Public Health Renewal in Nova Scotia

1. Public Health Renewal in Nova Scotia Robert Strang, Chief Public Health Officer Janet Braunstein Moody, Senior Director Public Health Renewal Canadian Public Health Association 2008 Annual Conference Halifax, Nova Scotia June 2, 2008

2. Outline • Why a Review? • The Perfect Storm (or how the conditions were right for a Review) • What was the Process? • How to ensure a Report doesn’t sit on a Shelf • What was the outcome of the Review? • The Renewal of Public Health in Nova Scotia –Building a Public Health System to Meet the Needs of Nova Scotians • What’s happening ? • Be Careful for what you wish • What’s next?

3. Why a Review? • Decade of crumbling infrastructure • Krever Commission • Walkerton, North Battleford • 9/11 • CIHR – Future of Public Health • FPT Report of Public Health Capacity • SARS • November 2003: Learning from SARS – Naylor Report

4. How the stars aligned • National Attention to Fragility of Public Health System • Shared Issue and Buy-in from Stakeholders • Review identified by CEOs (Senior Management of District Health Authorities) • Public Health Working Group (Senior Manangement of Public Health), and • Public Health Association of NS (PHANS) (Non-government Organization. • High Level Govt Support • Heightened Sense of Risk

5. The Review Process (Success Factors) • External Consultant • Objectivity • Provincial Advisory Committee • PH at local and provincial level, CEO, Vice Resident of Community Health, MOHs, PHI, Academia, PHANS • Not representing organization but bringing knowledge to process • Met at sentinel times during review • External reviewers • Experts in Public Health • Provided advice, suggestions, validation, perspective and input to Consultant • Quality control

6. The Review Process • Building understanding iteratively • Phase I: Review of existing docs - November 2004 • Phase II: Site visits/key informants - December/January 2005 • Phase III: • Priorities and options – April 2005 • Oak Island retreat – May 2005 • Multiple group briefing – June 2005 • Stakeholder Forum September 2005 • Getting it through the System • Government approvals: October-January 2006 • Announcement of New Department- February 2006

7. How to Ensure a Report Doesn’t sit on a shelf • Good planning • Inclusive • Transparency – sharing of information • Expert review committee • Project management • Ongoing engagement of senior and elected officials • Good timing • Swift and tight timeframes • Start to finish: 11 months • Good luck • Good news story • Minister became Premier

8. The Review - Objectives • Assess current public health system in context of Naylor Report and other reports • Assess strengths, limitations and opportunities • Identify recommendations & actions

9. Review’s Main Findings • Widespread recognition of need for system renewal • Lack of collective vision for public health system • Fragmented structure not supporting integration of functions • Lack of clear roles, responsibilities and accountabilities • Major infrastructure challenges • Information, organization and workforce

10. What Needed to be Done • Improve structure and capacity provincially • Improve structure and capacity at DHA level • Improve how two system levels work together • Improve how each system level integrates with rest of health system • Address infrastructure: • People • Information • Organization

11. Review’s Actions for Renewal • Significant work required • Deterioration over a decade; fix will take a decade • Actions for Renewal are all inter-dependent • Cannot pick and choose • Most “actions” are projects unto themselves • Many important decisions within the actions • Will require system thinking and involvement of all players • System renewal must occur while system remains operational • Comprehensive in nature • Provide the path for renewal

12. ‘Be careful for what you wish!’ • Budget investment • 06/07: $1.14million • 07/08: $ 8.4 million (of which $3.2 vaccines) • 08/09: $ 3.9 million (of which $1.2 vaccines) • New staffing • 21 fte’s at provincial level • 25 fte’s at local level • Almost all are filled! • High profile, High expectations • Pressure to show results • Challenges of system change

13. What’s happened to date? • Leadership (CPHO) position and team in place • Re organization and consolidation into program areas • Focus on Public Health Human Resources Planning • As a system • With academic partners • Based on a Workforce Development Framework • Building Environmental Health and Population Health Assessment capacities • Participating on pan-Canadian initiatives (PANORAMA) • Building capacity: 25 new positions at local level; 21 positions at provincial level • New funding since Report accepted - 3 years

14. Long Term Focus • Leadership role in addressing government wide/horizontal issues especially those that address disparities in health • Developing an integrated, settings based approach • Local leadership in creating the environment and capacity for integrated work • Advocating and building robust population health assessment capacity (information and evidence) to make informed discussion • Patience (and joy) in re-building as it will take time, energy and commitment

15. Opportunities for collaborative partners • Widespread and shared recognition that the health of the population is paramount • Shared commitment at all levels of system and government that change is required • Interest by key stakeholders for change • Potential of the academic sector • Training, research, service • Potential for Atlantic provinces’ regional approaches • Training, surveillance, mutual aid, laboratory capacity, best practices/protocols/manuals • Federal gov’t • Collaboration and support

16. Ongoing factors that will build success…. • Working together • Collaboratively building the system • Ongoing change and transition • Critical mass, efficiency and resources are required to serve our population well • Open and honest communication is crucial • Community Health Boards are fundamental to success • We have a plan ! • “No attempt to improve public health will succeed that does not recognize the fundamental importance of providing and maintaining in every local health agency across Canada an adequate staff of highly skilled and motivated public health professionals.” [Naylor]

17. “Things won are done, joy's soul lies in the doing” Shakespeare, Troilus and Cressida

18. Thank you! Merci! Nakurmiik! • Questions? • Dialogue?