Municipal health conferences in the state of Baden-Wuerttemberg, Germany – ready for initiating and steering primary health care provisions at community level?

Abstract

Background: According to the Ottawa Charter of the World Health Organization Health created and lived by people within the settings of their everyday life; where they learn, work, play, and love. In this way, they attributed a central importance for human health to the living worlds, such as municipalities, districts or cities. In order to identify the future regional and municipal challenges in the health sector, in the state of Baden-Wuerttemberg at an early stage and to proactively control them, municipal health conferences were introduced in 2013 by the state government. In 2015 these became compulsory for all counties and municipalities and should take place at least once a year, usually under the direction of the district administration. Assessing the current municipal health conferences objectively shows, that only a few well-functioning and working conferences can be identified. Key questions remain: What are the factors that promote and inhibit the establishment? And how can results be measured? Method: The 37 counties / urban areas were examined with regard to their implementation and realization status. In the process, the implementation processes have been analyzed and problem areas were identified through internet searches, interviews and through participation as guests. Results: The diversity of the different structures of the state council offices in Baden-Wurttemberg is also reflected in the introduction and implementation of health conferences. On the one hand, there are only a few lighthouse projects in which health conferences are seen and used as an active designer of community health care and which have set goals to achieve sustainable outcomes. The overwhelming part of the municipal health conferences shows rather hesitant activities. If any, their activities show a rhythm of one to two annual plenary sessions and interim working groups for a more detailed discussion of topics. Structural introductory errors can be identified as inhibiting factors. The following prerequisites may be identified as promoting factors for the development of the effectiveness of health conferences: The need for excellent expert capacities and committed skills to control the committee and its subgroups, specification or self-elaboration of clear guidelines for action, definition of achievable and measurable target values, as well as systematic evaluation of the results and outcomes. Conclusions: On the whole, health conferences as a driver and designer of regional health care, which is to actively advise and decide on a future-oriented, needs-based health care provisions, remain behind its possibilities. Clear guidelines for action and best-practice examples are encouraging processes in which the relevant stakeholders jointly identify municipal needs, negotiate municipal strengths and weaknesses, and look for new care solutions. The actual possibilities can be found in already well functioning health conferences, which unfortunately are so far still in the minority. At the same time policy processes indicate that legislative changes will lead to a transfer of power to initiate primary health care provisions at community level to municipally authorities. Therefore, municipally should strengthen activities in order to be prepared for future tasks and responsibilities.