(WP)EUD(O)/ICP/HSE/006-E Report Series No.: RS/200 I /G E/71 (MAA)
English only
REPORT WORKSHOP ON HEAL THY CITIES: EVALUATION AND FUTURE DIRECTIONS
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE OF THE WESTERN PACIFIC Johor Bahru, Malaysia 18-20 October 200 I
Notfor sale Printed and Distributed by: World Health Organization Regional Office for the Western Pacific P.O. Box 2932 1000 Manila Philippines November 2001
CONTE NTS
SUMMA RY
1.
........... 1 INTROD UCTION ... .. ... ........ ..... ..... ........... ... ...... ..... ... ..... ....... .... ... ............ ....... .. .........
1.1 1.2 1.3 1.4 1.5
l Backgro und informat ion ...... ........... .. .... .. ......... ................... ... .. .... ......... ....... ... .... ........... 1 ........ Objectiv es .. ........ ...... ................. ..... ...... ...... ......... ...... .......... ........ .......... ... ...... ........ 2 . .. ...... Participa nts .. ..... .. .......... ........ ... .. .... .. ... ... .. .................... .. ....... .... .. .... ... .. .... .......... ... 2 Organiza tions .............. .. ... ....... .... .... .. ... .. .... ...... .. .. .... .......... .. ......... .... ... .. ............ .... ....... 3 . ...... Opening ren1arks .. ........ ................. .... .... ...... ... .. . -..... .. .. .. ...................... ..... ..............
2.
...... .... 3 PROCEE DINGS ............ ..... ..... ................ .................... .. ....... ... ... .... .... ... ... ....... ............ 2.1 2.2 2.3 ... 3 Summar y of country and city reports ...................... ... .. .... ... .. ..... ... .. .. ..... .. ..........-..... .. .. 7 ..... .......... .. .. Summar y of discussio n on evaluatio n methodo logies ................... .. ........ 8 .... .. ... ......... Summar y of group discussio ns .. .. .. ..... ... ......... .... .. .. ... ........ ....... ..... ..............
3.
I0 CONCLUSIONS ..... .. ... ....... ......... .... ...... ......... ..... ..... ... ...... ....... .... ....... ..... .. .. .... .. .. .. ........ .... . 3.1 3.2 3.3 3.4 Progress in impleme nting the regional action plan and . ]0 new developm ents on Healthy Cities initiative s ......... .... .. .. ......... .. .......................... .. 11 .... ......... .. ... . Evaluatio n methodo logies for Healthy Cities projects ............. .. .............. Areas requiring strengthe ning and activities to 1I promote the Healthy Cities approach ........... ..... .. ..... .. .. ......... ... ....... ..... .. ... ..... ..... ... .. ... 1 ! .. .... ...... ...... Targets to be achieved in each country by 2003 .. .. ... .. .... .............. ............
AN EXES: ANNEX 1 - LIST OF PARTIC IPANTS , TEMPO RARY ADVISE RS OBSERV ERS AND SECRET ARIAT MEMBE RS ....... ...... .... .. ...... .. ... ....... .. 13 - PROGR AMME OF ACTIVI TIES ... ........... .. .. .... ...... ... ... ................................ 23 - LIST OF DOCUM ENTS DISTRIB UTED DURING THE WORKS HOP .... .. ... ... .. ... ... .. ............... ..... ... ...... .. .. .. ..... ........... 27 -OPENI NG SPEECH BY THE WHO REGION AL DIRECT OR FOR THE WESTER N PACIFIC AT THE WORKS HOP ON HEAL THY CITIES : EVALU ATION AND FUTURE DIRECT IONS, JOHOR BAHRU , MALAY SIA, 18-20 OCTOB ER 2001 ....... .. ... .. ... ..... ....... 29 -COUN TRY SPECIFI C TARGE TS TO BE ACHIEV ED BY 2003 ...... .... ....... .. ... ........... - .. .. .......................... ... .. .. 31
ANNEX 2 ANNEX 3
ANNEX 4
ANNEX 5
Key words Healthy cities I Urban health I Mal ays ia
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SUMMARY
Objectives of the workshop The WHO Western Pacific Regional Office conducted a Workshop on Healthy Cities: Evaluation and Future Directions from 18 to 20 October 2001 in Johor Bahru, Malaysia. The objectives of the workshop were to : (1) review and evaluate the progress made in implementing the regional action plan on Healthy Cities for 2000-2003, and new development and activities at the city project level;
(2) critically assess case-study reports on the evaluation of Healthy Cities projects, and the evaluation methodologies applied; (3) based on the review of activities in the past two years in (1) and (2) above: a) identify areas where further strengthening is required; b) identify activities that would enhance implementation of the regional action plan and promote the Healthy Cities approach; c) recommend evaluation methodologies to be used in future Healthy Cities projects; and d) propose targets to be achieved by 2003 in each country. The workshop was attended by 34 participants from Cambodia, China, Fiji, the Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea, the Philippines and VietNam. In addition, there were two temporary advisers, ten observers, and four secretariat members. Conclusions Progress in implementing the regional action plan and new developments on Healthy Cities initiatives • Several countries demonstrated progress in implementing the 2000-2003 regional action plan, as illustrated in the country reports. Countries have strengthened capacity in implementation of Healthy Cities projects in a number of imp01tant areas including: developing a national coordinating structure, preparing national guidelines which provide technical suppott to the cities, and advocating to national and provincial governments. Also countries have developed mechanisms for advocacy, communication and networking as part of a national network and vehicle for direct exchange. Concerning the third item of the Regional Action Plan (to set up systems that ensure the sustainability of projects and programmes), most countries have been preparing for implementation . The actions regarding the establishment of systems that ensure the sustainability of projects and programmes should be strengthened by (1)
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implementing evaluation activities. The outcomes of the workshop will facilitate the actions in each country according to the Regional Action Plan. • Twenty-three cities reported on the significant progress made towards implementing the Healthy Cities approach. A wide variety of activities were reported covering improvement of physical infrastructure, protection and enhancement of the natural environment and social, cultural and economic strengthening activities. Success factors identified from the presentations included: local political and administrative support, effective planning processes, committed leadership, meaningful community involvement and the use of a variety of settings for imp Iem entation. Sustainability and strengthening of Healthy Cities in the future will depend on improved evaluation and monitoring processes, information dissemination, increased community involvement, broadening the range of activities Healthy Cities covers, harnessing the power of the combination of top down and bottom up action to solve health problems, and ensuring the initial momentum is maintained.
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(2)
Evaluation methodologies for Healthy Cities projects • Healthy Cities projects should pay more attention to evaluation. Each evaluation programme should be adapted to national cultures. It should act as a means of involving the community in Healthy Cities projects. The results of evaluation should continuously feed back to the design and implementation of projects. Evaluation designs should adopt ecological, qualitative, and quasi-experime ntal methods and thus expand the repertoire beyond epidemiologica l approaches and standards (such as randomised trials) that are more appropriate for clinical interventions. Quality of life in cities has many dimensions. Sets of indicators for evaluation of Healthy Cities projects should reflect this. They should not be restricted to narrow, mono-disciplin ary approaches that do not account for the richness and the diversity of life in each setting. Further development of evaluation methods should be promoted through the publication of common terminology, the dissemination of models of good practice, and the creation of oppot1unities for skill development.
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(3)
Areas requiring strengthening and activities to promote the Healthy Cities approach
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•
The workshop identified, as priority areas for further strengthenin g, sustaining the momentum created; going beyond the heath sector; involving the community and private sector; reporting and documentati on ; national coordination ; evaluating projects; developing and maintaining databases; and disseminatin g information on Healthy Cities programmes and activities at local, national and internationa l levels . In order to address these areas, future activities should focus on the training and awareness raising of many different stakeholders (governmen t and non-govern ment organization s, profit and non-profit organization s and the community) through workshops, seminars, study visits and other information disseminatio n mechanisms ; their involvemen t in planning, implementa tion and evaluation of Healthy Cities projects; the strengthenin g of documentati on and reporting of project implementa tion and use of websites to disseminate the information ; and developmen t of national guidelines and capacity to support local initiatives.
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(4)
Targets to be achieved in each country by 2003 • National and city programmes defined targets to be achieved by the end of2003 (Annex 5). These targets serve as the milestones against which progress in Healthy Cities can be assessed in the next-two years.
1. INTRODUCTION
1. 1
Background information
The WHO Regional Office for the Western Pacific convened the "Meeting on Health Protection and Health Promotion: Harmonizing our Response to the Challenges of the 21st Century" from 16 to 20 August 1999 in Manila Philippines. One product of the meeting was a Regional Action Plan on Healthy Settings. Since this meeting, WHO has been focusing on actions related to specific healthy settings. As part of its activity, WHO conducted the "Workshop on Healthy Cities: Preparing for the 21st Century" in Malacca, Malaysia, from 11 to 14 October 1999. The workshop concluded that the Healthy Cities concept and approach had been generally accepted among cities and countries in the Region, especially within the health and local government sectors . The number of Healthy Cities projects in the Region was growing. However, the stages of development of Healthy Cities initiatives varied from country to country and also among cities in the same country. Although priority areas of concern differed from city to city, the general areas of priority concern among developing countries included basic sanitation, safe water supply, proper sewage disposal, safe food and better living conditions. More developed countries noted social and lifestyle-related issues and industrial pollution among their priorities. The workshop reviewed draft regional guidelines and a draft regional database on Healthy Cities. It also formulated a regional action plan on Healthy Cities for 2000-2003, consisting of actions that should be taken by both countries and the international community. Following the workshop, both the regional guidelines and database on Healthy Cities were finalized and made available through the WHO Western Pacific Regional Office website . Member States, in collaboration with WHO, have subsequently implemented country-level activities in support of the regional action plan, including strengthening national intersectoral coordination in implementing Healthy Cities projects; developing national action plans; and conducting evaluation studies on Healthy Cities projects. The extent to which these actions have been implemented varies from country to country. Two years after the development of the regional action plan on Healthy Cities, a workshop was proposed to review and evaluate the progress made in implementing the regional action plan; to review case studies on evaluation methodologies for Healthy Cities projects; and to discuss future directions in promoting the Healthy Cities approach. The Workshop on Healthy Cities: Evaluation and Future Directions was held from 18 to 20 October 200 I in Johor Bahru, Malaysia. This repoti summarizes the discussions and conclusions of the workshop. 1.2 Objectives The objectives of the workshop were to : (1) review and evaluate the progress made in implementing the regional action plan on Healthy Cities for 2000-2003, and new development and activities at the city project level; (2) critically assess case-study reports on the evaluation of Healthy Cities projects, and the evaluation methodologies applied; (3) based on the review of activities in the past two years in (1) and (2) above :
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a) identify areas where fllliher strengthening is required ; b) identify activities that would enhance implementation of the regional action plan and promote the Healthy Cities approach; c) recommend evaluation methodologies to be used in future Healthy Cities projects; and d) propose targets to be achieved by 2003 in each country. 1. 3 Participants
The workshop was attended by 34 participants. They were coordinators or staff of Healthy Cities projects/programme s in Cambodia, China, Fiji, the Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea, the Philippines and VietNam. There were ten observers from the Food and Agriculture Organization, Australia, Japan, Malaysia, and Thailand. WHO provided two temporary advisers and four WHO staff members, serving as the secretariat, for the workshop . A Iist of participants, observers, consultants and secretariat members is provided in Annex 1. 1.4 Organizations
The workshop programme is provided in Annex 2, and a list of documents distributed during the workshop in Annex 3 . The documents include country reports on the implementation ofthe regional action plan and city reports on new developments and activities related to Healthy Cities initiatives by the participants, working papers by the temporary advisers and a WHO staff member and other handouts, including regional guidelines on Healthy Cities. Copies of these papers can be obtained upon request from the WHO Regional Office for the Western Pacific. The officers ofthe workshop were selected as follows: Chairperson Vice-Chairperson Rapporteur Dato' Dr Tee Ah Sian, Malaysia Mr Manasa Niubalerua, Fiji Ms Lourdes Risa S. Yapchionco, Philippines
The technical sessions of the workshop started with a review of progress in implementing the regional action plan on Healthy Cities for 2000-2003 , and new developments and activities of Healthy Cities projects at the city level. The participants and a WHO staff member presented papers to support the discussion. A field trip to Healthy Cities project sites in Johor Bahru was also organized . These sessions addressed the first objective of the workshop . With respect to the second objective, the temporary advisers and a participant from Viet Nam presented case studies on the evaluation of Healthy Cities/healthy settings projects. A plenary discussion followed these presentations to assess and suggest appropriate evaluation methodologies for Healthy Cities projects. The participants conducted group discussions to identify areas that require st;engthening and activities to further promote the Healthy Cities approach. They also carried out group discussions to set country specific targets to be achieved by 2003 . These discussions fulfilled the third objective.
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Finally, draft conclusions of the workshop were prepared by the workshop officers with supp01t from the temporary advisers, and presented, modified, and adopted at a plenary session . 1.5
Opening remarks
On behalf of Dr Shigeru Omi, WHO Regional Director for the Western Pacific, Dr De Silva, WHO Representative in Brunei Darussalam, Malaysia and Singapore addressed the opening. He reviewed the historical development of Healthy Cities programme in the Region, particularly focusing on recent regional developments, such as the development and implementation of a regional action plan for Healthy Cities initiatives and a regional database on Healthy Cities projects available on the WHO website . He also mentioned that the Healthy Cities approach had gained popularity, but evidence that it has worked effectively needs to be provided . In this connection, WHO embarked on an initiative to develop appropriate evaluation methodologies for Healthy Cities projects, which would be discussed during the workshop. Dr De Silva then wished the participants fruitful discussions dur.ing the week. The full text of the opening speech is provided in Annex 4. Dato' Dr Tee Ah Sian, Deputy Director General (Public Health , Ministry of Health, Malaysia) welcomed the patticipants. Her speech focused on the role of Malaysia in promoting the Healthy Cities approach, the importance of evaluating the effectiveness of the approach and the involvement of communities in Healthy Cities activities to make them sustainable. Malaysia has been actively promoting the Healthy Cities approach since its inception in 1994, and has received a number of visitors from abroad to learn about the country ' s success in developing Healthy Cities projects. Dato' Dr Tee stated that the Malaysian Healthy Cities programme now needed to demonstrate that it could produce tangible outcomes . She concluded her speech by wishing the participants an enjoyable stay in Malaysia. The Honourable Dato' Hj Johari bin Suratman, Mayor of Johor Bahru, extended his warm welcome to all patticipants . He highlighted rapid urbanization taking place in the world, particularly in developing countries. As a result, physical and social environments are deteriorating. The Honourable Mayor stated that the Healthy Cities approach could effectively address these physical and social determinants of health, and as one of the two pioneering Healthy Cities projects in Malaysia, Johor Bahru had implemented innovative activities to protect and promote the health of its citizen. The Mayor concluded his address by thanking WHO for selecting Johur Bahru as the workshop venue, and declared the workshop open .
2 . PROCEEDING S
2.1
Summary of country and city repo1ts
2.1.1 Summary of country and WHO repo1ts on the implementation of the regional action plan on Healthy Cities Country rep01ts were made from nine countries: Cambodia, China, Fiji , Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea, Philippines, and VietNam. Several countries demonstrated progress in implementing the 2000-2003 regional action plan, as illustrated in the country reports.
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Country reports discussed the following specific items in addition to providing general information : • partnership arrangements, compliance and enforcement, education and communication, socio-economic development plan, public investment programme, and poverty reduction (Cambodia); projects regarding the development of a national coordinating structure and national guide! ines providing technical support to the cities, an integration of healthy cities programme with a national hygienic city programme, the organizational structure of patriotic health campaign committee from central to local governments, future action plan (China); healthy settings, healthy towns and cities, healthy islands, organizational structure, health promoting communities programme (Fiji); introducing healthy cities in Lao People's Democratic Republic; introducing the 'setting approach'- school, village, market, hospital; developments since 1999, future plans (Lao People's Democratic Republic); national development for Healthy Cities projects, national healthy cities meeting for the city mayors with government departments and agencies, focuses of healthy cities project, future plans (Malaysia); activities completed to implement regional action plan, strengthening implementation capacity, special issues covered by Healthy Cities projects, achievements, weaknesses, constraints, future needs (Mongolia); healthy islands, health, promoting school, healthy markets (healthy city), healthy village, healthy workplace, future plans, lesson learned (Papua New Guinea); national framework, current situation 2001-2002, initial cities involved 1999-2001, targets for 2002-2004, capability building (Philippines); and activities completed, strengthening implementation capacity, developing mechanisms for advocacy, communication and networking, setting up system that ensures the sustainable of the project, achievements (VietNam).
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Countries have strengthened capacity in implementation of Healthy Cities projects in a number of important areas including: developing a national coordinating structure, preparing national guidelines which provide technical support to the cities, and advocating to national and provincial governments. Also countries have developed mechanisms for advocacy, communication and networking as part of a national network and vehicle for direct exchange. Concerning the third item of the Regional Action Plan (to set up systems that ensure the sustainability of projects and programmes), most countries have been preparing for implementation. However, it is in the mid-term of the 2000-2003 plan. It is expected that project sustainability will be strengthened through the implementation of evaluation activities. The imp01iance of evaluation was discussed and evaluation methodologies were developed at the present workshop. The outcomes of the workshop should facilitate each country's efforts to complete the activities ofthe Regional Action Plan.
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2.1.2 Summary of city repot1s on new developments and activities Reports were made from 23 cities in 10 countries. The types of cities varied considerably in terms oftheir population size (from Mount Hagen, Papua New Guinea 21 000 and Suzhou, China 5.78 million) but the majority of the cities represented population sizes of300 000 to 500 000 . They also differed in their level of development and approach to Healthy Cities. The problems they were dealing with, however, had many similarities. For all cities the forces of globalization are creating considerable challenges and some opportunities. Those cities which are less economically developed were primarily concerned with establishing effective water and sanitation systems, controlling informal settlements, tackling communicable diseases and establishing basic infrastructures for transpm1. Cities with higher levels of economic development were also concerned with these basic issues, but also faced problems with noncommunicable disease, substance abuse, and improving environmental conditions. The strong impression from the city repot1s was that Healthy Cities has taken on an ecological mandate and all cities repot1ed on activities they were undertaking in order to improve the environment. These included establishing eco-gardening programmes, recycling schemes and river clean up programmes. Cities were also concerned with the social and cultural aspects of cities such as crime reduction and health education . Generally the city repot1s indicated that projects were operating across a range of activities and implementing a holistic view of health through their Healthy Cities initiatives . An idea ofthe range of projects repot1ed on is provided in Table 1. In all cities, the settings approach was used to implement strategies. The most common settings were schools and markets. Others included workplaces, hospitals and country specific settings such as healthy Khoroolol in Mongolia. Two approaches to Healthy Cities were evident. Those where Healthy Cities was well institutionalize d and had established committee structures, strong local political support, some evidence of community pat1icipation and a focus on those activities that involved action across sectors rather than the general health improvement work of the city. These cities generally had identified Healthy Cities initiatives and a variety of means of pub! icizing their projects. These means included logos, annual meetings, labelled products (hats, t-shirts, pens, etc). They also had officers who were specifically identified as having a Healthy Cities mandate as part of their work programme . In other cases, Healthy Cities was seen as an outcome and many existing activities within the city were described as being pat1 of the Healthy Cities efforts. In these cities, there tended to be less emphasis on identifying Healthy Cities as an entity in its own right. ln most cities there are other programmes with similar aims and processes. These programmes include primary health care initiatives, sanitary cities, hygienic cities, sustainable urban development, eco-partnership s and also disease specific initiatives such as Prostar in Malaysia. Some cities had moved towards integrating these various approaches, recognizing the common elements. ln other cities this remained a challenge . Success factors that emerged from the city repot1s included: • • strong local political and administrative suppot1 for the project; the importance of strong planning processes to establish priorities for action and agency commitment to those priorities; committed leadership with continuity and passion for the concept of Healthy Cities ;
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at least a commitment to and initiation of community involvement; and use of the settings approach to take Healthy Cities to the community level.
Cities have made modest progress with defining indicators and developing evaluation processes. Most cities have a database of indicators that provide a basic description of the health ofthe city. Future plans presented from the cities included: • • • • • • developing better mechanisms for evaluation and reporting; spreading the idea to other towns and districts; encouraging networking through conferences and visits to other cities; expanding the concepts of Healthy Cities to a variety of settings; increasing the level of community involvement; improving capacity building, including recognition of the need for this activity to be on-going as new officers become involved in Healthy Cities; ensuring the Healthy Cities initiative has a range of activities; harnessing the power of top down - bottom up action to solve health problems in the most effective manner; and specific activities that reflect local priorities (for example flood prevention (Philippine cities)and clean indoor stoves (Mongolian cities).
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Issues that need to be tackled in the future include those identified above and the following: • • • maintaining momentum once a Healthy Cities project is not longer a new project; dealing with changes in personnel in local, state and provincial government; and deciding how much effort should be spent on indicators. The underlying message (supported by European experience) is that these should be kept simple and manageab Ie.
Table I. Healthy Cities Activities Reported by Cities
Physical Infrastructure Flood control Clean water infrastructure Sanitation improvement Solid Waste disposal Recreational facilities
Protection/improvement of natural environment River clean up Eco-gardening Greening of cities Recycling schemes Improving parks
Social, cultural and economic Economic equity Gambling Reduce substance abuse Unemployment Squatter resettlement
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Improving road quality Improving housing stock School environment improvement
Garden cities
Maintaining traditional values Education on lifestyles Healthy food in markets Crime prevention
2.2
Summary of discussion on evaluation methodologies
A discussion on the development of evaluation methodologies for Healthy Cities produced a consensus, summarized in Table 2 below. The discussion was based on the country experiences, and on three case studies, from Australia, Lao People's Democratic Republic, and VietNam. Table 2. Summary of Consensus on Evaluation Methodology REASONS FOR EVALUATION Many processes inherent in Healthy Cities programmes will bene1it from good evaluation: a. ADVOCACY: properly presented results can be used to garner resources and support b. ACCOUNTABIL ITY: the positive effects of Healthy Cities projects will justify the investment in them c. AUDIT: the assessment of the quality of programmes against set standards will identify good practice. correct improper practice and help identify undesirable effects d . ASSESSMENT: the traditional uses of evaluation. with proper design and content. would assess the level of association between project activities and related effects, as well as make visible the by-products that would tend to otherwise remain intangible. a. PARTICIPATOR Y: the community needs to be involved at all levels. in planning. in detining indicators. in deciding on evaluation. b. CULTURALLY RELEVANT: The great diversity of cities in the Region requires national adaptation of sets of indicators to cultural features. c. DEVELOPMENT AL: Healthy Cities are not to be evaluated against a static set of checklist items. but a continuous processes of feedback must be adopted that informs planners and communities on progress and allows them to adjust plans during implementation. The etlects of Healthy Cities projects should be documented at two levels: a. SETTING-SPECI FIC EVALUATION should use indicators that are relevant to core functions of individual settings (e.g. food safety in markets) but also be expanded to incorporate the wider functions (e.g . the broad opportunities for health promotion in markets). b. CITYWIDE EVALUATION views the whole package. the city as a collection of individual settings. and the effects of all health-related projects \Vi thin it (whether they are run directly by Healthy Cities coordinatot·s or not). Both setting-specific and city-wide evaluation would need to adopt indicator sets within a holistic set of domains that may be informed by numerous alternative models. for example: a. OTTAWA CHARTER with the action areas of policy, environment, personal skills. community action. health services b. QUALITY OF LIFE in cities as indicated by such adjectives as clean, safe, beautiful, happy, healthy KEY QUESTIONS TO BE ANSWERED a. CITY PROFILE: What is the context of the programme? The protile will describe the city, assess needs for intervention. and set baselines for monitoring trends or measuring change. b. PROJECT FEATURES: Healthy City coordinators will need to document process (What has their project done'l How well was it done?) and outcome (What has changed? In the
STYLES OF EVALUATION
LEVELS OF EVALUATION
DOMAINS OF INDICATORS
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~nvironm~nt'l
In health'l) , Process measures will need to be balanced against outcome measures depending on the pmposed application (standard-setting needs more outcome evaluation: project monitoring may largely be based on process) .
NEEDS FOR FUTURE DEVELOPMENT
a. TERMINOLOGY: Consensus should be developed on a simple set of key terms in relation to the evaluation of Healthy Cities in the Region. Such a standard would clarify concepts and reduce semantic debate. b. MODELS OF GOOD PRACTICE in evaluation should be documented and disseminated . c. The SKILLS AND COMPETENCIES in the design. execution, and application of good evaluation should be identified . Opportunities should be provided for these skills to be developed among managers and practitioners
2.3
Summary of group discussions
2. 3. 1 Identification of areas that require strengthening, and activities to further promote the Healthy Cities approach This theme was discussed by five groups, and each group discussed areas that require strengthening and activities to enhance implementation of the regional action plan on Healthy Cities for 2000-2003 and promote the Healthy Cities approach. The results of these group discussions were then reported by each group and commented on at a plenary session. The patticipants considered that the following areas would require strengthening in the future: • • • • • • • • sustaining the momentum created; going beyond the heath sector; involving the community and private sector; rep01ting and documentation; national coordination; evaluating projects; developing and maintaining databases; and disseminating information on Healthy Cities programmes and activities.
The patticipants suggested that the following activities would enhance the implementation of the regional action plan and promote further the Healthy Cities approach: • Activities necessary to sustain the momentum created include the training/retraining of stakeholders; sharing success stories through conferences and by outside speakers; organizing celebrations and events; employing full time coordinators; providing recognition; creating greater awareness and commitment; introducing new activities; and strengthening organizational structure through clearer roles and functions, strategic planning and political endorsement, and budget allocation.
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•
Activities necessary for going beyond the health sector include the sensitization of other sectors and assessment of health impacts related to their activities; strengthening linkages with other sectors; where applicable, giving the coordinating role to a non-health sector; involving non-health sectors in Healthy Cities conferences. Activities required to involve the community and private sector include the increased application of the settings approach , involving them from the planning stage; creating oppo11unities and mechanisms for participation; making the concept of Healthy Cities clear to them; and garnering support for community initiative from local authorities. Activities for reporting and documentation include reporting on activities from the beginning; providing visual evidence on the before and after project implementation ; and providing reports and documents to the WHO web page . Activities required to strengthen national coordination include establishing a national coordinating structure in countries where there is no such structure; involving and networking different stakeholders in the government and private sectors and non-government and non-profit organizations; I inking with other similar initiatives implemented in the country or city; and organizing regular consultations. In terms of evaluating the projects, activities suggested include the involvement of different stakeholders with regular feedback of the results to them ; involving research institutions to support evaluation activities; and developing specific indicators for settings and general indicators for overall Healthy Cities projects. Activities required to develop and maintain databases include supporting the WHO website database and establishing a database on the evaluation of Healthy Cities projects on the WHO website. Activities required to disseminate information on Healthy Cities programmes and activities include preparing newsletters and fact sheets; organizing visits, forums and conferences; and providing websites and consultancy.
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2. 3. 2 Setting targets to be achieved in each country by 2003 Country delegation s reported on key targets for 2002 to 2003. Targets fell into two areas : a. Action-related: These related to anticipated developments in the national Healthy Cities programmes over the next two years . b. Evaluation-related: These related specifically to the development of appropriate evaluation methodologies in the countries . A listing of country-specitic targets is included in Annex 5.
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3. CONCLUSIONS
3.1 Progress in implementing the reg ional action pl an and new deve lopments on Healthy Cities initiatives Country Reports • Several countries demonstrated progress in implementing the 2000-2003 regional action plan, as illustrated in the country reports . Countries have strengthened capacity in implementation of Healthy Cities projects in a number of important areas including: developing a national coordinating structure, preparing national guidelines which provide technical support to the cities, and advocating to national and provincial governments. Also countries have developed mechanisms for advocacy, communication and networking as part of a national network and vehicle for direct exchange. Concerning the third item of the regional action plan (to set up systems that ensure the sustainability of projects and programmes), most countries have been preparing for implementation. The actions regarding the estab\ ishment of systems that ensure the sustainabi I ity of projects and programmes should be strengthened by implementing evaluation activities. The outcomes ofthe workshop will facilitate the actions in each country according to the regional action plan.
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City Reports • Twenty-three cities reported on the significant progress made towards implementing the Healthy Cities approach . A wide variety of activities were reported covering improvement of physical infrastructure, protection and enhancement of the natural environment and social , cultural and economic strengthening activities. Success factors identified from the presentations included: local political and administrative support, effective planning processes, committed leadership, meaningful community involvement and the use of a variety of settings for implementation . Success factors identified from the presentations included : local political and administrative supp01i, effective planning processes, committed leadership, meaningful community involvement and the use of a variety of settings for implementation . Sustainability and strengthening of Healthy Cities in the future will depend on improved evaluation and monitoring processes, information dissemination, increased community involvement, broadening the range of activities Healthy Cities covers, harnessing the power of the combination oftop down and bottom up action to solve health problems, and ensuring the initial momentum is maintained.
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3.2
Evaluation methodologies for Healthy Cities projects • Healthy Cities projects should pay more attention to evaluation. Each evaluation programme should be adapted to national cultures . It should act as a means of involving the community in Healthy Cities projects . The results of evaluation should continuously feed back to the design and implementation of projects. Evaluation designs should adopt ecological, qualitative, and quasi-experimental methods and thus expand the repertoire beyond epidemiological approaches and standards (such as randomised trials) that are more appropriate for clinical interventions. Quality of life in cities has many dimensions. Sets of indicators for evaluation of Healthy Cities projects should reflect this . They should not be restricted to narrow, mono-disciplinary approaches that do not account for the richness and the diversity of life in each setting. Further development of evaluation methods should be promoted through the publication of common terminology, the dissemination of models of good practice, and the creation of opportunities for skill development.
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3. 3
Areas reguirinf! srren21hening aod activ ities to promote rhe Healthy CHies approach • The workshop identified, as priority areas for further strengthening, sustaining the momentum created~ going beyond the heath sector~ involving the community and private sector; reporting and documentation; national coordination ; evaluating projects; developing and maintaining databases; and disseminating information on Healthy Cities programmes and activities at local , national and international levels. In order to address these areas, future activities should focus on the training and awareness raising of many different stakeholders (government and non-government organizations, profit and non -profit organizations and the community) through workshops , seminars, study visits and other information dissemination mechanisms; their involvement in planning, implementation and evaluation of Healthy Cities projects ; the strengthening of documentation and reporting of project implementation and use of websites to disseminate the information ; and development of national guidelines and capacity to support local initiatives.
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3.4
Targets to be achieved in each country by 2003 • National and city programmes defined targets to be achieved by the end of2003 (Annex 5) . These targets serve as the milestones against which progress in Healthy Cities can be assessed in the next two years.
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ANNEX 1 LIST OF PARTICIP ANTS, TEMPORA RY ADVISERS, OBSERVERS AND SECRETARIAT MEMBERS 1. PARTICIPANTS
CAMBODIA
Dr Koeut Meach Deputy Director Municipalit y Health Department #101 Monireth Street Phsardoeum Korsangkat Tuolkok District Tel. No.: 855-23-9826 09 Ms Mom Sandap · Secretary, Phnom Penh Municipalit y Health City Committee Phnom Penh
CHINA
Professor Chen Shaoxian Head, Faculty\ of Preventive Medicine Guangdong College of Pharmacy 40 Guanghanzh i Street, Haizhu District Guangzhou 510224 Tel. No.: 86-20-3407- 4336 FAX No .: 86-20-3407- 6324 Emai I: chenshx((i) 163 .net Mr Gao Qifa Section Chief Ministry of Health I Xi Zhi Men Wai Nan Lu Beijing, I 00044 Tel. No. : 86-10-6879- 2349 FAX No .: 86-10-6879- 2514 Email: gqifa@vaho o.com Ms Wang Jiefang Vice Headmaster Office of Kuerl Patriotic Health Campaign Committee, Lixiang Road, Kuerl 841000 Xinjiang Tel. No.: 86-996-202- 5043 Mr Yan Qiang Vice Headmaster Office of Suzhou Patriotic Health Campaign Committee, 169 Shizi Street Suzhou City
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Jiangsu Province 215006 Tel. No.: 86-512-521-5870 FAX No.: 86-512-521-4977
FIJI
Mr Manasa Niubalerua Chief Health Inspector Ministry of Health Box 2223, Government Building Suva Tel. No.: (6769) 306 177+ FAX No.: (679) 306 163 Mrs Ilisapeci Movono Director National Substance Abuse Advisory Council, PO Box 2565 , Government Buildings Suva Tel. No .: 314219
LAO PEOPLE'S DEMOCRATIC REPUBLIC
Mr Viliya Douangvilaykeo Chief of Healthy City Project, Luangprabang Department of Public Health Luangprabang Province Healthy City Office Department of Public Health Luangprabang Tel. No.: 856-71-252-760 Fax No. 856-71-212-067 Dr Wath Kongkeo Deputy Director Champassack Provincial Health Department Pakse Champassack Province Tel .IF AX No.: 856-31-212017 E-mail: ccca@laoel.com Dr Ratthiphone Oula Chief of Primary Health Care/ Healthy City Coordinator Health Department Vientiane Municipality P.O. Box 1634 Vientiane Tel./F AX 856-21-217827 Emai I: mcca@ laotel.coii!
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Annex I Dr Khatthanaphone Phandouangsy Medical Officer of Health Promotion Division/ Healthy Cities Secretariat Hygiene and Prevention Department Ministry of Health Vientiane Tel./FAX 856-21-214010 Dr Khamphiane Vanhmany Head ofTechnical Addministration Health Public Department, Vientiane Province P.O. Box 1829 Vientiane Tel. No.: 856-23-21 1-071/019 Dr Souksakhorn Vongxay Chief of Sanitation and Water Supply Station Khammouane Province Health Office Thakhek City Khammouane Province Tel. No.: 856-51-212059 Fax No ;: 856-51-212324 MALAYSIA
Dr Ponnudurai Doraisingam Deputy Director, Disease Control Division Ministry of Health BlokE Kompleks Pejabat-Pejabat, Jalan Dungun 50490 Kuala Lumpur Tel. No.: 603-2540088 FAX No.: 603-254-3366 Zlidph.gov.my Email : dorai1 Dr Mohd Ariffbin Fadzil State Health Officer 3 Abatan Kesihatan Dekl KM4, Jalan Cheras 56000 Kuala Lumpur Tel. No.: 039845166 FAX No.: 039857295
Dr Hjh Rosnah Ismail
Deputy Director of Health (Public Health Division) Ma1acca State Health Office 6th Floor Wisma Persekutuan Jala:n Hang Tuah 75300 Malacca Tel. No. 06-2828344 FAX No.: 06-2864761 E-mail : rhi (i/'Qc.ari ng.my
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Annex I Dr Andrew Kiyu Deputy Director of Health (Public Health) State Health Department , Sarawak Kuching Sarawak Tel. No .: 60 82 423 0 II Fax No.: 60 82 424 959 Emai I: andrew .kivu(@sarawak.health. gov .my Dr Daud bin Abdul Rahim Health Officer, Office of the District of Health Johore Bahru, Johore Pejabat Kesihatan Jalan Abdul Samac! 80 I 00 J ohor Bahru Tel. No.: 607-222479 1 Fax No.: 607-223654 9 Email: dauddrw)va hoo.com Dato' Dr Tee Ah Sian Deputy Director General (Public Health) Ministry of Health Kementerian Kesihatan Malaysia Tingkat 3, BlokE, Komplek Pejabat Jln Dungun Damansara Height 50490 Kuala Lumpur Tel. No.: 603-254248 8 FAX No.: 603-253934 5 Email: teesian@mo h.gov.my
MONGOL IA
Mr Devee Batsukh Vice Governor Governer's Office of Darkhan-Uu l aimag Box 195, Poost Office II, Darkhan-19 5 Tel. No.: 976-1372-3 5234 FAX No.: 976-1372-37 121 Dr Shinee Enkhtsetseg Officer in Charge of Environmen tal Health Ministry of Health, Olympic Street-2, Ulaanbaatar -51 Tel. No.: 976-1 1-32-31 II FAXNo.: 976-11-32-1 278 Email: ~hinee @hotmajl.c om
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Annex l Dr Dashzev eg Nansalm aa Director of Health Departm ent Governo r's Office of Orkhon Aimag P.O . Box 110 Orkhon aimag Tel. No.: 976-01-3 52-2065 9 FAX No. : 976-01-3 52-2043 6 Ms Ganbaat ar Tsendsu ren Chief of Hygiene Inspection Departm ent Agency of Health Inspecto rate of Ulaanba atar City SB-1 khoroo, Enkhtaiv an District Ulaanbaa tar-48 Tel. No.: 976-1-32 -7795 FAX No .: 976-1-32 -4328 Email : heinsog@ mongoln et
PAPUA NEW GUINEA
Mr Jubal Agate Principal Adviser Health Promotio n Depertm ent of Health P.O . Box 807 Waigana l, Poti Moresby Tel. No. : 675-301- 3744 FAX No.: 675-301- 3742 Mr Wak Kewa Coordina tor, Social Services Mt Hagen City Authorit y PO Box 75 Mt Hagen Western Highland s Province Tel No. 675-42-2711 FAX No. : 675-42-2 842
PHILIPPINES
Dr Alberto Herrera City Health Officer Marikina City Health Office Marikina Tel. No.: 942-1 084 FAX No.: 948-0410 Dr Eduardo S. Posadas City Health Officer City Health Office San Fernando La Union
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Anne x 1 Ms Marce lina Tanta y Chief of the Execu tive Staff Valen zuela City Metro Manil a Ms Lourd es Risa S. Yapch iongc o Chief Health Progr am Offic er Burea u of Local Health Devel opme nt Depar tment of Health Build ing 3, San Lazaro Comp ound, Rizal Aven ue Sta Cruz, Manil a Tel. No.: 871 5570 FAX No.: 711 62 85/781 89 77
VIET NAM
Dr Nguy en Ba Hoach Vice Head ofMe dical Profe ssiona l Divis ion Thanh Hoa Provi nce Health Depar tment Hai Thou ng Lan Ong Street Thanh Hoa Tel. No: 84-37 -7560 96 Dr Nguy en Hung Long Chief in Envir onme ntal Health and Offic er in Charg e, Healt hy Cities Projec t Depar tment of Preve ntive Medic ine Minis try of Health 138A Giang Vo Hano i Tel. No.: 84-4- 846-1 325 FAX No.: 84-4- 846-0 507 Dr Nguy en Ba Nho Depu ty Direc tor Hai Phong City Centr e of Preve ntive Medi cine 21 Le Dai Health St. Hai Phong City Tel. No.: 84-31 -8212 50 Dr Tran Sophi a Depu ty Director, Can Tho City Health Depa rtmen t 1 Ngo Due Ke St. Can Tho City Tel. No.: 84-71 -8236 11 FAX No.: 84-71 -8236 11
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Annex 1
2. Temporary Advisers
Professor Fran Ballin Department of Pub! ic Health Flinders University of South Australia GPO Box2100 Adelaide 500 I Tel. No.: 61-8-204-5983 FAX No.: 61-8-374-0230 Emai I: fran.baum@.tl inders.eclu.au Professor Takehito Takano Department of Public Health and Environmental Science, Tokyo Medical and Dental University School of Medicine Yushima 1-5-45 Bunkyo-ku 113-8519 Tokyo Tel. No.: 81-3-5803/5190 FAXNo.: 81-3-3818-7176 Email: whocc.hlth(q)med.tmd.ac. jp 3. Observers Disease Control Division Ministry of Health Malaysia
Dr Faridah Mohd. Amin Disease Control Division Depat1ment of Public Health Ministry of Health 2"d Floor, Block E Offices Complex Jalan Dungun, Bukit Damansara 50490 Kuala Lumpur Malaysia Tel No.: 03-254088 FAX No.: 03-2525667/2561566 E-mail: drfar@.moh_,_mw.IlJ.Y Sharif bin ldros L3-03, Komplek Pusat Bandar Jalan Bandar, 81700 Pasir Gudang, Johor Malaysia Tel No.: 07-251 3720/21/22/251 4021 Fax No.: 07-251 5260 E-mail: pbtpg@po.jaring.my
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Annex 1 Food and Agriculture Organization
Ms Annoek van den Wijngaart Associate Professional Officer Nutrition Food and Agriculture Organization Regional Office for Asia and the Pacific
Maliwan Mansion 39, Phra Atit Road Bangkok I 0200 Thailand Tel. No.: (662) 697 4153 FAXNo.: (662)2819757 Email: Annoek.vanden Wijngamt(iMao .Q.I:g Johor Bahru City Council
Dr Rahim Tumin Director of Health Johor Bahru City Council Jalan Dato' Onn Peti Surat 232,80720, Johor Bahru Johore Malaysia Tel. No.: 60-7-228-2525 FAX No.: 60-7-223-0619 Dr Somchai Durongdej Head of Department of Nutrition Department ofNutrition, Faculty of Public Health Mahidol University, Rajvithi Road, Rajthawee, Bangkok I 0400 Thailand Tel. No.: 661-442-8934 FAX No.: 662-274-7343 Email: phsdr(@.mucc.mah idol.ac.th Dr Jayakumar Gurusamy Occupational and Environmental Health Malacca State Health Department 6th Floor Wisma Persekutuan, Jalan Hang Tuan 75300 Malacca Tel. No.: 06-2828344 FAX No.: 06-2864761 Mr Richard Hicks Chairperson, Healthy Cities Noarlunga PO Box 437 Noarlunga Centre Noarlunga South Australia 5168 Tel. No.: 61-8-8384-9361 FAX No.: 61-8-8384-9710 Emai I: h icks.richard(cv.saugov .sa.gov .au
Mahidol University
Malacca State Health Department
Noarlunga Centre
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Annex I
Tokyo Citizen's Council for Health Promotion
Dr Keiko Nakamura Acting Chairman of the Programme Promotion Committee, Tokyo Citizen's Council for Health Promotion, c/o Tokyo Metropolitan Public Health Promotion Foundation, Kabukicho 2-44-1 Shinjuku, Tokyo 160-0021 Japan Tel/FAX No.: 81-3 5285-8897 Dr Masafumi Watanabe Research Associate Tokyo Medical and Dental University School of Medicine Yushima 1-5-45 Bunkyo-ku 113-8519 Tokyo Tel. No.: 81-3-5803/5190 FAXNo.: 81-3-3818-7176
Tokyo Medical and Dental University
4. Secretariat Members Dr Takeo Fujiwara Consultant WHO Regional Office for the Western Pacific P.O. Box 2932 I 000 Manila Philippines Tel. No.: 63-2-528-9884 FAX No.: 63-2-521-1036 Email: fujiwarat(ci),wpro .who.int Ms Nanna Jtirgenssen Associate Professional Officer Office ofthe WHO Representative in Lao People's Democratic Republic Boite postale 343 Vientiane Laos Tel. IF AX No.: (85621) 413432 Dr Gauden Galea Regional Adviser in Health Promotion WHO Regional Office for the Western Pacific P.O. Box 2932 I 000 Manila Philippines Tel. No.: 63-2-528-9760 FAXNo.: 63-2-521-1036 Email: ga\eag(@wpro .who.int
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Dr Hisashi Ogawa (Responsi ble Officer) Regional Adviser in Environm ental Health WHO Regional Office for the Western Pacific P.O. Box 2932 I 000 Manila Philippine s Tel. No. : 63-2-528- 9908 FAX No .: 63-2-521- 1036 Email: ogawah@ wpro .who .int
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ANNEX2 PROGRAMME OF ACTIVITIES
18 October. Thursday 0800- 0830 0830- 0930 Registration Opening ceremony Opening speech by Dr U.H.S De Silva, WHO Representative in Brunei Darussalam, Malaysia and Singapore on behalf of the Regional Director, WHO Regional Office for the Western Pacific Welcome address by Dato' Haji Johari bin Suratman, the Mayor of Johor Bahru Opening address by Dato' Dr Tee Ah Sian, Deputy Director General (Public Health), the Ministry of Health, Malaysia Self-introduction of participants, observers Designation of officers of the meeting (chairperson, vice chairperson, rapportuer)
0930- 1000 1000- 1015
Group photograph and tea/coffee break Introduction to the workshop (objectives, programme of activities) and administrative briefing Dr H. Ogawa, Regional Adviser in Enviromnental Health, WPRO
Objective 1: Review of progress in implementing the regional action plan on Healthy Cities for 2000-2003, and new developments and activities at city level
1015 - 1230
Country actions Cambodia China Fiji Lao PDR Malaysia Mongolia Papua New Guinea Philippines VietNam
1230- 1400 1400- 1630
Lunch WHO actions- by Dr H. Ogawa
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Annex 2 City reports Cambodia China Lao PDR Malaysia 1630 - 1730 High tea reception by WHO
19 October 200 l, Friday 0830 - 1010 City reports (continued) Mongolia Papua New Guinea Philippines VietNam 1010 - 1030 1030 - 1045 Tea/coffee break Urban programmes of partner agencies FAO regional office for Asia and the Pacific Tokyo Citizens' Council for Health Promotion
Objective 2: Review of case-study reports on the evaluation of Healthy Cities projects and suggestion on appropriate evaluation methodologies 1045 - 1200 Case studies on the evaluation of Healthy Cities projects Professor F. Baum, "Healthy City Evaluation Framework Testing Project - Evaluation of a Healthy Cities Initiative : Noarlunga Community Action on Drug" Professor T. Takano, "Practical Methodologies for the Evaluation of Healthy Cities projects" Ministry of Health, VietNam, "Case Study Report on Healthy Marketplaces, Ga Market, HaiPhong, VietNam" 1200- 1320 Discussion on appropriate evaluation methodologies Facilitated by Dr Gauden Galea, Regional Adviser in Health Promotion 1320- 1330 1300- 1500 Noarlunga Healthy Cities project. Lunch
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Annex 2
1500- 1700
Field trip to Urban Forest Partk in Johor Bahru
20 October 2001, Saturday 0830- 0850 Summary of implementation of the regional action plan Professor T. Takano
0850-0910
Summary of new developments and activities of Healthy Cities projects Professor F. Baum
0910-0930
Summary of discussion on appropriate evaluation methodologies Dr G. Galea
0930- 0945
Tea/Coffee Break
Objective 3: Identification of areas that require strengthening, and activities to further promote the Healthy Cities approach 0945- 1130 1130- 1230 1230- 1400 Group discussion (Briefing by H. Ogawa) - 5 groups Reporting back of group discussion Lunch
Objective 4: 1400- 1500 1500- 1530 1530- 1600
Setting feasible targets to be achieved by each country for 2003 Country-specific discussion (Briefing by G. Galea) Presentation of country-specific targets for 2003 Presentation and adoption of the workshop conclusions - Professor T. Takano (Facilitator)
1600- 1615 1615 - 1645
Closing Coffee/tea
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ANNEX 3 LIST OF DOCUM ENTS DISTRI BUTED DURIN G THE WORK SHOP WPR/IC P/HSE/ ( 1)/200 1.1 WPR/IC P/HSE/ ( 1)/200 1.1.a WPR/IC P/HSE/ ( 1)/200 1. I .b WPR/IC P/HSE/ ( 1)/200 1/IB I WPR/IC P/HSE/ ( 1)/200 I /182 Worksh op Agenda Program me of Activiti es Timetab le Informa tion Bulletin I Informa tion Bulletin 2 (List of particip ants, tempora ry advisers , observe rs and secretar iat member s) Review of progres s in implem enting the Regiona l Action Plan on Healthy Cities for 2000-20 03: WHO Actions Healthy City evaluati on framew ork testing project - evaluati on of a Healthy Cities initiativ e: Noarlun ga commu nity action on drug Practica l method ologies for the evaluati on of Healthy Cities projects Case study report on healthy marketp lace, Ga Market -HaiPh ong, VietNa m Country Report: Cambod ia Country Report: China Country Report: Fiji Country Report: Lao People's Democr atic Republi c Country Report: Malays ia Country Report: Mongol ia Country Report: Papua New Guinea Country Report: Philippi nes Country Report: VietNa m City Report: Phnom Pehn, Cambo dia City Report: Suzhou , People's Republi c of China City Report: Kuerl, People's Republi c of China City Repott: Nanhai, People's Republi c of China City Report: Suva, Fiji
WPRIIC P/HS E/( I )/200 1.2
WPR/IC P/HSE/ ( I )/200 1.3
WPR/IC P/HS E/( 1)/200 1.4 WPRIIC P/HSE/ ( I )/200 1.5 WPRIIC P/HSE/ ( 1)/200 1/INF/ I WPR/IC P/HSE/ ( 1)/200 I/lNF /2 WPRIIC P/HSE/ ( 1)/2001/I NF/3 WPRIIC P/HSE/ ( I )/200 1/INF/4 WPR/IC P/HSE/ (1 )/200 1/INF/5 WPRIIC P/HSE/ ( I )/2001/ INF/6 WPR/IC P/HSE/ (1 )/2001/ !NF/7 WPRIIC P/HSE/ ( I )/2001/I NF/8 WPR/IC P/HSE/ ( I )/200 1/INF/9 WPR/IC P/HSE/ (1 )/2001/I NF/1 0 WPRIIC P/HSE/ (1 )/2001/! NF/11 WPRIIC P/HSE( I )/200 1/INF/1 2 WPRIIC P/HSE( I )/200 1/INF/13 WPR/IC P/HSE( 1)/200 1/INF/1 4
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Annex 3 WPR/IC P/HS£( 1 )/200 1/INF/15 WPR/IC P/HSE( 1)/200 I /INF/16 WPR/IC P/HSE( I )/200 1/INF/17 WPR/IC P/HSE( 1)/200 1/INF/1 8 WPR/IC P/HSE( I )/200 1/INF/1 9 WPR/IC P/HSE( 1)/200 1/INF /20 WPR/IC P/HSE( 1)/2001/I NF/21 WPR/IC P/HS£( 1 )/200 1/INF/2 2 WPR/IC P/HSE( I )/2001 /INF/23 WPR/IC P/HSE( 1)/2001 /INF/24 WPR/IC P/HSE( I )/200 1/INF/25 WPR/IC P/HSE( I )/200 I /INF/26 WPR/IC P/HSE( 1)/200 1/INF/2 7 WPR/IC P/HSE( I )/200 1/INF/2 8 WPR/IC P/HS£( 1 )/200 1/INF/2 9 WPR/IC P/HS£( 1 )/2001/ INF/30 WPR/IC P/HSE( I)/2001 /INF/31 WPR/IC P/HSE( l )/200 1/INF/3 2 WPR/IC P/HSE( I )/200 l/INF/2 4 City Repott: Luangp rabang, Lao People's Democr atic Republi c City Report: Champa ssack, Lao People's Democr atic Republi c City Report: Vientia ne City, Lao People's Democr atic Republi c City Repott: Vientia ne Provinc e, Lao People' s Democr atic Republi c City Report: Thankh ek City, Lao People's Democr atic Republi c City Report: Kuala Lumpur , Malays ia City Rep01t: Malacca , Malays ia City Report: Kuching , Malays ia City Report: Johor Bahru, Malays ia City Report: Darkhan , Mongol ia City Report: Orkhon , Mongol ia City Report: Ulaanba atar, Mongol ia City Report: Mt Hagen, Papua New Guinea City Report: Valenzu ela City, Philipp ines City Report: Marikin a City, Philipp ines City Report: San Fernand o City, Philipp ines City Report: Thanh Hoa, VietNa m City Report: Hai Phong, VietNa m City Report: Can Tho City, VietNa m
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ANNEX 4 OPENING SPEECH BY THE WHO REGIONAL DIRECTOR FOR THE WESTERN PACIFIC At the Workshop on Healthy Cities: Evaluation and Future Directions, Johor Bahru, Malaysia, 18-20 October 200 I
I am pleased to address the opening of this WHO Workshop on Healthy Cities: Evaluation and Future Directions, and would like to welcome all of you to the workshop. This is the third WHO regional meeting on Healthy Cities held in the Western Pacific Region. The first one was held in Beijing, China, in October 1996, where patiicipants reviewed the initial development of Healthy Cities projects since 1994. The second meeting was held in Malacca, Malaysia, in October 1999. Participants in that meeting reviewed draft regional guidelines and a regional database on Healthy Cities projects, both of which have been subsequently finalized and are available on the WHO website. They also produced a regional action plan on Healthy Cities for 2001-2003. Consistent with the regional action plan , Member States have been undertaking country and city-level Healthy Cities activities, including the strengthening of national intersectoral coordination in implementing Healthy Cities projects; development of national action plans; and studies on evaluating Healthy Cities projects. The extent to which these actions have been implemented varies from country to country. Two years after the development of the regional action plan on Healthy Cities, we are convening this workshop to review and evaluate the progress made in implementing the plan ; to review case studies on evaluation methodologies for Healthy Cities projects; and to discuss future directions in promoting the Healthy Cities approach and propose targets to be achieved by 2003 in each county. As you are aware, the Healthy Cities concept and approach have been accepted among countries and cities in the Region, and the number of cities implementing Healthy Cities projects has been growing. Now, there are around 180 cities in 12 countries implementing and countries implementing and planning for Healthy Cities projects in the Region. Despite its popularity, there is no clear evidence that the Healthy Cities approach works effectively in improving the health of people living in cities . Moving towards the next phase of developing Healthy Cities programme, we need to demonstrate the effectiveness of the approach, for which practical evaluation methodologies are essential. The workshop will address this issue, and you will recommend appropriate evaluation methodologies for use in the future. You have a full 3-days of work ahead of you, including a field trip to Healthy Cities project sites in Johor Bahru tomorrow. I urge you to participate in the workshop actively, and hope that you will have fruitful and pleasant days in Johor Bahru. Finally, l would like to express my appreciation to our hosts for this workshop, the Ministry of Health, Malaysia, and the City of Johor Bahru and its Healthy Cities project teams. Thank you.
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ANNEX 5 COUNTRY-SPECIFIC TARGETS TO BE ACHIEVED BY 2003
COUNTRY
PLANNED ACTIONS OVER 2002-2003 PROGRAM DEVELOPMENTS EVALUATION METHODOLOGIES
CAMBODIA
• • •
Capacity building Strengthening the Healthy Cities strategy Implementation (building on existing high levels of cooperation across levels of government, private sector, and with NGOs) To formulate national guidelines To set up national database To build national expert committee on healthy cities projects Mobilise political support of the Healthy City Concept through Ministerial briefing (Ministry of Local Government, presentation to National Health Promotion Council, workshop policy makers and stakeholders of cities and town Develop and establish 2 Healthy Cities- Suva & Lautoka using the Healthy Settings Five-Step Approach Strengthen existing initiatives within Municipality boundary
•
Clear policy on evaluation Planning Methodology developed Annual report on activity (monitoring of actions)
• • •
CHINA
• • •
•
To set up indicators system based on key settings (and international guidelines)
FIJI
•
• • •
Base-line Data through city profile (Step 3 of Fiji's five-step approach) Develop appropriate protocol for collection of baseline data Establish Indicators for Process and Impact/Outcome Evaluation from Profile when determining activities to address identified issues Process Evaluation- good & effective planning is
•
•
•
necessary to ensure systematic reporting. "Keep it simple" will be the catchphrase
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Annex 5 COUNTRY PLANNED ACTIONS OVER 2002-2003 PROGRAM DEVELOPMENTS under the Healthy Island banner- Healthy Korovou Town, Sigatoka, Rakiraki Market LAO PDR EVALUATION METHODOLOGIES the catchphrase
• •
Participatory Evaluation methods Survey and needs assement of overall approach and individual activities, strategies, and policies (for improvement and future planning) Annual report publication Feedback the results of evaluation to stakeholders, decision makers, local authorities, and communities Feed back results of evaluation into planning processes
•
Develop national guidelines on Healthy Cities . Strengthen intersectoral collaboration at national and city levels Capacity-building
• •
• •
• • • MALAYSIA
Training and retraining for staff in Healthy Cities Communication, intersectoral, promoted at a! I levels
•
Develop and document model approaches for extension to other cities Strengthen intersectoral collaboration at national level (MOH, Local authorities, and other key stakeholders) by conferences and workshops Merge with other programmes to avoid overlap e.g. Local Agenda 21, sustainable development Capacity building: introduce Healthy Cities concept to MOH and other partners- organise training in four regions
•
•
Pa1iicipatory evaluation
•
Community involvement: intersectoral evaluation Po Iitical involvement to promote high level commitment).
•
• •
Projects: introduce evaluation of outcomes Set up database and evaluate the city profile
•
•
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Nnnex 5 COUNTRY PLANNED ACTIONS OVER 2002-2003 PROGRAM DEVELOPMENTS MONGOLIA Ev ALlJATION METHODOLOGIES
•
Re-establish HCC Committee at National Level Develop multisectoral plan of action and implement it Establish database on Healthy Cities at National Level Develop public awareness (media, education in schools, health educators, local government, and community leaders) Develop partnership with the citizens'groups such as churches, NGOs, and business community for civic activities Reconstitute the national coordinating structure
•
Capacity-building on skills to provide evaluation of HCP Baseline survey and set up general and specific indicators Process and outcome evaluation National Coordination Committee on Healthy Islands to periodically monitor progress on implementation ofthe plan and to provide feedback to those involved .
•
•
• PAP UA NEW GUINEA
• •
•
•
PHILIPPINES
•
• • •
Capability building on evaluation Develop an appropriate evaluation tool Evaluate the first five cities
•
League of cities to adopt the Healthy City concept Expansion of Membership Strengthening of activities in the three original cities: Quezon City, Makati, Dagupan City
• •
•
Expand to four more cities Sharing on best practices in Healthy Cities
•
•
Theme to be decided by the national coordinating structure;
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Annex 5
COUNTRY
PLANNED ACTIONS OVER 2002-2003 PROGRAM DEVELOPMENTS related to the national health goals and general concerns of cities EVALUATION METHODOLOGIES
VIETNAM
•
Healthy Cities to expand to 10 other cities and develop healthy settings for each city (school , workplace, market, hospital. .. ) Submit programme to government to get support for national programme (aim for national budget for Healthy Cities) Develop Healthy Tourism, integrate into HIV/AIDS programme, introduce and apply ecological tourism model
• •
Development of methods and guidelines for evaluation
•
•
Identification of eva! uation indicators for each setting
•