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EfshariBari in the City in 10 Steps

The ’10 Steps to EfshariBari in the City’ guide is under development and is intended to help local authorities develop a gradual program for advancing health in their respective cities

Information about the ‘EfshariBari in the City’ program
Information about the 30 local authorities which joined in 2018

The ten steps to EfshariBari in the City initiative; the steps are divided into three main steps in chronological order of implementation, from engaging the mayor, mapping, organization, construction of a work plan, implementation, assessment and evaluation. Having said that, it is important to remember that things are more complex in reality and at times, some steps occur simultaneously or in a different order.

Stage 1: How to start

Step 1: Initiation, committing the mayor and interested parties
Step 2: Appointment of Coordinator, Steering Committee and Leading Team (Management Infrastructure)
Step 3: Mapping needs and existing activities as a basis for planning and evaluation

Stage 2: How to get organized

Step 4: Set goals, objectives and success metrics
Step 5: Determine priorities and methods of action (towards formulation of a work plan)
Step 6: Developing plans with existing and new partners and pooling resources
Step 7: Preparation and approval of a multidimensional work plan

Stage 3: What to do

Step 8: Implementation and ongoing running of the program
Step 9: Advertising and communication with residents
Step 10: Assessment, evaluation and ongoing improvement


About the ‘EfshariBari in the City’ in 10 Steps’ work plan

The work plan presented here, ‘EfshariBari in the City in 10 Steps’ is the first part of the full guide for local authorities, which is under development and will be distributed in the future.
Even before development is complete, you can learn about the sub-stages at each step and use the comments and recommendations for tools, some of which access information and application tools for all stages.
The full work plan can be downloaded as a PDF from this link or perused below.
‘EfshariBari in the City in 10 Steps’ Work Plan

’10 Steps to EfshariBari in the City’ Work Plan

How to start: steps 1-3

Step Number Description of main actions Comments and recommendations for tools
Step 1: Initiation, committing the mayor and interested parties Initiation, contacting potential partners and preparation of the issue for presentation 
  • The initiative to create an environment that enables residents an active and healthy life (or empowerment), with emphasis on exercise, nutrition and a smoke free environment (EfshariBari in the City), can come in various ways and by taking various steps.
  • The move(s) can be led by one initiator or a group of initiators, including residents, from the local authority and outside of it
  • Recruitment of stakeholders and partners from the city's leading authorities and institutions. It is recommended that you continue to harness more partners and strengthen existing partnerships throughout the process.
  • Why join? Joining the national program enables a gradual and professional process of establishing a stable policy and making the authority one that offers a solution to many obesity and health problems through nutrition and exercise. The national program operates on mutually complementary levels, including legislation and regulation, infrastructure, field activities, and dissemination of applied information to the public, focusing on three main subjects: a healthy diet, incorporating exercise into daily life, a smoke free environment. It is recommended to review these documents even if there is no intention of joining the official program now, to promote steps to make the Authority more active and healthier. Summary of the EfshariBari in the City program.
  • About the EfshariBari National Program for Active and Healthy Living EfshariBari National Program.
    It is also recommended to view the EfshariBari National Project regarding a healthy lifestyle with an emphasis on nutrition and physical activity : Guide to Nutrition Promoting City (2017) | Active and Healthy City, 2012 | Healthy Nutrition – Ministry of Health
Presenting the topic to the mayor and harnessing them
  • It is important to determine in advance which factors will present the initiative to the mayor – it is advisable to form a team.
  • If there are difficulties in getting the process started, you can skip to step 5, take action and return to this step with proven successes.
Statement of public intent by the mayor and endorsement of the city council
  • Written commitment statement and/or a public statement, vital for getting the process started and ensuring its implementation. Example of statement document from the last call out.
    The mayor will convene the council members and get their endorsement.
  • It is advisable to issue a public statement at this stage, and/or at a later date in the process.
Step 2:Tea Appointment of Coordinator, Steering Committee and Leading m (Management Infrastructure) Appoint a program coordinator and determine the administrative mechanism
  • Appoint a dedicated coordinator with relevant experience and training, for at least 20 weekly hours. The role of the coordinator: harnessing partners, planning, managing and coordinating all the activities and moves to promote active and healthy living among the residents of the authority.The coordinator’s training, development and professional accompaniment must be monitored and updated. All this is provided by the ‘EfshariBari in the City’ program, health bureaus and the Healthy City network on Ministry of Health Website, Healthy City Network and EfshariBari Website. Full description of the coordinator role and recommendations for appointment.
  • The mayor or director or anyone on their behalf will decide on the administrative structure for determining and leading the actions, including responsibilities and hierarchies.
  • For cities in the Healthy Cities Network, a healthy city coordinator is recommended to serve as the designated coordinator or other role in the program.
Establishing a steering committee for the EfshariBari program or expansion of an existing committee
  • The committee will represent all partners inside and outside the authority, headed by the mayor, a counselor or director. The committee will meet regularly.
  • The steering committee should include: program coordinator, relevant departmental and unit managers in the authority (at least health, education, sports and welfare), Ministry of Health regional health coordinator, Ministry of Sports inspector, regional director of the Ministry of Education, resident representative, public sector, business and civil society stakeholders (associations) and spokesman representative.
  • General proposal for potential steering committee partners:
    • Chairman – Mayor or city council member
    • Coordinator – Process lead / urban health coordinator
    • embers: urban environment committee chair and members, urban health committee chair and members, city council members in charge of education, welfare and urban planning, director, city engineer, treasurer, departmental / divisional managers, representatives of the city's health system: district health bureau and kupat kholim, representatives of the district's welfare and environmental systems, representatives of  community groups: parents' committees, student councils and volunteer organizations, researchers on sustainability, public health, welfare, local government and public administration.
Consolidating a leading team
  • The coordinator will assemble a leading team or teams to assist in implementation of the program to be determined.
  • Teams will be involved in planning and execution of the program. For example, you can designate a data collection team, a partner harnessing team, and so on.
Step 3: Mapping needs and existing activities as a basis for planning and evaluation Mapping needs and activities carried out in the field
  • Collecting data (mapping) showing current realities in nutrition and exercise is essential for both planning and evaluation (see assessment measures in step 4).
    Mapping refers in part to the policy, environment and scope of the challenges facing the authority. It is recommended to do a mapping using EfshariBari in the City index questionnaire.
  • Existing sources of information can be used, and/or mapped and researched for specific areas and/or topics, depending on the authority's resources and planning progress. For example, a survey of residents, observations, expert opinions, health fund data, and more. Population Survey for Testing Health Behavior. You can use the resident questionnaire listed in Guidelines for preparing an urban profile on behalf of the Healthy Cities Network - pages 46-68, and the entire chapter C on information gathering
    The following surveys and reports can be used: Physical Activity Survey of Israeli Residents Over the Age of 21 (2012) | Knowledge, Attitudes and Behavior Survey - KAPHBSC Reports: An International Research Program on Youth Health and Welfare
  • Once all available sources of information have been exhausted, it is worth examining the existence of additional entities within the authority (e.g. Strategy and Planning Division) or outside the authority (e.g. academia) for assistance and integration later.
Preparing a report as a basis for planning and evaluation
  • Writing a conclusion and recommendation report for the authority on the basis of mapping (index questionnaire) to show the extent of the problem.
  • Relevant national and/or authority-level data can be displayed. Examples of national metrics and access to national data from the Ministry of Health:
    Ministry of Health state-of-the-art BI system enables analysis of student growth data by a variety of parameters. The data provides a basis for comparing trends over time and will help to evaluate intervention BI system for growth of students in Israel >>The Ministry of Health will soon launch a health data portal by region. 
  • In the Healthy Cities Network, the urban health profile can be used. Guidelines for preparing a Healthy Cities Network profileIt is recommended to use the principles, assessments and recommendations given in EfshariBari pilot evaluation report for local authorities.
  • The following factors may help to write the report and/or analyze data.Healthy Cities Network | Health Promoters in Health Bureaus | Health promotion professionals from the academy and the third sector.
Presenting the report before the steering committee Findings discussed by steering committee as detailed in step 4 below.

How to get organized: steps 4-7

Step Number Description of main actions Comments and recommendations for tools
Step 4: Set goals, objectives and success metrics Set goals and operative targets
  • Steering team discussion to formulate a list of achievable goals and objectives, including priorities, in line with the results of mapping and health professionals' recommendations.Sample goal: Increase number of health promoting schools by 25% in the coming year.
  • You can use a sample template to set measurable goals and objectives: smart, listed in the guide itself.
Determining success metrics for goals and objectives
  • Each of the objectives should be defined using relevant sources of information. For example – the index defined is the percentage of elementary schools promoting health in Israel. The source of information for this measure is data published by the Ministry of Education.
    Also, the methods of collection and the frequency of collection of the indices (quarterly / semi-annual / annual / bi-annual, etc.) should be determined.
  • It is advisable to use EfshariBari in the City key metrics as shown in the mapping questionnaire.
    Existing national indices can also be used, see step 3, for example:A star model of health promoting schools, as detailed in the call out.
  • Additional assessment metrics can be examined using qualitative tools (interviews, focus groups, etc.) or quantitative (questionnaires, telephone surveys, school surveys, municipal staff surveys, etc.).
Step 5: Determine priorities and methods of action (towards formulation of a work plan) The importance of an overall and multidimensional program In order to make a meaningful and sustainable change in the lives of residents, it is important to integrate a number of strategies at the policy, environment and individual level, and to implement intervention programs aimed at different audiences. Local policy programs are essential to implement long-term change, see below.
Determine actions in local policy In addition to setting specific health promotion measures throughout the authority, it is important to develop an overall urban policy in the following areas in particular: nutrition, exercise, and a smoke-free environment. This is to ensure a stable and permanent commitment on the part of the Authority. 
The policy set outlines the city's commitment to creating a sustainable environment, permeates into the authority’s executive fabric and enables residents to make healthy choices across all frameworks and stages of life– and most importantly, for the long-term.Sample actions: establish a policy for the existence of a designated and permanent health promotion officer (standard / department / permanent unit) in each local authority and council; compliance with EfshariBari threshold conditions every year and so on. Additional examples in the "Policy" category listed in each of the following tables are recommended (Physical Activity and Nutrition Policy).
Choosing actions in any of the following areas: Exercise, nutrition, a smoke free environment and breastfeeding
  • It is recommended to study and delve into the content worlds that are relevant to EfshariBari in the City – exercise, nutrition, and smoking prevention – and select at least one physical activity and at least one nutrition activity. Experience shows that working in these arenas at the same time leads to long-term results.
  • Exercise: You can use the Active, Healthy City Brochure, 2012;Anyone Can: A Guide for a Walking Trustee – Retirees and the Senior CitizensSports for All:
    A Guide to Running Exercise Programs and Popular Sports for Senior CitizensAn exercise recommendation table will be published soon, with relevant recommendations from world literature, along with application tools and examples from the field.
  • Nutrition: From joining the EfshariBari program, nutrition and food programs will involve a licensed nutritionist.A healthy nutrition recommendation table will be published soon, this table will include relevant global literature recommendations, along with application tools and examples from the field.
    It is also useful to use the New Guide for Cities Promoting Healthy Nutrition
  • Smoke-free environment: It is recommended to refer to the recommendations that appear in the smoke-free city brochure on the Healthy Cities Network Website. A table of recommendations on a clean environment based on recommendations from world literature will be published soon, alongside tools for implementation and examples from the field.We recommend following the new legislative amendments on smoking
  • Breastfeeding: Breastfeeding Promotion Committee; Promotion, protection and support for breastfeeding at Tipat Halav; Employed and student rights to breastfeed, work and study; Breastfeeding and return to work; EfshariBari Guide to Work – Breastfeeding; Breastfeeding encouragement video; The importance of breastfeeding
Step 6: Developing plans with existing and new partners and pooling resources Continue harnessing partners – and co-planning programs Formulating and writing various programs with relevant partners. It is recommended to strengthen relationships with existing partners as well as continuing to harness other partners relevant to the chosen course of action.
Resource planning, pooling and budget allocation Resources are required to realize work plans.
Occasionally, existing personnel or budgets from a particular department or partnership may be sufficient but sometimes additional personnel or budgets are required.
Given the possibility, the mayor and departmental partners will allocate dedicated budgets and allocate personnel resources and current budgets to realize various objectives.As part of EfshariBari in the City, support from the Ministry of Health should be monitored through call outs published from time to time. It is worthwhile to keep up to date on the Website of the local government center, the Ministry of Health, the Ministry of Culture and Sport and EfshariBari site.
It is recommended that you submit support requests to the Ministry of Culture and Sports from the sports budget. Sports Administration – Sports Budgets for Local Authorities. In addition, monitor call outs, support requests and grants – from relevant sources, including: Grants – Ministry of Culture and Sport, Ministry of the Interior, Health Promotion in Education Website
National budgets can be used such as the National Walking Encouragement Program (National Road Safety Authority), the National Smoking Prevention Program, the Cancer War Association, the Israeli Diabetes Association (Eyal), and more.
Step 7: Preparation & approval of a multidimensional work plan Writing an overall work plan that specifies actions, schedules, budgets and partners Establishing a written and detailed work plan for EfshariBari in the City, namely promoting healthy nutrition, exercise and a smoke free environment. The program consists of operations and programs that operate in different frameworks and channels and is aimed at a wide range of populations.
The program will include at least: goals and objectives, actions*, partners, implementation officer, scheduling and budget.
  • The program can include all or some of the health promotion principles. Guiding Principles in Health Promotion, including the Ottawa Declaration;You can use the information and staff of the Healthy Cities Network.
    Additional tools will be available upon completion of the guide.
Program approval The program must be approved by the steering committee and then by the mayor or anyone on his / her behalf, according to generally accepted procedures in each authority.
Exposure of the program to authority employees It is advisable to take all actions needed to acknowledge senior executives and employees of the program and continue to develop additional partnerships to implement the program.
Exposure is essential to committing all authority employees in promoting the various programs.

What to do: steps 8-10

Step Number Description of main actions Comments and recommendations for tools
Step 8: Advertising & communication with residents Distribution of information and publication of main axes of approved program After the program is approved, initial exposure is required. The publication will be done in collaboration with the spokesperson department, if any. If not, it is recommended that the coordinator be assisted by local communications agencies (ISRAC, local authorities, authority-owned billboards, etc.).
Official launch (ceremony / event) in the presence of the mayor  It is advisable to hold an event for the general public and advertise the event through billboards and local media, including the media and online press.
  • Using the EfshariBari in the City and/or Ministry of Health Logo requires approval from the staff accompanying the Health Ministry Project
Maintains regular contact with residents throughout the program
  • It is recommended to allow continuous communication with the general public throughout the program, for example: accessing and highlighting contact modes through the authority's Website, email, social networks.Advertising on the authority's Website and/or Facebook page, as far as possible.
    It is recommended to include a link to the EfshariBari National Project Website / page within a month of joining the “EfshariBari in the City” National Program Website.
  • If the authority does not have a digital platform, use the EfshariBari Website or EfshariBari Facebook page.Examples of offline platforms and media to which written information can be attached are: property taxes, local government, direct mail – creation and distribution of printed information, outdoor signage. 
  • Examples of local authority content can be found through the Local Authorities Map on the Local Government Center Website
Responding to public inquiries and mechanisms for feedback and suggestions 
  • It is advisable to set up a contact procedure (via the Public Inquiry Line – 106) and appoint a contact person at the authority.
  • It is useful to prepare an online feedback form and set up a timetable for the authority’s response. 
    For inspiration, you should look at public inquiries in general areas under the responsibility of the Ministry of Health.
  • Public feedback will help assess project progress
Step 9: Implementation and ongoing management of the multidimensional program Program implementation, assimilation and management Implement the program according to the work plan and ongoing management.
Implementation into selected frameworks while expanding program exposure among change agents: position holders who are in direct contact with target populations. For example – authority employees, education system employees, youth movement representatives and the primary health care system, volunteers, parents' committees, food providers and more.Ongoing training and change agents.
At this point, more partners can be hired to execute the program.
Synchronization with national programs and campaigns
  • Ongoing management of the program requires synchronization of actions and decisions taken at the national level of the EfshariBari in the City program and relevant government offices.
  • It is recommended to integrate an event program in coordination with national and global campaigns and activities, as published from time to time on websites and social networks of the Ministry of Health, the Ministry of Culture and Sport and the Ministry of Education and EfshariBari sites. And at the Ministry of Culture and Sports sites. For example – activity during breastfeeding week, national walking day and world health days.
  • You can keep up with professional factors in nutrition and physical activity, such as various sports associations, the Knesset lobby, and so on.
Ongoing updates All program partners must be regularly updated – inside and outside the authority, including professional and political echelons. It is important to choose methods of updating (e.g., personal meetings, written reporting, online reporting, etc.).Continuous review of partners and advocates for activity expansion and pooling of resources is recommended (see step 6).
Step 10: Assessment, evaluation and ongoing improvement  Assessment and monitoring Systematic monitoring of components of the work plan – and an examination of executors. Regular contact with partners for monitoring the application, identifying challenges and exploring possible solutions.
Assessment and evaluation
  • Track the metrics set for the work plan in Step 4, according to predefined points in time.It is advisable to use research and measurement personnel and determine factors that can assist in planning and execution.
  • EfshariBari in the City indices questionnaire – it is recommended to use it as a monitoring tool for examining change and progress of healthy behaviors. You can use the resident questionnaire in the guideline for preparing an urban profile on behalf of the Healthy Cities Network – pages 46-68, and the entire chapter C on information gathering.
  • It is recommended to use the principles, assessments and recommendations given in EfshariBari pilot evaluation report for local authorities.
  • The scope of assessment and measurement varies according to the size of the authority and its resources. In small municipalities this can be done informally, and in larger municipalities – through surveys, interviews and discussion groups, feedback from residents and the like.
Focused evaluation of intervention programs Certain intervention programs*, for example, a Tipat Halav intervention program or pilot program, require planning and implementation of assessment and measurement according to goals and objectives. The evaluation that accompanies the intervention programs as determined in the planning and development phase must be performed and monitored.*As opposed to the program including EfshariBari in the City.
Analysis of findings and their presentation in an evaluation report – receiving feedback At the end of each assessment period, as predetermined, a report / presentation summarizing what has been done up to the point in time during which an evaluation has been carried out must be included, and the attainment of goals and objectives and/or recommendations for attainment, if not yet achieved. The report / presentation to the mayor and various forums should be provided for feedback.

Congratulations on completing the 10 Steps to EfshariBari in the City! Where to go from here?

Ongoing improvement

Continue operating in accordance with feedback received. This process is spiral and allows you to continue to deepen efforts for EfshariBari in the City, while accurately matching relevant parameters. Therefore, at the end of the 10 steps, we recommend returning to the top of the table – re-emphasizing the mayor's commitment, ensuring up-to-date mapping and completing blanks if necessary.  This is an opportunity to promote programs that have stalled due to exchange of manpower and/or budget constraints, refresh budgets and existing partnerships as well as harnessing new partners for the upcoming year.

EfshariBari in the City in 10 Steps work plan (Hebrew)