|dc.description.abstract||The furious pace of global urbanisation has serious impacts on the long-term sustainability and health of the local communities in which we live. The debate about relationships between population size, environmental management and human well-being must now encompass the fundamental concept of sustainability (Rees, 1992; WCED, 1990; McMichael, 2002; Hancock, 1996). Increasingly, the local municipal level is the most influential setting in which to change our relationship with the environment (Chu, 1994; Chu et al., 2000).
In the 1980s, the World Health Organisation (WHO) met this global challenge by advocating healthy public policy and laying foundations for its global Healthy Cities Movement. Significant support developed in the early nineties for participatory health planning action in local government: over 2000 cities world-wide developed municipal public health plans (MPH Plans). The Healthy Cities Movement through regional networks of cities and towns encouraged government partnerships with non-government agencies and industry, to anticipate and mitigate urbanisation’s negative impacts. In Queensland eighteen local governments have developed and implemented MPH Plans using a seven-step process (Chapman and Davey, 1997; WHO (1997b) to improve local planning for health and address the social determinants of health through agency collaboration.
There is however limited understanding and evidence of the success factors for the effective implementation of MPH Plans. Studies of the evaluation of Municipal Public Health Planning (MPHP) approaches have focused predominately on the evaluation of the process of planning, without conducting comprehensive evaluation of its implementation. The organisational barriers that contribute to ineffective health-planning implementation have not been well researched and documented. Here lies the gap in the research: MPHP requires thorough qualitative assessment, not only of the planning process, but also the implementation impacts.
This research explores the achievements, barriers and success factors associated with MPHP implementation in local government organisations by developing a process and impact evaluation framework and applying it to two MPHP projects in Queensland: one, local planning in an expanding tourist city of over 400,000 people; the second, a regional approach involving two provincial cities with a combined population of 100,000 residents. The research examines the degree of collaboration resulting from health planning and assesses if the aims of the MPH Plans have been met. MPHP is both a health promotion tool and a strategic business planning process applied in local communities: this research seeks to understand more about organisational strategic management issues that act as barriers to planning or impact on the success of planning outcomes.
This study design uses qualitative methods with a triangulation approach to analyse and understand the complexities of MPH Plan implementation. Grounded theory provides a methodology for interpreting meanings and discovering themes from the comprehensive process and impact evaluation consisting of preliminary cases studies, key informant interviews, using specific process and impact indicator questions and an analysis of MPHP models compared to other CPHP models and legislative frameworks. The impacts of the intervention are discussed and relate to the implementation effects of MPHP on individuals and organisations including council, government and non-government agencies and on the community.
Achievements and barriers associated with MPHP are identified and discussed. Three main factors emerged. Firstly, MPHP had significantly increased the degree of intersectoral collaboration between the agency project partners, with particular success in clarifying the role of agencies in the management and delivery of public health services. The principles of successful partnerships need to be further articulated in local government settings to successfully implement MPHP. Secondly, positive political and organisational support was found to be a critical factor in the success of the planning implementation. Thirdly, and most importantly, the aims of the MPHP had not been substantially met due to a lack of financial and human resources. The study concluded that, although MPHP has strengths and weaknesses compared to other CPHP models, its features most suit local government.
Success factors recommended for effective MPHP include formalising collaboration and partnerships and improved agency organisational governance in planning; building individual and organisational capacity to strengthen strategic planning; integrating the many layers of regulatory planning in local government and other agencies; sustaining planning structures and processes through regulation and commitment to investment in implementation stages of MPHP. The study’s major recommendation is that, for MPHP local government should facilitate a three-dimensional platform approach: healthy governance – long-term vision, recognising the many layers of planning, supported by state legislation and local industry and with awareness of legislative planning frameworks; a platform mechanism – sustaining agency networking, hosting the stakeholder forum, supporting the advisory committee, enhancing communication; and strategy implementation – in the context of an improved understanding of organisational behaviour, local government and agencies must action priority strategies, formalising agency partners responsibility, articulating desired outcomes, monitoring progress and evaluation.
This recommended Platform Approach to MPHP provides an effective model for managing and implementing future MPH Plans, allocating resources three ways: to build people’s capacity to engage in planning mechanisms, to build organisational capacity to manage planning outcomes and to build more effective Healthy Cities planning approaches. The MPHP evaluation framework developed in this thesis could be used to evaluate other MPHP projects in local governments both in Australia and internationally.||