This chapter describes the results of an OECD survey to map community health actions in the Basque country. It provides an overview of the level of involvement of different actors and the population groups targeted, as well as resources involved.
Community Action to Strengthen Health Equity in the Spanish Basque Country
Abstract
Community action has gained importance in the Basque Country in recent years. However, a comprehensive overview of the scope and purpose of initiatives, the involved actors, and the processes in place to organise, co‑ordinate, and finance community action is missing. Such information could serve as a foundation for a future strategy for community action, by integrating existing efforts into a unified and coherent approach. To gather information on ongoing community action initiatives, an extensive online survey was widely distributed to stakeholders throughout the Basque Country (Section 6.1 describes the details of the OECD survey). The OECD survey complements a survey undertaken by Osakidetza among its staff about ongoing community action within Osakidetza by expanding the set of actors and therefore providing a more complete picture of ongoing efforts (refer to Chapter 3, Section 3.3.3 for more information on the mapping undertaken by Osakidetza). The OECD survey also complements the information on the role of the DHBC summarised in Chapters 2 to 5.
This chapter starts with a description of the OECD survey, its distribution process, and the respondents, followed by a detailed overview of the scope of community action in the Basque Country (Section 6.1). It highlights the number of initiatives run by various institutions and across localities and gives an overview of the level of involvement in community action of different actors in the Basque Country (Section 6.2). The chapter also discusses the population groups targeted by current community action initiatives (Section 6.3) and ends with a description of the involved costs and funding sources used by various institutions (Section 6.4).
To collect information on ongoing community action, an online survey was distributed as widely as possible among various stakeholders involved in community action in the Basque Country. The survey was implemented in LimeSurvey1 and was designed to be completed in about 30 minutes. It asked respondents about the number and context of community action initiatives they are currently involved in, how they organise, co‑ordinate and finance initiatives, the initiatives’ target groups, monitoring and evaluation tools used, as well as their general feedback on community action.
The survey link was sent via e‑mail by the DHBC to various stakeholders involved in community action, including:
all municipal governments
all community nurses and reference persons in health centres (refer to Chapter 3, Section 3.3.3 for an overview over staff working on community action within Osakidetza)
all public health technicians2 and health promotion technicians from within DPHA (corresponding to almost the entire workforce within the DPHA)
all affiliated pharmacies to the three official colleges of pharmacists in the Basque Country
third sector actors engaged in community health who are known to the DHBC.
To increase response rates, the e‑mail also asked respondents to forward the survey to anyone working in community action. The first e‑mail was sent on the 23 January 2024 to close to 900 staff of municipalities, Osakidetza, and the DPHA as well as contacts from the third sector, and on 31 January to more than 4 300 pharmacists working in the 843 pharmacies in the Basque Country. Pharmacists were therefore by far the largest recipient group, followed by Osakidetza employees. A reminder was dispatched to all recipients on 15 February 2024.
The e‑mail hence reached the representative sample of all municipal governments and all pharmacies in the Basque Country, as well as all relevant staff working on community action within Osakidetza and the DPHA. The sample is less complete for the third sector as it relied on the contacts available to the DHBC.
A total of 256 respondents answered the survey, of which 177 respondents completed 100% of the questions included in the survey and another 79 respondents answered at least half of them (see Figure 6.1). Of the 177 people who completed the survey, nine replied that neither they nor anyone else at their organisation is involved in community action, corresponding to about 3.5% of responses. These responses are dropped from the analysis. Among those involved in community action who filled in the survey completely, the largest share of respondents works for Osakidetza (51 respondents), followed by 31 respondents working at a municipal government and 24 working at the DPHA. Also counting responses who answered at least half of the survey increases responses from Osakidetza to 64, from municipal governments to 44 and from the DPHA to 30. Among those 44 however, several are employed within the same municipality but in different services, reducing the count of responses from unique municipalities to 32. Of the respondents from within Osakidetza, about half report to be working in primary care (32) and a quarter are employed as community nurses (17). Only one respondent reports to work in a mental health centre.
While pharmacists were by far the largest recipient group who received the e‑mail with the survey link, only 28 filled in the survey completely. An additional 42 started but did not complete the full survey. These numbers correspond to a response rate of between 0.6‑1.6%. The low response rate and the low completion rate confirm feedback from pharmacists collected before and after the survey who often found that the survey did not correspond well to the type of projects that pharmacies are involved in (see Box 6.1 for an overview) and was therefore difficult to answer. As discussed in Chapter 1, the health promotion initiatives run by pharmacies do not fall strictly within the category of community action, as they are often run in isolation and without collaboration with other local actors. For this reason, the evaluation of the survey responses in Chapters 6 and 7 excludes responses from pharmacists and focusses on the 180 responses (140 complete and 40 answered at least half) obtained from other institutions instead.
Respondents are geographically well distributed, as 58% of all responses are from individuals working in municipalities outside the three biggest cities. One exception to this pattern are respondents from Álava, who report to work in Vitoria-Gasteiz almost exclusively. Given the overall population distribution of Álava, with almost 80% of the population living in Vitoria-Gasteiz, this response pattern is not surprising (Instituto Vasco de Estadistica, 2023[1]). The geographical distribution of respondents from the individual institutions is very similar to the total distribution of responses plotted in Figure 6.1, with the exception of respondents from the third sector who are much less dispersed and report to mainly work in one of the three big cities.
Number of respondents from each institution by completeness status (Panel A) and number of respondents who report to work in each municipality (Panel B), 2024
Note: “Completed answers” refers to respondents who filled in all questions of the survey and submitted their answers. “Answered at least half” refers to respondents who have proceeded to answer at least the first half of the questionnaire. “No participation” refers to respondents who report that their institution is not involved in community action. If this answer option is chosen on the first page, the survey automatically terminates, and the answer is therefore recorded as completed. The municipality refers to the respondent’s place of work. Panel B is computed using the total of 180 responses. This includes responses who filled in at least half of the survey but excludes all responses from pharmacists. DHBC is the abbreviation of Department of Health of the Basque Country and DPHA is the abbreviation for the Directorate of Public Health and Addictions within the DHBC.
Source: Data collected via the OECD community action survey.
Interviews with representatives from the official college of pharmacists of Gipuzkoa and members from the Pharmacy Directorate within the DHBC revealed that pharmacies often run various initiatives for their local communities. A typical example of such initiatives is the Methadone Maintenance Programme, which offers supervised treatment with methadone to individuals suffering from addiction. Other programmes offer free fast tests for sexually transmitted diseases such as HIV or free tests of cholesterol levels or blood pressure. For more details on these programmes offered by pharmacies refer to Chapter 3, Section 3.3.1.
While these initiatives make a significant contribution to health promotion and prevention in the Basque Country, they typically do not fall strictly within the category of community action. This observation is also reflected in the low number of pharmacies that are part of local networks for health and well-being, a finding from the OECD mapping survey (Section 6.2) and confirmed in a mapping undertaken by the official college of pharmacists of Gipuzkoa on pharmacies’ involvement in local networks in the second quarter of 2024 (Otaegui Arrazola, 2024[2]). That survey found that, in the first half of 2024, only 12 of the 288 pharmacies in Gipuzkoa were part of a local network. Nevertheless, many pharmacies expressed a strong interest in becoming part of such networks in the future and some new networks will be established before the end of the year.
The survey in Gipuzkoa additionally uncovers two initiatives involving pharmacies that employ a community action approach. The first is the initiative Farmazia Lagunkoia, which is part of Donostia Lagunkoia, the San Sebastián Friendly City project. Farmazia Lagunkoia utilises focus groups consisting of pharmacies, representatives from the colleges of pharmacists, pharmacy users (in particular older people), professionals from health and social services as well as representatives from various associations to develop criteria for friendly pharmacies for older people. The programme is currently extended to all of the Basque Country under the name Euskadi Lagunkoia.
Erlauntza, operating across neighbourhoods in Donostia-San Sebastián, is another initiative of pharmacies that employs a community action approach. The core of this initiative are neighbourhood networks linking various actors who work at the neighbourhood level with the aim of sharing knowledge and establishing connections to facilitate joint work and new projects. Typically, the network members include local pharmacies, health centres, representatives from the department of health, from local sports centres, from local culture centres, from local associations, as well as technicians from social services and health promotion from the city council of Donostia-San Sebastián.
The success of these two initiatives has demonstrated the value of including pharmacies in community action work. Through their accessibility and daily interactions with the community, pharmacies receive real-time information on both health concerns and resources of the local community, and they are in an ideal position to disseminate information and promote various offers and services available within the community to the community. The mapping survey undertaken by the official college of pharmacists of Gipuzkoa further revealed strong interest by pharmacies to be more engaged in community action in the future and the official college of pharmacists of Gipuzkoa is aiming to increasingly promote community action among pharmacists in the Basque Country.
Source: Otaegui Arrazola (2024[2]) and discussions of the authors with representatives of pharmacies in the Basque Country.
Assessing the response rate for the remaining institutions excluding pharmacies, reveals that of the about 900 recipients who received the e‑mail with the survey link, slightly above 20% filled in the survey at least half and 16.5% filled it in completely. It is at first glance challenging to understand whether this response rate allows for a representative picture of ongoing community action in the Basque Country. On the one hand, it is likely that mainly the organisations who are most involved in community action replied to the survey and the survey is therefore unlikely to be fully representative of all institutions in the Basque Country. Further, only a selected sample of third sector organisations who are known to the DPHA received the survey link, making it unlikely that the respondents from the third sector are representative of all the work on community action by the third sector. On the other hand, several considerations demonstrate that the survey is likely to have reached a fairly representative share of organisations among the DPHA, Osakidetza and municipal governments that are currently actively involved in community action in the Basque Country.
First, the wide distribution of respondents both across locations and across institutions is reassuring as it shows that the survey reached a diverse set of institutions and locations across the Basque Country. Second, a closer look at the number of possible respondents by institution reveals that among municipalities and Osakidetza, for instance, a sizeable share of all possible organisations active in community action responded to the survey.
Benchmarking the 32 distinct responses from municipal governments with the 56 municipalities that have received support from Bherria, an organisation aiding municipal governments with various aspects around community action over the last 7‑8 years,3 sets the response rate among municipal governments active in community action at close to 60%. A similar exercise for Osakidetza shows that the survey has potentially been answered by about 50% of all health centres (excluding mental health centres), with 63 responses from local health centres (excluding one response from a mental health centre) and a total of 122 health centres in the Basque Country (Open Data Euskadi, 2023[3]).4 A response rate of close to 50% among Osakidetza is also plausible as 17 out of a total of 36 community nurses answered the survey questionnaire. Comparing the total responses from district staff of the DPHA to the total number of staff employed by the DPHA at the district level (refer to Chapter 4, Table 4.2 for an overview of staff at the DPHA), shows that the response rate among district staff of the DPHA is very close to the overall response rate of 20%.
Overall, although the survey responses are unlikely to be a good representation of all community action in the Basque Country, they are likely fairly representative of the actors who are currently most actively involved in community action in the Basque Country. The survey hence allows to draw valid conclusions on aspects related to the organisation of community action in the Basque Country within all surveyed organisations.
In a first step, the survey aimed to assess the extent of community action in the Basque Country by asking about the number of ongoing projects of an organisation that can be classified as community action. To ensure the collection of comparable data, the survey defined community action on the first survey page as follows:
“Community action is, above all, a type of social action. Community action for health is defined as the social relations of cooperation between people in a given area or space of coexistence (community), with a triple transforming function:
Improve the living conditions of those who inhabit the coexistence space (improve the social determinants of health and reduce health inequalities in that space).
Strengthen links and social cohesion, without forgetting groups in situations of exclusion.
To enhance the capacities for individual and collective action in processes to improve their health and well-being (to favour the autonomy of the community and its capacity for self-management and organisation).
The community is defined as:
The population living together in a specific geographical space (neighbourhood, village, town, city...) and is aware of its identity as a group sharing needs and resources.
A community is defined by three key factors:
Proximity around a common territory.
Links of interest, identity or functional ties. Its members are aware of their identity as a group and share needs and resources.
The agents, who jointly play a leading role and condition collective life in that space. These agents are the citizens (organised and unorganised), the technical resources (that offer their services to the citizens) and the administrations (managers of the public).”
The survey results show that there is considerable community action ongoing in the Basque Country. Summing up the number of initiatives reported and removing potential duplicates5 reveals a conservative estimate of 1 180 active community action initiatives (Figure 6.2). This number is significantly more than the 337 active initiatives collected on the Euskadi Aktiboa platform run by the Health Promotion unit from DPHA to gain an overview over ongoing initiatives (see Chapter 3, Section 3.2.1). Part of this discrepancy could be explained by a different understanding of the concept of community action by different actors however, the structure of the OECD community action survey does not allow for a more in-depth analysis of the initiatives mentioned. The survey only asked respondents for the total number of ongoing community action initiatives but did not require the respondent to provide more details on the nature of the initiatives. It is hence difficult to assess whether these initiatives covered in this report indeed all adhere to the definition of community action mentioned at the beginning of the survey. Other reasons for this discrepancy could be a higher visibility of the OECD community action survey due to renewed interest in community action by the DPHA and related communication activities.
The initiatives are spread out geographically across municipalities, with 53 out of 56 municipalities with at least one respondent reporting ongoing initiatives. More than 700 of the initiatives are concentrated in the four largest cities of the Basque Country, with most happening in the Bilbao area (307 initiatives).
The intensity of participation in community action among different actors is not easily quantifiable with the data gathered in the OECD community action survey. This section elaborates on several measures for assessing the intensity and significance of community action, highlighting their respective advantages and disadvantages when evaluating community action intensity for a specific organisation.
The most straightforward measure of community action intensity within an organisation is the total number of ongoing initiatives. On average, third sector organisations report the highest number, with a mean of 13 initiatives per organisation (Figure 6.2). Following are municipal governments, with an average of 9.7 initiatives per municipality, and Osakidetza with an average of 6 initiatives per respondent. Respondents from the DPHA at the district level report an average of 3.8 initiatives and a total of 51 ongoing initiatives spread across 14 municipalities. It is important to recognise that the average number of initiatives per organisation is linked both to the strategic orientation and main task of an organisation, as well as its size. While neither Osakidetza nor the DPHA’s nor municipal governments sole focus is on community action, it may well be the main focus of certain third sector organisations.
Average number of initiatives per organisation within an institution (Panel A) and total number of reported community action initiatives by respondent’s municipality of work (Panel B), 2024
Note: DPHA is the abbreviation for the Directorate of Public Health and Addictions within the Department of Health of the Basque Country. The figure is based on 180 responses.
Source: Data collected via the OECD community action survey (see Section 6.1).
Further corroborating evidence that third sector organisations are more likely to focus mainly on community action than other institutions surveyed is shown in Figure 6.3. The figure demonstrates that among surveyed third sector organisations, many report that their employees work 50% or more of their time on community action. This finding is in stark contrast to Osakidetza or district level DPHA staff who mostly dedicate less than 10% of their time to community action.
Analysing the number of staff involved in community action as a measure for intensity by computing the full-time equivalent reveals that an average of 2.7 full-time equivalent employees work on community action in third sector organisations.6 Osakidetza respondents report an average of 1.7 full-time equivalent employees, followed by an average of 0.75 reported by municipal governments, and an average of 0.54 by district staff of the DPHA.
Close to 90% of third sector staff reports having a mandate for health promotion, making community action an official part of their work duties.7 This percentage is similar or higher among all other institutions shown in Figure 6.4, with the exception of the DPHA at the district level (see Box 3.1 of Chapter 3 for a description of the territorial organisation of the DPHA). Among staff at the DPHA district level, 35% indicate not having such a mandate, suggesting that more than a third of the DPHA staff at the district level engage in community action despite it not being part of their job description. This finding is in line with the observation that only very few employees of the DHBC (in full-time equivalents only 5) have a mandate for health promotion and that all of them work either at the central or sub-directorate level as discussed in Chapter 4, Section 4.2.1. DPHA employees at the district level do not have a mandate for health promotion.
The percentage of work hours employees spend on community action work, 2024
Note: The different shades of green denote the share of their work time that employees devote to community action. DPHA is the abbreviation of the Directorate of Public Health and Addictions within the Department of Health of the Basque Country and district refers to the DPHA district employees. The figure summarises the 164 responses from the institutions listed on the horizontal axis.
Source: Data collected via the OECD community action survey (see Section 6.1).
Figure 6.4 further shows that, in line with most respondents having a health promotion mandate, a total of 60% respondents report to work on community action only during their work hours. The rest either divide their time spent on community action between work hours and free time, or work only on their personal time. Working on personal time is particularly common among district staff of the DPHA with close to 45% of such respondents reporting to work on community action in their free time. This share is around 33% for the other respondents. In all cases, personal time spent on community action is often considerable, with a reported five hours per week on average.
An organisation’s focus on community action can also be assessed by the strategic priority placed on it by the (local) leadership of an organisation. Figure 6.5 shows the respondents’ perception of the strategic priority of community action at their local organisation by institution. Respondents from the third sector perceive a longstanding and high importance of community action in their organisation, while the perceived importance of community action in municipal governments and Osakidetza is larger today compared to the past. In contrast, the perceived strategic priority remains low among staff of the DPHA. This finding might reflect the discordance between the work undertaken at the central level of the DPHA, which has had a high strategic priority for community action for many years, and the lack of an official mandate (and resources) for the DPHA professionals working in the sub-directorates and district offices (see Chapter 3 and 4 for a discussion) In line with the low perceived strategic priority among respondents from DPHA, 56% of respondents from district offices of the DPHA name lack of a global strategy as one of the top three major challenges for community action in the Basque Country, the highest percentage among all institutions considered (see Chapter 7, Section 7.7).
Share of respondents who work in community action with and without a mandate for health promotion, by institution, 2024
Note: The share of respondents who report not to have the mandate for health promotion but who work on community action nonetheless is shown in light green. In dark and medium green are those who do have the mandate for health promotion. Among those, those who participate in community action only during work hours are shaded in dark green, and those who participate both during work hours and during personal time are medium green. DPHA is the abbreviation of the Directorate of Public Health and Addictions within the Department of Health of the Basque Country. The figure summarises responses by 166 respondents from institutions on the horizontal axis.
Source: Data collected via the OECD community action survey (see Section 6.1).
Share of respondents who agree with a statement about the perceived strategic priority of community action at their local organisation, by institution, 2024
Note: The figure shows the share of respondents who report that their perception of the strategic priority that the leadership of their local organisation assigns to community action is “low”, “neither high or low”, “low in the past”, “more important now”, or “high for many years”. DPHA is the abbreviation of the Directorate of Public Health and Addictions within the Department of Health of the Basque Country. The figure summarises responses by 164 respondents from institutions on the horizontal axis.
Source: Data collected via the OECD community action survey (see Section 6.1).
A last measure for the importance an organisation assigns to community action is whether an organisation participates in networks for community action. Such networks are a common way to co‑ordinate and organise stakeholders involved in community action and are recommended by the Basque Government in the Methodologic guide to address health from a community perspective (Chapter 3, Section 3.2.1) to promote community action. The OECD community action survey first inquired whether the organisation a respondent works for is part of a local network (network with local stakeholders such as individuals, representatives of associations, etc.) and/or an institutional network (network with mainly institutional actors such as municipal governments, the DPHA, etc.). Results show that participation in both local and institutional networks is frequent among most institutions with 87% of respondents from Osakidetza, DPHA, municipal governments and the third sector reporting to be part of at least one network and 62% reporting to be part of both types of networks. A geographical analysis reveals that although networks are prevalent across the three provinces, they are most common in Gipuzkoa.
Additionally, the survey asked respondents to indicate the other organisations that are part of their networks. Examining the groups most frequently mentioned as other local network members by respondents reveals that government staff working closely with people (such as social service workers, district staff of the DPHA, teachers, etc.) are the most prevalent members of local networks, closely followed by community nurses and other healthcare professionals (Figure 6.6). There are only few mentions of non-institutional members such as representatives of excluded groups (immigrants, isolated groups, ethnic minorities, and low socio‑economic status groups), suggesting that even local networks seem to remain mainly at the institutional level.
Number of times a group on the horizontal axis was mentioned as a member part of the same local network as the respondent, split by the respondent’s institution, 2024
Note: The figure plots the number of times a group is mentioned as being part of the same local network as a respondent, with the respondent’s institution highlighted in different shades of green as indicated in the legend. To green shades are rescaled to reflect the share of answers coming from a certain institution among the total times an answer on the x-axis was chosen. The rescaling avoids that, for example, Osakidetza would occupy a much larger share of each bar simply because the survey was answered by more respondents from within Osakidetza compared to other institutions. The rescaling also allows to compare answers from different institutions both within and across bars. DPHA is the abbreviation of the Directorate of Public Health and Addictions within the Department of Health of the Basque Country. Government staff working closely with people includes, among others, social service staff, district staff of the DPHA, and teachers. The figure summarises responses by 131 participants.
Source: Data collected via the OECD community action survey (see Section 6.1).
Combining the results from the various measures suggests that work on community action is particularly important among the third sector. But also municipal governments, Osakidetza, and to some extent the DPHA are increasingly involved in community action.
Although a significant share of community action targets the entire community (around 42% of all reported initiatives, see Figure 6.7), the majority of initiatives in the Basque Country focus on a specific segment of the population. Asking respondents to list the main target groups of their initiatives shows that initiatives most often target young people and the elderly. Other common target groups are women or individuals with substance use disorder (Figure 6.7). Especially among Osakidetza and the third sector, initiatives targeting specific health issues are also common.
The OECD community action survey aimed to not only evaluate the primary target groups of initiatives, but also the key issues being tackled by ongoing community action initiatives. As the literature puts forward that one important motivation for relying on community action is its potential impact on social cohesion and inequalities (Popay et al., 2021[4]; Popay, Whitehead and Povall, 2007[5]), the survey asked respondents to estimate the proportion of initiatives they believe to affect either. At 51% and 45% respectively, the results indicate that respondents believe about half of initiatives to improve social cohesion and slightly fewer of them to reduce inequalities.
Lastly, respondents were asked to gauge the reach of their initiatives by commenting on the share of the eligible population they believe participates in their initiatives. The majority of respondents estimate their reach to be slightly less than 30% of their target population, with most estimates falling between 25‑35%. Notably, the figures provided by staff from the DHPA are lower, reported at 18% of their target population.
Number of times a specific target group/concern was mentioned by the respondents of the survey (left axis) and share of initiatives that target the whole community (right axis), 2024
Note: The figure shows the number of times a specific target group or concern is mentioned by respondents as the target group/concern of at least one ongoing initiative for community action in dark green. The corresponding axis the left-hand side axis. The light green bar shows the reported share of initiatives that target the whole community. This is based on 137 responses. The corresponding axis is on the right-hand side.
Source: Data collected via the OECD community action survey (see Section 6.1).
The OECD community action survey reveals that approximately 70% of ongoing initiatives require additional funding beyond salaries paid to employees working on community action. The percentage varies slightly across institutions and is highest among municipalities (77%) and lowest among Osakidetza staff (63%).
Institutions employ varying strategies to finance the additional costs for community action initiatives, where additional costs refer to all costs incurred to set up and run an initiative apart from the salaries paid to staff members. Examples for additional costs might be costs to advertise an initiative (posters, flyers), the provision of food or drinks for an initiative, buying/renting material, etc. Osakidetza entities indicate that they pay around 61% of these additional costs from the budget of their OSI or local health centre, while municipalities cover about 50% of the additional costs with municipal funds. Staff working at the DPHA district level report no own contributions, in line with district offices of the DPHA not having a separate budget from the territorial vice directorate offices of the DPHA.
The remaining costs are funded through various external sources, with grants from the central DHBC being the most popular (Figure 6.8) (see Chapter 3, Section 3.2 for an overview over the grants available from the DHBC and to Section 3.1.2 for a discussion of the amounts).8 Despite the relatively small budget devoted by the DBHC to community action compared to the total budget of the Department (see Chapter 4), DHBC grants are utilised and appreciated by numerous institutions implementing community action initiatives in the Basque Country. Grants from municipal governments, from other departments of the Basque Government, and from provincial governments are also important external funding sources, with municipal grants being particularly important for Osakidetza, the third sector, and pharmacies. Conversely, grants from foundations or private donors play a negligible role.
The OECD community action survey demonstrates that DHBC grants are not only used widely, but also receive high satisfaction ratings from respondents who use them regarding the application and reporting process. Among those who have received funding, nearly 80% of respondents find the criteria for obtaining the DHBC grants transparent, and approximately 60% consider both the application and reporting process after receiving the grant to be straightforward. Osakidetza employees stand out with 75% reporting that both processes are cumbersome. There is more consensus among respondents on grant amounts, with less than 46% finding DHBC grant amounts adequate to cover a substantial portion of the costs of a community action initiative. This indicates that the maximum grant amounts set by the DPHA described in Chapter 3, Section 3.2. might be inadequate to cover most initiatives.
Aside from DHBC grants, many respondents also benefit from support for community action provided by municipal governments. The most common form of support from municipalities is the provision of facilities such as meeting rooms and gyms, offered free of charge. Nearly 90% of respondents from municipal governments state that their municipality provides such access, and more than 55% of other respondents currently benefit from this offer. In addition to facilities, over 70% of municipal governments further provide financial support for community action initiatives, and slightly more than 60% offer technical support when needed. Other contributions from municipal governments, such as providing food or drinks for events or offering sponsored items like T‑shirts for sports events, are less common, with only 10‑20% of municipal governments providing such in-kind support.
Number of times a funding source was mentioned in the top 3 of financing sources used by respondents, 2024
Note: The underlying question asked respondents to pick the funding sources used from the list of sources shown on the horizontal axis, and to then rank them according to usage. The figure plots the number of times a funding source was chosen by respondents in the top 3 of funding sources used. DHBC is the abbreviation of Department of Health of the Basque Country and DPHA is the Directorate of Public Health and Addictions within the DHBC. The underlying question for this figure was answered by 116 respondents.
Source: Data collected via the OECD community action survey (see Section 6.1).
Despite the grants from the DHBC and support from municipal governments, respondents nonetheless name funding as third most important challenge for further improving community action in the Basque Country. Other challenges to community action as perceived by respondents are described in more detail in Chapter 7, Section 7.7.
References
[1] Instituto Vasco de Estadistica (2023), Population by districts of Alava 2023, https://en.eustat.eus/elementos/ele0011400/population-by-districts-and-censual-sections-of-alava-according-to-sex-age-groups-and-nationality/tbl0011433_i.html (accessed on 10 April 2024).
[3] Open Data Euskadi (2023), Centros de salud, ambulatorios y hospitales públicos de Euskadi, https://opendata.euskadi.eus/catalogo/-/centros-de-salud-publicos-en-euskadi/ (accessed on 11 April 2024).
[2] Otaegui Arrazola, A. (2024), Papel de la farmacia comunitaria en las redes locales de salud de Gipuzkoa, Unpublished.
[4] Popay, J. et al. (2021), “Power, control, communities and health inequalities I: theories, concepts and analytical frameworks”, Health Promotion International, Vol. 36/5, pp. 1253-1263, https://doi.org/10.1093/heapro/daaa133.
[5] Popay, J., M. Whitehead and S. Povall (2007), Community engagement in initiatives addressing the wider social determinants of health A rapid review of evidence on impact, experience and process WHO-EURO View project Socioeconomic inequalities in risk of and exposure to gastrointestinal infections in the Uk View project, https://www.researchgate.net/publication/242611483.
← 2. This group includes food safety and environment safety inspectors. Refer to Section 3.2.4 for more details on mandates and functions of DPHA staff.
← 4. While it is not possible to rule out that some of the 63 responses refer to the same health centre, the fact that only the four largest municipalities, all with multiple health centres, register more than one response from Osakidetza suggests that most of the 63 responses are from unique health centres.
← 5. Removing potential duplicates is not always straightforward as the survey only asked limited information on the place of work that would allow to understand whether two respondents work for the same organisation/institution or department and would therefore report on the same initiatives. For workers at municipal governments and from the DPHA, the information on the department where they work, combined with the municipality of work, should allow to eliminate duplicates with high certainty (note that the survey asks about all initiative of their workplace, not just the ones they are working on personally). For example, it is highly likely that two respondents who both report to work for the economic department of a certain municipal government, do indeed work for the same institution. The same goes for third sector organisations since the name of the organisation and its location are known. The approach is however much less straightforward for respondents working for Osakidetza as the municipality of work combined with the information that someone works in a primary care unit does not uniquely pin down a primary care centre. Two respondents working for a primary care centre in a certain municipality therefore could but need not work in the same one, especially in larger municipalities. The reported number of initiatives by such two respondents could therefore either be duplicates or indeed distinct initiatives. In such cases, a conservative approach is taken and only one response from the same department/institution and the same municipality is considered (usually the largest one).
← 6. The full-time equivalent is computed by multiplying the number of employees reported to work on community action by the average percentage of time they devote to community action.
← 7. The survey specifically inquired about a mandate in health promotion and not a mandate for community participation in general. However, only about half the third sector organisations that replied to the survey specifically work on health, hence it is likely that at least some interpreted the question to refer to a mandate for community participation more generally.
← 8. The survey question asked respondents about their use of grants from the DHBC and named two grants from the DPHA as examples. The framing of the question was (translated to English): “Do you use health department grants (such as grants for playgrounds, or grants for safer school walks, or others) as a funding source to finance community action initiatives for health and well-being?”. Hence, while the two examples given are grants from the DPHA, it is possible that some respondents refer to grants from the DHBC that are not coming from the DPHA but from another directorate within the DHBC.