Whenever I used to write anything about health impact assessment I started with "HIA it is a new field". That’s no longer the case. People have been grappling with how to make HIAs routine for more than twenty years. This has taken different forms. It’s described as institutionalisation, mandating, capacity-building, integration, harmonisation and even theoretical alignment. People have often conflated quite different HIA activities as the same thing, complicating things. This led to people talking at cross-purposes.
How to make HIA part of routine practice is really none of these things. It’s about how we get HIA to the next level.
The next level?
What do I mean by this? The next level represents deeper embedding in routine practice. A more sophisticated understanding of when HIA can be useful. A large enough body of practitioners with varying levels of experience.
These challenges apply within countries but also globally.
How do we get from where we are to this next level? We have describe what the current state of practice is (this varies). We also have articulate what our desired future state would be. And then we have to describe what steps lie between.
Maturity models can help us.
Maturity models
Maturity models are quality improvement tools that were first used in information technology. ‘Maturity’ referred to the optimisation of processes, including changes from ad-hoc to formalised arrangements and ongoing quality improvement. This involved describing different levels of maturity across several different domains.
The different domains in a maturity model are usually rated for their maturity:
- initial - involves individual heroes, is not well documented and hard to replicate
- repeatable - processes are well enough described or understood that they can be repeated
- defined - the processes are defined and confirmed
- managed - the processes are managed in line with agreed metrics
- optimising - process management includes ongoing optimisation and improvement.
In some cases a sixth level is added. This involves embedding capability across all processes.
What would HIA maturity models include?
HIA maturity models would enable us to think about which domains of maturity matter. These could include:
- organisational capacity
- workforce
- leadership
- resources and tools
- resource allocation.
I think use of maturity models would enable more sophisticated thinking about capacity building. It would enable discussions to move beyond their historical focus on regulations and workforce. I've attempted to pull together a draft HIA maturity model below.
This model isn't perfect and it won't be applicable in all settings. It will need to be adapted, changed and maybe even started from scratch. I hope maturity models like it will enable a more nuanced way of thinking about the domains of capacity that are required and to focus activity and investment.
In summary
Maturity models give systems, organisations and HIA practitioners a better framework for understanding the range of capabilities that we need for HIA to flourish. HIA maturity models would identify:
- the domains of HIA capability
- provide a basis for appraising HIA capability, development and performance
- describe the characteristics of different levels of HIA capability
- provide a description of what enhanced capability and practice would involve.
I think maturity models represents a promising area of practical and conceptual development for HIA. I'm interested in what you think.
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