International Network of Health Promotion Foundations Capacity Building – sustainable financing...
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International Network of Health Promotion Foundations
Capacity Building – sustainable financing and infrastructures for HP
www.hpfoundations.net
International Network of Health Promotion Foundations
Infrastructure for health promotion investment: models for financing HPgovernment based approach within ministry public bodies closely linked to government health promotion foundations private foundation
ThaiHealth
Health Scotland Austrian HPF DoHA ChagnonAustralia Foundation
Colin Sindall: Department of Health & Ageing, Australia
Graham Robertson: Health Scotland (former CEO)
Krissada Raungarreerat: ThaiHealth
Rainer Christ: Austrian Health Promotion Foundation
Diane Le May: Quebec en Forme
International Network of Health Promotion Foundations
What do Health Promotion Foundations do?
– Build capacity for promoting health;– Mobilize civil society and support community actions
for health by providing resources, training and technical assistance
– Fund health promotion initiatives to promote health and prevent disease
– Build a health promotion evidence base– Work collaboratively across sectors – Advocate for health promoting policies– Address equity issues– Trial innovative programs in sensitive areas (drugs,
STIs, etc.) that may expose governments to political criticism
International Network of Health Promotion Foundations
Characteristics of HP Foundations Characteristics of HP Foundations
• Budget Stability:Budget Stability: funding is enshrined in legislation, can funding is enshrined in legislation, can plan and implement long term programmesplan and implement long term programmes
• Independent Operation: Independent Operation: operate WITH, but not AS operate WITH, but not AS government: supporting government priorities and government: supporting government priorities and direction.direction.
• No Bureaucratic Constraints:No Bureaucratic Constraints: quickly react to quickly react to emerging needsemerging needs
• Multi-Sectoral: aMulti-Sectoral: across a range of government departments, cross a range of government departments, nongovernmental and community-based organizationsnongovernmental and community-based organizations
[1] The Establishment and Use of Dedicates taxes for Health. WHO WPRO 2004[2 ] INHPF (http://www.hpfoundations.net) Access 2009-04-07[3] Shaping the future of health promotion: priorities for action, IUHPE CCHPC 2007[4] Infrastructures to promote health: the art of the possible, Moodie et al
[1] The Establishment and Use of Dedicates taxes for Health. WHO WPRO 2004[2 ] INHPF (http://www.hpfoundations.net) Access 2009-04-07[3] Shaping the future of health promotion: priorities for action, IUHPE CCHPC 2007[4] Infrastructures to promote health: the art of the possible, Moodie et al
International Network of Health Promotion Foundations
How are Health Promotion Foundations funded?
Through a variety of methods: – Earmarked taxes
• Tobacco and / or Alcohol tax ThaiHealth (2% each)– Fiscal adjustments
• Austria (value added tax)– Appropriation from Treasury budgets
• VicHealth, Healthway (Australian HPFs) Malaysian Health Promotion Board
– Levy on health / sickness insurance• Switzerland : x Euro/insured person/year
Health promotion financing and organisation in Australia
Colin SindallSenior Adviser
Population Health DivisionDepartment of Health and Ageing
Capacity Building – sustainable financing and infrastructures for Health Promotion
Federal system of government with health responsibilities shared between Australian (Commonwealth) government + 6 states + 2 territories.
National responsibility for health promotion and disease prevention sits with the Australian Government Department of Health and Ageing, but states undertake significant proportion of program delivery; however, the mix is changing.
Australian Government provides largest share of total public health funding (64%), but states incur nearly three quarters (73.9%) of total public health expenditure.
Funding for public health (includes health promotion, health protection and preventive health services such as screening ) appropriated from consolidated revenue as part of the overall health portfolio budget.
Between 1999–00 and 2007–08 public health expenditure increased by around 78% in real terms, averaging 7.4% pa. Total 2007-08 = $2.2 billion; about $100 per head.
Reform commitments of current government and recent agreements by COAG (Council of Australian Governments, the peak intergovernmental forum of First Ministers, chaired by PM) have seen significant injections of new funding.
Major structural reform of health system underway: PHC reforms important for HP. Two states have HP foundations: currently no national equivalent, but legislation has
been introduced to create National Prevention Agency.
Context
Investing in prevention
The 2009-10 Budget delivers on the Rudd Government’s commitment at COAG to fund the single largest investment ever made in health promotion in Australia – focused on tackling the health problems caused by tobacco, obesity and excessive consumption of alcohol.
In partnership with the states and territories, the Australian Government will invest $872.1 million over six years in preventing lifestyle risks that cause chronic disease.
EXTRACT - MINISTER’S MEDIA RELEASE, 12 May 2009
COAG National Reform Agenda: a basis for sustainable HP?
1. COMPETITION
3. HUMAN CAPITAL
Healthier, better skilled and more motivated
workforce2. REGULATION
Health
Education & Training
Work Incentives
65+0
Develop good habits
(eg diet, exercise)
ChildcareOut of
school care
Literacy & numeracy skills
Maintain good habits
Tran
sition
in
to
wo
rking
life
Encourage & support work
Early w
ork
experien
ce
Balance work & study
Supporting re-entryBalance work & family
Maintain good health
Support ongoing participation
Balance work & leisure
Manage health
Maintain & refresh skill sets
Healthy Living
Lifelong Learning
Encouraging & Supporting Work
Early ch
ildh
oo
d d
evelop
men
t
Life Cycle
Demographic ageingChronic disease (& MH)Health system pressuresSocial inclusion
Source: Adapted from Victorian Department of Premier and Cabinet
HEALTH REFORM
Sustainable financing : opportunities, challenges, threats
Case for investment in “prevention” generally well supported in Australia, but funding from consolidated revenue always subject to decisions of government of the day and state of the economy.
Hypothecation of funding (eg from “sin taxes) historically not supported by central economic agencies at national level.
However, government’s recent increase in tax on alcopops (pre-mixed alcoholic drinks) enabled a portion of the revenue derived from the excise to support the funding of the COAG Partnership Agreement on Preventive Health; and announcement of a $50 million package of additional measures under the National Binge Drinking Strategy.
The government has stated that all of the revenue derived from the recent 25 per cent increase in tobacco excise will be dedicated to the new National Health and Hospitals Network Fund.
Legislation for proposed Australian National Preventive Health Agency (“National Prevention Agency”) enables the Agency to establish and operate a “Special Account” which would allow it to receive funding from different sources, including state governments.
Current funding allocated for Agency is $132m over four years.
Agency legislation may not passed.
Capacity building and sustainable financing
Graham Robertson
Public bodies closely linked to government
NHS Health Scotland
• Status: a national special health board, part of the National Health Service in Scotland
• Primary focus: to work with local NHS Boards and health improvement partners to develop and implement public health improvement and health inequalities programmes
NHS Health Scotland Funding
• Direct from government as an allocation within NHS budget overall
• Mixture of core (recurring) and non-core (project) funding
• 2010/11: £27m
Implications
Strengths• Part of whole system• (Relatively) secure funding• Efficiency and value added• Integrated delivery
Weaknesses• Topic-based funding• Mismatch between national and
local priorities• Perception of NHS domination• Bureaucracy
Opportunities• Access to local
capacity/resources• Access to government and
opportunity to influence policy
Threats• Public sector funding cuts• Visibility of contribution• Time-lag for impact
Set up by the Health Promotion Act 2001
Funded by an earmarked tax, 2% of tobacco and alcohol excise tax
Governing Board consists of experts and officials, chaired by the Prime Minister
Overview: ThaiHealth Overview: ThaiHealth
ThaiHealth Budget (2008) ThaiHealth Budget (2008)
16
GDP Thailad 240 Billion $
Total Gov. Budget 52.8 Billion
$ Gov. Health Budget 4.3
Billion $ ThaiHealth Budget 80 ThaiHealth Budget 80
million $ million $
(Less than 2% Gov. Health (Less than 2% Gov. Health
Budget) Budget)
Why the ThaiHealth Why the ThaiHealth ModelModel
Win-Win financing model by using the surcharge sin tax from harmful products to promote healthy people
The secured funding for the long-term and innovative health promotion initiatives
To mobilize a range of sectors to work collaboratively and flexibly
Obstacles & ChallengesObstacles & Challenges
Obstacles:Independence from political interferenceThreats from opposition industries (e.g.
tobacco, alcohol)
Challenges:Use health promotion influence the
national direction towards sustainable development
Building capacity and competencies of our various partners
Austrian Health Promotion FoundationAustrian Health Promotion Foundation
Austrian Health Promotion Foundation
Health Promotion Act, 1998Project fundingNational competence center for HPInformation and awareness raising
Financing model
Population: 8.336.549 (2008)
Funds: 7.250.000 Euro annually 9.113.250 USD (1,09 USD per capita)
Budget money (value added tax)
Relationship to Government and NGOs
Government:Board 15 Members representing various sectors and level of administration, health care and insurance sector, presided by the MOHAgreement on priorities (workplans)
NGOs:carry out the work in the field,get grants, are trained, consulted...
International Network of Health Promotion Foundations
International Network of Health Promotion FoundationsQuébec en Forme
Join the movement
National partnersGroup of regional partnersGroup of local partners
Organigram
Fondation Lucie et André Chagnon
Governement of Québec
Fund in promotion of healthy lifestyles480 millions $ over 10 years
Mobilization projects Promotion projects
25 %
75 %
Public Health Agency of Canada
1,3M$ (2008-2010)
How it became a reality
The good idea at the right moment…
Pilot scheme of partnership between la Fondation Lucie et André Chagnon and 3 ministries of the Government of Québec aiming to give access to physical activity and sportive programs to the youth between 4 and 12 years of age in underprivileged environments.
Governmental Action Plan 2006-2012 on promotion of healthy lifestyles and prevention of weight problems
Act creating the Fund for promotion of healthy lifestyles (June 2007)
Politique-cadre for healthy eating habits and an active lifestyle (2007)
Public Health Act (revised August 2007)
Mission
To contribute to the adoption and upholding of
an active lifestyle and healthy eating habits by
Québec Youth, from birth to age 17 inclusively.
What we do
What we want to achieve
To see all concerned actors of Quebec society to create environments favouring the adoption and the upholding of an active lifestyle and healthy
eating habits.
Vision
Meaning :
Be a catalyst rather than an operator; increase efficiency of ressources and ensure the sustainability of actions.
International Network of Health Promotion Foundations
Infrastructure for health promotion investment: models for financing HPgovernment based approach within ministry public bodies closely linked to government health promotion foundations private foundation
ThaiHealth
Health Scotland Austrian HPF DoHA ChagnonAustralia Foundation
Colin Sindall: Department of Health & Ageing, Australia
Graham Robertson: Health Scotland (former CEO)
Krissada Raungarreerat: ThaiHealth
Rainer Christ: Austrian Health Promotion Foundation
Diane Le May: Quebec en Forme
Advantages and disadvantages of different organisational models The Australian model for health promotion has generally worked well, although with room for
improvement. Location of health promotion responsibilities within the national health ministry has enabled a strong connection with the wider health and public policy agenda, and to the legislative, regulatory and fiscal levers of government.
The federal system has allowed for a considerable degree of flexibility and innovation at the state level and opportunities for learning. However, this has come at the cost of some fragmentation of effort and inconsistency in program delivery.
The proposed Prevention Agency would add value to the current health promotion environment by eg (a) consolidating social marketing functions; (b) providing a central authoritative source of evidence-based advice and recommendations for the Commonwealth Minister, for the Health Ministers Conference, for non-health ministries and for local government; (c) providing a national mechanism for collation and analysis of various sources of information, including evaluations of interventions; (d) supporting and building partnerships with other agencies (including state health promotion agencies, research groups, NGOs ) and sectors; (e) developing and promoting national standards, codes of practice and guidelines, and (f) supporting primary health organisations to deliver regional and community based health promotion programs.
With a strong relationship between the health department and the Agency, the advantages of both models - combining the flexibility and technical capacity provided by an Agency with the policy capacity and administrative expertise of government - might be realised.
Enjeux
- Perception of a Private foundation’s intervention in the interventions usually
taken by the state.
- Reactions of organisms and networks who would have prefered that the state
would directly deposit them the money.
- Silo and top-down thinking of different networks.
- Over-consultation and the pressure put on local actors
- Mobilization strategy of local actors vs the impacts on an active lifestyle and
healthy eating habits.
International Network of Health Promotion Foundations
International Network of Health Promotion Foundations
Capacity Building – sustainable financing and infrastructures for HP
www.hpfoundations.net