Nicolas Hervieu – Pluricité February 2014
City Health Networks in France
(les “Ateliers Santé Ville”)
Nicolas Hervieu – Pluricité February 2014
City Health Networks* in France
(*freely translated fromles “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).
Live discussion : use twitter hashtag #cityhealthnet
Hot tip : This presentation already online there!
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
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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
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20124 8
156
1610
17
52
3624
159
27
Experimentation (2000 – 2006)
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City Health Networks – how it grew up in France Widespread (2007-…)
They developed with “politique de la ville” (contracts were launched in 2000 and 2006)
Number created each year
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.
Source : yearly survey led by the french social cohesion and social equality agency (ACSé)
258 City Health Networks were operating during 2012
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City Health Networks & Local Health Contracts
No health contract(47%)
Discussing(24%)
Yes, signed!(29%)
Relationship as of December 2012 :Is there a local health contract onto your perimeter ?
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
OthersShared steering commitee
Local health contract coordination by the coordinatorInvolvement of the ASV to the urban policy awareness
Involvement of the ASV in the choice of the field of intervention
11%43%
52%70%
74%
What is the involvement of the city health network regarding this contract ?
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City Health Networks & Local Health Contracts – How they complementLocal 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…)
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City Health Networks – How it runsMainly, 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 part-time.
More than 2 coordinators
From 1 and 2 coordinator
1 coordinator
From 0,5 to 1 coordinator
Less than 0,5 coordinator
4%
3%
55%
22%
16%
Distribution of coodinators involved in the city health network on 12/31/2012 (full-time equivalents) :
One steering committee oversees the job (takes part in the diagnosis,adopts the action plan, the monitoring and the evaluation)
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.
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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
• 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
2) Mixed City health networks
• About 60-70% of Ateliers Santé Ville• The « typical » ASV – which mix direct and indirect actions
3) City health networks
“coordinator” of health care actions
• Large scale, across several cities• About 20% of ASV
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Shared diagnosis and action plan Targeted groups prevention
Even a Web TV !
Short link : http://url.pluricite.fr/ASV-TV
Long link : http://www.ville-armentieres.fr/fr/actu/webtv.php?type=video&id=641&emission=Atelier_sante_ville&page=1
Thematic prevention
City Health Networks – What they do
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City Health Networks – What for ?
Source : yearly survey led by the french social cohesion and social equality agency (ACSé)
Other themes
Facing health care refusal
Other chronical diseases
Alzheimer and other aging related diseases
Traumatism and violences
Improvement of health care professionals presence on the city health workshop territory
Environment
Tuberculosis and vaccinations
Mother and child health care
HIV / AIDS / STD / Hepatitis
Dental health care
Cancer (including screening)
Youth health
Addictive practices and at risk (including alcohol and tobacco)
Access to sanitaries and social rights
Mental health care
Nutrition
501
45
49
75
77
86
97
107
136
220
262
303
306
330
352
367
950
2012 total number of actions by theme
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.
Other themes
Improvement of health care professionals presence on the city health workshop territory
Facing health care refusal
Alzheimer and other aging related diseases
Traumatism and violences
Other chronical diseases
Mother and child health care
Environment
Tuberculosis and vaccinations
Cancer (including screening)
Mental health care
Dental health care
Access to sanitaries and social rights
Youth health
HIV / AIDS / STD / Hepatitis
Addictive practices and at risk (including alcohol and tobacco)
Nutrition
84355
2421
4018
4807
5072
5837
9153
10660
11620
28631
35318
41822
42777
44313
45333
84804
144935
2012 total number of beneficiaries* by theme
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City Health Networks – their backing
Source : yearly survey led by the french social cohesion and social equality agency (ACSé)
City Health Networks have on average an annual budget of 76 K€ (it’s a 17M€ policy overall)
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.
On average, a city health network receive funds from 3 different organisms.
Other fundings
Regional council
Communal centre for social welfare
County Council
Regional health agency
Cities/interconnected cities/municipalities
Social cohesion and social opportunities agency (ACSé)
5%
8%
13%
18%
41%
82%
93%
95%
92%
87%
82%
59%
18%
7%
Main contributors to the city health networks
City health networks financed City health networks not financed
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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
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
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