Community Hub Project

Background
People in rural areas or small towns often experience difficulty accessing the determinants or ‘building blocks of health’.  These have been defined as “access to food, adequate income, peace, shelter, social justice and equity” (World Health Organisation, 1986).  Durie (2001) talks about the foundations for Maori health and in addition to those already described, adds colonization, participation in society, and identity as key access to the Maori world.   The geographic isolation of these communities limits their ability to access many available opportunities and with no access to public transport and limited local infrastructural and facility provisions there are many obstacles to becoming active and healthy. In an effort to ensure that these communities’ physical activity, nutrition and health needs are met the Northland Sport and Physical Activity Strategy (NSPAS) partners and the PHO’s propose the development of ‘Community Hubs’.

The Community Hub project aims to have a community-based approach to sport, physical activity, nutrition and health promotion. The project will aim to attend to individual, interpersonal, community, and organisational needs, providing communities with an opportunity to participate in and influence programme development, implementation and evaluation. Each community hub will look to utilise and build on the community’s social and infrastructural strengths, whilst improving community identified areas of weakness.

This project highlights the importance of addressing problems at multiple levels and stresses the intervention and integration of factors within and across levels (interpersonal, organizational, community and public policy). This project is fundamentally about ‘enabling people to increase control over and improve their health’ (World Health Organisation, 1986) through community action and empowerment. The project aims have a bottom-up approach to sport, physical activity, nutrition, and health promotion, which ultimately builds community capacity and assists with creating physically active, healthy, and sustainable Northland communities. 

The project aims to assist communities in the Far North District, Kaipara and Whangarei District by providing these communities with a project facilitator. Communities will be prioritised by a District Steering Group made up of Iwi, Maori Health Providers, PHO’s, Sport Northland, Local Councils, HEHA facilitator and other local representatives.  The following lists the community selection criteria:

1. Low socio-economic
2. High Maori population
3. Located in an isolated area
4. Have low facility provisions
5. Have no/limited access to public transport
6. Have limited infrastructural provisions (e.g. roading, footpaths, parks, public toilets)

The project facilitator will assist communities with empowering and up-skilling themselves to make positive adaptations to their community. The project is fundamentally about creating sustainable healthy Northland communities, therefore as each community’s capacity develops, the facilitator will be able to minimise the leadership and facilitation role they play within the community. As this facilitation is minimised, their intensive support can focus on another community. It should be noted that each facilitator will still support and remain a contact for all communities they have assisted.

This project framework has already been successfully piloted in Northland through Manaia PHO. Manaia PHO developed the Healthy Hikurangi project, a successful project based on community development principles that has successfully been running since 2005. Manaia PHO in conjunction with NSPAS and other Northland PHO’s have recognised the strength of this project approach and are looking to extend the Community Hub project throughout Northland.

Evaluation
An external evaluator has been appointed by the Northland District Heath Board and will work alongside the Community Hub Facilitators to provide support and mentoring for the effective formative, process and outcome evaluation of the project. 

Project Sponsors and Finance
This project has received funding support from Manaia Health PHO, Tai Tokerau PHO, Northland Health Public Health Unit, Sport Northland, and the MOH HEHA evaluation fund.  The project has attracted sufficient resource to employ one FTE within Whangarei, and a .6 FTE within the Far North.  A .2 FTE will be employed at Kaipara Care Incorporated PHO.  Additional resource is required to extend the project in existing areas and / or other areas of Tai Tokerau.

Timeframe
The project has been planned for three years and upon receipt of funding will commence mid-2008.

Project Framework
Please note that this project has an organic process, while each community will follow the same fundamental framework, process and outcome will differ between communities. The process will be very dependent on existing community provisions and community capacity. The project will directly reflect what the community wants and each initiative’s implementation will be dependent on community ownership and leadership.

The project will:

• Employ Project Facilitator

The project will look to employ a Project Facilitator, this person would be responsible for leading the project within each community and helping the community to recognise and build their community capacity. The Project Facilitator will work to empower the community to take ownership and leadership of health, physical activity and wellbeing initiatives. The Facilitator will be there to help the community recognise and achieve their potential.

• Train Project Facilitator

The project has already been successfully piloted in Hikurangi and this piloting recognised facilitation as a key role. In an effort to ensure the same positive outcome is achieved with new communities, training for the Project Facilitator is required. Working with the project leader from ‘Healthy Hikurangi’ is vital and would allow the Project Facilitator to develop skills that allow them to approach each community appropriately. Ensuring that they understand the underlying principles of the project and how to approach each community is paramount.

This Facilitator will take a leadership and facilitating role. This approach emanates from the work of Turner (1999) and Laverack (2004) who both advise that any facilitator of community development should be a catalyst or organiser who encourages community empowerment. Specifically, Laverack (2004) notes this role should be “essentially one of the transformation of power-over – the control of decisions and resources – to allow others to gain more ownership and control by discovering their own power-from-within” (p. 97). This style of leadership supports the philosophy that health promotion is about ‘enabling people to increase control over and improve their health’.

To ensure this Facilitator empowers and enables the community they will:

• Give up the role of expert and avoid taking over a community project
• Acknowledge that they have relevant knowledge on what works and what doesn’t
• Support and foster community leadership
• Develop skills of working alongside, and with the community
• Be consultants and support agents
• Encourage and support community members to lead all aspects of the project
• Identify communities to implement the project: Whangarei District and Far North District

It is important that this project is recognised as a regional strategy and therefore a community from each district will be involved. Initially community reliance on the Facilitator will be large, but as each community builds their capacity, become empowered and self sustaining, reliance on the Project Facilitator will lessen. As this assistance is withdrawn the Facilitator will develop the project in a new community.

The communities selected in each district will be identified through a process of prioritisation by key stakeholders. The stakeholders will prioritise communities that have the following characteristics:

• Low socio-economic
• Maori
• Located in an isolated area
• Have low facility provisions
• Have no/limited access to public transport
• Have limited infrastructural provisions (e.g. roading, footpaths, parks, public toilets)

Please Note: The HEHA MAP (gap) analysis will also be utilised to identify existing areas with limited physical activity and health provisions.

Specifically each community project will involve:

• Community informing and local networking/collaboration development

Community informing involves educating and informing the community about the ‘Community Hub’ concept. This stage is very important for developing networks and establishing methods for collaboration. Community informing includes talking with all community education, social and health groups already working within the community about the project. This stage allows the Facilitator to introduce themselves and the project to the community. Specifically this informing/networking/collaborating process may include:

• Determining existing organisations and groups currently in existence and talking with these groups (phone and face-to-face)
• Utilising local newspapers or newsletters to advertise and inform the community about the project
• Developing an information sheet to place on community notice boards, in local businesses, mail outs, etc.
• Visiting local schools, community groups, and health providers (including local doctors)
• Visiting local shop keepers
• Inviting community members to attend a community meeting
• Talking with local Marae, iwi
• Identifying natural existing community leadership
• Community Steering Group Development

This development may happen at different stages for each community, but encourages community ownership and leadership. This group will be responsible for helping to support initiatives, developing new ideas and will become the trustees of any community trust developed. This group is paramount to the sustainability of the project.

• Identifying Community Needs and Ideas (part of the process evaluation)

This stage involves engaging the community and determining how they feel about their community and their community provisions. This stage is about clearly outlining what the community would like to achieve within this project. Specifically this idea development and consultation may include:

• Brief surveys asking the community about what makes their community a healthy/good place to live and what are the not-so-good things about their community. Ideally this would (when appropriate) be conducted by community members
• Talking with community groups/members etc
• Community meetings/presentations (these will be facilitated and organised by the Project Facilitator). At this meeting encourage brainstorming groups to develop initiative ideas, look for volunteers to drive and coordinate these initiatives, look for volunteers to develop a steering group

Projects will not be prioritised; instead they will be lead by volunteer community members that wish to take ownership of any one initiative.

Ideas that the community may come up with include:

• Training of volunteers (sports clubs, coaches, administrators)
• Upgrading walkways
• Activity (for youth, exercise classes, gym, aerobics, community sports, walking groups)
• Increasing food options available to the community (shops selling healthier food, low cost meals, health food at school, farmers market)
• Education (healthy eating, budgeting, gardening, physical activity)
• Growing in the community (fruit trees, gardens)
• Community Initiative Team Creation

Post community idea development and volunteer identification, project teams will be created. The creation of these groups will be facilitated by the Project Facilitator. These project teams will develop, drive and facilitate their specific initiative idea. Ensuring that all projects are driven by these project teams is very important, as it ensures the community have ownership over how the programme develops and is implemented.
Project teams might include:

• A number of community members that want to develop a walking group
• A group who would like to develop free or minimal childcare opportunities so more mothers are able to get active
• A number of community members who would like to look into the current state of local sports organisations and facilities
• A group that would like to develop some community gardens
• A number of community members that would like to develop some group fitness classes
• A group that would like to develop a community farmers market
• Initiative development

The project teams will develop the initiative. All initiatives will be driven by the community project team with initial assistance from the Facilitator. The Facilitator will as much as possible encourage the project team to have ownership and drive the strategy. As community capacity is developed the Facilitator will withdraw their involvement.

• Projects implementation

Projects will be implemented with assistance from the Project Facilitator. Initiatives will initially receive financial and resource support if required (applications for support can be made to the Facilitator). It is important that implementation is not seen as an outside process, if the community can establish the programme and implement it themselves, the initiative is far more likely to be sustainable.

• Projects evaluation (part of the process evaluation)

Projects will be evaluated by the community to determine how they can be improved and to determine their success. This evaluation will differ depending on the initiative type and stage of implementation. Some benefits or effects of interventions of initiatives may not be captured by a population-wide survey therefore this project aims to have evaluation methods that are as multilevel as the interventions and initiatives themselves. Evaluation may include:

• Focus Groups
• Community interviews
• Surveying
• Event and programme attendance
• Community Capacity Building

To ensure that this project is both sustainable and ultimately becomes completely ‘community led’ it is paramount that community capacity is developed. This is a significant component of the Community Hub project as it helps to establish an independent and non-reliant community that recognises how they can make positive community adaptations. Community capacity building will be very dependent on community needs, it is important to note that capacity building will be both a formal and informal community process that will happen continuously throughout the project.
Community capacity building may include:

• Supporting, up-skilling and providing training to the Steering Group
• Training members to run community groups/activities (e.g. aerobics classes) reducing the dependence on outside providers
• Sending members of the community on professional development courses (particularly those that are leading and coordinating initiatives in the community)
• Working with the community to develop their project planning skills
• Assisting the community with developing networks, particularly with council, local health providers, schools, etc.

Please note the following should be continuously recurring throughout the ‘Community Hub’ project

• Community informing/updating
• Community meetings and events
• New initiatives developed
• Evaluation of initiatives
• Submissions made to councils/developers etc. for infrastructural developments e.g. walkways, park developments, town centre developments
  (see following diagram)