HIA in your organisation lessons from Haringey PCT

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HIA in your organisation lessons from Haringey
PCT

• Julian Elston
• (Academic Specialist Trainee in Public Health)

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Group work

• Break into small groups
• Is HIA a useful tool?
• If so, how might you use/promote it in you
  location/organisation?
• What factors might facilitate or hinder you
  trying to use HIA ?

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Approach in Haringey

• About Haringey
• Inner/outer London with 225,000 population
• Very ethnically diverse and young population
• Big killers have average stats
• But sharp inequalities between west and east (LE
  8 years difference)
• East has areas of high deprivation
• These were recognised in PCT and LA
  strategies/plans
• Access to SRB, NDC and other regeneration funding

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HIA project in Haringey

• Initial HIA project
• Obtained 8,000 NDC funding in 2001/02
• Aim to bend mainstream by using HTA
• Funding for three years potentially
• Trained for a dozen or so local people for a
  range of organisations (PCT, LA, Sure Start) on
  HIA, mainly one day but some four-day
• Initially, undertook several rapid appraisal
  event at which 5-6 proposals/policies were
  reviewed

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Sustainable approach

• Second/third year there was uncertainty around
  future funding
• HIA work came to me
• Undertook four-day training with 10 others
• Organised a one-day Rapid Appraisal HIA event on
  the Infant Mortality Action Plan
• Sought a more sustainable approach to HIA

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Strategic approach

• Set up a HIA Steering Group to manage HIA work
• Steering Group decided a strategic approach was
  required
• Decided to embed HIA into the policy process like
  Equity Audit in LA
• Sought formal approval of HIA through the Health
  Inequalities Board and LSP
• Developed a HIA strategy
• Also promoted it in the LA, PCT, voluntary/
  community sector

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Strategic approach

• The Haringey HIA strategy had the following aims
• Promoting the use of Rapid Appraisal HIA to
  ensure it becomes recognised and accepted as an
  important element of proposal development
• Conducting a series of Rapid Appraisal HIA
  workshops to influence relevant local
  decision-making and demonstrate its effectiveness
• Developing capacity in local organisations and
  voluntary and community groups to plan and
  conduct Rapid Appraisal HIA
• Ensuring HIA becomes a sustainable programme of
  work in Haringey
• Key elements were to
• Develop and pilot a screening tool
• Continue to hold RA HIA events
• Maintain a database of HIA trained facilitators
• Present strategy to LSP and theme boards
• Develop local training materials and train
  trainers

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Reflections on Haringeys approach

• Facilitators
• Commitment from DPH to tackle inequalities
• Interested and enthusiastic individuals to
  undertake HIA work in the PCT and LA (i.e. me),
  preferably as part of job description
• Funds for training and running events/paying
  consultants etc
• Ran many rapid appraisals which did influence
  local policy/programmes
• HIA training generated interest and created some
  momentum
• Asking those trained to identify projects they
  might want to do a HIA on
• Ensuring a HIA event follows shortly after
  training so facilitators can use/re-enforce their
  skills

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Reflections on Haringeys approach

• Barriers
• HIA was a small part of my job. Organising and
  facilitating HIAs and writing up materials and
  reports took a lot of time and probably requires
  a dedicated part-time post
• Despite a developing strategic approach most of
  the work load fell to meleaving the project was
  overly dependent on one person
• Strategy/project balance. Developing a strategy
  took a lot of time and was slow, and used
  resources which could have been put towards doing
  a HIA and convincing others of its use
• Tension between using screening tool and being
  opportunistic and working with whats there.

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Reflections on Haringeys approach

• Barriers
• General lack of understanding about HIA and when
  to use it (LA, PCT, voluntary sector)
• Lack of confidence to do HIA/use it despite
  training (especially in community development)
  worked mainly with people in the LA executive and
  just started to get into planning. PCT had little
  capacity in this area
• Understanding LA (planning) processes and
  tendering of EIA to a consultant made it
  difficult to negotiate undertaking a PCT
• Size and complexity of the LSP a huge umbrella
  partnership of theme boards/ groups promoting
  HIA was logistically difficulty
• Organisation change
• the LSP structures were re-organised following
  Choosing Health and the Every Child Mattersthis
  created a HIA in the work programme and where to
  promote HIA
• Would have liked to have worked with LAs
  community development staff but the units work
  was under review