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HIA and Institutionalisation: The Slovak Experience

HIA and Institutionalisation: The Slovak Experience. Dr. Monica O’Mullane Trnava University, Slovakia 14 th April 2011, XI HIA INTERNATIONAL CONFERENCE, GRANADA, SPAIN Monica.omullane@truni.sk. Acknowledgements . XI HIA International Conference Committee

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HIA and Institutionalisation: The Slovak Experience

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  1. HIA and Institutionalisation: The Slovak Experience Dr. Monica O’Mullane Trnava University, Slovakia 14th April 2011, XI HIA INTERNATIONAL CONFERENCE, GRANADA, SPAIN Monica.omullane@truni.sk

  2. Acknowledgements • XI HIA International Conference Committee • Ministry of Education, Slovakia SAIA Fellowship- Slovenská Akademická Informačná Agentúra • Trnava University, Slovakia (Trnavská Univerzita) & the EU RAPID project

  3. Today’s presentation • Background to research in HIA in Slovakia • Rationale for my research study • Preliminary results and discussion • Where to next?

  4. Brief background- previous work in Ireland (2005-2008) • How and why do the overarching structures and underlying values influence the use of HIAs in policy? • Four HIA cases (Two from Northern Ireland; two from Republic of Ireland) • Used the Rossi et al 2004 criteria to measure the extent of HIA usage in public policy (local policy) (dependent variable) • Instrumental utilisation • Conceptual utilisation • Persuasive utilisation

  5. Hiaactivityto date in Slovakia • EU & WHO projects: HIA Toolkit for Cities 2005; “HIA-NMAC – Health Impact Assessment in New Member States and Pre-Accession Countries” 2005-2007; RAPID (Risk assessment from Policy to Impact Dimension) 2009-2012; Current Interreg proposal to develop HIAtool.org

  6. Guliš etal2005 (health care in Slovakia); Mannheimer et al (2007) “The actors on the local level would have the capacity to work intersectorally to bring about policy change if HIA was to be more supported/institutionalized.” • EHPR 2008: HIA needs strong leadership to be institutionalised and properly implemented; “inadequately covered by the health sector” [pg. 50] need to develop HIA processes and procedures; need greater MoH involvement with PHA

  7. Rationale for my research study – outline of study • In Slovakia the path for HIA institutionalisation has been centred on the legislative route; unique • 2007 legislation (355/2007) (The Protection, Support and Development of Public Health); Statutory instrument (May 2010- 132/2010) introduced in order to enforce HIA (starting January 2011) and change some features of 2007 act (implement replaced with consider)

  8. Wismar et al (2007) calls for each country to investigate this policy-supporting tool in terms of the extent of its institutionalisation. Such investigation is required in order to “explore the usefulness of the concept and the feasibility of its implementation in a specific national context” [pg.28] • Need to understand politico-administrative environment within which HIA must operate maximise HIA utilisation (Davenport, et al. 2006) • Each context has unique set of actors and environmental characteristics

  9. Policy sciences and HIA • Although policy sciences have much to offer, IAs have been marginalised in the field (Weston, 2002) • IA: Bridge between policy-makers and science • Bekker et al, (2004): Rational, Incremental, Mixed scanning models how knowledge utilization depends on decision-making model • Putters 1996: Rational v incremental • Putters 2005  must spend less time defining HIA, and more time understanding the policy process which must assimilate HIA knowledge • How to evaluate HIA as a policy-aiding tool? European Observatory on Health Systems and Policies (Wismar, 2004) • Institutionalism- March and Olsen (2005); Scott (2001); Pierson (2004)

  10. Research Study: Two Part • Semi-structured interviews with key informants to explore the discourse and experience around HIA • Postal questionnaire administered summer 2009 to heads of Environmental Health (36 regions of Public Health Authority); follow-up interviews with 3 heads of departments

  11. Study aim & objectives • To explore the degree to which the country is prepared (logistically and conceptually) for HIA • To explore perspectives and opinions of key stakeholders of the forthcoming HIA legislation

  12. The topic Guide: Outline • Do you think the time is right for HIA in Slovakia? • Do you believe there are institutional constraints that may impact on HIA? • Do you envisage/predict tension between the various interests in advancing HIA? • Do you think that values and beliefs (personal and professional) influence the way that HIA is developed? • Do you believe HIA will inform public policy in SK?

  13. Interviewees • 20 expert semi-structured interviews took place • General profile of the interviewees: • PHA (Public Health Authority) (national office, Bratislava); NGOs; Ministries of Health; Environment; Transport; and Defence; Regional heads of PHA (HIA committee); national and international experts on health care reform and HIA in Slovakia • Limitation: No public representatives (June 2010)

  14. Analysis of responses: Overview • To investigate how the political& institutionalinfluences affecting HIA • Overwhelming uncertainty about HIA: “in this moment I can’t imagine how will be used, this tool, at the single action like building some factory (nearby)” • Positive response to the legislation for HIA; a necessary instrument to enforce and implement HIA; cultural context regarding the necessity of legislation • Lack of capacities, people who can conduct HIA and who have knowledge of it; “We don’t have people or money or experience, but we only have legislation.” • Lack of support at ministerial level: New govt wants to change this with a PH Unit in the Ministry, time will tell ..

  15. To investigate how and why norms and values affect the degree to which HIA is institutionalised • Values and attitudes are a major influence; change in conceptualisation of health/ public health fundamental • People’s varied understanding of HIA impacts on their support of the process; willingness • Human resources can be a barrier; lack of understanding and willingness • Public health needs more support, education, financial resources. Because of this, “don’t have a chance to implement something new.”

  16. Discussion: The Time is right for HIA But.... • HIA legislation guarantees that it will be enforced. Mixture of feeling around this: Half say that it is a safety-net to ensure HIA is implemented; others say legislation will “kill the spirit” of HIA

  17. What to do with this research? • Complete and publish! • Current proposal for a HIARTU: Health Impact Assessment Research and Training Unit.

  18. Questions Please? Otázky? Thank you for your attention! Ďakujemzapozornos!

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