This report presents the findings of a process and impact evaluation of a Health Impact Assessment (HIA) on the implementation of the Hawke’s Bay District Health Board’s oral health strategy in the Flaxmere community. The HIA was lead by the Hawke’s Bay District Health Board (DHB) HIA team in collaboration with DHB’s Oral Health Steering Group. The evaluation was undertaken by the HIA Research Unit, University of Otago. The HIA was supported with funding from the Ministry of Health HIA Support Unit’s Learning by Doing Fund.
The evaluation was conducted concomitantly with the actual HIA. Data were gathered for the evaluation using a mix of methods including; participant observation, participant workshop evaluation feedback, documentary analysis and interviews with nine key stakeholders.
The HIA proved challenging mainly because of its application to an already endorsed and funded policy, and secondly because of the limited consultation that had been undertaken during the policy’s development phase. This feature underlines the need to ideally undertake an HIA when a policy is still in its development phase. It also illustrates HIA’s need for quality facilitation skills throughout the HIA process.
The HIA process used for the implementation of the oral health HIA proved effective, as indicated by both the workshop evaluation feedback forms and the key informant interviews. The latter lacked a community perspective, because the DHB had yet to feedback to the community at the time the evaluation interviews were carried out.
The final HIA report and recommendations were generally well received by all those interviewed. The positive response to the HIA report bodes well for the implementation of its recommendations. The final decision had yet to be announced at time of writing this report. Further evaluation at some later point in time would be valuable to assess the uptake of the HIA’s recommendations and their short-term impact.
This HIA was the first on a policy led by the DHB. The HIA team’s engagement of their DHB colleagues in the process was considered one of the key strengths of the HIA process. While this HIA was acknowledged as valuable to those HIA staff directly involved in the process, there is no evidence that it has impacted any further within the DHB. There are a number of reasons why this maybe the case. First it may be too early to see its full impact, it may be that one HIA is not enough to convince key decision makers; it may be that the context of change at the DHB has made it difficult to be innovative at this time, or a combination of reasons.
This evaluation indicates some of the potential for HIA to strengthen DHB policy making and community responsiveness, although it is not without costs in time and resources. It seems appropriate to recommend that all DHBs consider using HIA as a tool to assist them to develop effective policy, particularly in significant policy areas. Evaluation of such initiatives is important to build the case for using HIA.