Community Health Assessment and Improvement Planning
Public health is defined by three core functions: assessment, policy development and assurance. As part of a community health improvement process, LHDs complete community health assessments and community health improvement plans to support implementation of the three core functions. A variety of tools and processes may be used to conduct a community health improvement process; the essential ingredients are community engagement and collaborative participation.
PHAB describes the Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP) as follows:
The CHA is "a collaborative process of collecting and analyzing data and information for use in educating and mobilizing communities, developing priorities, garnering resources or using resources in different ways, adopting or revising policies, and planning actions to improve the population’s health. The development of a community health assessment involves the systematic collection and analysis of data and information to provide a sound basis for decision-making and action. Community health assessments are conducted in partnership with other organizations and members of the community and include data and information on demographics; socioeconomic characteristics; quality of life; community resources; behavioral factors; the environment (including the built environment); morbidity and mortality; and other social, Tribal, community, or state determinants of health status."1
The CHA is the foundation for the development of the CHIP. The CHIP is described as "a long-term, systematic plan to address issues identified in the...community health assessment. The purpose of the community health improvement plan is to describe how the health department and the community it serves will work together to improve the health of the population of the jurisdiction that the health department serves. The community, stakeholders, and partners can use a solid community health improvement plan to set priorities, direct the use of resources, and develop and implement projects, programs, and policies. The plan is more comprehensive than the roles and responsibilities of the health department alone, and the plan’s development must include participation of a broad set of community stakeholders and partners. The planning and implementation process is community-driven. The plan reflects the results of a collaborative planning process that includes significant involvement by a variety of community sectors."1
1. "Standards and Measures Version 1.5." Adopted December 2013. Public Health Accreditation Board. Available at: http://www.phaboard.org/wp-content/uploads/SM-Version-1.5-Board-adopted-FINAL-01-24-2014.docx.pdf
The first steps of a CHA/CHIP process involve two critical and interrelated activities: organizing the planning process and developing the planning partnership. The purpose of this phase is to structure a planning process that builds commitment, engages participants as active partners, uses participants' time well, and results in a plan that can be realistically implemented. This is the first phase of the MAPP process.
Find MAPP Phase 1 resources below.
Visioning guides the community through a collaborative process that leads to a shared community vision and common values.
Vision and values statements provide focus, purpose, and direction to a CHA/CHIP process so that participants collectively achieve a shared vision for the future. A shared community vision provides an overarching goal for the community—a statement of what the ideal future looks like. Values are the fundamental principles and beliefs that guide a community-driven planning process.
Visioning is ideally conducted at the beginning of the CHA/CHIP process, as it offers a useful mechanism for convening the community and building enthusiasm for the process, setting the stage for planning, and providing a common framework throughout subsequent phases. This is the second phase of the MAPP process.
Find MAPP Phase 2 resources below.
Collecting comprehensive data about a community is essential to understanding the health status and contributing and root causes that affect the local public health system and the community. This is the third phase of the MAPP process. Phase 3 contains four distinct assessments: the Community Themes and Strengths, Local Public Health System, Forces of Change, and Community Health Status Assessments.
Each assessment yields important information for improving community health, but the value of the four MAPP Assessments is multiplied by considering the findings as a whole. Disregarding any of the assessments will leave participants with an incomplete understanding of the factors that affect the local public health system and the health of the community.
Find MAPP Phase 3 resources below.
During this step, participants use data to develop and prioritize a list of issues facing the community. Strategic issues are identified by exploring the convergence of the results of the data collection efforts, such as through the four MAPP Assessments, and determining how those issues affect the achievement of the shared vision. This is the fourth phase of the MAPP process.
Find MAPP Phase 4 resources below.
During this step, participants take the strategic issues identified and formulate goals, strategies and an action plan related to those issues. The result is the development and adoption of an interrelated set of strategy statements and a plan of action including activities, timeframes, responsibility parties, and performance measures. This is the fifth phase of the MAPP Process.
Find MAPP Phase 5 resources below.
The Action Cycle links three activities—Planning, Implementation, and Evaluation. Each of these activities builds upon the others in a continuous and interactive manner. This is the sixth phase of the MAPP process - While the Action Cycle is the final phase of MAPP, it is by no means the "end" of the process.
During this phase, the efforts of the previous phases begin to produce results, as the local public health system develops and implements an action plan for addressing priority goals and objectives. This is also one of the most challenging phases, as it may be difficult to sustain the process and continue implementation over time.
Find MAPP Phase 6 resources below.
Essential to any CHA/CHIP Process is monitoring and evaluation. Below are resources to help you monitor and evaluate CHA/CHIP work.
Subcommittee Process Evaluation Survey: The San Antonio MAPP partnership developed this survey to gather feedback from MAPP committee participants and evaluate the overall MAPP process. Periodically using this survey will help determine the sustainability of the process.
Community Survey for Measuring Progress: The Northern Kentucky District Health Department created this community survey to measure how well its community was achieving its vision. The model standards are based on the strategic issues identified in the Example Master Health Plan from phase five.
PARTNER Tool: PARTNER (Program to Analyze, Track, and Record Networks to Enhance Relationships) is a tool that allows partners in a public health collaborative to measure and monitor their collaborative activity over time. The tool uses social network analysis to measure the relationships between partners and to demonstrate how resources are exchanged and the levels of trust within the collaborative. The tool includes a survey that is linked to an analysis tool, making it simple for anyone to send out a survey to their partners and analyze the data. The PARTNER tool is free, with various levels of technical support (including analysis, report and presentation preparation, and workshops) available.
W.K. Kellogg Foundation Logic Model Development Guide: This Logic Model Development Guide provides step-by-step guidance on creating and using logic models for program planning, implementation, and evaluation.
MAPP Outcome and Process Evaluation Tips: This PowerPoint includes process evaluation information for each of MAPP's six phases and tips on how to prepare for a MAPP outcome evaluation. The slideshow includes sample process and outcome evaluation questions and additional recommendations.
Gliffy Online Diagram Software: This free online software can help MAPP communities diagram planning, evaluation, and communication materials such as organizational charts, logic models, flowcharts, and business processes.
How to Monitor for Population Health Outcomes: This 52-page article, "How to Monitor for Population Health Outcomes: Guidelines for Developing a Monitoring Framework," was written by Dr. John Wren and published by the New Zealand Ministry of Health in July 2007. It provides guidance on how to develop indicators to monitor progress in achieving population health outcomes.
Models, Frameworks and Guides
- CDC Assessment and planning frameworks: CDC identifies common elements of assessment and planning frameworks and provides information about commonly used frameworks
- Mobilizing for Action Through Planning and Partnerships: Mobilizing for Action through Planning and Partnerships (MAPP) is a community-driven planning process for improving community health. Facilitated by public health leaders, this framework helps communities apply strategic thinking to prioritize public health issues and identify resources to address them. MAPP is not an agency-focused assessment process; rather, it is an interactive process that can improve the efficiency, effectiveness, and ultimately the performance of local public health systems.
- The Association for Community Health Improvement (ACHI) Community Health Assessment Toolkit: The ACHI Toolkit is a guide for planning, leading and using community health needs assessments to better understand -- and ultimately improve -- the health of communities. It presents a suggested assessment framework from beginning to end in six steps, and provides practical guidance drawn from experienced professionals and a variety of proven tools.
- New York State DOH Community Health Assessment Development Page: The NYSDOH has identified 10 steps in the CHA development process by using planning models and frameworks. This website contains descriptions of the 10 steps along with actions and checklists for each.
- Community Tool Box, Chapter Three: Assessing Community Needs and Resources: The Community Tool Box, created by the Work Group for Community Health and Development at the University of Kansas, provides information on how to build healthier and more equitable communities. Chapter Three of the tool box ("Assessing Community Needs and Resources") provides practical, step-by-step guidance on how to embark on the community health assessment process.
- Guide and Template for Comprehensive Health Improvement Planning, Version 2.1: This guide, created by the Connecticut Department of Public Health, Planning and Workforce Development Section, provides a framework for the development of health improvement plans through approaches that are logical, systematic, and based on historically successful planning initiatives, and is easily adaptable for use by other governmental and community organizations.