YEARBOOK 2000 - Local relationship of the organisations

In order to define the main characteristics of local decision-making systems, respondents were asked both about the participants and the levels of the local decision-making process. The first question in this respect was the following: are there any proposals related to the Healthy Cities programme submitted to or discussed by the assembly of the local government?

All the 18 towns without exception responded that proposals were on the agenda of local government meetings. At the same time, it is obviously also important to know who submits such proposals. In 61% of the member towns it is the mayor, and in the remaining 39% various committees put forward the proposals. Health, and Health and Social Welfare committees were mentioned the most frequently. In addition to these, environmental and/or education committees were also listed among those who made proposals.

Nonetheless, having proposals submitted by various committees is not the most adequate solution, since it is quite natural to suppose that in such cases the proposal is discussed as a 'committee issue' rather than a programme component of the Healthy Cities project. If, however, the proposal is made by the mayor, this situation is not likely to occur, because the multi-sectoral character and the commitment required from several actors give proper identification to the issue.

The local multi-sectoral steering committee plays an important part in the decision-making process. There is only one member town, where this multi-sectoral steering committee has not been set up yet. It is true, that this town has been a member of the Association since 2000 only, and may very well have initiated the set-up of the committee already.

Local multi-sectoral steering committees consist of at least 6 and at most 27 members. The areas involved in the multi-sectoral body are quite different in each town. The respondents mentioned altogether 112 professional areas involved in the committees. There are also towns with similar sectoral composition. Diagram 5 shows the various professional fields by frequency of mentioning.

The data in the diagram also illustrate which are the areas that can be found in the multi-sectoral committees of several towns and can, therefore, be considered of higher importance through their participation in the decision-making or consultation processes related to the programmes. At the same time, this review may give ideas to some member towns about which professional fields they could involve in the work of their local steering committees.

The category named 'others' includes professional areas which were mentioned with a frequency of less than 3%. These are the following: lawyer, Department of Transport, Statistical Office, the media, the county government, National Health Insurance, politician, sports and sociologist.

As the data in the diagram show, health services, education and environmental protection are the most frequently mentioned professional fields. This leads to the conclusion that they are probably represented in most of the multi-sectoral committees. There is no reason to be surprised at this, especially with regard to the former remarks about the general associations to the notion of 'health'.

Some of the findings related to certain professional areas are, however, quite surprising. Let us see just a few examples: Sports were mentioned less than three times, which means that the representative of this professional field can be found in not more than two local multi-sectoral committee. The media are in a quite similar situation. This issue deserves more attention especially as far as the possible connection between health, wellness and sports, or between the communication of programmes and the media is concerned, not speaking of the support that the actors of local economy could give to promote the implementation of local programmes.

Another important factor in the local decision-making process - and also other aspects of the operation - is the existence and activity of potential local support systems. In order to elicit information on this aspect of the local project, respondents were asked to evaluate three of the potential local support systems - political, technical and financial - on a scale of 1-5, and thus demonstrate the degree of support that the local project enjoys.

The evaluation of the various support systems on the basis of the average values indicated has lead to the conclusion that technical/professional support graded the highest (3.66 average value) by the respondents; this is followed by political support (3.22 average value) and finally by financial support (2,77 average value). The values indicating the ratings of the support provided by the various systems are shown in Diagram 6.

In order to understand the differences and similarities experienced in the evaluation of the support provided by the various systems, we made attempts to find interrelationships in the background. As a result, we have come to the conclusion that the evaluation of two systems was identical in 72.2% of the member towns, the difference in the rating of the third being only 1 point.

The above data point to the conclusion that individual support systems constitute an interrelated system, and do not appear as individual dimensions in their relation to the local Healthy City project. It is reasonable to assume that when the project succeeds in obtaining local support in one dimension, is becomes easier to gain support from other systems as well, which may reach the same magnitude. Once the support of at least two systems is obtained, the third dimension also catches up.

As a part of this section on the level of support obtained respondents were asked whether local businesses or the members of the local community are in any way connected with the Healthy City programme.

50 % of the member towns mentioned support provided by the business sector.
Typically support was given in two different forms: there was direct financial support, on the one hand, and participation in programmes related to the profile of the business concerned, or support in kind, on the other (e.g. making available the auxiliary materials necessary for screening programmes, presentation of products, publications, transport, etc). Financial support is, of course, an extremely important factor in all programmes or activities but the Ethical Code of the WHO excludes quite unambiguously all supporters who manufacture or distribute products which are detrimental to health and no support of this kind has been reported, but we find it important to point out these rules in the present context as well.

At the same time, there was no mention of local business organisations supporting the programme by organising certain actions or initiatives within their own organisations, or adopting parts of the local Healthy Cities project. In the future more effort should be made to achieve 'support' of this kind.

Every organisation mentioned getting support from the members of the local community. The typical forms of this support include the following: participation of the local civil organisations in the work of the multi-sectoral steering committee, participation in the organisation and implementation of specific programmes, joint grant applications with the groups of the local community, and - in some cases - financial support to the implementation of programmes.

The last question concerning support given to the local project, respondents were asked to give a list of the events which enjoyed the most extended support, or represented the most threatening obstacle to the implementation of the objectives of the local Healthy City project.

The events mentioned as representing the most significant support were the following: financial support obtained from local government or various funds to specific activities/programmes, the development and successful maintenance of new forms of technical co-operation, improvement in the enforcement of interests, increasing visibility in local public life due to the better use of the opportunities offered by various communication channels; infrastructural development.

Among the obstacles that hinder the achievement of the project's objectives respondents mentioned the lack of financial resources in the first place. This, in turn, can be the source of several other problems, like the difficulty experienced in the transformation of voluntary work into full-time employment, which sets a limit upon the organisation and implementation of programmes. A further obstacle respondents mentioned is the insufficiency of the enforcement of interests, which decreases people's interest and support. These two key problem areas are obviously interrelated with each other and their synergy makes problems even worse.

The most important message communicated by the list of problems can be summarised in the conclusion that due to the lack of professional level institutionalisation, the programmes can be maintained only at an 'amateur level' in the long run - even if the term is used in a positive meaning. Among the conditions of professional institutionalisation we could mention the development of an autonomous organisation, together with the provision of the full-time human resources and infrastructural background which are indispensable for activities.

Respondents were also requested to draw organograms to give a clearer picture of the decision-making mechanisms. The information provided by the organograms was considered necessary to clarify unambiguously the relationships and institutional hierarchies which characterise the external and internal organisation structure of the institutions acting as a background to the local Healthy City projects.

The analysis of the organograms revealed several specific sets of relationship. It was also found that all organisations have a wide range of both formal and informal relationships. These relationships have developed both horizontally and vertically, and can work either one way only or mutually in both directions.

Two organisations, namely local municipal governments and the Hungarian Association of Healthy Cities play an outstanding role among the partnerships the local organisations maintain. Relationship with the local government is mainly generated by the reporting and accounting requirements, while the relationship with the Hungarian Association of Healthy Cities is based on the performance of the tasks arising from the membership in the Association.

Whenever the institutional background is found in the form of a foundation or public endowment, the relationship with the board of trustees as the supervising body or occasionally the employer, has a determining role.

In case the institutional background is ensured by the Mayor's Office, the co-ordinator is expected to meet the requirements of the formal relationships deriving from his position designed within the institutional structure of the office. This is the situation in which the responsibilities, duties and competencies are easily confused - as it has already been pointed out several times in this study before.

Every organisation has built some kind of parnerships with various partners during the implementation of the local programmes. These partnerships are typically horizontal, developed primarily through bilateral co-operation. The same can be stated concerning the relationships with professional actors, sponsors or other co-operating parties.
The analysis of local partnerships revealed a positive aspect, namely that none of the organisations presented a one-way subordination chain in the organograms. At the same time the systems of relationships are complex enough to meet the WHO requirements, which require a strong multi-sectoral character.

The only finding that is not considered to be positive in all cases is the recognition that the co-ordinator of several towns is, at the same time, a member of a special and strict hierarchy, and the set of relationships organised around it. The consequence of this situation is that his or her efforts made to enforce the interests of the local Healthy City project may get into conflict with his/her role within the other hierarchy. In order to avoid situations of this kind it is recommended in the chapter analysing the general characteristics of the organisations that each member town should develop an independent organisation that would ensure the institutional background to the programmes. If this means the establishment of a new institution outside the local government structure, the form of a non-profit organisation is recommended regarding the specific features of the activities to be performed.