MAPP Basics - Introduction to the MAPP Process

"Coming together is the beginning. Keeping together is progress. Working together is success." – Henry Ford

What is MAPP?

Mobilizing for Action through Planning and Partnerships (MAPP) is a strategic approach to community health improvement. This tool helps communities improve health and quality of life through community-wide strategic planning. Using MAPP, communities seek to achieve optimal health by identifying and using their resources wisely, taking into account their unique circumstances and needs, and forming effective partnerships for strategic action.

The MAPP tool was developed by the National Association of County and City Health Officials (NACCHO) in cooperation with the Public Health Practice Program Office, Centers for Disease Control and Prevention (CDC). A work group composed of local health officials, CDC representatives, community representatives, and academicians developed MAPP between 1997 and 2000. The vision for implementing MAPP is:  

"Communities achieving improved health and quality of life by mobilizing partnerships and taking strategic action."

The following seven principles are integral to the successful implementation of MAPP:
Systems thinking — to promote an appreciation for the dynamic interrelationship of all components of the local public health system required to develop a vision of a healthy community.
Dialogue — to ensure respect for diverse voices and perspectives during the collaborative process.
Shared vision — to form the foundation for building a healthy future.
Data — to inform each step of the process.
Partnerships and collaboration — to optimize performance through shared resources and responsibility.
Strategic thinking — to foster a proactive response to the issues and opportunities facing the system.
Celebration of successes — to ensure that contributions are recognized and to sustain excitement for the process.

Benefits of Undertaking MAPP

Below are just some of the benefits to be derived from the MAPP process.

• Create a healthy community and a better quality of life. The ultimate goal of MAPP is optimal community health—a community where residents are healthy, safe, and have a high quality of life. Here, a "healthy community" goes beyond physical health alone. According to the World Health Organization, "Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity" (101st Session of the WHO Executive Board, Geneva, January 1998, Resolution EB101.R2). The Institute of Medicine echoes this definition and notes that "health is…a positive concept emphasizing social and personal resources as well as physical capabilities" (Improving Health in the Community, 1997, p. 41).

• Increase the visibility of public health within the community. By implementing a participatory and highly publicized process, increased awareness and knowledge of public health issues and greater appreciation for the local public health system as a whole may be achieved.

• Anticipate and manage change. Community strategic planning better prepares local public health systems to anticipate, manage, and respond to changes in the environment.

• Create a stronger public health infrastructure. The diverse network of partners within the local public health system is strengthened through the implementation of MAPP. This leads to better coordination of services and resources, a higher appreciation and awareness among partners, and less duplication of services.

• Engage the community and create community ownership for public health issues. Through participation in the MAPP process, community residents may gain a better awareness of the area in which they live and their own potential for improving their quality of life. Community-driven processes also lead to collective thinking and a sense of community ownership in initiatives, and, ultimately, may produce more innovative, effective, and sustainable solutions to complex problems. Community participation in the MAPP process may augment community involvement in other initiatives and/or have long-lasting effects on creating a stronger community spirit.

The Elements of MAPP

The MAPP tool was designed to include the following key elements.
1) MAPP emphasizes a community-driven and community–owned approach — Because the community's strengths, needs, and desires drive the process, MAPP provides the framework for creating a truly community-driven initiative. This creates stronger connections throughout the community and provides access to the collective wisdom necessary to addressing community concerns.

2) MAPP builds on previous experiences and lessons learned — Information from previous planning efforts and established assessment tools was used in the development of MAPP. Most notably, MAPP builds on the Assessment Protocol for Excellence in Public Health (APEXPH). Released in 1991, APEXPH has guided hundreds of local health departments through internal organizational capacity assessments and collaborative community health assessment processes. While building on the familiar concepts of APEXPH, MAPP is more progressive in a variety of ways:

3) MAPP uses traditional strategic planning concepts within its model — Strategic planning assists communities in more effectively securing resources, matching needs with assets, responding to external circumstances, anticipating and managing change, and establishing a long-range direction for the community. The MAPP model includes basic strategic planning concepts, such as visioning, an environmental scan, the identification of strategic issues, and the formulation of strategies.

4) MAPP focuses on the creation and strengthening of the local public health system — Local public health systems are defined by MAPP as the "human, informational, financial, and organizational resources, including public, private, and voluntary organizations and individuals, that contribute to the public's health." This focus is important because "the public's health depends on the interaction of many factors; thus, the health of a community is a shared responsibility of many entities, organizations, and interests in the community" (Institute of Medicine, Improving Health in the Community). The MAPP process brings these diverse interests together to collaboratively determine the most effective way to conduct public health activities.

5) MAPP creates governmental public health leadership — While MAPP focuses on the local public health system, it is anticipated that governmental public health entities will take leadership roles in initiating MAPP in their communities. Thus, MAPP will help to create a greater recognition of the important roles governmental entities—such as local health departments, boards of health, and environmental agencies—play in their communities.

6) MAPP uses the Essential Public Health Services to define public health activities — The Essential Public Health Services and other public health practice concepts have been incorporated into MAPP, providing much-needed links with other public health initiatives. The Essential Public Health Services are a list of 10 public health activities that should be undertaken in all jurisdictions. (See Backgrounder – The Essential Public Health Services.) The use of the Essential Services framework and the focus on the local public health system provides a crucial link with the National Public Health Performance Standards Program (NPHPSP), being developed by CDC, NACCHO, and other national public health organizations. The local-level instrument of the NPHPSP is an integral part of MAPP's Local Public Health System Assessment.

7) MAPP brings four assessments together to drive the development of a community strategic plan — Four unique and comprehensive assessments gather information to drive the identification of strategic issues.

• The Community Themes and Strengths Assessment identifies themes that interest and engage the community, perceptions about quality of life, and community assets.
• The Local Public Health System Assessment measures the capacity of the local public health system to conduct essential public health services.
• The Community Health Status Assessment analyzes data about health status, quality of life, and risk factors in the community.
• The Forces of Change Assessment identifies forces that are occurring or will occur that will affect the community or the local public health system.

How Does MAPP Work?

MAPP includes two graphics that illustrate the process communities will undertake. Both graphics display the MAPP process, but in different ways.

	In the MAPP model, the "phases" of the MAPP process are shown in the center of the model, while the four MAPP Assessments—the key content areas that drive the process—are shown in four outer arrows.
	In the illustrated "community roadmap," the process is shown moving along a road that leads to "a healthier community."

The MAPP guidance was developed to be practical and user-friendly. Two products provide information about the MAPP process:

1. A 24-page Field Guide is available for dissemination among community participants and local health departments nationwide. The Field Guide provides an easy-to-read, eye-catching overview of the MAPP process.
2. The MAPP Web site (located on NACCHO's Web site at www.naccho.org) provides in-depth guidance, tools, and resources for each phase. This information will be most useful to facilitators, lead staff, committee chairs, and other individuals playing lead roles in MAPP processes. For each phase, the following is provided:
3. • At-A-Glance – These sections offer brief descriptions of the purpose of the phase, the necessary participants and their roles, and the action steps.
   • In-depth Guidance – The heart of each phase is a discussion of the purpose of the activity along with "how to" guidance relating to a series of steps for conducting the phase.
   • Vignettes – Brief examples of how the activity was conducted in various jurisdictions provide practical examples of how each phase has been implemented in practice. The vignettes are from a wide variety of jurisdictions. An example from Chicago, IL, is used throughout the entire tool so that users can follow one community's progress through the entire MAPP process.
   • Tools – Worksheets, instruments, matrices, tip sheets, and other useful tools have been included where appropriate.
   • References and Resources – Descriptions and contact information for useful resources may be helpful to communities seeking to further tailor the process.

The MAPP guidance is intended to serve as a best practice model. MAPP should be implemented in the manner that best fits the needs of the community. Vignettes and tip sheets provide suggestions and ideas for tailoring the process. As MAPP is implemented across the nation, NACCHO intends to develop further recommendations and tips for customizing the process.

While it is presented as a phase-by-phase approach to community-wide strategic planning, MAPP represents a continuous process in which phases often reflect back on one another. Community-driven strategic planning is not a sequential activity and is most successful when it is interwoven with the activities of local public health system partners in a sustained manner.

Finally, it is worth restating that MAPP must be a community-driven process. There should be a high level of participation from community organizations and residents. The dialogue principles, discussed in the Tip Sheet – Engaging the Community, should guide community and stakeholder involvement. Boards of health and other governing bodies are especially crucial to a community-wide strategic planning effort, since they are necessary in implementing policy changes or making resource allocation decisions.

MAPP is intended to lead communities to an unprecedented union among the community organizations, agencies, groups, and individuals that comprise the local public health system. Through broad ownership, communities can create an effort that is sustainable, builds on collective wisdom, uses resources from throughout the community, and, ultimately, leads to community health improvement.

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