Design process of a local public health strategy – A case study

Abstract

Introduction: The study presents a case study of the first phase of a public health policy planning process in a Budapest district, focusing on health needs assessment and intervention planning. In autumn 2023, the Budapest Institute won a commission from a municipal government of a capital district to assess health-related needs and local health services, and to develop a public health program that offers significant health gains, is targeted based on need, and takes into account the municipality's budgetary and organizational capacity constraints.

Methodology: The methodology employed a mixed approach: qualitative data collection included 18 semi-structured interviews with healthcare workers and municipal staff, and five focus groups were organized with district residents over 40 years of age. The quantitative analysis was based on administrative databases, including census data from the Hungarian Central Statistical Office (KSH), primary care coverage data from the National Health Insurance Fund (NEAK), and a special national database examining the health situation in segregated areas.

Results: The results revealed significant territorial inequalities within the district. Cardiovascular mortality, hospital admissions due to asthma and COPD were remarkably high, and mammography screening uptake was alarmingly low, particularly in segregated areas. Prescription medication collection fell below the national average, indicating gaps in care provision. A significant proportion of district residents (13%) were not registered with a general practitioner, and 5% had no health insurance coverage. In reproductive health, the rates of pregnancy terminations and young mothers were exceptionally high. The qualitative research highlighted problems in doctor-patient relationships, infrastructural deficiencies in general practices, and long waiting lists for specialist care. Low-status residents often avoid healthcare due to fear of sick leave or lack of insurance.

Based on the research, a 15-point intervention package was developed, with the starting point being the establishment of a public health cabinet with political, financial, and professional resources. Additionally, they recommend free vaccination programs, reproductive health development, improvement of healthcare providers' conditions, and enhancement of relationships between providers and residents, for example through employing public health professionals and health mediators.

Conclusions: The study also critically reflects on the limitations of the research process: difficulties in data access, obstacles to stakeholder engagement, the division of competencies between different administrative levels, and tensions between political deadlines and professional rigor all influenced the work. The authors emphasize that a publicly accessible, continuously updated database would be essential for local public health planning, supporting the planning and monitoring of healthcare provision in disadvantaged areas.