Local public health projectification in practice: a qualitative study of facilitators and barriers to a public health plan implementation

Abstract

Aims: To identify factors perceived by local government employees to affect the implementation of a municipal public health plan. Methods: Qualitative individual interviews ( n=13) were carried out. Participants were sampled from three districts in Oslo municipality, Norway, and asked about their experiences with an ongoing implementation of the Oslo Public Health Plan (2017–2020). The conceptual framework of public sector projectification – a growing reliance on project organisation of policies – informed the study. The consolidated framework for implementation research was used to aid data coding and subsequent thematic analysis. Results: Implementation facilitators included factors perceived to support flexibility, including plan adaptability to the local setting, and factors perceived to enable structure and control during the implementation process, such as the articulation of specific goals and a shared understanding of public health work. Barriers were mainly related to complex aspects of the plan, such as the need to involve multiple stakeholders and levels of governance, and to tensions between the time-limited implementation process and the permanent organisational structures. Conclusions: This study has demonstrated how research-based methods can be used for the evaluation of a local community implementation process. It has identified implementation determinants using a predetermined taxonomy of operationally defined factors that are likely to influence implementation. However, while implementing a time-limited public health plan can be seen as ‘taking action’ in relation to multidimensional and complex problems, further research is needed to investigate whether plan implementation has a long-term impact on the surrounding organisation and, eventually, on public health outcomes.