Oulunkaari and Vaala: Regional well-being health centre - A description of an HuIA process

Need for Human Impact Assessment

Human Impact Assessment (HuIA) was used in the construction of a sub-regional model to promote well-being and health in social welfare and health care services for the Oulunkaari sub-region (Ii, Yli-Ii, Ylikiiminki, Kuivaniemi, Pudasjärvi, Utajärvi) and the municipality of Vaala.

The motivation for constructing a new model was the need to improve social welfare and health care services identified by the municipalities and the partial crisis with regard to cost control, securing adequate services, the availability of special competence, the use of temp doctors and the demands of health care management. Since the intermunicipal authorities for public health were dismantled in the 1990s, the municipalities have engaged in little cooperation in social welfare and health care services. In health care in particular, municipal resources and medical practices have focused on treating the sick. In the promotion of well-being and health, there are differences in competence and practices between municipalities. The large age groups will be retiring by 2010. A shortage not only of employees with special competence but of basic employees, too, is expected.

The purpose of the Hyvinvoinnin terveyskeskus (Well-being health centre) project financed by the Ministry of Social Affairs and Health and the municipalities was to:

• change the regional structure of social welfare and health care services, i.e. bring actors in the sub-region together to provide services jointly
• to develop the content of services from the point of view of promoting health and preventing illness

The process and its participants

Involved in the project were all the municipalities in the Oulunkaari sub-region and the municipality of Vaala. The health centre planning was carried out in 2003, following this structure:

• Municipality rounds (interviews with leading elected officials, local authority leaders, basic security managers, directors of medical services and directors of nursing)
• Service structure study
• Survey of social welfare and health care information systems
• Availability of private and third-sector services
• Constructing a model for the promotion of well-being and health in social welfare and health care services
• Regional level
• Local level
• Municipal level
• Training in preventive work
• Publicity

Human impact assessment was applied in the construction and selection of the model. The HuIA was implemented at two seminars during autumn 2003. These seminars were attended by leading elected municipal officials, leading local authority civil servants in the social welfare and health care sectors, and various partners, making a total of 49 participants. The HuIA method was presented at the first seminar. The second seminar involved group work on describing various models and comparing the impacts of the models on the goals set by the municipalities. Then, a sub-regional well-being health centre model was constructed based on the solutions that the municipalities considered good and feasible for implementation at the present time.

Examined models and their impacts

The models were created on the basis of municipal interviews and service structure studies conducted by the expert hired for that purpose. Comparison of the models was based on national recommendations (national health project, national social project and the Health 2015 public health project). The municipalities had differing ways of solving identified problems.

The models examined were:
'Municipal solution model' The municipality produces social welfare and health care services itself, with occasional local deals with other actors (third sector, entrepreneurs). Difficulty in finding employees with special competences and problems in the availability and quality of special services.

'Local solution model' As above, but more joint action initiatives with neighbouring municipalities. Joint competitive tendering for privatized services. Networking and division of duties between employees with special competences. Provision of special services is agreed on jointly.

'Sub-regional solution model' Each municipality provides its own community services. Special competences are distributed among central communities. Provision of special services is agreed on jointly. Networking and division of duties between employees with special competences. Companies and organizations participate actively in the service network.

'National health project model and the recommendations of the national social programme and the Health 2015 programme' Basic health care is provided in sub-regional units with a population of 20,000 to 30,000 each. Local conditions are taken into account; geographical distance must not hinder access to services. A survey of sub-regional cooperation in the welfare sector should be conducted nationwide by 2003.

The models were described with reference to these factors:

• Securing access to high-quality services for local residents
• Promoting the well-being and health of local residents
• Organizing, producing and jointly using specialist services
• Division of duties in special competences, specialization and consultation possibilities
• Role of companies and organizations in the service system
• Social welfare and health care services management and its development
• Service productization, improvements in cost calculation and statistical competence
• Social welfare and health care service information systems
• Design and introduction of online services and telecommunications applications
• Developing smoothly flowing service structures and care chains
• Developing the division of duties between doctors and nurses
• Strengthening an attitude to work that promotes health and prevents illness
• Well-being and competence of employees at work

Use and benefits of HuIA

• to harmonize and network municipal social welfare and health care services and to sort out their division of duties
• to improve access to social welfare and health care services sub-regionally, to diversify the range of services and to improve their quality
• to promote well-being and health in the sub-region

The matter proceeded to the sub-regional council and the municipal councils for decisions in December 2003.

Further information

Kirsti Ylitalo
Special adviser
Oulunkaari sub-region

Kyösti Juujärvi
Municipal manager
Utajärvi municipality