Appendix 1: Strategic Priorities and Guidance for Public Health Units
This Strategic Priorities and Guidance for Public Health Units (PHUs) is intended to provide strategic guidance to PHU service planning for 2016/17. It includes higher level strategic direction of focus/actions and, in some cases, the population targeted under each issues area. The information is gathered from Public Health Issues Leads and colleagues across the Ministry of Health (the Ministry).
Core Functions approach
PHUs are expected to align the activities in their 2016/17 PHU Annual Plans with Results Based Accountability™ (RBA) and the core functions approach. We have not shown the RBA and core functions alignment in this document because it is about guidance on strategic directions.
How to use this Update
Please use this information as appropriate. The Ministry is mindful that not all activities outlined in the Strategic Priorities Update will be relevant or appropriate for your population of coverage and that you may be required to prioritise some activities over others to ensure that existing resources are used most efficiently and effectively.
What is important is for you to ensure your service delivery is aligned with the strategic priorities of the Government, the Ministry and your DHB(s), and that all regulatory requirements are fulfilled.
As the Strategic Priorities and Guidance for PHUs is intended as higher level strategic guidance to PHU service planning, not every activity that PHUs carry out on a daily basis is included in the document. For example, Communicable Diseases activities relating to surveillance are not considered here because it is core business-as-usual activity.
We start with Government targets, then non communicable disease and long-term conditions, followed by other issues areas (the latter in alphabetical order, and not in order of importance or its potential for integration).
The Government’s Strategic Priorities: Better Public Services Results Targetshttp://www.ssc.govt.nz/bps-supporting-vulnerable-children
ISSUE DIRECTION/FOCUS / TARGET POPULATION
Increase infant immunisation rates (Note: increasing infant immunisation rates is also a Health target).
Better Public Services Results Targets:
By December 2014, 95 percent of eight-month-olds will have had their primary course of immunisation at six weeks, three months and five months by the eight-month milestone. The eight-month immunisation target is part of the Government's Better Public Services (BPS) initiative for Supporting Vulnerable Children. Progress towards the target will be measured for five years from 1 July 2012 until June 2017.
As well as the existing DHB performance measure to maintain coverage of two-year-olds at 95 percent, the DHB’s annual plans for 2015/16 included two new performance measures for immunisation at age 5 years and for HPV. For 2016/17, these performance measures have been increased to: (i) 95 percent of five-year olds to be fully immunised for age; (ii) 70% of eligible girls to have been fully immunised for the HPV vaccine (for 2016/17 this is the 2003 birth cohort measured at 30 June 2017).
While increasing childhood immunisations is a priority, it is important that other publicly-funded immunisation programmes also achieve high coverage, for example, antenatal immunisation and the annual influenza programme. / Children and adults eligible for vaccines as recorded on the National Immunisation Schedule (including childhood vaccines, HPV, influenza vaccine, adult boosters [Td] and those eligible for high risk programmes).
Parents, guardians, whānau and community (including refugee and migrants) for promotion of immunisation campaigns.
Health Target:
· 95 percent of eight-month olds will have their primary course of immunisation (six weeks, three months and five months immunisation events) maintained until 2017.
· Maintain 95% of two-year olds fully immunised.
PHU contribution:
· Continue to support your respective DHBs/PHOs towards achieving the current immunisation health targets, performance measures and the Government’s BPS targets.
· Your role, in terms of the support/advice you give to immunisation promotion, will be as agreed with the local DHB(s) and Immunisation Steering Committees. With support from the Ministry, work towards eliminating measles in New Zealand.
Note: The Well Child Tamariki Ora Quality Improvement Framework[1] has one immunisation health indicator, which will be reported against by DHBs every six monthly. / Specific health provider groups (eg, Lead Maternity Carers, authorised vaccinators, Primary Care providers and vaccinators, BCG vaccinators).
Reduce the incidence of rheumatic fever
Better Public Services Results Targets:
Reduce the incidence of rheumatic fever by two-thirds to 1.4 cases per 100,000 by 2017 (national target). Each DHB has been informed of its 2016/17 target by the Ministry of Health.
PHU contribution: Primordial prevention
· Determine your role in supporting the DHBs’ implementation of Rheumatic Fever Prevention Plans, including evaluation of effectiveness of interventions and application of any learning.
· Refer to guidance under Social Environments to ensure that effective primordial prevention strategies are delivered.
PHU contribution: Managing notifications
· Ensure that cases of acute and recurrent acute rheumatic fever are entered and updated in EpiSurv in a timely manner.
· Work with the reporting medical practitioner to ensure that all fields in the rheumatic fever case report form are reported and completed accurately.
· Undertake remedial work on any incomplete rheumatic fever notifications from July 2014 using the new notification form.
· Actively promote timely notification of acute and recurrent rheumatic fever within 7 days of hospitalisation among hospital-based medical practitioners in the area, and provide feedback to services on the timeliness of their notifications.
· Support, as required, implementation of any actions following the national DHB audit of recurrent hospitalisations for rheumatic fever and unexpected rheumatic heart disease.
ISSUE DIRECTION/FOCUS / TARGET POPULATION
Reduce the number of assaults on children
Better Public Services Results Targets:
Halt the ten-year rise in children experiencing physical abuse and reduce the number of children experiencing substantiated physical abuse by over 1,000 on projected numbers by 2017.
PHU contribution:
Please focus on how your PHU might be able to contribute to the Better Public Service Priorities Result 4: reducing assaults on children, and implementation of the Children’s Action Plan.
In July 2015, a new work programme of the Ministerial Group on Family Violence and Sexual Violence was launched to ensure government agencies respond better to family and sexual violence, through: stopping family violence from occurring, reducing the harm caused by family violence, and breaking the cycle of family violence (https://beehive.govt.nz/webfm_send/68).
PHUs can contribute to the Primary Prevention component of this work programme by using a health promotion model that addresses the determinants of health at the individual, family/whānau, community and societal levels. Activities should focus on reducing risk factors for family violence and sexual violence and on strengthening protective factors that contribute to healthy relationships, which may include:
o Support of primary prevention programmes, such as MSD-led It’s Not OK campaign and related projects (eg, White Ribbon Day, Te Rito Network activities, TLA partnerships, using It’s Not OK Community Action Toolkit), and healthy relationship programmes in schools.
o Support of the Violence Implementation Programme (VIP) in DHBs.
o Support of DHB VIP community collaboration and action that will achieve health equity.
o Support Whānau Ora service providers and Iwi to promote family violence prevention programmes and services that are responsive to Māori and are culturally competent. / Universal approach with a focus on priority
populations for your PHU region, Māori and Pacific people, migrants and refugees, disabled people, and youth.
ISSUE DIRECTION/FOCUS
Reduce long-term welfare dependence
Better Public Services Results Targets:
Policy work is underway to look at how Health can better contribute from July 2016 to reducing long-term welfare dependence. There is a focus on improving sexual and reproductive health promotion and individual sexual health services to reduce the number of unintended teenage pregnancies. PHU sexual health activities can contribute to efforts to reduce the number of unplanned teenage pregnancies.
For your general information:
Evidence shows that young people who are empowered to take charge of their sexual and reproductive health are less likely to have unintended pregnancies in adolescence.
PHU contribution:
Health promotion activities that support young people’s empowerment are encouraged. This may include :
· conducting a needs analysis to better understand the knowledge, attitudes, behaviours and service landscape
· encouraging collaborative work between clinical services and health promotion services, and supporting youth-friendly health service provision
· participating and/or encouraging NGO participation in the DHB Service Level Alliance Teams.
ISSUE DIRECTION/FOCUS
Improve outcomes at a local level: Social Sector Trials
For your general information:
Under the Social Sector Trials (SSTs) programme, the Government has introduced local leadership for social services in 16 towns and suburbs around New Zealand to improve social and health outcomes in those communities. The SSTs involve the Ministries of Education, Health, Justice and Social Development, and the New Zealand Police working together to change the way that social services are delivered. Having consulted with the community and with the guidance and approval of an advisory group (on which the local DHB is represented), each SST lead sets goals and milestones through an Action Plan and reports against that plan directly to Ministers and to a Joint Venture Board, which comprises the Chief Executives of the five agencies.
In August 2014, Cabinet approved, in principle, the first six SSTs (Waitomo, Taumarunui, South Waikato, Kawerau, Horowhenua and Gore District) becoming a permanent part of social service delivery in their communities, subject to a transition plan for each being approved by Ministers and to a successful 2015 budget bid. The other 10 are to be extended for two years from 1 July 2015, with a view to them going through a similar transition process at the end of that period.
PHU contribution:
It is important that PHU activities in those towns where there are SSTs are aligned with the SST action plans. Information about the SST locations and individual plans can be found on: http://www.msd.govt.nz/about-msd-and-our-work/work-programmes/initiatives/social-sector-trials/
Long Term Conditions – Prevention, Identification and Management: guidance for DHBs and PHUs
Long term conditions are ongoing, long term or recurring conditions. The prevalence of long term conditions is increasing, causing premature mortality and morbidity, which is directly or indirectly linked with the underlying disease. Māori and Pacific people, people living in low socioeconomic circumstances, people with disabilities and people with mental health and addiction issues are disproportionately affected by some long term conditions, with a more significant impact from ill health and earlier mortality.
DHB prevention and treatment services need to adapt to meet this increasing burden of long term conditions, with consideration given to cardiovascular disease, cancer, diabetes, chronic respiratory conditions, and mental ill health. Focus needs to be placed on providing evidence-based services that are people-centred and closer to where people live, learn, work and play. Services should focus on wellness and prevention (for example, strategies to help make healthy choices easier), early identification, and integrating management and treatment in community-based services. This can both stop the occurrence, and slow the progression of many long term conditions. DHBs are expected to identify new activity to deal with this rising burden, and identified disparities, while also committing to continue current programmes to deal with the burden of long term conditions (eg, current Chronic Obstructive Pulmonary Disease and Asthma programmes).
DHBs and PHUs should collaborate with their local PHO/s and other local partners (eg, Iwi, education providers, local government, government agencies, non-government organisations, and businesses) to develop appropriate actions for the prevention, identification and management of long term conditions to implement integrated programmes. The local partners/key stakeholders for each priority should include any groups that will be involved in the implementation of the specific plan.
Interventions/approaches known to work that must be considered and reflected as appropriate in the DHB approach follow:
· Population based and targeted prevention.
· Collaborative programmes that make healthy choices easier, and target higher risk populations.
· Workforce capacity and capability.
· IT solutions.
· Consumer and community co-design.
· Effective primary care and community /services closer to home.
· Self-management programmes.
Effective collaborative action and outcomes (as outlined in dot point two above) that cross community and primary care organisations maximise physical activity, good nutrition, quit smoking and reduction in the harmful use of alcohol (including demand reduction and control), and support for mental health promotion programmes. Where DHBs have reflected one of the above approaches this should be clearly identified within the Annual Plan, as DHB Annual Plans will be assessed against the reflection of the above dot points, particularly how joint participants bring different perspectives from their areas of expertise (eg, physical activity).
Some key areas associated with long term conditions have recently been chosen by the Whānau Ora Partnership Group (comprising of representatives from the Iwi Chairs Forum and six Ministers representing the Crown) to highlight health sector activity to support Whānau Ora. These are part of a larger set of indicators. Health sector activity will need to focus on progress in five key areas that contribute to Whānau Ora - mental health (reduced rate of Māori committed to compulsory treatment relative to non-Māori), tobacco (better support for pregnant women to quit smoking), asthma (reduced asthma admission rates for Māori and Pacific children), oral health (Māori and Pacific 5 year old children who are caries free), and obesity (B4 School Check services). These have been chosen to achieve accelerated progress towards health equity for Māori and Pacific, and Whānau Ora in the next four years.
Further guidance on common risk factors
As the four conditions which make the largest contribution to morbidity and mortality due to long term conditions (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) share four behavioural risk factors (tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol), some guidance for PHUs on the four risks factors are given below. We start with Healthy Families NZ, then Tobacco, Nutrition and Physical Activity, Alcohol and Other Drugs, and Mental Health.
ISSUE DIRECTION/FOCUS / TARGET POPULATIONHealthy Families NZ
For your general information:
· Healthy Families NZ is the Government’s flagship prevention platform – a key part of the Government’s wider approach to helping New Zealanders live healthy, active lives.