After reviewing and discussing the basic concept of partnership; theories and models of partnership; partnership movement in the development of health promotion, this section examines how relevant sectors work together for achieving urban governance and what the challenges and determinants for successful partnership are based on international literature and experiences. Therefore, this part is divided into three sub sections: partnership and urban governance; determinants for successful partnership and challenges and barriers in building partnership.
1. Partnership and Urban Governance
Partnership relates to urban governance. Partnership only can run well if urban governance is comprehensively understood. Chapter two, section 2.3.2 has already explained more detail about urban governance. There are three main actors to develop good urban governance: government, private sector and Non Government Organizations (NGOs). Starting from this concept it can be said that government and governmental bodies at all levels are only one of the elements of urban governance actors. Government needs other key sectors such as private sector and NGOs. Therefore, building partnership for health needs all these three actors. According to Stoker (1998) in Green, at al., (2009) there are five propositions of governance as follows:
· Governance refers to multiple organizations and players
· Governance recognizes the boundaries and responsibilities for addressing socio-economic matters.
· Governance recognizes mutual dependence among organizations in joint action.
· Governance is about autonomy of players
· Governance recognizes government is able to use new tools to guide (Green, Price, Lipp, & Priestley, 2009).
As explained in the previous chapter that urban governance is determined by various factors including community capacity, actor participation, openness and transparency and leadership, there is no a single model of urban governance. Green at. al. (2009) in their paper on partnership structures in the WHO European healthy cities project concluded that although there are some theories which describe governance and urban governance. However, there is no single governance model for the development an effective partnership (Green, et al., 2009; Tagunicar, 2009). Governance differs from government, governance is more facilitating while government is commanding or instructing.
2. Determinants for Successful Partnership
It is not easy to implement a collaborative partnership. A variety of literature has explained a range of factors that influence an effective partnership in general both private and public sector. However, study on specific issues such as healthy city is still very limited especially in developing countries including in Indonesia. Therefore, to obtain a comprehensive understanding, this section reviews factors affecting the successful partnership internationally.
Building an effective partnership with an integrated and holistic approach is necessary to present structure for related sectors and institutions to express their thoughts; and a mechanism for designing holistic and comprehensive strategies which involve communities and other parties (Tagunicar, 2009). Tagunicar (2009) further explains that the process of building a partnership is multi aspects; it offers possibility for change; it mobilizes resources to make changes; it develops a long time vision; and it looks for and involves various partners. The process of building a partnership requires an effective partnership structure; trust among partners and learning from partners. Hence, there are some traits of an effective partnership. Strong partnership has to have nature of voluntarism; common aims and interests; mutual dependency and support; synergy and commitment to work together; shared capabilities and resources; and clear communication. In addition, partnership needs respect and trust each other (Tagunicar, 2009).
World Economic Forum, Global Corporate Citizenship Initiatives, in cooperation with IBLF (International Business Leaders Forum), Harvard University and John F. Kennedy School of Government published a report on Partnering for Success in business perspective written by Nelson (2005). He expresses that there are seven factors affecting successful partnership: partnership relies on honesty and transparency and clear communication to achieve trust and understanding; it requires clear roles and responsibilities; commitment; target oriented; mutual respect in differences of approaches, capabilities, and time. Additionally, an effective partnership can be built when all partners gain mutual benefit; and understanding the local partners and beneficiaries’ needs (Nelson, 2005). Davies (1998) notes that there are several prerequisites for an effective partnership: openness and transparency among partners; avoidance of suspicious attitudes and behavior; adoption organizational structure of partnership (differences in business and civil society organisations); skills and capacity building. Davies (1998) states that partnership occurs if there is “an enabling climate set by the public sector and intergovernmental organisations which underpins partnership” (Davies, 1998 p.185)
Building a better partnership requires basic principles. Hudson and Hardy (2002) and Wildridge et al. (2004) express six principles of partnership. Partnership needs acknowledgment of the partnership needs. This relates to the history of partnership and willingness to working in partnership; partnership requires clarity and realism of purposes. Partnership can only work well if the purposes of partnership are clear and realistic. In addition, partnership needs trust. Trust is essential to work together in implementing and planning related issues (Rinehart, Laszlo, & Gwen O. Briscoe, 2001). Hudson and Hardy (2002) and Wildridge et al. (2004) further explain that an effective partnership occurs if there are trust maintenance and development; establishment of clear and strong partnership management; and monitoring, review and organizational learning (Hudson & Hardy, 2002; Wildridge, Childs, Cawthra, & Madge, 2004).
Mattessich and Monsey (1992) wrote a book entitled Collaboration: What Makes It Work. The book was a review of research literature on factors that influence an effective collaboration. This book is relatively old. However, the book explains in detail about the factors influencing the effectiveness of collaboration. They outlined 19 aspects influencing the successful collaboration grouped into six categories: factors related to the context/environment; factors related to the membership characteristics; factors related to the process and structure; factors related to the communication; factors related to the aims; and factor related to the resources.
Factors related to the context/environment include the history or previous work experiences of collaboration in the community; collaborative group is regarded as a leader in the community, political and social climate conducive. Of the three aspects, mostly research identified that previous work experiences are essential to build an effective partnership. The second factor is factors related to the membership characteristics. These include the importance of mutual respect, understanding and trust, appropriate cross-section of collaborative members, the collaborative members see collaboration as in their self interest, and ability and willingness to compromise. All those factors are important. However, the most important aspects of factors related to the characteristics of membership are mutual respect, understanding and trust and appropriate cross section of members. The third factor is factors related to the process and structure. There were five aspects identified in this factor which are members share a stake in both process and outcome and multiple layers of decision making. These factors are the most significant factors related to the aspects of process and structure of collaboration. Others aspects include flexibility, clear roles and policy guidelines and adaptability. Wildridge et al. (20004) add one aspect in the factors associated with the process and structure which is appropriate pace of development (Wildridge, et al., 2004). Thus, according to Wildridge et al. (2004) number of indicators is to be 20 indicators.
The fourth aspect is factors related to communication. These include open and frequent communication, established formal and informal communication links. Some studies identified the importance of communication in which communication was done openly and more frequent both formal and informal communication. In addition, factors related to aims of collaboration. Three aspects identified which are concrete, attainable goals and objectives, shared vision, and unique purpose. Finally, factor related to resources. These include sufficient funds and skilled convener (Mattessich & Monsey, 1992).
Gillies (1998) evaluated the impact of partnerships for health promotion in Northern and Southern countries. Through reviewing published literature and using case study, Gillies found that the larger the level of public engagement in practices of promoting health, the better the impact of alliances. Voluntarism, peer project and public activities made sure greatest impact from community approach. Additionally, organizational structure of partnership that had a duration or period in the process of planning and implementation was found to be a key success factor in building partnership. This is because such structure provides a mechanism for members/players to share power, to have responsibility and authority and also allow local people to articulate differences (Gillies, 1998).
Organizational structure of partnership determines much an effective partnership. Green at al. (2009) developed new partnership structures in the WHO European Healthy Cities Project. By conducting interviews of 24 representatives of the cities, results of a structured questionnaire from 44 cities and also supported by publications and documents from the project from 1998 to 2003, the study found that partnership structure among them combines formal and informal partnership methods. Cities were organized in different way because local government had differences in local problems and choices. Mostly cities experienced a change in the process of decision making and health planning as a result of membership of the WHO European Healthy Cities Network (Green, et al., 2009). They further explained that three critical factors for successful partnership were identified from respondents: membership of the WHO-European Healthy Cities Network (EHCN) and strong political will (Mayors and local politicians); a project infrastructure with full time of project coordinator; and community participation.
Donchin et al. (2006) evaluated the implementation level of principles and strategies of the Israel Healthy Cities Network and contributions the network to its members. The study covered six aspects of the principles and strategies of the healthy cities, namely equity policy and political support; management; promoting health programs; community engagement; intersectoral partnerships and environmental activities. 36 coordinators involved in the Healthy Cities Network during 2003 were contacted by mail and at the annual meeting. However, only 18 participants actively completed the questionnaires. This study found that the intersectoral collaboration dimension obtained the highest score while the implementation of the environmental protection dimension was the lowest score. The coordinator who invested more than 20 hours a week was positively associated with a higher score on the dimension of management. Coordinator who had previous work experience was associated with the higher score of community participation and intersectoral collaboration. This study concluded that strong political support and commitment supported by coordinator capability will lead to a better healthy city implementation (Donchin, Shemesh, Horowitz, & Daoud, 2006). This research has to be tested in other cities especially in developing countries because healthy city program might have same strategies and principles but different in the level of implementation
Learning from the partnership literature: Implications for UK University/National Health Service Relationships and for Research Administrators Supporting Applied Health Research written by Bauld and Langley (2010), it argues that there are nine predicting success factors of partnership: all partners need to be committed to work together and to solve the identified problems; they have to trust each other; they have to have a commitment to sharing resources; they have to be prepared to share information; an effective partnership requires strong leadership; small partners need to be recognized; all partners have to agree the purposes of partnership; process of management for the collaboration need to be clear and the last is partnership need clear communication (Bauld & Langley, 2010).
Roussos and Fawcett (2000) conducted long review on collaborative partnership as a strategy for improving community health. The review aimed to examine factors affecting an effective partnership and the effect of partnership on environmental change including community and system change; community behavior change and population health outcome. By searching the relevant literature in electronic journal databases such as HEALTHSTART, MEDILINE and PSYCHLIT, bibliographies of previous reviews, descriptive papers and several recommendations from authors, they found some wider contributors to the effectiveness of partnership for community health: social and economic factors; social capital (trust and degree of community participation). Rinehart et al. (2001) separately explain that trust is the core of an effective collaboration. In addition, Roussos and Fawcett (2000) add that a collaborative partnership depends on the partnership context including previous collaborative experiences among relevant stakeholders in sharing resources, responsibilities, and risks; and public control in agenda setting. The effectiveness of a collaborative partnership can be seen from the population outcomes. This generally takes longer to know the effect of partnership, for example, the effects to mortality and morbidity rate. Reduced obesity and sport injuries rate are a number of examples of the community behavior change (Roussos & Fawcett, 2000).
Although the reviewers have examined various published studies on partnership at local level (county, city or neighborhood) to address community health problems, they recognize that these still have some limitations including potential bias from publication caused by paid evaluation of partnership studies as part of national policies, the samples being too general, or the review only focuses on health related concerns (Roussos & Fawcett, 2000). Future research is expected to examine an effective partnership using a specific sample of people, groups/institutions or cities. The study may include healthy city partnership at local government level. Research relies on literature review is needed. However, by doing triangulation including observation, in-depth interview, and FGDs directly it will produce better quality research.
3. Challenges and barriers in building partnership
Building collaboration and partnership is not easy because it involves many people and sectors from different viewpoint, work culture and interest (Barton, Tsourou, & World Health Organization. Regional Office for, 2000). A variety literature has examined challenges, barriers and difficulties to build an effective partnership. However, studies of partnership related to them are still lacking especially in the local government with certain issues like healthy cities. This section reviews a variety of challenges, barriers and difficulties to produces an effective partnership. By knowing and understanding those issues, they make easier for partnership players and decision maker to formulate and look for solution.
Based on literature review conducted by Roussos and Fawcett (2000) there are several issues relating to challenges and barriers of partnership. The challenges and barriers are lack of trust and respect and this is the most frequently mentioned challenges. Another challenge is distribution of power and control is inequitable. Then, conflicts among stakeholders relate to differences in perspectives, values, beliefs, priorities and assumptions; conflict about funding; difference in emphasis on task and process; time-consuming process; community representation (who and how represents community ) (Roussos & Fawcett, 2000).
There are several lesson learned of partnership obstacles as reported by Nelson (2005) on Partnering for Success written World Economic Forum, Global Corporate Citizenship Initiatives, in cooperation with IBLF (International Business Leaders Forum), Harvard University and John F. Kennedy School of Government. He noted five main barriers to produce an effective partnership: lack of trust and understanding; diverse modus operandi; different timeframes; lack of clarity and communication and lack of skills and capabilities /competencies (Nelson, 2005). These challenges are issues faced by private sector or economic perspective. It may be different with other private sector in one country to another or different from public sector.
McQuaid (2000) expresses there are potential disadvantages in working partnership. These include: first, unclear goals. Unclear goals and objectives are frequently considered as a main cause of the partnership failure. Many existing partnerships agreed global aims but the aims in detail were probably unclear or the partners had different understanding. Without clarity of purposes this leads to misinterpretation, lack of coordination, and conflicts among the partners. The second of potential disadvantages of partnership is resources costs. It means that resources costs are considerable in relation to time spent by staff in meeting, discussion and making contract or in postponing decisions because of consultation with partners. The third challenge of partnership is uneven power. It does not mean totally partners have same power. Some partners may have more power than others due to the larger engagement in the area or have greater political authority in the certain aspects. Balance of power between partners is probably more appropriate that unequal power. The fourth problem is cliques gaining power. For example, the partnership process is dominated by certain groups, actors or cliques resulting the increase their benefits and advantages rather than in general wellbeing and welfare for all members.
The fifth issue is impacts on other services. These include the partners’ scope, for example, local government having large ranges of responsibilities while others such as health departments, regional planning agencies and Non Government Organizations have much narrower responsibilities. The sixth is organizational difficulties. These include differences in missions, orientations, structures and process of partnerships. Others include legal and technical problems; and political problems as well both external political issues and internal bureaucracy. The last challenge of partnership is differences in viewpoint among partners. They have different philosophy in seeing problems, priorities and may solutions (McQuaid, 2000). This paper only reviews the involvement of public and private sector to manage public services; these do not involve for instance community organizations or Non Governmental Organizations. The more organizations involved the more complexity of partnership challenges exist. Therefore, the involvement of community organizations or Non Government Organizations in this partnership may lead to different challenges.
Scholars like Bauld and Langley (2010), Holtom (2001), Hudson and Hardy (2002) and Walshe, Caress, Chew Graham and Todd (2007) identified five main challenges to inter-sectoral working between health and social services taken from the theoretical framework developed by Wiston and Hardy (1991). Therefore, to overcome partnership problems, partners or decision makers have to address those problems: structural; procedural; financial; professional; and status and legitimacy. The structural problems relate to fragmented responsibilities and lack of shared structure. The procedural problems associate with operational and planning system. Different organizations may have differences in operating and planning them. In addition, problems relate to financial. Each organization has differences in funding and budget streams. Professional problems associate with differences in values and roles. The last challenge is status and legitimacy problems. This is slightly related to political aspects. There is difference between partnership developed by elected and appointed (Bauld & Langley, 2010; Holtom, 2001; see also Bauld and Langley, 2010 and Hudson and Hardy, 2002; Hudson & Hardy, 2002; Walshe, Caress, CHEW GRAHAM, & Todd, 2007). This paper is very useful for me because it provides how the partnership obstacles are addressed including the experience at local level. However, it only involves two main partners who are health department and social services department. The problem will be different from others if number of players involved is multi actors and departments.
Partnership practice guide issued by VCOSS (Victorian Council of Social Services) notes six main challenges of partnering: First, partnership for what? It indicates that the reasons for establishing the partnership have to be clear, understood and accepted by members. Second, partnership needs trust with others. Without trust partnership does not work well. Third, challenge of leadership. A leader represents the organizations. Therefore, a leader is a key attribute from partnership members. Fourth, challenges relates to partnership membership including consistency; and skill, knowledge and experience of members in helping organizations. In addition, challenges associated with partnership authority and resources (Victorian Council of Social Services). The challenges identified in this partnership practice guide aim more on guiding social services organizations to implement the program. Such challenges need to be tested in practical experiences.
Working in partnership often is not an effective way to address the complex issues. Gray (1989) noted, as cited in Wildridge (2004), a range of conditions in which collaboration between potential collaborators is not appropriate. Generally, this occurs due to differences in fundamental ideology, unequal power distribution, antagonism history, and increased costs caused by this collaboration. Furthermore, partnership will fail if there is lack of perceived appreciation, increased workload as a result of new partnership structure, and difference in work culture. Difference in coordination line of accountability also can cause to a lack of clarity of role at management process including team and personal management (Wildridge, et al., 2004). This paper fully relied on the 141 literature collected from a variety of international published articles. A number of arguments relating to the obstacles in working partnership may be better when testing on the real field conditions, especially at the local level.
Israel et al. (1998) assessed partnership approach based on review of community-based research. They found a range of significant partnership challenges: lack of trust and respect; unfair distribution of power and control; differences in values, beliefs, perspectives, priorities, assumptions, and languages; funding conflicts caused by different priorities, task and process; time consuming; community representation and how is community defined (Israel, Schulz, Parker, & Becker, 1998). Many references used to review the partnership approach, approximately 200 references. However, of 200 references only 2 references related to healthy city research: research written by Hancock (1993) on the healthy city from concept to application: implementations for research, and published by World Health Organization (1998) in Copenhagen entitled healthy cities: action strategies for health promotion. Therefore, the challenges of partnership mentioned above need further to be examined, especially relating to the implementation of healthy cities.
Israel et al. (2006) reviewed challenges and facilitating factors in sustaining community-based participatory research partnership. Generally, there are three groups of challenges to partnership sustainability: challenges on sustaining relationships and commitments. These include lack of time and resources, sharing sources, and morale and energy maintenance; challenges on sustaining knowledge, capacity and values. The challenges included here are limited time and resources and lack of awareness of Community Based Participatory Research CBPR). The last is challenges on sustaining funding, staff, programs, and policy change. These include funding of infrastructure for CBPR and limited time to complete research (Israel et al., 2006). The challenges of this partnership only relate to the Community Based Participatory Research Partnership, these are not related to partnerships such as health promotion programs and healthy cities.
Glendinning (2002) published an article entitled Partnership between health and social services: developing a framework for evaluation. She has different emphasis in seeing the problem of partnership. The problems of partnership according to her consist of two aspects which are policy problems and definition problems (Glendinning, 2002). Partnership is a policy problem because it is encouraged between different policies and statutory bodies, for example, between public sector and private sector; between public sector and non government organizations; between government organizations and private sector; between politicians and Non Government Organizations. Audit Commission (1998:5) as cited in Glendenning (2002, p.116) argued that “partnership working is a potentially powerful tool for tackling difficult policy and operational problems that local agencies face”. Another problem of partnership is partnership definition itself. Huxham et al. (2000) explain that the term to describe cross sectoral and organizational working including alliance, networking, collaboration, cooperation, coordination and joint working are often used interchangeably (Boydell, 2007; El Ansari, Phillips, & Hammick, 2001). There is no standard word used to represent them (Huxham, Vangen, & Eden, 2000).
Bauld and Langley (2010) published a relatively new article entitled Learning from the Partnership Literature: Implications for UK University/National Health Service Relationships and for Research Administrators Supporting Applied Health Research issued by Journal of Research Administration (Bauld & Langley, 2010). This paper noted that different model of partnership has different barriers and challenges and this has to be identified at the beginning of partnership process. As an example, some partnerships occur in name only, and do not succeed to realize their maximum goals (Rummery, 2002). It is probably because of legal and policy barriers for sharing resources and information or other capitals. Organizations may have limited authorities to address the existing challenges. One thing that we have to note that although partners have to share some levels of interdependence, this does not mean interdependencies are similar for each collaborator or essentially equitable (Rummery, 2002). Different partners have different issues or different countries have different context of partnership challenges. Therefore, these barriers of partnership need to be examined in the real practice.
A number of challenges and determinants for successful partnership at different programs and levels have been discussed above. The challenges and determinants like these occur in almost all countries and regions in both developed and developing countries including Indonesia in which healthy cities are being implemented. However, there is still limited research that proves what kind of challenges and success factors affecting successful partnership in implementing the healthy cities programs, especially at local government level. Therefore, considering various factors as mentioned in chapter 2, chapter 3 and chapter 4, this research aims to examine and identify a variety of challenges, determinants and needs for achieving successful healthy cities partnership in Indonesia especially at local government level. The following chapter explains research methodology.
4. Conclusion
This paper argued that working in partnership would be effective if determinants for successful partnership are improved including environment; membership nature; process and structure; communication; purpose; resources; and recognition/acknowledgement. Several partnership challenges occurred due to structural; procedural; financial; professional; status and legitimacy; and appreciation factors.
REFERENCES
. Department of Justice, Office of Community Oriented Policing Services.
No comments:
Post a Comment