Published on February 20, 2014
City Health Networks in France (les “Ateliers Santé Ville”) Nicolas Hervieu – Pluricité February 2014
City Health Networks* in France (*freely translated from les “Ateliers Santé Ville”) This presentation is based on national figures from national studies conducted every year by the french social cohesion and social equality agency (ACSé). Those studies are built on a 200+ questions survey, completed by about 95% of France City Health Networks. It‟s fairly precise! Our consultancy, Pluricité, have been conducting the surveys since 2011 Live discussion : use twitter hashtag #cityhealthnet Hot tip : This presentation already online there! Nicolas Hervieu – Pluricité February 2014 2
City Health Networks what is this ? It‟s a focus on public health in disadvantaged neighbourhoods It comes on top of “common law” health prevention policies. It’s rather new in France (2000) Each City Health Network is a small cell It covers one or a few neighbourhoods It generally has no team, just 1 pilot (called coordinator – not always on full time) It stems from local willingness, and then get additional state Funds. They “make people do” It first builds up a diagnosis share by local partners It aims to coordinate health services delivered locally It fosters local population participation Nicolas Hervieu – Pluricité February 2014 3
City Health Networks – how it grew up in France Widespread (2007-…) Experimentation (2000 – 2006) 52 36 15 4 8 2000 2001 2002 16 6 2003 2004 10 2005 24 17 2006 2007 2008 2009 27 15 2010 9 2011 2012 Number created each year Source : yearly survey led by the french social cohesion and social equality agency (ACSé) 258 City Health Networks were operating during 2012 They developed with “politique de la ville” (contracts were launched in 2000 and 2006) Improving health in disadvantaged neighbourhoods has been one of the priorities of the urban policy "politique de la ville" which concentrates on critical urban areas with a particularly poor housing and sanitary situation. Pilot networks were introduced in two regions in 2001, and got a positive evaluation in 2003. They came as a standard “health tool” in new contracts in 2006. Nicolas Hervieu – Pluricité February 2014 4
City Health Networks & Local Health Contracts Relationship as of December 2012 : Is there a local health contract onto your perimeter ? No health contract (47%) Yes, sign ed! (29%) Discussing (24%) Created in 2009, the development of the local health contract continue. When there is a local health contract onto the perimeter, most of the city health networks are involved in the preparation phase of this contract (90%). More than half of the local health contract are led directly by the coordinator of the city health contract What is the involvement of the city health network regarding this contract ? Involvement of the ASV in the choice of the field of intervention Involvement of the ASV to the urban policy awareness Local health contract coordination by the coordinator Shared steering commitee Others Nicolas Hervieu – Pluricité 74% 70% 52% 43% 11% February 2014 5
City Health Networks & Local Health Contracts – How they complement Local Health Contracts have a wider territorial coverage They encompass one or several cities, when City Health Networks focus on neighbourhoods. They often share similar thematic range and objectives though 1st approach to generate synergies : governance When both exist in a city, only one pilot („coordinator‟) is appointed, and she/he runs both instruments 2nd approach to generate synergies : common projects thematic approach or populational approach (according to age, or particular situations: pregnant women, disabilities…) Themes : prevention (vaccination, nutrition, cancer, diabetis, cardio-vascularies diseases), access to health care services (first resort care), territorial strategy…) and social-medical (mental health care, addictions…) Nicolas Hervieu – Pluricité February 2014 6
City Health Networks – How it runs Mainly, the city health networks are initiated and supported by local authorities (but 8% are local NGO‟s!) They work mostly citywide (69%), 16% focus on only neighborhoods, 15% span over several cities, It‟s a “one man show” kind of instrument, One coordinator manages it, on full or an parttime. 55% of city health networks are managed by one full-time job (possibly two people). Most are women, The city health networks have several full-time coordinators only in the largest areas. Distribution of coodinators involved in the city health network on 12/31/2012 (full-time equivalents) : 16% Less than 0,5 coordinator 22% From 0,5 to 1 coordinator 55% 1 coordinator From 1 and 2 coordinator More than 2 coordinators 3% 4% One steering committee oversees the job (takes part in the diagnosis,adopts the action plan, the monitoring and the evaluation) Nicolas Hervieu – Pluricité February 2014 7
City Health Networks – each one of a kind They are born from local will, and designed to suit local needs…and means. So different they are! From our analysis, we see 3 kinds (personal typology) 1) Local City health networks 2) Mixed City health networks 3) City health networks “coordinator” of health care actions Nicolas Hervieu – Pluricité • Proximity, smaller intervention scale • Direct action : all the actions are initiated, build and led by the ASV (which implies more human resources) • About 10-20% of ASV • About 60-70% of Ateliers Santé Ville • The « typical » ASV – which mix direct and indirect actions • Large scale, across several cities • About 20% of ASV February 2014 8
City Health Networks – What they do Shared diagnosis and action plan Targeted groups prevention Thematic prevention Even a Web TV ! Short link : http://url.pluricite.fr/ASV-TV Long link : http://www.villearmentieres.fr/fr/actu/webtv.php?type=video&id=641&emission=Atelier_sante_ville&page=1 Nicolas Hervieu – Pluricité February 2014 9
City Health Networks – What for ? 2012 total number of actions by theme 2012 total number of beneficiaries* by theme 950 Mental health care 367 Access to sanitaries and social rights 352 Addictive practices and at risk (including… 330 Nutrition 144935 Addictive practices and at risk (including… 84804 HIV / AIDS / STD / Hepatitis 45333 Youth health 44313 Youth health 306 Access to sanitaries and social rights 42777 Cancer (including screening) 303 Dental health care 41822 Mental health care 35318 Cancer (including screening) 28631 Tuberculosis and vaccinations 11620 Tuberculosis and vaccinations 107 Environment 10660 Environment 97 Mother and child health care 9153 Improvement of health care professionals… 86 Other chronical diseases 5837 Traumatism and violences *Include both direct and indirect beneficiaries (e.g beneficiaries of communication actions on prevention, awareness campaign…) Nutrition 5072 262 Dental health care 220 HIV / AIDS / STD / Hepatitis Mother and child health care 136 Traumatism and violences 77 Alzheimer and other aging related diseases 75 Other chronical diseases 49 Facing health care refusal 45 Other themes Alzheimer and other aging related diseases 4807 Facing health care refusal 4018 Improvement of health care professionals… 2421 501 Other themes 84355 Source : yearly survey led by the french social cohesion and social equality agency (ACSé) Main topics are nutrition, mental health care and access to sanitaries and social rights. Leading topics largely depends on call for projects launched during the year. Nicolas Hervieu – Pluricité February 2014 10
City Health Networks – their backing City Health Networks have on average an annual budget of 76 K€ (it’s a 17M€ policy overall) Main contributors to the city health networks City health networks financed Social cohesion and social opportunities agency (ACSé) 93% Cities/interconnected cities/municipalities Other fundings 18% 41% County Council Regional council 7% 82% Regional health agency Communal centre for social welfare City health networks not financed 18% 13% 8% 5% 59% 82% 87% The State is the main contributor to the city health networks through the social cohesion and social equality agency with 93% of the city health networks financed (and providing 45% of the total budget), followed by the cities or interconnected municipalities (45% of the total budget), and regional health agencies. 92% 95% On average, a city health network receive funds from 3 different organisms. Source : yearly survey led by the french social cohesion and social equality agency (ACSé) Nicolas Hervieu – Pluricité February 2014 11
Long term sustainability Today, some organisms might hesitate to develop these networks because they think that the State's financial commitment is not sufficient to sustain this policy in the long run. For health care providers, health networks raise the question of how to situate local health actions with respect to the national policy (local problems may not be in line with national priorities). However, city health networks are well integrated. For most of the municipalities, health networks are an appreciated tool to improve local health policy. As we saw, city health networks are really adaptable to the territory of intervention (neighbourhood, communal, intercommunal…), with appropriate means. It responds also to some areas issues, where many do not have full access to health. It‟s a problem of both offer and demand, which is better addressed by finely tuned actions toward specific targets. Nicolas Hervieu – Pluricité February 2014 12
Thank you for your attention Get all data from annual reports published by l’Acsé Enquête annuelle de suivi 2013 des ateliers santé ville Short link > url.pluricite.fr/health It rings a bell ? Let‟s keep in touch Nicolas Hervieu – Pluricité firstname.lastname@example.org February 2014 14
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