partnerships for sustainable health – revisit the policy

Partnerships for Sustainable Health – Revisit

the PolicyDatu Dr Andrew Kiyu

Consultant Epidemiologist,Sarawak Health Department.

[email protected]

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

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

8

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).

11

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/

15

Why We Need Partnerships and

Intersectoral Action for Health

17

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

18

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


22

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


24

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


25

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


27

Partnerships

28

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

32

http://en.wikipedia.org/wiki/Partnership

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.

36

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

38

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

40

http://cowanglobal.wordpress.com/tag/partnership-working/

http://cowanglobal.files.wordpress.com/2010/07/five-degress-of-partnership-working.png


Sustainable health or health care

42

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

44

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

48

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

55

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

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

62

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

65

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

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

http://cowanglobal.wordpress.com/tag/partnership-working/



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

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ANXIETY

FRUSTRATION

RESISTANCE

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CORRUPTION

77




CHANGE

INCENTIVES

INCENTIVES

INCENTIVES

INCENTIVES

INCENTIVES

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STRATEGY

STRATEGY

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CHANGE

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INCENTIVES

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FALSE START

CORRUPTION

79




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




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




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




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




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]

partnerships for sustainable health – revisit the policy

Health & Medicine