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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Nicolas Hervieu – Pluricité February 2014 3

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 ?

Nicolas Hervieu – Pluricité February 2014 6

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.

Nicolas Hervieu – Pluricité February 2014 8

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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Nicolas Hervieu – Pluricité February 2014 11

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

Nicolas Hervieu – Pluricité February 2014 12

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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It rings a bell ? Let’s keep in touch

nhervieu@pluricite.fr