Building capacity for health promotion—a case study from China

Abstract

During the period 1997-2000 a technical assistance project to build capacity for community-based health promotion was implemented in seven cities and one province in China. The technical assistance project formed part of a much larger World Bank supported program to improve disease prevention capabilities in China, commonly known as Health VII. The technical assistance project was funded by the Australian Agency for International Development. It was designed to develop capacity within the Ministry of Health (MOH) and the cities and province in the management of community-based health promotion projects, as well as supporting institutional development and public health policy reform. There are some relatively unique features of this technical assistance which helped shape its implementation and impact. It sought to provide the Chinese MOH and the cities and province with an introduction to comprehensive health promotion strategies, in contrast to the more limited information, education and communication strategies. The project was provided on a continuing basis over 3 years through a single institution, rather than as a series of ad hoc consultancies by individuals. Teaching and learning processes were developmental, leading progressively to a greater degree of local Chinese input and management to ensure sustainability and maintenance of technical support for the project. Based on this experience, this paper presents a model for capacity building projects of this type. It describes the education, training and planning activities that were the key inputs to the project, as well as the limited available evidence on the impact of the project. It describes how the project evolved over time to meet the changing needs of the participants, specifically how the content of the project shifted from a risk-factor orientation to a settings-based focus, and the delivery of the project moved from an expert-led approach to a more participatory, problem based learning approach. In terms of impact, marked differences before and after the implementation of the training activities were identified in key areas for reform, in addition to the self reported positive change in knowledge, and a high level of participant satisfaction. Key lessons are summarized. Technical assistance projects of this kind benefit from continuity and a high level of coordination, the provision of culturally and linguistically appropriate teaching, and a clear understanding of the need to match workforce development with organizational/institutional development.

Reorientation of health services: enablers and barriers faced by organisations when increasing health promotion capacity

“…Many authors acknowledged the challenges of the political environment, through changing priorities, access to resources and long-term funding. 18,[22][23][24]26,32,35,38,41 Only one study related to an Indigenous health service. 42 This study examined the organisation's capacity to conduct brief interventions with clients.…”

“…26,30,33 The majority of studies reported the enablers and barriers from a practitioner's point of view. 18,[21][22][23][24][25]33,37,38 As managers were identified as gatekeepers to many of the enablers and barriers to health promotion practice within an organisation, further exploration of the supports required to assist the management role would be useful.…”

“…18,24,[32][33][34][35] Access to expertise outside the organisation during and after the change process was important. One-off, short-term assistance such as training would not embed the skills and systems learned without support to translate this into practice.…”

“…21 This was identified in studies that addressed the need to improve knowledge and skills through training 24,26,27,31,33,34,37,38 and by practitioners who identified that health promotion knowledge and skills were required to effectively deliver health promotion approaches. 25,29,36,39,40,42 While this finding is not necessarily surprising, the frequency with which it was mentioned in the studies highlights its importance.…”

“…To increase organisational health promotion capacity, management support, 18,20-33 a skilled and knowledgeable workforce, [34][35][36][37][38] external specialist assistance, 18,24,32,34,35 resource allocation, 20,22,27,31 leadership 26,27,29,31,33,39,40 and access to external partners to work on health promotion approaches 21,[25][26][27] were the most commonly reported enablers. Management support was reported in two ways: first, the line manager's influence on work practice; and second, the influence of the organisation's ethos and practice.…”