Municipal Public Health Planning Framework - Part B

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6. Planning stages

Page content: 6.1 Pre-planning | 6.2 Municipal scanning: Collecting information | 6.3 Partnership development | 6.4 Implementation | 6.5 Evaluation

The overall development of an MPHP consists of five broad stages:

1. Pre-planning
2. Municipal scanning
3. Partnership development
4. Implementation, comprising
   1. Prioritisation
   2. Strategy development
   3. Action planning
   4. Monitoring
5. Evaluation.

Planning exercises aim to provide some certainty in the face of an ambiguous or uncertain future and are often associated with change. Two interconnected levels of planning are important to Municipal Public Health Plans - strategic and operational.

Planning does not progress in a linear fashion from pre-planning to implementation and evaluation, but rather tends to be a series of cyclic, overlapping or spiralling processes. That is, various activities from each of these stages tend to be occurring at the same time and there is a coursing backwards and forwards between the stages and activities within each of these stages. In this regard, planning can be seen as a form of 'action planning' (or 'action research' - Section 6.3).

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6.1 Pre-planning

The development of an MPHP is a process of gathering appropriate and relevant information, analysing it and then determining priorities, objectives and strategies to be pursued by all the stakeholders in the process. Other critical functions requiring a concerted effort include:

• Managing and coordinating the planning development process
• Ensuring that all stakeholders, potential partners and the broad local community are involved and informed in a timely and meaningful fashion
• Coordinating information
• Ensuring accountability for the planning process
• Keeping it on track.

Pre-planning is a critical management process to be undertaken by those responsible for the MPHP. Elements that need to be considered for a project plan include:

• Ensuring that the MPHP project is based on a clear need and rationale
• Ensuring the participation of stakeholders
• Ensuring strong leadership
• A process champion
• A tailored planning process
• Open communication leading to commitment.

A key component of project planning is to be clear about the capacity of the contributing organisation(s) to foster and implement creative strategic planning. Organisational capacity involves at least three components: organisational commitment, skills, and structures. In order to enhance health outcomes, we may first need to improve programs by using organisational development strategies to strengthen organisational support systems.

It should be noted that many organisational development initiatives will require the systematic involvement of all organisational stakeholders, and be led by specialist staff in management and human resources. It is not the intention of this document to create an expectation that MPHP planning and project staff be responsible for instigating processes that require an organisation-wide response. Rather, the intention is to assist MPHP staff to gain a realistic perspective of what organisational change needs to occur, and what they can realistically achieve.

Some organisational issues for management and practitioners to consider are listed in Checklist 1.

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6.2 Municipal scanning: Collecting information

Information can be used to build a profile of the community and major health issues affecting it, which all participants in the process share. Although sharing a picture of the municipality does not necessarily mean that everybody will immediately agree on what is important, it does provide a common starting point for the discussions and decisions that follow.

Collection of information will help determine:

• The nature and characteristics of a community
• Community strengths, resources and capacities
• Whether current services and initiatives are responding appropriately to illness and are promoting health
• Where there is a gap in services
• Where new services are necessary to remove an existing health inequality
• Where existing services can be better targeted
• What environmental changes are necessary to improve health
• How community structures are affecting health and the need for community development.

Needs assessments are conducted to:

• Bring about change and adapt to a changing environment
• Challenge established thinking and educate about new issues and priorities
• Guide policy, planning and the allocation of funding
• Prevent costly mistakes.

In the context of developing an MPHP, a major source of health information is derived from community consultation exercises from which community-identified health capacities and needs emerge.

See Checklist 2. See also Checklist 3.

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A useful way to ensure that comprehensive information is collected, is to map municipal data across the four environmental dimensions (discussed in Section 4.3), as shown in Figure 6. Other useful sources of information can be found in the Victorian Burden of Disease Study and the Primary Care Partnerships' Core Data Set, Integrated Service Planning: Interim Guidelines, and Selecting and Accessing Population Data: An information Resource. (These are available on the PCP website: www.health.vic.gov.au/pcps).

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6.3 Partnership development

6.3.1 Vision and goals | 6.3.2 Inter-organisational partners: Involving key stakeholders | 6.3.3 Internal local government stakeholders | 6.3.4 Why is community participation important?

6.3.1 Vision and goals

'Effective partnerships require the establishment of a clear vision which speaks to the ethical and moral underpinnings of the work of the member organisations, and to which individual participants can make personal commitments' (Labonte 1997, p.100).

Vision in this context relates to a description of what municipal public health looks like when the plan is successfully developed and implemented, which in turn, inspires others to commit to this vision. The overall goal of the MPHP is to improve municipal public health status and this should be stated at the beginning and throughout the planning process, so that every participant remains focused.

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6.3.2 Inter-organisational partners: Involving key stakeholders

Council's role in municipal public health planning is as a coordinator and facilitator - it certainly is not the role of Council to undertake all of the strategies in the MPHP. Many organisations in the municipality will be undertaking initiatives and projects, which will be reflected in the goals and priorities of the MPHP. One of the marks of a successful MPHP is the extent of ownership and participation of local health, welfare and community organisations.

Input from people and organisations from a diverse background creates an opportunity for the discussion of different issues and a subsequent sharing of knowledge and understanding, better relationships, and an appreciation of the issues and features of the key stakeholders. The result of this active participation is a better planning process, a quality MPHP, and improved chances of enhancing municipal public health status. In this way, gaps in program delivery and target groups not being adequately serviced will be more easily identified. The involvement of other key organisations also increases the knowledge, skill and resource base of the MPHP.

The identification of key stakeholders or partners is essential; they should be brought into the process as early as possible. Once the key organisations and stakeholders in the municipality have been identified, a decision will have to be made as to the membership of the MPHP Advisory/Steering Committee, who will be kept informed of progress, and who will be consulted.

Examples of key organisations within the municipality are many and varied, but could include those listed in Figure 7.

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6.3.3 Internal local government stakeholders

Careful consideration must also be made to identify the individuals and departments within Council that have a critical role in the successful planning, implementation and evaluation of the MPHP. Without the communication, commitment and involvement of these key internal stakeholders in the development of the MPHP, the document risks being seen as purely the role and responsibility of the 'health' branch and will not reflect the whole-of-council approach required.

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6.3.4 Why is community participation important?

The involvement and participation of the municipal community in the development of the MPHP is an important part of the planning process. Community participation involves engaging people as members of communities in identifying, deciding about, planning for, managing and/or delivering programs and policy. Ideas of social justice and equity involve inclusion and participation and the need to include not just other service providers but also the users of those services. The term, 'community participation', is often used in conjunction with other terms such as consultation, collaboration, involvement, empowerment, community capacity building, and community development.

Refer to Checklists 2, 3, 4 and 5, and the Glossary.

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6.4 Implementation

6.4.1 Deciding on MPHP priorities | 6.4.2 Strategy development | 6.4.3 Action plan | 6.4.4 Monitoring

6.4.1 Deciding on MPHP priorities

The MPHP must be designed with the contexts of the local, state, and national health policy and issues in mind, and can be used as a rationale for attracting additional funding. Importantly, public health issues are usually broad in scope and consequently demand approaches that are intersectoral in nature, so there is a critical need for implementation by collaboration. Objective and priority setting therefore are processes that are part of implementation planning.

In practice, priorities fall into two categories:

• Public health priorities, that is, those priorities that have been identified to be particularly relevant to the municipality.
• Planning process priorities, that is, those priorities that are particularly relevant to the sustainability and success of the planning process.

The MPHP is a document that Council manages; it is not a document in which Council (in isolation) undertakes all of the strategies.

Refer to Checklist 6 and 7.

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6.4.2 Strategy development

The formulation of MPHP strategies is the critical link between:

• The vision of the MPHP
• The identified public health issues in the municipal environment
• The auspicing MPHP Committee / Reference / Advisory Group
• The purpose of the public health planning process
• The intent of the legislation.

The development of strategies in the context of the MPHP is as much an exercise in the appropriate management of community resources as it is an exercise in planning practice.

Strategy formulation by definition provides an opportunity for innovation. For local strategic public health planning, there is a need, because of the changing local environment, to identify and recognise changes and issues and be creative (the ability to combine ideas in a new way) and innovative (the implementation of a new idea) in response to these changes and issues.

Formulating strategies to address public health issues involves selection, that is, deciding which strategies will be adopted for particular issues. To assist the selection of strategies, it is necessary to describe them in enough detail to permit judgements to be made. Further, selection of strategies must take into account whether they are consistent with the vision and values of the MPHP and the participating organisations and individuals, and with resource limits. The added advantage of setting criteria is that they can be used for future evaluation purposes.

Refer to Checklist 8.

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6.4.3 Action planning

The development of operational or service plans is required to implement the strategic planning that has occurred so far. Action planning involves putting the strategies into practice and involves review of progress.

Action planning can be progressed by utilising existing plans such as Community Safety, Disability Access, Health Promotion Plans, Recreation Strategies, Local Drug Strategies and so on, which can further the action required to address the priorities identified in the MPHP. In this way, duplication of effort is avoided and more detailed and specific action plans are directly linked to the strategic priorities identified in the MPHP.

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6.4.4 Monitoring

Monitoring enables responsible agencies and stakeholders - especially local government - to see first hand how implementation of the MPHP is progressing.

The project management approach taken to develop the MPHP so far should be continued, with communication of progress a critical ingredient in the overall MPHP process.

Monitoring is useful:

• For ensuring accountability to fund providers
• For gaining access to resource allocations from within Council and from other funding bodies
• For signalling when opportunities arise for further development of the Plan or when milestones are achieved.

It is important to develop a process for monitoring progress that gives attention to:

• How progress is recorded and reported
• To whom, and how often, progress is reported
• What actions will be taken if a strategy is facing difficulties or is not implemented.

An implementation steering committee, linked to a regular reporting mechanism to Council through the relevant Council committee, can keep Councillors and the Executive informed about the progress of the MPHP.

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6.5 Evaluation

Evaluation is the process by which we assess whether the MPHP has made a difference to municipal public health status. Useful evaluations have been defined as involving:

... the systematic collection of information about the activities, characteristics and outcomes of programs, personnel and products for use by specific people to reduce uncertainties, improve effectiveness and make decisions with regard to what those programs, personnel or products are doing and affecting (Patton, 1982).

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6.5.1 Why evaluate?

Evaluation is conducted for a wide range of reasons, including:

• Feedback and accountability

  • To provide information to evaluation users on, for example, how a particular program within the plan was

  • being used or understood.

  • To provide feedback to inform decision making at all levels: community, regional and national.

  • To account for what has been accomplished through project funding.

• Improvement

  • To provide information on how a program or plan could be improved and made more effective; this idea is closely related to ideas associated with the review processes.

• Resource allocation

  • To assist with the allocation of resources and make decisions as to whether targets and agreements have been met, for example, funding agreements or contract requirements.

  • To position high quality projects for future funding opportunities.

• Policy development

  • To contribute to policy development, an appropriately structured evaluation allows for the identification and assessment of any impacts or potential impacts on the planning process coming from policy and/or legislative changes, and changing state and federal government public health policies and priorities.

• Best practice

  • By promoting learning about which strategies work and which don't, the insights gained can contribute to the body of knowledge promoting health and wellbeing.

It is important to ensure that the plan is implemented in such a way that the information needed for evaluation is collected. This suggests that the purpose of the evaluation - and the evaluation questions asked - will guide the method of data collection, analysis, and the dissemination of results.

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6.5.2 Evaluations need to be 'do-able' and useful

Usefulness and utilisation are common themes of program evaluation. Practical, do-able evaluations will be guided by attention to four criteria of excellence:

Usefulness How can we make sure that the findings will be used?

Practicality How can we make the evaluation process practical and feasible?

Ethics How can we ensure that our particular evaluation questions and process are ethical?

Accuracy Which methodology is the best for helping us to capture our evaluation questions? (Patton, 1982)

The values that inform evaluation should come from the people who want the information, and who have the responsibility for using the findings, rather than from the evaluator. The role of the evaluator is to act as an advocate for process - to ensure that the evaluation aims to produce relevant, timely and useful information in a way that is practical, ethical and participatory. To do this, the evaluator must seek out and work closely with the MPHP's primary intended users, and clarify and facilitate their commitment to concrete, specific uses.

Key stakeholders of the MPHP, such as Councillors, other Council Departments, local community and health organisations, must seek to agree on the purpose and parameters of the evaluation and how it will proceed, and what can be realistically achieved. Key stakeholders will need to maintain a belief that the evaluation is being conducted effectively and that the exercise is worthwhile. It is important to actively involve the primary intended users, and show them the usefulness of both the evaluation process itself and its results. See Checklist 9.

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6.5.3 Communicating the effectiveness of the MPHP

A well-conducted evaluation is a part of demonstrating the effectiveness of the MPHP and, in turn, the achievements should be widely promoted and acknowledged. Strategies that assist in the reporting of information to the local community include:

• Launching the MPHP
• Regular newsletter to the community
• A community information/health issues day
• Presentations to local organisations
• Spreading information through the networks of organisations involved
• Press releases and articles in local newspapers
• Producing a video, a strategy which is good for people with low literacy levels
• Posters in public places
• Distributing the report widely to key local organisations.

If community members and other stakeholders have been closely involved in all stages of the MPHP process, then it is likely that they will also seek to be involved in disseminating the effectiveness of the MPHP.

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