An inter-sectoral approach to diabetes: evaluation

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

Let's Beat Diabetes is a five-year inter-sectoral partnership program for the prevention and management of Type 2 diabetes commencing in 2005. An evaluation of the program suggests that good progress is being made towards key performance indicators in all ten of the action areas. However there has been a noticable cultural shift, with the program becoming more task oriented and less strategy or process oriented. Collaboration between partners has sometimes been challenging.

Neue Entwicklungen

Let's Beat Diabetes (LBD) is a five-year intersectoral program for the prevention and management of diabetes, initiated by one of New Zealand's 21 District Health Boards (DHB) (see Survey (7) 2006 for details). The vision was for a 'whole society, whole life course, whole family' approach, with people and organisations in the community working together in partnership towards a common goal. The program is based upon the following ten action areas :

1. Supporting community leadership and action
2. Promoting behaviour change through social marketing
3. Changing urban design to support healthy, active lifestyles
4. Supporting a healthy environment through food industry accord
5. Strengthening health promotion co-ordination and activity
6. Enhancing well-child services to reduce childhood obesity
7. Developing a schools accord to ensure children are fit, healthy and ready to learn
8. Supporting primary case-based prevention and early intervention
9. Enabling vulnerable families to make healthy choices
10. Improving service integration and care for advanced disease.

Each Action Area has a set of goals, targets and key performance indicators. An independent evaluation is being undertaken throughout the five years of the program. The evaluation uses a continual learning model which includes participation and collaboration with providers and the community, and provides a continuous flow of feedback to key stakeholders.

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung

• Leistungserbringer

• Kostenträger: The idea was initiated by the District Health Board

• Wissenschaft

Stakeholder positions

The evaluation showed a clear shift in the way that the Let's Beat Diabetes program is perceived by some of the key stakeholders. This shift has been away from the broad vision of a population-based inter-sectoral approach to an approach based upon specific tasks and processes. The evaluation revealed some dissatisfaction amongst stakeholders about implementation of the program.

Actors and positions

Regierung
Local government	sehr unterstützend		stark dagegen
Leistungserbringer
Community groups	sehr unterstützend		stark dagegen
Local industries	sehr unterstützend		stark dagegen
Kostenträger
District Health Board	sehr unterstützend		stark dagegen
Wissenschaft
Academic researchers	sehr unterstützend		stark dagegen
current    previous

Actors and influence

Regierung
Local government	sehr groß		kein
Leistungserbringer
Community groups	sehr groß		kein
Local industries	sehr groß		kein
Kostenträger
District Health Board	sehr groß		kein
Wissenschaft
Academic researchers	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

Implementation of the programme has focussed on developing activities in the 10 Action Areas and the amount of interventions in these areas has increased significantly. While collaboration has been successful at the level of these individual interventions, the vision of whole community engagment in the program has become increasingly challenging to sustain. Subsequently, the DHB is tasked with maintaining the original vision of community partnership while also ensuring that progress is being made on the ground to respond to the accountability requirements that many health and other public sector programs face. Unfortunately, this has seen some of the partnership relationships become tenuous.

The influence of national policy has been very strong. National strategies are dictating the nature of specific interventions by competitive funding. Reporting structures and evaluations are also being structured and somewhat restricted by the national policy. Therefore implementation at many levels has been influenced by national and regional movements in policy and specific implementation strategies. There are pockets of successful implementation. Overall, while adoption of the idea has been successful, implementation is variable.  

Monitoring and evaluation

The evaluation has supported LBD and its partners in identifying the challenges that a collaborative partnership of this size might face. In response to the evaluation findings, LBD has reviewed its governance structure to identify an approach that can ensure input from the community and its partners at a level that also supports and drives the strategic direction of LBD. The degree of program adaptation has been influenced by program results: all initiatives within LBD have made adaptations based on evaluation findings.

The evaluation indicated that some partnerships have not resulted in a high degree of program implementation. These partnerships have been targeted for increased support. Most Action Areas are seeing successful achievement of their key performance indicators, for example in the food industry, social marketing, primary care and schools. This includes increases in specific outcome measures of participation in healthy life style activities as well as increased collaboration between  e.g., food industry and the District Health Board.

Expected outcome

Some partnerships are successful when working on specific initiatives, e.g. The food industry and the collaboration between education and health. However sustaining the ongoing strategic vision appears to be challenging in the context of the health sector and its accountability requirements. The program is in a tenuous situation because, as a public health initiative, the outcomes cannot be achieved by the DHB alone. Thus if the DHB takes a traditonal autocratic approach to partnership implementation and assessment of outcomes, the collaboration will not work and the program will not be successful. Maintaining a balance between strategy and program key performance indicators is imperative.

Some partnerships are successful when working on specific initiatives, e.g. Food industry and the collaboration between education and health. However sustaining the ongoing strategic vision appears to be challenging in the context of the health sector and its accountability requirements. 

References

Sources of Information

Counties Manukau District health Boards. Let's Beat Diabetes. www.letsbeatdiabetes.org.nz/page/diabetes_5.php

Centre for Health Services Research and Policy. CHSRP Projects. www.fmhs.auckland.ac.nz/soph/centres/chsrp/projects/default.aspx

Presentation outlining the evaluation process. www.letsbeatdiabetes.co.nz/file/pdf/LBD%20Programme%20Evaluation%20Nov2007.pdf.

Reform formerly reported in

An inter-sectoral approach to diabetes Process Stages: Umsetzung, Evaluation, Strategiepapier

Author/s and/or contributors to this survey

Broadbent, Rebecca, Janet Clinton and Toni Ashton

All three authors are from the Centre for Health Services Research and Policy (CHSRP).

Empfohlene Zitierweise für diesen Online-Artikel:

Broadbent, Rebecca, Janet Clinton and Toni Ashton. "An inter-sectoral approach to diabetes: evaluation". Health Policy Monitor, October 2008. Available at http://www.hpm.org/survey/nz/a12/2