Having an impact - Place based collaboration in the time of COVID-19
During the COVID-19 pandemic, many businesses, not-for-profit organisations, philanthropic funders, community groups and government departments have had to re-think their function and focus in response to the needs and demands driven by our changed circumstances. This re-orientation has also been true for Place-based collective impact initiatives like Hands Up Mallee.
Our collective impact initiative, located in the far North-West of Victoria, is driven by local community and agency partners in line with our shared goals and collective vision of a connected community where families matter and children thrive. In "normal" non-pandemic conditions, our community-led initiative has to be agile and adaptable while working to create the collaborative conditions needed for systems change.
These skills have never been more critical as COVID-19 altered the focus and work of our partners; we, too, have had to re-think our actions over the last 18 months. Through this adaptive process, the HUM Team found ourselves working in areas and ways that were new to us. In 2020, a large part of our work focused on supporting equitable food access, and alongside our partners, working to re-design local food security partnerships, supports, and distribution systems in our community.
In 2021 the HUM team were unexpectedly involved in the local vaccination roll-out to help reach parts of the community who were experiencing barriers to accessing vaccination. On the surface, local vaccination roll-out might seem an unlikely focus for a collective impact initiative. But our experience demonstrates that place-based collective impact initiatives bring enormously important insight, equity focus, community understanding and collaborative and relationship-focused ways of working, which are integral in local pandemic responses.
Although the inequitable impact of previous pandemics is well known, there has not been a well-integrated equity focus in Australia's pandemic response. The impact of this is starkly apparent in vaccine uptake: where we see members of the community who are at the highest risk of poor COVID-19 outcomes due to the social, structural and systemic determinants of health, amongst the least vaccinated groups. While our rates of universal vaccination coverage in Victoria are some of the highest in the world, our striving for greater numbers has seen a failure to focus on equitable access. Ndumbe et al. (2021) argue that our health and social systems are under enormous pressure due to COVID-19 and have been largely non-responsive to equity. These patterns are clear at national, state and local levels.
Kania and Williams et al. (2021) assert that as a methodology, collective impact must have a clear focus on equity, which they define as "fairness and justice achieved through systematically assessing disparities in opportunities, outcomes and representation and redressing [those] disparities through targeted actions.” As a focus on equity is a core condition of collective impact, it makes sense that a place-based collective impact initiative would turn their focus to inequities in vaccine roll-out, an issue of health equity, during the COVID-19 pandemic response. But how does a collective impact initiative centre equity in vaccine roll-out, especially when not directly involved in vaccine delivery? And what role can place-based collective impact initiatives play at a local level?
1) Using positional power to raise the issues of inequity in the vaccine roll-out
Hands Up Mallee’s role in this work has taken many different forms; the initial intervention involved using positional power to raise deeper understanding about the inequity of the vaccine roll-out with local and regional decision-makers and fund/resource holders. Mildura is an isolated, outer-regional local government area with a population of approximately 55,000 people. Our local health sector struggles to engage and retain sufficient staff even outside of pandemic conditions. Under the acute pressure of COVID, delivering a universal vaccination service on top of the usual workload was stretching resources to the limit. Our only dedicated active outreach team, tasked with meeting the needs of those in our community for whom the universal vaccination system was not appropriate, was located 400km away in Bendigo placing local services under further strain. The first hurdle was getting people to recognise equity of access to vaccination was an issue for some parts of our community; the second was getting people to commit to action in a system that was already at capacity.
In early September, our most crushing moment led to galvanization of local collaboration. We had drawn together twenty representatives from across the local social service sector to help design and staff a locally adapted active-outreach model. In a meeting with these agency staff a vaccine provider (who had previously committed to helping) announced they no longer had the capacity to administer active outreach vaccinations. While disappointing, the vaccine providers’ withdrawal fueled local determination to secure funding and develop our own model of active outreach. The only way forward was drawing on local people and agencies through new and unique partnerships to meet our community’s unique needs.
2) Hands Up Mallee then led efforts to secure funding for active-outreach vaccination.
Hands Up Mallee took an active role in securing funding and writing an application for a $40,000 grant to support the delivery of active-outreach vaccination clinics. The delivery model was developed in partnership with local government, who also acted as the fundholder and local social sector agencies and health providers who collaboratively delivered the clinics.
3) Drawing together partners to leverage the workforce and reach into community
Hands Up Mallee played a crucial role in drawing together partners, many of whom had never worked together before, to do the work. In undertaking this role, HUM worked with non-clinical organisations and people who were deeply connected to the community to determine how and when it was best to do the work and how best to communicate with the community. We worked in small, agile groups that developed bespoke models suited to different geographical and cultural communities. For example, our planning and approach for the clinic in Red Cliffs (a small satellite town) was entirely different to our method of reaching asylum seekers, refugees and undocumented migrants without Medicare cards.
4) Drawing on long-term, trusted relationships to get things done
This took various forms, but key to the initiative's success was the ability to quickly connect with partners, from a place of high trust and previous achievements, reach an agreement and move to action quickly. It resulted in a GP Clinic agreeing to work in partnership with local government, the Ethnic Communities Council and Hands Up Mallee to deliver weekend vaccination clinics which administered 706 vaccinations on site at the Sunraysia Mallee Ethnic Communities Council, to migrants, refugees and asylum seekers predominantly without medicare cards. When Mildura was hit with an acute outbreak of the Delta COVID strain, it meant that with the help of Sunraysia Community Health Services and Mildura Rural City Council as clinical partners we could draw on key local people with strong links into community where we needed to do the work. Aunty Jemmes, an Aboriginal Elder and Aboriginal Community Liaison Officer with the Victorian Police, was particularly important in getting the community tested and vaccinated because she was well known and trusted in the community. Without an existing relationship with Aunty Jemmes, there is no way we could have tested and vaccinated as many people in the community as we did, as quickly as we did.
“We started talking about what was going on in our community, the whole community, not just one part of it. The organisations involved actually listened and took notice of what we wanted for a change”
5) Listening, responding and adapting to community needs and feedback
The default position of services is to assume they know what the community needs. We all make assumptions, particularly in times of emergency when timeframes are tight, and decisions need to be made quickly. Hands Up Mallee played an important role in continuously liaising with and listening to the community about where, when and how active outreach testing and vaccination needed to occur in a way that was right for the parts of the community the vaccination teams were working to support. This often looked like agreeing to keep testing and vaccination pop-up clinics in parks longer than we initially planned; and trusting the community’s knowledge. We had vital feedback from the community that we needed to be patient and willing to sit in community parks for days to build a sense of safety and trust that allowed people to feel comfortable and confident to come and get vaccinated. Word of mouth ensured people knew we were there. This required a level of flexibility we aren’t generally used to – but it paid off, with 377 PCR tests (prior to approval of rapid tests) and 380 vaccinations occurring in community parks. This was genuinely community leading in a time of emergency – and it required us to work in an entirely different way.
Our challenge now is taking what we have learned and using it in our future work and that of our partners. As the authorising environment of the acute emergency fades, how do we keep working together collaboratively in ways that leverage resources for more significant impact, in ways that centre the community voice and in ways that focus on equity?