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May 2002
One of the hallmarks of the Urban Health Initiative is SYSTEMS
CHANGE. Systems change is a complex concept, and people may have
different understandings of it. In order to gain a common understanding
of the concept among those involved with the UHI, we have prepared
this paper to explain the UHI's definition of systems change.
Systems change, simply described, is getting best practices or
innovative ideas accepted and then generating or redirecting the
resources needed to support them for the long term. But systems
change is not simple to achieve. The following is a list of some
of the more common methods of securing change.
To change systems by using money differently:
- Obtain new resources from any source. Examples: private
donors, philanthropists, volunteer time, fees, insurance payments,
taxes, bonds, levies, etc.
- Expand currently available dollars. Examples: operate
under the aegis of federal matching grant programs such as SSA
Titles IV-E or XIX, private challenge grants, etc.
- Spend current funds for different purposes or with different
balance or emphasis. Examples: Moving federal, state or local
funds to address different problems or to support more effective
solutions. Asking business and private donors to evaluate or re-examine
their giving programs, etc.
To change how work is done:
- Reassign current staff or volunteers to perform new functions,
serve new groups, work in different locations, operate under different
rules, or otherwise perform differently in some way. Examples:
Community policing, PAL centers, using government workers to spot
child abuse, using teachers as health educators, using librarians
as after-school tutors, etc.
- Re-bid current service contracts. Examples: Focus key
strategies to support best practice standards. Focus services
on special target groups or areas. Encourage other funders to
use competitive bidding process instead of continuing allotments.
Compare costs of private health facilities vs. public, etc.
To change how either money is used or work is done:
- Change the rules, auspices or limitations previously placed
on funding sources so as to achieve more flexibility of application
for such funds, or to simplify administration. Examples: Secure
legislation to permit multi-year budgeting, litigation to open
a source of funds to an expanded group, reorganize government
departments or private agencies, negotiate or waive existing rules,
etc..
There are many methods that can be used to achieve any of the above.
Some of the most common vehicles are:
- Legislation or other policy rulings;
- Regulations or other administrative rules;
- Litigation;
- Retraining;
- Indispensable and visionary leadership;
- Changing performance evaluation measures.
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