partnerships for sustainable health – revisit the policy
TRANSCRIPT
Partnerships for Sustainable Health – Revisit
the PolicyDatu Dr Andrew Kiyu
Consultant Epidemiologist,Sarawak Health Department.
8th National Public Health ConferenceEquatorial Hotel, Malacca
2-4 August 20161
8th National Public Health Conference
Theme:“Managing Society in Combating Public Health Challenges”
2
3
VISION Ministry of Health Malaysia
“A Nation Working Together
for Health”
5
Schematic Overview of the Malaysian Health System
* SOCSO - Social Security Organization ** EPF - Employee Provident FundSource: Rozita Halina Hussein. Asia Pacific Region Country Health Financing Profiles: Malaysia, Institute for Health Systems Research. http://www.wpro.who.int/asia_pacific_observatory/hits/series/Hits_MYS_2_organization.pdf?ua=1 6
What is Policy?A Conceptual Continuum
Policy is considered to be a rule or principle that guides decision-making
Policy is • defined as the explicit (and thus
documented) formal decision • by an executive agency • to solve a certain problem • through the deployment of
specific resources, and • the establishment of specific sets
of goals and objectives • to be met within a specific time
frame.Evelyne de Leeuw (2007) “Policies for Health: The Effectiveness of their Development, Adoption, and Implementation”7
How Policy Impacts on Health
• Lasswell (1936) defined policy as “deciding who gets what, where and how”.
• Thus policy regulates choices in every domain pertaining to social determinants of health, • be it housing, social assistance, environmental
protection, employment and economic issues, agriculture or science and technology policy
• Lasswell, H. (1936) Politics: Who gets what, when, how. McGraw-Hill, New York. Cited by Evelyne de Leeuw (2007) “Policies for Health: The Effectiveness of their Development, Adoption, and Implementation” p55
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WHO Report 2006 – focused on human resources for health
http://www.who.int/whr/2006/whr06_en.pdf?ua=19
The key International declarations and publications that exhorts partnerships or
intersectoral actions for health:
• Alma-Ata Declaration (1978),
• Ottawa Charter for Health Promotion (1986)
• Intersectoral action for health : the role of intersectoralcooperation in national strategies for Health for All (1986)
• Intersectoral Action for Health: A Cornerstone for Health-for-All in the Twenty-First Century (WHO 1997),
• Adelaide Statement on Health in All Policies (WHO 2010).
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Declaration of Alma-Ata International Conference on Primary Health Care,
Alma-Ata, USSR, 6-12 September 1978 • VII: Primary health care:• …
• 4. involves, in addition to the health sector,
all related sectors and aspects of national and community development,
in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors;
and demands the coordinated efforts of all those sectors
• …• http://www.who.int/publications/almaata_declaration_en.pdf 12
Prerequisites for HealthOttawa Charter for Health Promotion
21 November 1986
The fundamental conditions and resources for health are:• peace,• shelter,• education,• food,• income,• a stable eco-system,• sustainable resources,• social justice, and equity.
• Improvement in health requires a secure foundation in these basic prerequisites.
• http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ 14
The need for concerted action by many sectors
• The prerequisites and prospects for health cannot be ensured by the health sector alone.
• … (it) demands coordinated action by all concerned, viz: • governments, • health and other social and economic sectors, • nongovernmental and voluntary organization, • local authorities, • industry • the media.
• People in all walks of life are involved as • individuals, • families and • communities.
• Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health.
• http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
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Why We Need Partnerships and
Intersectoral Action for Health
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Estimated Impact of Determinants of Health on Health Status of the Population
Source: Canadian Institute for Advanced Research, Health Canada, Population and Public Health Branch AB/NWT 2002 cited in Philip O’Hara (2005). Creating Social and Health Equity: Adopting an Alberta Social Determinants of Health Framework. Downloaded from http://www.issuelab.org/resource/creating_social_and_health_equity_adopting_an_alberta_social_determinants_of_health_framework
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Conceptual Framework of the Social Determinants of Health
WHO (2010). Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion. Paper 2 (Policy and Practice). http://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf19
Governance
IMPACT ONEQUITY IN
HEALTHAND
WELL-BEING
Macroeconomic Policies
Social PoliciesLabour Market, Housing, Land
Public PoliciesEducation, Health, Social Protection
Culture and Societal Values
SOCIOECONOMIC AND POLITICAL
CONTEXT
Socioeconomic Positions
Social Class Gender Ethnicity
(racism)
STRUCTURAL DETERMINANTS SOCIAL DETERMINANTS OF
HEALTH INEQUITIES
Education
Occupation
Income
INTERMEDIARY DETERMINANTSSOCIAL DETERMINANTS
OF HEALTH
Material Circumstances(Living and Working,Condition, FoodAvailability, etc.)
Behaviours andBiological Factors
Psychosocial FactorsSocial Cohesion &
Social Capital
Health System
Reasons for Intersectoral Action for Health
• Some examples of how health is impacted by actions beyond the health sector are:
• the decline of road deaths as a result of a set of measures that included road engineering and motor vehicle safety measures,
• 23% reduction in cardiovascular diseases and stroke due to a reduction in dietary salt intake from 10 g/day to 5 g/day,
• decrease in diarrhoea mortality because of improved access to clean water (21 % decrease) and sanitation (23% decrease),
• saving of thousands of lives through raising taxes on tobacco and
• increase in life expectancy attributed to additional years of education 20
Multisectoral - Definition by WHO
• Multisectoral (intersectoral) action • refers to action between two or more sectors within the public sector (1)
• Multistakeholder action • refers to action by actors outside the public sector (e.g. nongovernmental
organizations [NGOs] and the private sector).(2)
• The terms multisectoral action and intersectoral action are often used interchangeably, and they have the same meaning unless otherwise specified
Ref: (1) Paragraph 36 of the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases A/RES/66/2.
(2) Paragraph 37 of the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases A/RES/66/2.
Source: WHO Discussion Paper (Version dated 29 October 2014). Framework for country action across sectors for health and health equity. http://www.who.int/nmh/events/framework-discussion-paper-rev.pdf?ua=1
21
Four Forms of Action Across Sectors
Actions are initiated by the health authority
• participation from one or more ministries, • primarily focused on improving health and
health equity
Actions are initiated by head of government
Actions are initiated by non-health agency
Actions are initiated by head of government
• often arising to combat disease outbreaksor manage health emergencies
• all ministries participating most of the time.
• the road and transport authorities assume lead role in in the prevention of road deaths and injuries (Department of Town and Country Planning in P. Malaysia taking over Healthy Cities)
• find various sectors working together to address one or more public health issues
• E.g., Healthy cities, healthy schools
Source: WHO Discussion Paper (Version dated 29 October 2014). Framework for country action across sectors for health and health equity. http://www.who.int/nmh/events/framework-discussion-paper-rev.pdf?ua=1
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Six Components of Action Across Sectors
Establish the need and priorities for action across sectors
Frame planned action
Identify supportive structures and processes
Facilitate assessment and engagementImplement planned action across sectors
Ensure that monitoring, evaluation and reporting occurs
Source: WHO Discussion Paper (Version dated 29 October 2014). Framework for country action across sectors for health and health equity. http://www.who.int/nmh/events/framework-discussion-paper-rev.pdf?ua=1
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Institutional Capacity for Action Across Sectors
Expertise of individual practitioners
Existing policy commitments
Availability of funds
Availability of information and databases for planning
Organizational structure
Source: WHO Discussion Paper (Version dated 29 October 2014). Framework for country action across sectors for health and health equity. http://www.who.int/nmh/events/framework-discussion-paper-rev.pdf?ua=1
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Community Capacity for Action Across Sectors
Promoting health and policy literacy
Training leaders in techniques to support and enable:
• informed community participation• engagement with decision-making, • implementing and evaluating community action for health
Source: WHO Discussion Paper (Version dated 29 October 2014). Framework for country action across sectors for health and health equity. http://www.who.int/nmh/events/framework-discussion-paper-rev.pdf?ua=1
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Partnerships
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Why Partnerships For Health?Health• not solely the
responsibility of ministries of health.
• Should be everybody’s business
Partnership• based on the simple adage that “two heads are better
than one”• outcome of partnership work is not a simple addition of
the stakeholders’ inputs — it is a synergy of all inputs31
Partnership: Definition
A partnership is: • an arrangement• in which parties agree
to cooperate • to advance their
mutual interests • (http://en.wikipedia.org/wiki/Partnership)
A partnership is:• a shared commitment, • where all partners have a
right and an obligation to participate and
• will be affected equally by the benefits and disadvantages
• arising from the partnership.
• Ros Carnwell and Alex Carson. The concepts of partnership and collaboration; p7, 10;https://www.mheducation.co.uk/openup/chapters/9780335229116.pdf
• In: Ros Carnwell and Julian Buchanan (editors): Effective Practice in Health, Social Care and Criminal Justice: A Partnership Approach; 1 Dec 2008
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Types of PartnershipType Description
Project partnership
• time limited for the duration of a particular project• A partnership between the police and other road safety organizations to
lower the speed limit will end when their project is successful
Problem oriented partnership
• formed in response to a publicly identified problem• remain as long as the problem persists.• Examples of this might include Neighbourhood Watch schemes or
substance abuse teams.
Ideological partnership
• arise from a shared outlook or point of view. • similar in many ways to problem oriented partnerships, • but they also possess a certain viewpoint that they are convinced is the
correct way of seeing things
Ethical partnership
• have a sense of ‘mission’ and have an overtly ethical agenda, that seeks to promote a particular way of life.
• They tend to be democratic and reflective and are as equally focused on the means as the end.
• While most partnerships have codes of ethics or ethical procedures, ethical partnerships have a substantive ethical content in their mission and practice
Ros Carnwell and Alex Carson. The concepts of partnership and collaboration. P12-1333
Three Dimensions of Partnerships
In simple terms, the three dimensions translate into:• more resources,• more people, and • new expertise.
A unidimensional development that lacks support and input fromthe other two dimensions is likely to collapse.
WHO (2003). The power of partnership. http://www.who.int/management/powerpartnership.pdf
35Co
mm
unity
mob
ilisa
tion
• Technical development• Community mobilisation• Service enhancement
Example: Prevention and Control of HIV/AIDS in the early phase of the epidemic
• Taboo topics – Sex (especially MSM) and Substance abuse, and AIDS itself• Cannot discuss, cannot educate, cannot fund
• Difficult to identify and work with the individuals at risk
WHAT WAS DONE• partners were identified and an organisation structure for partnership was set
up• Malaysian AIDS Council was formed• Funds allocated to them to do the work that MOH cannot do
RESULT: • more resources,• more people, and • new expertise.
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Community Participation Ladder
37
CITIZEN CONTROL
DELEGATION
PARTNERSHIP
PLACATION
CONSULTATION
INFORMING
THERAPY
MANIPULATION
8
7
6
5
4
3
2
1
CITIZEN CONTROL
TOKENISM
NONPARTICIPATION
Arnstein’s Ladder (1969)Degrees of Citizen Participationhttp://www.vcn.bc.ca/citizens-handbook/arnsteinsladder.html
RESOLUTION/PREVENTION
LITIGATION
MEDIATION
JOINT PLANNING
CONSULTATION
INFORMATION FEEDBACK
EDUCATION
GEN
ERAL
PU
BLIC
LEAD
ERS
A new Ladder of citizen participation (Connor, 1998)http://geography.sdsu.edu/People/Pages/jankowski/public_html/web780/Connor_1988.pdf
Continuum of Involvement
Ros Carnwell and Alex Carson. The concepts of partnership and collaboration. P17
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Source: Jim Cowan, Cowan Global Limited 2010. Partnership workinghttp://cowanglobal.wordpress.com/tag/partnership-working/
THE FIVE DEGREES OF PARTNERSHIP WORKING
Co-existence“You stay on your turf and I’ll stay on mine”
Co-operation“I’ll lend you a hand when my work is done”
Co-ordination“We need to adjust what we do to avoid overlap and confusion”
Collaboration“Let’s all work on this together”
Co-ownership“We all feel totally responsible”
Deg
ree
of
part
ners
hip
wor
king
Token,Nominal
Pure
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Sustainable health or health care
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Three main (and overlapping) interpretations of sustainable health and health care
Addresses the rising costs of health care
addresses the impact of health care on the environment and resource consumption
addresses the roles of health care during major crises (e.g. the 2015-2016 Ebola epidemic in West Africa) and physical disasters (e.g. earthquakes).
sustainable health care is interpreted in the context of financial sustainability or affordability and accessibility of health care.
this involves ‘greening’ the sector with particular attention to energy, travel, waste, procurement, water, infrastructure adaptation and buildings.
sustainable health care is interpreted to mean that the health care do not collapse during times of disaster and the terms used are sustainable and resilient health care.
Prada, Gabriela, Kelly Grimes, and Ioulia Sklokin. Defining Health and Health Care Sustainability. Ottawa: The Conference Board of Canada, 2014.
UK. Sustainable development Unit, NHS (2009). “Fit for the Future: Scenarios for low-carbon healthcare 2030”
WHO. OXFAM, Rockfeller FoundationWHO. Hospitals Safe from Disasters
43
Resilient Health System
ADAPTIVE?Rebounds from shocks stronger
than before.
AWARE?Detects health threats before
they strike.
ITERGRATED?Rapidly deploys
resources from beyond
the health system.
SELF-REGULATING?
Prevents health disruptions from
turning into disasters.
DIVERSE?Delivers range
of services with universal
health coverage.
IS YOUR HEALTH SYSTEM RESILIENT?
IN TIMES OFCRISIS
LIVESSAVED
LIVELIHOODSPROTECTED
IN TIMES OFCALM
HEALTHIERPEOPLE
STRONGERNATIONS
RESILIENT HEALTH SYSTEMS PAY DIVIDENS
WE NEED HEALTH SYSTEMS THATBEND, NOT BREAK
ACCELERATED BY
GLOBALIZATION URBANIZATION CLIMATE CHANGE
CRISIS IS THE NEW NORMAL
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Likely features of a sustainable healthcare system – The Green Perspective
Source: http://www.sdu.nhs.uk/publications-resources/4/Fit-for-the-Future-/Cited by Knut Schroeder, Trevor Thompson, Kathleen Frith, David Pencheon (2013). Sustainable Healthcare. Wiley-Blackwell and BMJ Books.
Wellbeing is key
Hospital admissions are
rare
Low health inequalities
Care closer to home
Instant help online, by
telephone, or at a health centre
SustainableHealthcare
Buildings are in tune with the
environment, using almost no carbon
Friends, family and society promote healthy
living
We all recycle, reuse and minimize waste
Delivery of services takes long-term
financial, social and environmental costs into
account
46
Sustainable health and health care - Definition
Sustainable health and health care is the appropriate balance
between the cultural, social, and economic environments designed to meet the health and health care needs
of individuals and the population (from health promotion and disease prevention to restoring health and supporting end of life)
and that leads to optimal health and health care outcomeswithout compromising
the outcomes and ability of future generations to meet their own health and health care needs.
Prada, Gabriela, Kelly Grimes, and Ioulia Sklokin. Defining Health and Health Care Sustainability. Ottawa: The Conference Board of Canada, 2014. http://www.conferenceboard.ca/temp/10c2f6f4-6f74-4db1-b9ae-6f8995536c96/6269_defininghealth_cashc_rpt.pdf
47
Framework for Sustainable Health and Health Care
Prada, Gabriela, Kelly Grimes, and Ioulia Sklokin. Defining Health and Health Care Sustainability. Ottawa: The Conference Board of Canada, 2014.http://www.conferenceboard.ca/temp/10c2f6f4-6f74-4db1-b9ae-6f8995536c96/6269_defininghealth_cashc_rpt.pdf
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Appropriateness
Value for money
Fair and timely access
Accountability for results
Effe
ctiv
e di
seas
e pr
even
tion
and
heal
th p
rom
otio
n
Effe
ctiv
e he
alth
and
hea
lth
care
syst
ems
Fund
ing
mod
els
that
dr
ive
desi
red
beha
vior
s
Opt
imal
dev
elop
men
t, al
ignm
ent,
and
supp
ort o
f hum
an re
sour
ces
Leve
ragi
ng in
nova
tion
and
inno
vativ
e te
chno
logi
es
Stra
tegi
c al
ignm
ent w
ith
Dete
rmin
ants
of h
ealth
Sustainable health and health care
Four Guiding
Principles
Six Pillars
Success Factors For Partnerships
52
Five Features of Successful Partnership:Entering into a partnership
Successful partnerships
Welcoming culture
Mutual benefit
Membership
Common mandate /
purpose
Other key factors
important in the initiating
stage
Collaboration Roundtable (2001): The Partnership Toolkit: Tools for Building and Sustaining Partnerships. http://www.pcrs.ca/uploads/7L/_A/7L_ATXdmJl3bp9lgOtVTKA/partnershiptoolkit.pdf
53
Seventeen Features of successful partnership:Maintaining partnership
• Shared Vision• Common and Compatible Goals
and Objectives• Division of Roles and
Responsibilities• Balancing Power and Authority
(Joint Ownership, Decision-making and Accountability)
• Effective Communication• Supportive Structures and
Processes• Commitment
• Trust and respect• Commitment of time• Leadership• Resources• Partnership Agreement• Continuous nurturing• Mutual recognition• Adaptability and flexibility• Building capacity• Evaluation
Collaboration Roundtable (2001): The Partnership Toolkit: Tools for Building and Sustaining Partnerships. http://www.pcrs.ca/uploads/7L/_A/7L_ATXdmJl3bp9lgOtVTKA/partnershiptoolkit.pdf
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Partnership Challenges and Pitfalls
56
Five Obstacles to Partnering
General public
•Prevailing attitude of scepticism• Rigid / preconceived attitudes about specific sectors / partners•Inflated expectations of what is possible
Negative Sectoralcharacteristics
• Public sector: bureaucratic and intransigent• Business sector: single-minded and competitive• Civil society: combative and territorial
Personal limitations of people leading the
partnership
• Inadequate partnering skills• Restricted internal / external authority•Too narrowly focussed role / job• Lack of belief in the effectiveness of partnering
Organisational Limitation
•Conflicting priorities•Competitiveness (within sector)• Intolerance (of other sectors)
Wider external constraints
•Local social / political / economic climate•Scale of challenge(s) / speed of change•Inability to access external resourcesSource: The International Business Leaders Forum (IBLF) and the Global Alliance for Improved Nutrition (GAIN), 2003. The Partnering Toolbook. http://www.energizeinc.com/art/subj/documents/ThePartneringToolbookMarch2004.pdf
57
Partnership pitfalls
Potential challenges include the following:• passive and dominant partners ,• unrepresented or under-represented
stakeholders,• inflexible and insensitive partners,• unreliable partners,• human factors.
• WHO (2003). The power of partnership. http://www.who.int/management/powerpartnership.pdf
58
59
HEALTH: WHO Definition
Health is a state of complete physical,
mental and social well-being and
not merely the absence of disease or infirmity.• Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New
York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
• The Definition has not been amended since 1948.
60
How should we define health? (2011)
• “The WHO definition of health as complete wellbeing is no longer fit for purpose given the rise of chronic disease.”
• Machteld Huber and colleagues propose changing the emphasis towards
the ability to adapt and self manage in the face of social, physical, and emotional challenges.
• Machteld Huber at al. How should we define health? BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d4163 (Published 26 July 2011) Cite this as: BMJ 2011;343:d4163 http://www.bmj.com/content/343/bmj.d4163
61
Is it feasible to have:Health For All?
Sustainable Health?
• Recall the demise of Health for All 2000
• Health for All 2000 (Alma-Ata Declaration 1978)
• Health for All Beyond 2000
• Health for All
• John J Hall and Richard Taylor. Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries. MJA 2003; 178: 17–20. https://www.mja.com.au/system/files/issues/178_01_060103/hal10723_fm.pdf
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Health Systems are Central to the New Sustainable Development Agenda
• WHO (2015). Health in 2015: from MDGs, (Millennium Development Goals) to SDGs, (Sustainable Development Goals). P196http://apps.who.int/iris/bitstream/10665/200009/1/9789241565110_eng.pdf?ua=1 64
Sustainable Development Goal 3: Ensure Healthy Lives and Promote Well-being For All at All Ages
3.1: Reduce maternal mortality3.2: End preventable newborn and child deaths3.3: End the epidemics of AIDS, TB, malaria and NTDsand combat hepatitis, waterborne and other communicable diseases3.7: Ensure universal access to sexual and reproductive health-care services
3.a: Strengthen implementation of framework convention on tobacco control3.b: Provide access to medicines and vaccines for all, support R&D of vaccines and medicines for all3.c: Increase health financing and health workforce in developing countries3.d: Strengthen capacity for early warning, risk reduction and management of health risks
3.4: Reduce mortality from NCDs and promote mental health3.5: Strengthen prevention and treatment of substance abuse3.6: Halve global deaths and injuries from road traffic accidents3.9: Reduce deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination
TARGET 3.8: Achieve universal health coverage, including financial risk protection,Access to quality essential health-care services, medicines and vaccines for all
INTERACTIONS WITH ECONOMIC, OTHER SOCIAL AND ENVIRONMENTAL SDGs AND SDG 17 ON MEANS OF IMPLEMENTATION
MDG Unfinished and Expanded Agenda New SDG Targets
SDG 3 Means of Implementation Targets
Is “Partnership towards sustainable universal health coverage” more appropriate?
• World Health Organization (November 22, 2010). "The world health report: health systems financing: the path to universal coverage". Geneva: World Health Organization. http://whqlibdoc.who.int/whr/2010/9789241564021_eng.pdf
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Current pooled funds
Reduce cost sharing and fees
Population: who is covered?
Services:Which services are covered
Direct cost:Proportion of the cost covered
Extend to non-covered
Includeotherservices
66
Revisit the policy
67
Examples of Existing Partnerships and Intersectoral Collaboration
National level• COMBI (Communication for Behavioural Impact)• KOSPEN (Komuniti Sihat Perkasa Negara)• MyOHUN (Malaysian One Health University Network),• HIV/AIDS Getting to Zero • National Blue Ocean Strategy,
State level• Village Health Promoter programme in Sarawak• OSTPC (One-Stop Teenage Pregnancy Centre) in
Sarawak
68
Unmet Needs for Partnerships
Examples of urgent social and public health problems that need intersectoral action
• the broad social determinants of health, including poverty,
• broken homes and families, • teenage pregnancies, • healthy cities and settings, • road traffic accidents, • workplace accidents, • drownings, • elderly care, • hospice care 69
Revisit Partnerships between health and non-health sectors
70
Partnership and Intersectoral Action for Health
What is the Form of intersectoral action?
Do we have the necessary success
factors?
What are the challenges?
• Actions are initiated by the health authority, focussing on improving health and equity
• Action initiated by head of government to address:
(1) health emergency / outbreak, or
(2) broad public health issues eg through Healthy Cities
• Actions are initiated by non-health agency eg to address Road traffic accidents
• Welcoming culture,
• membership,
• mutual benefit,
• common mandate or purpose
• Prevailing attitude of scepticism,
• bureaucracy,
• inadequate institutional capacity,
• inadequate partnership skills,
• conflicting priorities,
• scale of challenge,
• speed of change,
• etc71
Revisit Partnerships with the Community
72
Partnerships with the Community
Empowerment• Is the community
empowered to participate fully?
• Do they want to be empowered?
CITIZEN CONTROL
DELEGATION
PARTNERSHIP
PLACATION
CONSULTATION
INFORMING
THERAPY
MANIPULATION
8
7
6
5
4
3
2
1
CITIZEN CONTROL
TOKENISM
NONPARTICIPATION
Arnstein’s Ladder (1969)Degrees of Citizen Participationhttp://www.vcn.bc.ca/citizens-handbook/arnsteinsladder.html 73
Revisit Partnerships within The Health Sector
74
Source: Jim Cowan, Cowan Global Limited 2010. Partnership workinghttp://cowanglobal.wordpress.com/tag/partnership-working/
How do we move from co-existence to co-ownership within the health sector?
Co-existence“You stay on your turf and I’ll stay on mine”
Co-operation“I’ll lend you a hand when my work is done”
Co-ordination“We need to adjust what we do to avoid overlap and confusion”
Collaboration“Let’s all work on this together”
Co-ownership“We all feel totally responsible”
Deg
ree
of
part
ners
hip
wor
king
Token,Nominal
Pure
75
Revisit Overall Partnerships and Intersectoral action for health
76
Slide from: Thilina Rajapakse (2015). Managing Complex Change for Sustainable Rural Transformation; Case of Saemaul Undong of Korea. https://www.linkedin.com/pulse/managing-complex-change-sustainable-rural-case-undong-rajapakseAdapted from: Ambrose, D. (1987). Managing complex change. Pittsburgh, PA: Enterprise Group.
Complex Change Management MatrixLEADERSHIP SHARED
VISION SKILLS RESOURCES INCENTIVES STRATEGY GOVERNANCESUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
77
Slide from: Thilina Rajapakse (2015). Managing Complex Change for Sustainable Rural Transformation; Case of Saemaul Undong of Korea. https://www.linkedin.com/pulse/managing-complex-change-sustainable-rural-case-undong-rajapakseAdapted from: Ambrose, D. (1987). Managing complex change. Pittsburgh, PA: Enterprise Group.
Complex Change Management MatrixLEADERSHIP SHARED
VISION SKILLS RESOURCES INCENTIVES STRATEGY GOVERNANCESUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
78
Slide from: Thilina Rajapakse (2015). Managing Complex Change for Sustainable Rural Transformation; Case of Saemaul Undong of Korea. https://www.linkedin.com/pulse/managing-complex-change-sustainable-rural-case-undong-rajapakseAdapted from: Ambrose, D. (1987). Managing complex change. Pittsburgh, PA: Enterprise Group.
Complex Change Management MatrixLEADERSHIP SHARED
VISION SKILLS RESOURCES INCENTIVES STRATEGY GOVERNANCESUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
79
Slide from: Thilina Rajapakse (2015). Managing Complex Change for Sustainable Rural Transformation; Case of Saemaul Undong of Korea. https://www.linkedin.com/pulse/managing-complex-change-sustainable-rural-case-undong-rajapakseAdapted from: Ambrose, D. (1987). Managing complex change. Pittsburgh, PA: Enterprise Group.
Complex Change Management MatrixLEADERSHIP SHARED
VISION SKILLS RESOURCES INCENTIVES STRATEGY GOVERNANCESUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
80
Slide from: Thilina Rajapakse (2015). Managing Complex Change for Sustainable Rural Transformation; Case of Saemaul Undong of Korea. https://www.linkedin.com/pulse/managing-complex-change-sustainable-rural-case-undong-rajapakseAdapted from: Ambrose, D. (1987). Managing complex change. Pittsburgh, PA: Enterprise Group.
Complex Change Management MatrixLEADERSHIP SHARED
VISION SKILLS RESOURCES INCENTIVES STRATEGY GOVERNANCESUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
81
Slide from: Thilina Rajapakse (2015). Managing Complex Change for Sustainable Rural Transformation; Case of Saemaul Undong of Korea. https://www.linkedin.com/pulse/managing-complex-change-sustainable-rural-case-undong-rajapakseAdapted from: Ambrose, D. (1987). Managing complex change. Pittsburgh, PA: Enterprise Group.
Complex Change Management MatrixLEADERSHIP SHARED
VISION SKILLS RESOURCES INCENTIVES STRATEGY GOVERNANCESUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
82
Slide from: Thilina Rajapakse (2015). Managing Complex Change for Sustainable Rural Transformation; Case of Saemaul Undong of Korea. https://www.linkedin.com/pulse/managing-complex-change-sustainable-rural-case-undong-rajapakseAdapted from: Ambrose, D. (1987). Managing complex change. Pittsburgh, PA: Enterprise Group.
Complex Change Management MatrixLEADERSHIP SHARED
VISION SKILLS RESOURCES INCENTIVES STRATEGY GOVERNANCESUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
83
Slide from: Thilina Rajapakse (2015). Managing Complex Change for Sustainable Rural Transformation; Case of Saemaul Undong of Korea. https://www.linkedin.com/pulse/managing-complex-change-sustainable-rural-case-undong-rajapakseAdapted from: Ambrose, D. (1987). Managing complex change. Pittsburgh, PA: Enterprise Group.
Complex Change Management MatrixLEADERSHIP SHARED
VISION SKILLS RESOURCES INCENTIVES STRATEGY GOVERNANCESUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
SHAREDVISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
84
Conclusion -1
• Partnerships and intersectoral Actions for Health are easier said than done.
• We still have a long way to go before we can achieve our vision of “A nation working together for health”
85
Conclusion -2
In order for partnerships and intersectoral action to work, we need to:
1. overcome the barriers to partnerships,2. acquire the knowledge and skills
in working with communities and how to work in partnerships at the levels of the institution as well as individual staff level,
3. set up the governance tools (structures, processes, financial and mandates) that foster coherence, collaboration and partnership
86
Sarawak Health Department
Sarawak Health DepartmentJalan Diplomatik, Off Jalan Bako, 93050 Kuching, Sarawak
Tel: 082-473200, Fax: 082-443031, Email: [email protected]