a positive attitude towards health and health services and opportunities for constructive action at the local level.
The legislation requires that MPHPs be prepared in consultation with the Secretary of the Department of Health & Community Services. In practice this means that discussion and negotiation with H&CS will need to be built in at key stages in the plan development process. It does not mean that plans require H&CS approval.
This will enable councils to take into consideration the following issues when developing MPHPs:-
To facilitate this, councils can liaise as necessary with the MPHP project officers and regional staff of the Department.
Councils beginning work on plan preparation should make arrangements to meet with departmental staff to discuss plan development processes, training and other assistance needs, and other preliminary issues before plan development gets under way.
While a sound information base is important for the plan, it will be necessary to limit the time and effort put into this phase of the process to ensure that there is adequate time for policy development, writing and review. Only material directly relevant to the identified issues should be collected, although it is tempting at the start to amass all available information.
The most useful source of information is personal knowledge, particularly that held by the steering committee, council officers and local workers. These people should be able to arrange access to other valuable sources: council reports, plans and files, consultant's reports to council, records of local groups, government authority reports and resource information.
It will be helpful when formulating the plan to have collected examples of policies and actions from other places which relate to similar issues. These may be adopted, adapted or used as a springboard to innovative solutions.
Generating Goals, Objectives and Actions
These guidelines provide advice on the key components which should be included in a MPHP, identify optional elements and set out a number of major themes which plans might be expected to address.
The level of detail within each of the core elements will depend on the size, capacity and particular circumstances of each council. However, sufficient information should be provided for them to be informative and relevant, giving a picture of the council's activities to the community.
Plans should not be lengthy documents - they should be clear concise and easy for the average person to read and understand.
A brief description of the key demographic, socio-economic, and environmental features of the LGA, and their likely implications for the health status of the community (current and future). This will include some (but not necessarily all) of:
Goals and objectives spell out what a plan is trying to achieve. Specific objectives for each major issue can be valuable in clarifying directions for the future.
The problem solving phase, when the plan's recommendations are formulated, is the most creative part of the process. Discussion sessions, brainstorming, workshops and interviews can involve the working groups, councillors and council officers, and the general community in considering what is to be done about major issues. Initially, a wide range of innovative options for possible courses of action can be generated. These are then refined, and the realistic ideas selected. Proposals that will be seen as extravagant, infringing on individual's rights, or otherwise unrealistic have little chance of implementation. The plan recommendations need to be acceptable to the community, while still tackling the problems effectively. The advice of council officers and councillors is very valuable at this stage, particularly on what is feasible, what has already been tried and failed, and possible alternatives. Similar principles used to develop other planning documents for the council such as the Corporate Plan can be followed for the development of the MPHP. This involves:-
Actions/strategies are the means of implementing goals and objectives, they are initiatives taken over the short term to implement the plan. They provide the day-to-day programs and activities which allow staff to respond to the identified needs of the community in a constructive and meaningful way. Action statements should encompass the following:-
To increase the likelihood of implementation, it is important that recommendations be carefully thought through and described. This includes an indication of how they would be done, by whom, and where the resources would come from. A thorough description for an action project would include:
It is easier to prepare a written report of a MPHP if a draft outline of the document is drawn up at an early stage in the process, and a format is determined for presenting each issue ( see examples in appendix ii). The writer can then collect and organise the material, and start writing as soon as possible in a form that will be readily incorporated into the final report.
Putting words onto paper is the best way to crystallise thoughts and ideas, and provide a basis for discussion. Although it is tempting to defer writing until information is collected and strategic directions decided, this will prolong the process. It is better to write an initial rough, incomplete draft that can be discussed, added to and refined. Word processing facilities are invaluable for this.
If there are several authors, thorough editing will be needed to ensure a consistent standard and style of expression. Regardless of the author, the report will benefit from a critical review by another person who is a competent editor.
A concise, clearly written document is more likely to be read and understood than one that is long winded and poorly organised. Generally, the shorter the better, as long as the rational for proposals is adequately explained.
While writing the plan, or any other material for public distribution, the author needs to be aware of readers' potential sensitivities. Extreme caution is therefore required in the choice of words, to avoid offending groups who are needed as allies in implementing the plan. On the other plan it is important to give credit where it is due. Express support for the continuation of good practices or programs that are already occurring.
Another form of written expression to be avoided is the directive statement: 'council shall/will/must do' something. The MPHP is a set of recommendations, not directions, to council and other organisations. Once adopted by council, it may be appropriate to express policies and actions as 'council will', but before this stage such wording may cause offence at being told what to do.
A summary at the beginning of the plan is useful. Councillors and many other readers need a brief overview of the whole document before going on to read the detail. A brief profile of the area may follow: its population, resources and other demographic characteristics. Next a brief explanation of the overall aims of the MPHP, and the process by which it has been prepared. An outline of how the plan has come about and a brief examination of the broad health priorities at the federal, state and regional level and the relationship of these priorities to local health planning.
This would then be followed by the identification of health issues, and the processes used to identify them, from which the identified goal areas, objectives and strategies would be developed. Any further documentation could then be placed in the appendices.
Regular progress reports will keep people informed on what is being done, and allow objections to be raised and dealt with promptly causing minimum disruption and delays at later stages. This applies to working groups reporting back to steering committee reporting to council. An appropriate interval for reports to council from the steering committee is advisable/appropriate monthly.
Initial arrangements for the plan should specify exactly which steps in the process require approval from council. These may include an issues statement, and a draft version of the plan, before the final draft is submitted to council for adoption. Close involvement of some councillors in the process, and good communication with officers who will be advising council will reduce the likelihood of deferral of decisions, which would delay the process.
The first step in the approvals process is the agreement of the steering committee on a draft version suitable for council, other key agencies in the municipality and possible wider circulation.
A verbal presentation to council, preferably at a special meeting, is the best way of explaining the rationale and contents of the draft plan. This could be followed by a discussion session. Busy councillors cannot be expected to read lengthy documents. If any individual councillors have strong objections, a separate meeting with them to formulate acceptable modifications,( may be worthwhile).
Some revisions will doubtless be necessary after circulation. Some compromises will almost certainly be needed if the plan is to be accepted, and most importantly, acted upon.
Provided that council is kept adequately informed during the preparation process and is reasonably satisfied with the draft, there should be no major obstacles to adoption of the final plan as council policy. An interim step may be its acceptance in principle, subject to specific amendments and final editing.
Producing And Promoting The Finished Document
Once the plan has been finalised and approved, it can be prepared for publication. The standard of production will depend on the available funds, as well as the intended distribution of the document. Decisions to be made about production include:
If the text is stored on computer disc and use can be made of a laser printer, preparation of camera ready art for offset printing is relatively straightforward. This form of production is likely to be the most economical, unless a very small number of copies (under 20) is required.
A final, careful proof-reading of the document is always worthwhile before it is reproduced.
The availability of the finished document is an important opportunity to publicise the plan and promote its implementation. Any of the publicity measures suggested previously could be used. In addition there could be an official launch by the mayor or shire president, to which all relevant groups and the media would be invited. A formal presentation to council staff could be useful, including a workshop on steps to implementation.
The Act states that every council must review its MPHP annually and if appropriate, amend the Plan.
Reviewing a plan annually allows councils to revise or amend sections of the MPHP without rewriting the whole plan. It is an opportunity to focus on the strategies which have been undertaken in the previous twelve months and to evaluate their effectiveness.
However, review of the MPHP does not have to take the form of a once a year exercise, it may be done regularly throughout the year by the implementation committee. This is a particularly easy task if performance indicators have been included in the original plan.
Reviewing gives the implementation committee an opportunity to reflect on its processes and make adjustments to the plan or expected outcomes, before commencing the next years program. Priorities may have changed within council or the community and some strategies may be discarded as unrealistic, others may have to have timelines revised. By reviewing the MPHP on a regular basis it can be kept current, manageable and achievable.
Councils are required to rewrite their MPHP every three years. For most councils this should be a relatively easy process, particularly if a review has been carried out regularly.
An evaluation, by its nature, will be more thorough than a review and involve more of the people affected by the plan. An evaluation is an opportunity to redefine goals and objectives, take a fresh look at the issues raised previously, which might now be included in the new plan.
An evaluation will allow community members and health agencies to comment on changed priorities or circumstances within the municipality, which may alter the approach the plan will take for the following three years.
An evaluation will provide opportunity for the MPHP, if it has not already done so, to be linked more closely to the corporate plan.
Appendix 1 -Public Health Issues.
Public health issues include a wide range of problems, concerns, and dangers which might be faced by a council. Whether or not any of these are a priority for a given council will depend on local circumstances. Obviously, pollution of the ocean beaches is not a problem likely to be faced by an inland municipality. The list below is not intended to be comprehensive, nor does it necessarily capture the element or "angle" on the issues which any particular council might want to highlight.
Nevertheless, it may offer some ideas and represent something of a preliminary checklist for councils when thinking actual and potential public health dangers affecting the municipal district:
