Partnerships for sustainable health – revisit the policy

Partnerships for
Sustainable Health – Revisit
the Policy
Datu Dr Andrew Kiyu
Consultant Epidemiologist,
Sarawak Health Department.
kiyu.andrew@gmail.com
8th National Public Health Conference
Equatorial Hotel, Malacca
2-4 August 2016
1

8th National Public Health Conference
Theme:
“Managing Society in Combating Public Health Challenges”
2

VISION
Ministry of Health Malaysia
“A Nation
Working Together
for Health”
5

Schematic Overview of the Malaysian Health System
* SOCSO - Social Security Organization ** EPF - Employee Provident Fund
Source: Rozita Halina Hussein. Asia Pacific Region Country Health Financing Profiles: Malaysia, Institute for Health Systems Research.
http://www.wpro.who.int/asia_pacific_observatory/hits/series/Hits_MYS_2_organization.pdf?ua=1 6

What is Policy?
A Conceptual Continuum
Policy is
considered to be a
rule or principle
that guides
decision-making
Policy is
• defined as the explicit (and thus
documented) formal decision
• by an executive agency
• to solve a certain problem
• through the deployment of
specific resources, and
• the establishment of specific sets
of goals and objectives
• to be met within a specific time
frame.
Evelyne de Leeuw (2007) “Policies for Health: The Effectiveness of their Development, Adoption, and Implementation”7

How Policy Impacts on Health
• Lasswell (1936) defined policy as “deciding who
gets what, where and how”.
• Thus policy regulates choices in every domain
pertaining to social determinants of health,
• be it housing, social assistance, environmental
protection, employment and economic issues,
agriculture or science and technology policy
• Lasswell, H. (1936) Politics: Who gets what, when, how. McGraw-Hill, New York. Cited by Evelyne de
Leeuw (2007) “Policies for Health: The Effectiveness of their Development, Adoption, and
Implementation” p55
8

WHO Report 2006 – focused on human
resources for health
http://www.who.int/whr/2006/whr06_en.pdf?ua=1
9

The key International declarations and
publications that exhorts partnerships or
intersectoral actions for health:
• Alma-Ata Declaration (1978),
• Ottawa Charter for Health Promotion (1986)
• Intersectoral action for health : the role of intersectoral
cooperation in national strategies for Health for All
(1986)
• Intersectoral Action for Health: A Cornerstone for
Health-for-All in the Twenty-First Century (WHO 1997),
• Adelaide Statement on Health in All Policies (WHO 2010).
11

Declaration of Alma-Ata International
Conference on Primary Health Care,
Alma-Ata, USSR, 6-12 September 1978
• VII: Primary health care:
• …
• 4. involves, in addition to the health sector,
all related sectors and aspects of national and community
development,
in particular agriculture, animal husbandry, food, industry,
education, housing, public works, communications and
other sectors;
and demands the coordinated efforts of all those sectors
• …
• http://www.who.int/publications/almaata_declaration_en.pdf 12

Prerequisites for Health
Ottawa Charter for Health Promotion
21 November 1986
The fundamental conditions and resources for health are:
• peace,
• shelter,
• education,
• food,
• income,
• a stable eco-system,
• sustainable resources,
• social justice, and equity.
• Improvement in health requires a secure foundation in
these basic prerequisites.
• http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
14

The need for concerted action by many sectors
• The prerequisites and prospects for health cannot be
ensured by the health sector alone.
• … (it) demands coordinated action by all concerned, viz:
• governments,
• health and other social and economic sectors,
• nongovernmental and voluntary organization,
• local authorities,
• industry
• the media.
• People in all walks of life are involved as
• individuals,
• families and
• communities.
• Professional and social groups and health personnel have a
major responsibility to mediate between differing interests
in society for the pursuit of health.
• http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
15

Why We Need
Partnerships and
Intersectoral Action
for Health
17

Estimated Impact of Determinants of Health on
Health Status of the Population
Source: Canadian Institute for Advanced Research, Health Canada, Population and Public Health Branch AB/NWT 2002
cited in Philip O’Hara (2005). Creating Social and Health Equity: Adopting an Alberta Social Determinants of Health
Framework. Downloaded from
http://www.issuelab.org/resource/creating_social_and_health_equity_adopting_an_alberta_social_determinants_of_heal
th_framework
18

Conceptual Framework of the Social
Determinants of Health
WHO (2010). Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health
Discussion. Paper 2 (Policy and Practice). http://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf19
Governance
IMPACT ON
EQUITY IN
HEALTH
AND
WELL-BEING
Macroeconomic
Policies
Social Policies
Labour Market,
Housing, Land
Public Policies
Education, Health,
Social Protection
Culture and
Societal Values
SOCIOECONOMIC
AND POLITICAL
CONTEXT
Socioeconomic
Positions
Social Class
Gender Ethnicity
(racism)
STRUCTURAL DETERMINANTS
SOCIAL DETERMINANTS OF
HEALTH INEQUITIES
Education
Occupation
Income
INTERMEDIARY DETERMINANTS
SOCIAL DETERMINANTS
OF HEALTH
Material Circumstances
(Living and Working,
Condition, Food
Availability, etc.)
Behaviours and
Biological Factors
Psychosocial Factors
Social Cohesion &
Social Capital
Health System

Reasons for Intersectoral Action for Health
• Some examples of how health is impacted by actions beyond
the health sector are:
• the decline of road deaths as a result of a set of measures
that included road engineering and motor vehicle safety
measures,
• 23% reduction in cardiovascular diseases and stroke due to
a reduction in dietary salt intake from 10 g/day to 5 g/day,
• decrease in diarrhoea mortality because of improved access
to clean water (21 % decrease) and sanitation (23%
decrease),
• saving of thousands of lives through raising taxes on
tobacco and
• increase in life expectancy attributed to additional years of
education 20

Multisectoral - Definition by WHO
• Multisectoral (intersectoral) action
• refers to action between two or more sectors within the public sector (1)
• Multistakeholder action
• refers to action by actors outside the public sector (e.g. nongovernmental
organizations [NGOs] and the private sector).(2)
• The terms multisectoral action and intersectoral action are often
used interchangeably, and they have the same meaning unless
otherwise specified
Ref: (1) Paragraph 36 of the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases A/RES/66/2.
(2) Paragraph 37 of the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases A/RES/66/2.
Source: WHO Discussion Paper (Version dated 29 October 2014). Framework for country action across sectors for health and health equity.
http://www.who.int/nmh/events/framework-discussion-paper-rev.pdf?ua=1
21

Four Forms of Action Across Sectors
Actions are initiated by
the health authority
• participation from one or more ministries,
• primarily focused on improving health and
health equity
head of government
non-health agency
head of government
• often arising to combat disease outbreaks
or manage health emergencies
• all ministries participating most of the time.
• the road and transport authorities assume lead
role in in the prevention of road deaths and
injuries (Department of Town and Country
Planning in P. Malaysia taking over Healthy Cities)
• find various sectors working together to
address one or more public health issues
• E.g., Healthy cities, healthy schools
22

Six Components of Action Across Sectors
Establish the need and priorities for action across sectors
Frame planned action
Identify supportive structures and processes
Facilitate assessment and engagement
Implement planned action across sectors
Ensure that monitoring,
evaluation and
reporting occurs
24

Institutional Capacity for Action Across Sectors
Expertise of individual
practitioners
Existing policy commitments
Availability of funds
Availability of information
and databases for planning
Organizational structure
Source: WHO Discussion Paper (Version dated 29 October 2014). Framework for country action across sectors for health and health
equity. http://www.who.int/nmh/events/framework-discussion-paper-rev.pdf?ua=1
25

Community Capacity for Action Across Sectors
Promoting health and
policy literacy
Training leaders in techniques
to support and enable:
• informed community participation
• engagement with decision-making,
• implementing and evaluating community action for health
Source: WHO Discussion Paper (Version dated 29 October 2014). Framework for country action across sectors for health and
health equity. http://www.who.int/nmh/events/framework-discussion-paper-rev.pdf?ua=1
27

Why Partnerships For Health?
Health
• not solely the
responsibility of ministries
of health.
• Should be everybody’s
business
Partnership
• based on the simple adage that “two heads are better
than one”
• outcome of partnership work is not a simple addition of
the stakeholders’ inputs — it is a synergy of all inputs
31

Partnership: Definition
A partnership is:
• an arrangement
• in which parties agree
to cooperate
• to advance their
mutual interests
• (http://en.wikipedia.org/wiki/Partnership)
A partnership is:
• a shared commitment,
• where all partners have a
right and an obligation to
participate and
• will be affected equally by the
benefits and disadvantages
• arising from the
partnership.
• Ros Carnwell and Alex Carson. The concepts of partnership and
collaboration; p7, 10;
https://www.mheducation.co.uk/openup/chapters/9780335229116.
pdf
• In: Ros Carnwell and Julian Buchanan (editors): Effective
Practice in Health, Social Care and Criminal Justice: A
Partnership Approach; 1 Dec 2008
32

Types of Partnership
Type Description
Project
partnership
• time limited for the duration of a particular project
• A partnership between the police and other road safety organizations to
lower the speed limit will end when their project is successful
Problem oriented
partnership
• formed in response to a publicly identified problem
• remain as long as the problem persists.
• Examples of this might include Neighbourhood Watch schemes or
substance abuse teams.
Ideological
partnership
• arise from a shared outlook or point of view.
• similar in many ways to problem oriented partnerships,
• but they also possess a certain viewpoint that they are convinced is the
correct way of seeing things
Ethical
partnership
• have a sense of ‘mission’ and have an overtly ethical agenda, that seeks to
promote a particular way of life.
• They tend to be democratic and reflective and are as equally focused on
the means as the end.
• While most partnerships have codes of ethics or ethical procedures, ethical
partnerships have a substantive ethical content in their mission and
practice
Ros Carnwell and Alex Carson. The concepts of partnership and collaboration. P12-13
33

Three Dimensions of Partnerships
In simple terms, the three
dimensions translate into:
• more resources,
• more people, and
• new expertise.
A unidimensional
development that lacks
support and input from
the other two dimensions
is likely to collapse.
WHO (2003). The power of partnership. http://www.who.int/management/powerpartnership.pdf
35
Communitymobilisation
• Technical development
• Community mobilisation
• Service enhancement

Example: Prevention and Control of HIV/AIDS
in the early phase of the epidemic
• Taboo topics – Sex (especially MSM) and Substance abuse, and AIDS itself
• Cannot discuss, cannot educate, cannot fund
• Difficult to identify and work with the individuals at risk
WHAT WAS DONE
• partners were identified and an organisation structure for partnership was set
up
• Malaysian AIDS Council was formed
• Funds allocated to them to do the work that MOH cannot do
RESULT:
• more resources,
• more people, and
• new expertise.
36

Community Participation Ladder
37
CITIZEN
CONTROL
DELEGATION
PARTNERSHIP
PLACATION
CONSULTATION
INFORMING
THERAPY
MANIPULATION
8
7
6
5
4
3
2
1
CITIZEN
CONTROL
TOKENISM
NONPARTICIPATION
Arnstein’s Ladder (1969)
Degrees of Citizen Participation
http://www.vcn.bc.ca/citizens-
handbook/arnsteinsladder.html
RESOLUTION/
PREVENTION
LITIGATION
MEDIATION
JOINT PLANNING
CONSULTATION
INFORMATION
FEEDBACK
EDUCATION
GENERALPUBLIC
LEADERS
A new Ladder of citizen participation (Connor, 1998)
http://geography.sdsu.edu/People/Pages/jankowski/
public_html/web780/Connor_1988.pdf

Continuum of Involvement
Ros Carnwell and Alex Carson. The concepts of partnership and collaboration. P17
38

Source: Jim Cowan, Cowan Global Limited 2010. Partnership working
http://cowanglobal.wordpress.com/tag/partnership-working/
THE FIVE DEGREES OF PARTNERSHIP WORKING
Co-existence
“You stay on your turf and I’ll stay on mine”
Co-operation
“I’ll lend you a hand when my work is done”
Co-ordination
“We need to adjust what we do to avoid overlap and confusion”
Collaboration
“Let’s all work on this together”
Co-ownership
“We all feel totally responsible”
Degreeof
partnershipworking
Token,
Nominal
Pure
40

Sustainable health or
health care
42

Three main (and overlapping) interpretations of
sustainable health and health care
Addresses the rising costs
of health care
addresses the impact of
health care on the
environment and
resource consumption
addresses the roles of
health care during major
crises (e.g. the 2015-2016
Ebola epidemic in West
Africa) and physical
disasters (e.g.
earthquakes).
sustainable health care is
interpreted in the context
of financial sustainability
or affordability and
accessibility of health
care.
this involves ‘greening’
the sector with particular
attention to energy,
travel, waste,
procurement, water,
infrastructure adaptation
and buildings.
sustainable health care is
interpreted to mean that
the health care do not
collapse during times of
disaster and the terms
used are sustainable and
resilient health care.
Prada, Gabriela, Kelly Grimes, and Ioulia Sklokin.
Defining Health and Health Care Sustainability.
Ottawa: The Conference Board of Canada, 2014.
UK. Sustainable development Unit, NHS (2009).
“Fit for the Future: Scenarios for low-carbon
healthcare 2030”
WHO. OXFAM, Rockfeller Foundation
WHO. Hospitals Safe from Disasters
43

Resilient Health System
ADAPTIVE?
Rebounds from
shocks stronger
than before.
AWARE?
Detects health
threats before
they strike.
ITERGRATED?
Rapidly deploys
resources
from beyond
the health
system.
SELF-
REGULATING?
Prevents health
disruptions from
turning into
disasters.
DIVERSE?
Delivers range
of services
with universal
health
coverage.
IS YOUR HEALTH SYSTEM RESILIENT?
IN TIMES OF
CRISIS
LIVES
SAVED
LIVELIHOODS
PROTECTED
IN TIMES OF
CALM
HEALTHIER
PEOPLE
STRONGER
NATIONS
RESILIENT HEALTH SYSTEMS PAY DIVIDENS
WE NEED HEALTH SYSTEMS THAT
BEND, NOT BREAK
ACCELERATED BY
GLOBALIZATION URBANIZATION CLIMATE CHANGE
CRISIS IS THE NEW NORMAL
44

Likely features of a sustainable healthcare
system – The Green Perspective
Source: http://www.sdu.nhs.uk/publications-resources/4/Fit-for-the-Future-/
Cited by Knut Schroeder, Trevor Thompson, Kathleen Frith, David Pencheon (2013). Sustainable Healthcare. Wiley-Blackwell and BMJ Books.
Wellbeing is key
Hospital
admissions are
rare
Low health
inequalities
Care closer to
home
Instant help
online, by
telephone, or at a
health centre
Sustainable
Healthcare
Buildings are in
tune with the
environment, using
almost no carbon
Friends, family and
society promote healthy
living
We all recycle, reuse
and minimize waste
Delivery of services
takes long-term
financial, social and
environmental costs into
account
46

Sustainable health and health care - Definition
Sustainable health and health care is
the appropriate balance
between the cultural, social, and economic environments
designed to meet the health and health care needs
of individuals and the population
(from health promotion and disease prevention
to restoring health and supporting end of life)
and that leads to optimal health and health care outcomes
without compromising
the outcomes and ability of future generations
to meet their own health and health care needs.
Prada, Gabriela, Kelly Grimes, and Ioulia Sklokin. Defining Health and Health Care Sustainability. Ottawa: The Conference Board of Canada, 2014.
http://www.conferenceboard.ca/temp/10c2f6f4-6f74-4db1-b9ae-6f8995536c96/6269_defininghealth_cashc_rpt.pdf
47

Framework for Sustainable Health and Health Care
Prada, Gabriela, Kelly Grimes, and Ioulia Sklokin. Defining Health and Health Care Sustainability. Ottawa: The Conference Board of Canada, 2014.
http://www.conferenceboard.ca/temp/10c2f6f4-6f74-4db1-b9ae-6f8995536c96/6269_defininghealth_cashc_rpt.pdf
48
Appropriateness
Value for money
Fair and timely access
Accountability for results
Effectivediseaseprevention
andhealthpromotion
Effectivehealthandhealth
caresystems
Fundingmodelsthat
drivedesiredbehaviors
Optimaldevelopment,alignment,
andsupportofhumanresources
Leveraginginnovationand
innovativetechnologies
Strategicalignmentwith
Determinantsofhealth
Sustainable health and health care
Four
Guiding
Principles
Six Pillars

Success Factors For
Partnerships
52

Five Features of Successful Partnership:
Entering into a partnership
Successful
partnerships
Welcoming
culture
Mutual
benefit
Membership
Common
mandate /
purpose
Other key
factors
important in
the initiating
stage
Collaboration Roundtable (2001): The Partnership Toolkit: Tools for Building and Sustaining Partnerships.
http://www.pcrs.ca/uploads/7L/_A/7L_ATXdmJl3bp9lgOtVTKA/partnershiptoolkit.pdf
53

Seventeen Features of successful partnership:
Maintaining partnership
• Shared Vision
• Common and Compatible Goals
and Objectives
• Division of Roles and
Responsibilities
• Balancing Power and Authority
(Joint Ownership, Decision-
making and Accountability)
• Effective Communication
• Supportive Structures and
Processes
• Commitment
• Trust and respect
• Commitment of time
• Leadership
• Resources
• Partnership Agreement
• Continuous nurturing
• Mutual recognition
• Adaptability and flexibility
• Building capacity
• Evaluation
Collaboration Roundtable (2001): The Partnership Toolkit: Tools for Building and Sustaining Partnerships.
http://www.pcrs.ca/uploads/7L/_A/7L_ATXdmJl3bp9lgOtVTKA/partnershiptoolkit.pdf
55

Partnership Challenges
and Pitfalls
56

Five Obstacles to Partnering
General public
•Prevailing attitude of scepticism
• Rigid / preconceived attitudes about specific sectors / partners
•Inflated expectations of what is possible
Negative Sectoral
characteristics
• Public sector: bureaucratic and intransigent
• Business sector: single-minded and competitive
• Civil society: combative and territorial
Personal limitations of
people leading the
partnership
• Inadequate partnering skills
• Restricted internal / external authority
•Too narrowly focussed role / job
• Lack of belief in the effectiveness of partnering
Organisational
Limitation
•Conflicting priorities
•Competitiveness (within sector)
• Intolerance (of other sectors)
Wider external
constraints
•Local social / political / economic climate
•Scale of challenge(s) / speed of change
•Inability to access external resources
Source: The International Business Leaders Forum (IBLF) and the Global Alliance for Improved Nutrition (GAIN),
2003. The Partnering Toolbook.
http://www.energizeinc.com/art/subj/documents/ThePartneringToolbookMarch2004.pdf
57

Partnership pitfalls
Potential challenges include the following:
• passive and dominant partners ,
• unrepresented or under-represented
stakeholders,
• inflexible and insensitive partners,
• unreliable partners,
• human factors.
• WHO (2003). The power of partnership. http://www.who.int/management/powerpartnership.pdf
58

HEALTH: WHO Definition
Health is a state
of complete physical,
mental and
social well-being and
not merely the absence of disease or infirmity.
• Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New
York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health
Organization, no. 2, p. 100) and entered into force on 7 April 1948.
• The Definition has not been amended since 1948.
60

How should we define health? (2011)
• “The WHO definition of health as complete wellbeing is
no longer fit for purpose given the rise of chronic
disease.”
• Machteld Huber and colleagues propose changing the
emphasis towards
the ability to adapt and self manage
in the face of social, physical, and emotional
challenges.
• Machteld Huber at al. How should we define health? BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d4163
(Published 26 July 2011) Cite this as: BMJ 2011;343:d4163 http://www.bmj.com/content/343/bmj.d4163
61

Is it feasible to have:
Health For All?
Sustainable Health?
• Recall the demise of Health for All 2000
• Health for All 2000 (Alma-Ata Declaration 1978)
• Health for All Beyond 2000
• Health for All
• John J Hall and Richard Taylor. Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing
countries. MJA 2003; 178: 17–20. https://www.mja.com.au/system/files/issues/178_01_060103/hal10723_fm.pdf
62

Health Systems are Central to the New Sustainable
Development Agenda
• WHO (2015). Health in 2015: from MDGs, (Millennium Development Goals) to SDGs, (Sustainable Development Goals). P196
http://apps.who.int/iris/bitstream/10665/200009/1/9789241565110_eng.pdf?ua=1 64
Sustainable Development Goal 3:
Ensure Healthy Lives and Promote Well-being For All at All Ages
3.1: Reduce maternal mortality
3.2: End preventable newborn and
child deaths
3.3: End the epidemics of AIDS, TB,
malaria and NTDs
and combat hepatitis, waterborne
and other communicable diseases
3.7: Ensure universal access to
sexual and reproductive health-
care services
3.a: Strengthen implementation of
framework convention on tobacco
control
3.b: Provide access to medicines
and vaccines for all, support R&D
of vaccines and medicines for all
3.c: Increase health financing and
health workforce in developing
countries
3.d: Strengthen capacity for early
warning, risk reduction and
management of health risks
3.4: Reduce mortality from
NCDs and promote mental
health
3.5: Strengthen prevention and
treatment of substance abuse
3.6: Halve global deaths and
injuries from road traffic
accidents
3.9: Reduce deaths and
illnesses from hazardous
chemicals and air, water and
soil pollution and contamination
TARGET 3.8: Achieve universal health coverage, including financial risk protection,
Access to quality essential health-care services, medicines and vaccines for all
INTERACTIONS WITH ECONOMIC, OTHER SOCIAL AND ENVIRONMENTAL SDGs AND SDG 17 ON MEANS OF IMPLEMENTATION
MDG Unfinished and
Expanded Agenda
New SDG Targets
SDG 3 Means of
Implementation Targets

Is “Partnership towards sustainable universal
health coverage” more appropriate?
• World Health Organization (November 22, 2010). "The world health report: health systems financing: the path to
universal coverage". Geneva: World Health Organization. http://whqlibdoc.who.int/whr/2010/9789241564021_eng.pdf
65
Current pooled funds
Reduce cost
sharing
and fees
Population: who is covered?
Services:
Which services
are covered
Direct cost:
Proportion of
the cost
covered
Extend to
non-covered
Include
other
services

Examples of Existing Partnerships and
Intersectoral Collaboration
National level
• COMBI (Communication for Behavioural Impact)
• KOSPEN (Komuniti Sihat Perkasa Negara)
• MyOHUN (Malaysian One Health University Network),
• HIV/AIDS Getting to Zero
• National Blue Ocean Strategy,
State level
• Village Health Promoter programme in Sarawak
• OSTPC (One-Stop Teenage Pregnancy Centre) in
Sarawak
68

Unmet Needs for Partnerships
Examples of urgent social and public health problems that
need intersectoral action
• the broad social determinants of health, including
poverty,
• broken homes and families,
• teenage pregnancies,
• healthy cities and settings,
• road traffic accidents,
• workplace accidents,
• drownings,
• elderly care,
• hospice care 69

Revisit Partnerships
between health and
non-health sectors
70

Partnership and Intersectoral Action for Health
What is the Form of
intersectoral action?
Do we have the
necessary success
factors?
What are the
challenges?
• Actions are initiated by the
health authority, focussing
on improving health and
equity
• Action initiated by head of
government to address:
(1) health emergency /
outbreak, or
(2) broad public health
issues eg through
Healthy Cities
• Actions are initiated by
non-health agency eg to
address Road traffic
accidents
• Welcoming culture,
• membership,
• mutual benefit,
• common mandate
or purpose
• Prevailing attitude of
scepticism,
• bureaucracy,
• inadequate
institutional
capacity,
• inadequate
partnership skills,
• conflicting priorities,
• scale of challenge,
• speed of change,
• etc
71

Revisit Partnerships with
the Community
72

Partnerships with the Community
Empowerment
• Is the community
empowered to
participate fully?
• Do they want to be
empowered?
CITIZEN
CONTROL
DELEGATION
PARTNERSHIP
PLACATION
CONSULTATION
INFORMING
THERAPY
MANIPULATION
8
7
6
5
4
3
2
1
CITIZEN
CONTROL
TOKENISM
NONPARTICIPATION
Arnstein’s Ladder (1969)
Degrees of Citizen Participation
http://www.vcn.bc.ca/citizens-
handbook/arnsteinsladder.html 73

Revisit Partnerships
within The Health Sector
74

Source: Jim Cowan, Cowan Global Limited 2010. Partnership working
http://cowanglobal.wordpress.com/tag/partnership-working/
How do we move from co-existence to co-
ownership within the health sector?
Co-existence
“You stay on your turf and I’ll stay on mine”
Co-operation
“I’ll lend you a hand when my work is done”
Co-ordination
“We need to adjust what we do to avoid overlap and confusion”
Collaboration
“Let’s all work on this together”
Co-ownership
“We all feel totally responsible”
Degreeof
partnershipworking
Token,
Nominal
Pure
75

Revisit Overall Partnerships
and Intersectoral action for
health
76

Slide from: Thilina Rajapakse (2015). Managing Complex Change for Sustainable Rural Transformation; Case of Saemaul Undong of Korea.
https://www.linkedin.com/pulse/managing-complex-change-sustainable-rural-case-undong-rajapakse
Adapted from: Ambrose, D. (1987). Managing complex change. Pittsburgh, PA: Enterprise Group.
Complex Change Management Matrix
LEADERSHIP
SHARED
VISION
SKILLS RESOURCES INCENTIVES STRATEGY GOVERNANCE
SUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
77

LEADERSHIP
SHARED
VISION
SUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
78

LEADERSHIP
SHARED
VISION
SUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
79

LEADERSHIP
SHARED
VISION
SUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
80

LEADERSHIP
SHARED
VISION
SUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
81

LEADERSHIP
SHARED
VISION
SUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
82

LEADERSHIP
SHARED
VISION
SUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
83

LEADERSHIP
SHARED
VISION
SUSTAINABLE
CHANGE
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
INCENTIVES
STRATEGY
STRATEGY
STRATEGY
STRATEGY
STRATEGY
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
GOVERNANCE
STRATEGYINCENTIVES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
RESOURCES
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
SKILLS
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
LEADERSHIP
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
SHARED
VISION
CONFUSION
SABOTAGE
ANXIETY
FRUSTRATION
RESISTANCE
FALSE START
CORRUPTION
84

Conclusion -1
• Partnerships and intersectoral Actions for
Health are easier said than done.
• We still have a long way to go before we can
achieve our vision of
“A nation working together for health”
85

Conclusion -2
In order for partnerships and intersectoral action to work, we
need to:
1. overcome the barriers to partnerships,
2. acquire the knowledge and skills
in working with communities and
how to work in partnerships at the levels of the
institution
as well as individual staff level,
3. set up the governance tools
(structures, processes, financial and mandates)
that foster coherence, collaboration and partnership
86

Sarawak Health Department
Sarawak Health Department
Jalan Diplomatik, Off Jalan Bako, 93050 Kuching, Sarawak
Tel: 082-473200, Fax: 082-443031, Email: sarawakhealth@srwk.moh.gov.my

Partnerships for sustainable health – revisit the policy

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