YEARBOOK 2000 - Human resources of the local projects

The reason why questions about human resources were asked was the belief that the quality of human resources employed can give a characteristic picture about the number of staff, their level of education required in the operation of local Healthy Cities programmes and the implementation of their activities, their special expertise, and - on the other hand - of the degree of institutionalisation.

Of all the characteristics of human resources we first focused on the co-ordinators;
the main reason being that there is no qualification or specialist training for co-ordinators, the skills and expertise required mainly in problem solving can only be acquired through hands-on learning. It is true all the more so that even today co-ordinators are not expected to be a specialists of all fields involved, but it is more important for them to acquire managerial skills and capabilities, in addition to good judgement of when to call in experts and which ones either as consultants or participants in the implementation of certain programmes.

In the survey of human resources available it was important on the one hand to examine to what extent the person acting as co-ordinator could be considered as a 'constant' participant in a given programme - that is whether he or she has had enough time to acquire the skills needed for the continuous implementation of the programmes and, on the other, to examine the composition and operation of the multi-sectoral steering committee. Questions eliciting information about these points were also included in the questionnaire. The answers concerning the co-ordinators have revealed, that in 55% of the member towns the person of the co-ordinator has not changed since the local launch of the programme. 33% of these members joined the programme in 2000. In the other member towns the present co-ordinator is at least the second in line. Diagram 3. shows the changes of co-ordinators before the present ones.

When talkin gabout co-ordinators' tasks it's not only important to see how many co-ordinatiors have worked so far for the local project but also crucial to see how long each person have held the post. The number of co-ordinators who have acted so far in this function and the period during which they held this position - with special regard to the present co-ordinators - allows us to draw certain conclusions concerning the fluctuation/turnover of the co-ordinators. Using the relevant data, we made calculations for the typical 'co-ordinator years' in the individual member towns to find out how long the present co-ordinator has been in office, and the distribution of the previous ones over the previous years. The data illustrating the trends in the co-ordinator years in the different member towns are shown in Table 1.

A closer look at the co-ordinator periods and the number of co-ordinator changes leads to the conclusion that in 55% of the member towns the present co-ordinator has been in office for 100% of the time that has elapsed since they joined the national programme. In about one-third of the member towns the present co-ordinator has been in office for 86-50% of the time of their participation in the HAHC, and this value is 25% or less only in the remaining 20% of the member towns. Consequently, it can be stated that the majority of member towns has a relatively constant co-ordinator which has certainly a positive impact on the continuity of activities, the planning period and the acquisition of co-ordinating skills as well.

The questions related to the co-ordinators included one about the status of the immediate superiors in line, in order to clarify the decision-making hierarchy of the local programme. The co-ordinator was found to report directly to the mayor in 11 towns, to the head of some civil organisation in 2, to a department head in the mayor's office also in 2 towns. In the remaining towns the co-ordinator report to the head of some professional institution. Regarding the requirements if joining the WHO Healthy Cities Programme - which specify that the mayor of the member town should bear the highest responsibility for the implementation of the programme - it is hardly understandable that there are co-ordinators who do not report directly to the mayor (this does not apply to the civil organisations). This observation also points towards the need to further develop programme identity.

As far as the co-ordinators' level of education is concerned, 17 of them have university or college degree and only one GCSE. This could be considered quite a good level.

In the case of foreign languages, however, there is a lot to improve. 13 of the co-ordinators do not have a foreign language certificate at all, the remaining five co-ordinators have altogether 2 elementary level, 5 intermediate and 2 advanced level certificates. The languages spoken are English, German, Russian and Italian.

In several ways, the lack of foreign language skills is a more serious drawback than the lack of special knowledge that can be acquired in regular courses since the Hungarian Healthy Cities Programme is a member of an international movement, which uses English as working language. It is obvious, that without the mastery of foreign languages it is not possible to maintain relations with the international forums, or to ensure the quick flow of information. This situation means an obstacle, preventing the member towns from taking their own initiatives in order to exploit the opportunities offered.

The form in which co-ordinators are employed represents another important aspect of the whole programme. Data related to this point are shown in Diagram 4.

The two co-ordinators who are employed full time, work in the two project cities of the WHO European Healthy Cities project, because this is the only way to become a 'project city'. The other co-ordinators, who do not work full time are mainly local government staff, or are employed in the health services, mental hygiene or education.

At the same time, most of the co-ordinators fulfil their co-ordinating duties as a part of their full-time job. Here again, the question arises about the identity of the co-ordinators, whose main job includes very 'similar' activities to those of a co-ordinator. How are they capable of separating the tasks belonging to their main job from their duties as co-ordinators? If this separation is not really possible, which 'identity part' will dominate their work?
Should there be a conflict of interest or competition between the 'main job' and the 'co-ordinator function', which side will they take?

Another question that arises in this context is whether the work of the co-ordinators acting as volunteers, doing a part time job really serves the purpose? The doubts are all the more justified, because one of the questions asked the respondents to indicate the number of hours per month spent on co-ordinating activities, if it is not his/her full-time job. The highest number was 100 hours per month. This - taking a work week as 40 hours - equals two and a half weeks and exceeds the working hours of a part time job. Other figures indicated by volunteers or part-time co-ordinators were between 60 -20 hours per month. There is a great discrepancy especially with respect to the fact that full-time co-ordinators are also employed in some towns.

Questions concerning the human resources available for the programme included some questions about other staff members as well. The answers revealed that not more than 11.1% of all member towns employ full time helping staff for the implementation of the programme. 22.2% of the towns employ part time staff, to assist in the activities. The other organisations (66.7%) usually hire support staff for special activities. 72.2% of the towns also reported that volunteers regularly participate in the organisation of the various programmes and the performance of certain tasks as well.

The availability of volunteers is a good indicator of local (both civil and professional) community's support and that of a positive attitude. In this way the commitment of volunteers can also be interpreted as a feedback that the local communities consider the programmes important and worth of their support.

At the same time, the extremely small number of paid staff can be seen as a feedback on two points: it is possible that the continuous operation and the implementation of the programmes do not really require full time employees; or more full-time employees would be necessary, but the organisation is not in the position to hire them.

In both cases it seems reasonable to ask whether a programme can be successfully maintained on the long run if human resources available are practically restricted to the co-ordinator as standard staff, bearing in mind that so far only 2 full-time co-ordinators have been reported, and the position of the other, not full-time co-ordinators is somewhat vague at least with respect to the separation of the main job and the co-ordinating function.

Summarising the analysis of human resources, we can conclude that the data available prove the need to make significant changes in the field of human resources in nearly every member town. First of all, it should be made unambiguous whether the co-ordinator belong to the Healthy Cities programme or some other functions. The terms of his or her employment and the status of the support staff should also be clarified. If these two issues are viewed together, it becomes quite clear why the member towns of the HAHC are not capable to becoming into project cities in the provided number (the quota set for Hungary is four). The co-ordinators are not employed full time, and even the present co-ordinators were, they do not speak English which would be one of the crucial human resources points required from project cities by WHO.

It is important to point out here again, that the main criteria employed in the selection of the co-ordinators should not necessarily be the experience or expertise in the field of the health services. The recruitment and appointment of co-ordinators is often governed by the fallacy that only medical doctors, or health service staff can deal with matters related to health. This may be true in many cases, but not necessarily in this one, considering that the dominant feature of the Healthy Cities programmes is multi-sectorality.

On the other hand, the current situation of human resources can be seen as an indicator, providing a kind of feedback on the operation and development of the local healthy city programmes from a certain aspect, namely that many member towns that work without a full-time co-ordinator, joined the programme 6 or even 10 years ago. However, the fact, that during this time they did not feel the need or found the opportunity to appoint a full-time co-ordinator raises the question whether there has been any development or progress in the commitments made by the town, or is the nature of the programme is such that a part-time, or volunteer co-ordinator can cope with the work load. These considerations rely on the assumption that gradual development of the activities inevitably requires the employment of a full time co-ordinator as time goes on. This process, however, has not taken place in any of the member towns over the last 10 years. It should become an inevitable step in the further development of the programmes and also included among the main objectives.

In order to avoid possible misinterpratation, we wish to point out that the main issue about the employment of co-ordinators is not whether they work full -time or part -time, but whether their duties and responsibilities are clearly identified and separated from other positions. The best and most apparent form of this separation would be, of course, full-time employment of co-ordinators. However, this is not absolutely necessary if other efficient operational forms can be found, because here, again it is not the form that matters but the efficiency of operation.