Présentation des ateliers santé ville au colloque organisé par la coopération Suisse en Roumanie "Community Integrated Health and Social Service"

1. City Health Networks
in France
(les “Ateliers Santé Ville”)
Nicolas Hervieu – Pluricité
February 2014

2. City Health Networks*
in France
(*freely translated from
les “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).
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
Live discussion : use twitter hashtag #cityhealthnet
Hot tip : This presentation already online there!
Nicolas Hervieu – Pluricité
February 2014
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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
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4. City Health Networks – how it grew up in France
Widespread (2007-…)
Experimentation (2000 – 2006)
52
36
15
4
8
2000
2001
2002
16
6
2003
2004
10
2005
24
17
2006
2007
2008
2009
27
15
2010
9
2011
2012
Number created each year
Source : yearly survey led by the french social cohesion and social equality agency (ACSé)
258 City Health Networks were operating during 2012
They developed with “politique de la ville” (contracts were launched in 2000 and 2006)
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.
Nicolas Hervieu – Pluricité
February 2014
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5. City Health Networks & Local Health Contracts
Relationship as of December 2012 :
Is there a local health contract onto your perimeter ?
No health
contract
(47%)
Yes, sign
ed!
(29%)
Discussing
(24%)
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
What is the involvement of the city health network regarding this contract ?
Involvement of the ASV in the choice of the field of intervention
Involvement of the ASV to the urban policy awareness
Local health contract coordination by the coordinator
Shared steering commitee
Others
Nicolas Hervieu – Pluricité
74%
70%
52%
43%
11%
February 2014
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6. City Health Networks & Local Health Contracts
– How they complement
Local 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…)
Nicolas Hervieu – Pluricité
February 2014
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7. City Health Networks – How it runs
Mainly, 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 parttime.
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.
Distribution of coodinators involved in the city health network on 12/31/2012 (full-time
equivalents) :
16%
Less than 0,5 coordinator
22%
From 0,5 to 1 coordinator
55%
1 coordinator
From 1 and 2 coordinator
More than 2 coordinators
3%
4%
One steering committee oversees the job
(takes part in the diagnosis,adopts the action plan, the monitoring and the evaluation)
Nicolas Hervieu – Pluricité
February 2014
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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
2) Mixed City
health networks
3) City health
networks
“coordinator” of
health care actions
Nicolas Hervieu – Pluricité
• 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
• About 60-70% of Ateliers Santé Ville
• The « typical » ASV – which mix direct and indirect actions
• Large scale, across several cities
• About 20% of ASV
February 2014
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9. City Health Networks – What they do
Shared diagnosis and action plan
Targeted groups prevention
Thematic prevention
Even a Web TV !
Short link : http://url.pluricite.fr/ASV-TV
Long link : http://www.villearmentieres.fr/fr/actu/webtv.php?type=video&id=641&emission=Atelier_sante_ville&page=1
Nicolas Hervieu – Pluricité
February 2014
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10. City Health Networks – What for ?
2012 total number of actions by theme
2012 total number of beneficiaries* by theme
950
Mental health care
367
Access to sanitaries and social rights
352
Addictive practices and at risk (including…
330
Nutrition
144935
Addictive practices and at risk (including… 84804
HIV / AIDS / STD / Hepatitis
45333
Youth health
44313
Youth health
306
Access to sanitaries and social rights
42777
Cancer (including screening)
303
Dental health care
41822
Mental health care
35318
Cancer (including screening)
28631
Tuberculosis and vaccinations
11620
Tuberculosis and vaccinations 107
Environment
10660
Environment 97
Mother and child health care
9153
Improvement of health care professionals…
86
Other chronical diseases
5837
Traumatism and violences
*Include both direct and indirect beneficiaries
(e.g beneficiaries of communication actions on
prevention, awareness campaign…)
Nutrition
5072
262
Dental health care
220
HIV / AIDS / STD / Hepatitis
Mother and child health care 136
Traumatism and violences
77
Alzheimer and other aging related diseases
75
Other chronical diseases
49
Facing health care refusal
45
Other themes
Alzheimer and other aging related diseases
4807
Facing health care refusal
4018
Improvement of health care professionals… 2421
501
Other themes
84355
Source : yearly survey led by the french social cohesion and social equality agency (ACSé)
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.
Nicolas Hervieu – Pluricité
February 2014
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11. City Health Networks – their backing
City Health Networks have
on average an annual budget
of 76 K€ (it’s a 17M€ policy
overall)
Main contributors to the city health networks
City health networks financed
Social cohesion and
social opportunities
agency (ACSé)
93%
Cities/interconnected
cities/municipalities
Other fundings
18%
41%
County Council
Regional council
7%
82%
Regional health
agency
Communal centre for
social welfare
City health networks not financed
18%
13%
8%
5%
59%
82%
87%
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.
92%
95%
On average, a city health
network receive funds from 3
different organisms.
Source : yearly survey led by the french social cohesion and social equality agency (ACSé)
Nicolas Hervieu – Pluricité
February 2014
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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
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13. 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
It rings a bell ? Let‟s keep in touch
Nicolas Hervieu – Pluricité
nhervieu@pluricite.fr
February 2014
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