Renewing the Mandatory Health Programs and

Services Guidelines

Association of Public Health Epidemiologists of Ontario

May 12, 2006

2

Background

• Mandatory Health Programs and Services Guidelines (MHPSG)• Minimum requirements for fundamental public health services targeted at

prevention of disease, health promotion and health protection to which all 36 Boards of Health are expected to comply

• 1997 MHPSG: 3 general standards and 14 program standards (3 thematic areas: Chronic Diseases & Injuries, Family Health and Infectious Diseases)

• 1999 review initiated

• Mandatory Program Steering Committee and 5 Technical Review Committees

• Consultations with Boards of Health and Ministries• 2003 – 4 drafts of Standards (Chronic Diseases, Injury Prevention,

Reproductive Health and Child Health)

• Ontario has been the leader in the establishment of standards for public health in Canada (Québec – 2003-2012 program, BC in development process)

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Background (cont’d)

• Review of MHPSG committed to in Operation Health Protection, 2004

• 3 Ministries involved• MHP – Chronic Disease Prevention, Injury Prevention, Child Health and

Reproductive Health (4 of 17 programs transferred in Fall 2005)• MCYS – Healthy Babies Healthy Children component of Child Health• MOHLTC – Control of Infectious Diseases, Infection Control, Rabies

Control, STDs, TB Control, Vaccine Preventable Diseases, Food Safety, Safe Water, Sexual Health, Early Detection of Cancer, Health Hazard Investigation, Equal Access and Program Planning and Evaluation

• The final report from the Capacity Review Committee (CRC) recommends areas for improvement:• Replace existing guidelines with program standards• Inclusion of organizational standards (governance, human resources,

financial, knowledge exchange)• Greater link with performance management system

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Considerations for New Standards

Structure• Move towards performance standards that are linked with specific performance

measures for increased accountability• Establish ongoing review, enhancement and support processes so that

standards are continually evolving

Content• Technical revisions to reflect new science, evidence and best practices in public

health• Incorporate fundamental/core requirements for all public health programs to

ensure consistency across the province• Explore parameters to allow responsiveness to local health issues and needs• Addition of Emergency Preparedness as a new specific program standard• Potential for inclusion of standards to address organizational performance

(governance, financial, human resources management, research and knowledge exchange, etc.)

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Conceptual Model for Standards

ORGANIZATIONAL STANDARDS

PROGRAM STANDARDS

PROGRAM AREAS

• Overarching Principles:• Standards• Integral component of Performance Management System• Dynamic and evolving• Social determinants of health• Recognition of local priorities and contexts

• Program Areas:• Chronic Diseases and Injury Prevention• Family Health• Infectious Diseases• Emergency Preparedness (new)

• Program Standards:• Goals• Long-term Objectives• Short-term Objectives• Strategies/Activities (Population Health Assessment, Health Surveillance, Health

Promotion, Disease and Injury Prevention and Health Protection)

PE

RF

OR

MA

NC

E

ME

AS

UR

ES

Governance, HR, financial, knowledge exchange, etc.

Core

Flexible

6Operational Model

Performance Standards Strategic Committee (PSSC)• Responsible for key deliverables including: process for ongoing review and refinement of the

Standards (linked with PM Strategy); an overall framework to guide the development of the Standards; ongoing consultation; revised Standards and Measures; and a roll-out strategy for dissemination and uptake

• Report to CMOH and co-chaired by CRIB & a field representative• Membership:

• Government: PHD, MHP and MCYS• Field: representation from public health units (including epidemiologists), municipality and

other expertise (academic, performance, financial, IT)

Writing Teams• 8 to 12 teams, approximately 6 people per team• Responsible for drafting program standards – focused work & considerable time commitment• Membership: government and field (including epidemiologists)

Inter-Ministerial Committee• Platform for discussion on priorities and information exchange across government • Report to PSSC• Membership: EDU, MCSCS, MCYS, MHP, MMAH, MOE, OMAFRA

7Organization

ReportingAdvisoryTechnical Support

Inter-Ministerial Committee

Inter-Ministerial Committee

Writing TeamsWriting Teams

Expert AdviceExpert Advice

CMOH/ADMCMOH/ADM

Minister(s)Minister(s)

Revised StandardsRevised Standards

Performance Standards Strategic

Committee

Performance Standards Strategic

Committee

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Methodology

Input and Advice

(roundtables with field &

experts)

Strategic Framework

(developed by PSSC)

Writing Teams

(PHD, MHP, field &

consultants)

1st Draft of Standards

Consultation

(with field & experts)

2nd Draft of Standards

Consultation

(with field & experts)

Final Draft Standards

Performance Measurement

Expert Advice

Other inputs (e.g. PHAC endeavours, core competencies)

Strategic Committee Review

9Methodology (cont’d)

1 year time-frame

Concurrent development across program areas

Stakeholder consultation activities Input and advice from field via roundtables and Public Health Portal

(potentially) Ongoing and specific sessions with AMO (PH Task Force), City of Toronto,

key associations (OPHA, alPHa, APHEO) and others

Supporting products Documents developed during review process to be disseminated (e.g.

systematic and literature reviews, best practices documents, etc.)

Communication Ongoing communication of process and progress

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APPENDIX:

Experience from Other Jurisdictions

11Experience from other Jurisdictions (Québec)PH Program 2003-2012• 2012 objectives and activities, different strategies • Evaluation framework – progress reports by regions 2006, 2009 and 2012

12Experience from other Jurisdictions (BC)

A Framework for Core Functions in Public Health – in development (evidence papers, performance areas)

13Experience from other Jurisdictions (US)

Indicators

Essential Public Health Services1. Monitor health status to identify community health problems2. Diagnose and investigate health problems and health hazards3. Inform, educate and empower people about health issues4. Mobilize community partnerships to identify and solve health

problems5. Develop policies and plans that support individual and

community health efforts6. Enforce laws and regulations that protect health and ensure

safety7. Link people to needed personal health services and assure the

provision of health care when otherwise unavailable8. Assure a competent public and personal health care

workforce9. Evaluate effectiveness, accessibility and quality of personal and

population based health services10.Research for new insights and innovative solutions to health

problems

StandardAssessmentQuestions

2 Levels• State• Local (Governance & System Performance)

Healthy People 2010• 2 overarching goals – Increase Quality and Years of Healthy Life, Eliminate Health Disparities• 28 focus areas – with specific objectives• 10 Leading Health Indicators (Physical Activity, Overweight & Obesity, Tobacco Use, Substance Use, Responsible

Sexual Behaviour, Mental Health, Injury and Violence, Environmental Quality, Immunization, Access to Health Care)

Emergency Preparedness & Response• Guide• Capacity Inventory