Promoting needs‐oriented health programme planning through public health nurses in Japan

Enhancing needs-oriented health policy development and planning is one of the core competencies of nurses, particularly public health nurses (PHNs). In promoting population health and reducing health inequity, PHNs play a critical role as leaders in health programme planning (American Public Health Association, & Public Health Nursing Section, 2013). In Japan, most PHNs have worked as public servants and are well positioned to enhance health programme planning (Yoshioka-Maeda, 2014). This article explores two critical directions in Japanese public health nursing practice: policy-based and needs-oriented programme planning. The policy system has a hierarchical structure involving policy, programmes, and projects that have a vital connection, in that policies establish the goals of programmes, and programmes include projects that are implemented as a means of achieving those goals. Policy is a general term for government policies, measures, ideas, and visions. Its function is to clarify various matters to be resolved by local governments and declare them as policy issues. Programmes divide the projects into related fields. Projects are concrete measures designed to resolve policy issues and are generally called health services (Mayama, 2001). The policy development process involves the following three phases: policy formulation, implementation, and modification. The most crucial step is the policy formulation phase, which includes the assessment of the current status of the community with respect to identifying issues, analysing the causal relationships between issues, concentrating on priority issues and agenda setting, considering existing programmes and projects, and developing proposals (O'Grady, 2016). Through this process, we should consider the community's vision and ideal status, and recognize gaps between the goals of local policies and the current situation. In the policy development process, street-level bureaucracy plays a crucial role in identifying community needs through daily practice (Lipsky, 2010). Japanese PHNs play the following dual roles: street-level bureaucracy and public health nursing. They plan new health services to meet community health needs and reduce health inequity in their daily practice (Yoshioka-Maeda, Murashima, & Asahara, 2006). Traditionally, prefectural and municipal governments have developed policies based on national government laws, policies, and visions. In addition, the governor of each prefecture and municipality delivered his or her policy speech, and each local government pursue the goals of the master plan. To achieve these visions and goals, public servants should develop concrete, relevant policies, and programmes. In this top-down approach, PHNs have played a central role in developing health programmes by modifying these policies and visions to fit community situations (Yoshioka-Maeda, 2014). Decentralization began in the early 2000s in Japan, with each prefecture and municipality developing needs-oriented policies, programmes, and projects. Through the provision of individual care, PHNs identified community health problems, which became policy issues in local government. Moreover, they developed new health programmes to resolve health issues in difficult cases. In addition, they focused on complex cases, which constituted the core of and starting point for the development of needs-oriented health programmes. This approach differs from traditional community health assessments, which require the collection of a vast amount of information to identify health issues (Yoshioka-Maeda et al., 2006). The importance of policy development by PHNs was emphasized in the early 2000s (Yoshioka-Maeda, 2014), and national examinations for PHNs currently include questions regarding health programme planning (Japan Ministry, Health Labour, & Welfare, 2017); however, many mid-level PHNs did not have the opportunity to learn about this during their undergraduate training. To address this issue, we conducted a randomized control trial to examine ways to improve their competency, knowledge, and skills regarding health programme planning, which is essential to the development of a needs-oriented healthcare system using web-based learning modules (Yoshioka-Maeda, Shiomi, Katayama, & Hosoya, 2019). Web-based learning is advantageous because it is convenient, cost effective, and does not require transportation (Du et al., 2013) and could be suitable for busy mid-level PHNs. Japanese PHNs who have worked as public servants have used two critical approaches. First, they developed policy-based programmes suitable for community situations by modifying national and local government policies and visions. Second, PHNs developed needs-oriented programmes to resolve community health issues identified through the provision of individual care. The findings of this study could enhance means of improving the crucial dual roles of PHNs in health programme planning. None. None.