The NAC coordinated a Working Group of major stakeholders (The Thoracic Society of Australia and New Zealand, The Royal Australian College of General Practitioners, Pharmaceutical Society of Australia, Pharmacy Guild of Australia, Australasian Society of Clinical Immunology and Allergy, Asthma Australia, Consumers' Health Forum, Asthma Educators' Associations, Australian Divisions of General Practice, Department of Health and Aged Care, the Asthma Foundation of New South Wales and individual experts) to consider the strategies listed in this earlier document.

From the original twenty-two strategies, sixteen strategies were prioritised.  In some instances strategies were combined with others.

A decision was made to prioritise strategies which would most effectively, in the short to medium term,

1. significantly reduce the prevalence and severity of asthma and the risk of asthma;
2. contribute to favourable health outcomes through better understanding, skill and commitment; and
3. reduce the social and economic impact of asthma on the community.

Purpose

The purpose of the Implementation Plan is to enable people with asthma to obtain best asthma control, and has been developed to:

• focus effort, resources and attention on priority areas where return for investment will be greatest;
• provide a means to coordinate and provide direction for asthma activity - research, education, management; and
• identify gaps in asthma activity which must be filled if our goals are to be achieved.

Collaboration and Cooperation

The Implementation Plan has been developed from the collaborative effort of the major stakeholders in asthma.  The implementation will involve more than forty organisations – non-government consumer organisations, health professional bodies, academic institutions, industry groups and government departments.  This collaborative and cooperative strength has led to most of the improvements in asthma management to date.

General developments in health are already assisting asthma programs or have the potential to do so:

• the Department of Health and Aged Care initiative for Quality Use of Medicines
   
• the work of the Divisions of General Practice (most of which have an NAC Asthma Liaison Officer)
   
• the National Public Health Partnership (NPHP), which is developing a national approach to public health and coordinating national strategies
   
• the NPHP Legislation Reform Working Group, which is examining federal and state public health law with the aim of establishing harmony across jurisdictions.  This will help to encourage uniform drugs and poisons scheduling, which affects national uniformity on the provision of bronchodilators to settings such as schools and workplaces
   
• the National Asthma Strategy Implementation Plan should be linked to other relevant national programs and strategies – Active Australia, National Aboriginal Health Strategies, National Rural Health Policy, National Healthy Ageing Strategy.

Balance

Although this is a national plan it has drawn on local and state/territory level expertise and experience for much of its content.  In turn the plan has been designed so that it will be relevant to these jurisdictions in its application.  Any national plan will require adaptation at local level and sensitive adaptation for specific target groups.

Just as balance between local, state and national activity has been a consideration, so too has the delicate balance between health professionals and people with asthma;  mainstream, high priority and special needs groups; rural and urban situations; and research, education and management strategies.

Terminology

Adopting the terminology of the NSW Physical Activity Task Force, the Working Group delineated roles and responsibilities of participating organisations according to the following:

Lead Agency

The collection of information and ideas pertaining to each strategy was coordinated by an agreed Lead Agency (or Agencies) (refer Appendix I) already active in the area, with the willingness and capacity to implement and monitor the strategy when the plan is underway.  This provides a clear role for defined agencies in asthma-related tasks, which clarifies and rationalises asthma endeavours, reduces overlap and fosters collaboration.

The lead agency is expected to play a major part in resourcing, developing, implementing and monitoring the strategy in collaboration with other relevant organisations and groups. Being a lead agency means that an organisation accepts the principal and ongoing responsibility for a component of the strategic plan. While the lead agency may work in partnerships to achieve the intended results, it has the main responsibility for:

• articulating the appropriate strategies and, where applicable, targets;
   
• ensuring formal organisational endorsement and support for these strategies and targets;
   
• involving organisations identified in the strategic plan as collaborating agencies, other organisations and individuals as appropriate;
   
• developing a plan (working in partnership with the collaborating agencies) to monitor the implementation of the strategy, develop performance indicators, evaluate the effectiveness of the strategy in achieving the strategic goals, and report on the implementation and evaluation; and
   
• making recommendations for monitoring progress in achieving this plan and any agreed targets.

Collaborating Agency

The creation of partnerships across the community, in a diverse range of organisations, is critical to the success of the plan.  Collaborating agencies are key partners in implementing the strategies coordinated by the lead agency.  They are expected to be involved in the development, implementation and monitoring of the strategies on an ongoing basis.¹⁵

Process

Two major information-gathering and consultation exercises were undertaken in the preparation of this plan.  This consultative process extended ownership of the plan as well as generating information and comment:

• An initial exploration of current asthma activity provided a more substantial picture of the depth and breadth of activity, identified gaps or inadequacies and provided a more comprehensive list of organisations, agencies and government departments that could be involved in the National Asthma Strategy and its implementation. 
   
• The second broader consultation presented vested interest groups with the results of the first exercise and requested further comment and input.  Lead agencies took responsibility, with some devoting staff to the project and others convening meetings of stakeholders.  The National Asthma Campaign coordinated the exercises.

ELEMENTS OF THE PLAN

Implementation Groups

As already stated, each strategy has been assigned a lead agency.  These agencies will work with the collaborating agencies listed, but it is understood that others will emerge in the course of the strategy implementation.

Current Situation

Each strategy lists some of the major activities currently being undertaken and by whom.  Many activities have the potential to be promulgated nationally, if they are not already.

Planned Activities

Local, state and national organisations are all involved in planning.  Where possible, this is incorporated into the Implementation Plan and in some instances extended or expanded.

What Needs to be Done

The plan identifies and describes for each strategy what activity needs to be undertaken, how and by whom.  Some of these activities are very specific as they are based on evidence of what is known to be effective.  Others are more general, requiring research and trialling or acknowledging differences in interpretation and application across the country.

Timelines

The timeframe for the Goals and Targets document was to the year 2010.  The timeframe for the Implementation Plan is three years.  Most activities outlined have been given a timeline within this three-year period.  Realistically, asthma health outcomes will not change significantly in three years, but this is a reasonable period in which to monitor uptake of the sustainable interventions outlined in the plan.

Monitoring and Evaluation

The National Asthma Strategy Implementation Plan proposes a set of goals, targets and implementation strategies relating to asthma in Australia. It provides where available, baseline measures and broad performance indicators as outlined in the original Goals and Targets document. These are matched with priority strategies throughout the plan. Some of these measures are already in place, some exist but are not applied with any consistency due to funding restraints and the absence of national monitoring mechanisms. For others, measures are yet to be developed. A national evaluation and monitoring strategy will take into consideration measurement of prevalence, mortality, hospital admissions, school and work absenteeism, number of GP visits, extent of systematic asthma education, follow-up after hospital discharge, use of medication and quality of life for people with asthma.

Already in place are the regular national epidemiological surveys of the asthma management practices of adults and children, general practitioners and pharmacists conducted by the NAC.

Specific elements of the National Asthma Strategy have their own evaluation plans. The recent evidence-based review of Step Six of the Asthma Management Plan is an example of this (refer Appendix 2).

Adoption of the Implementation Plan

The NAC will monitor the extent to which the Implementation Plan is activated and establish the extent to which activities outlined are being undertaken.

An important aspect of the role of Lead Agencies will be to assist in the development and application of a system to monitor and evaluate the Implementation Plan.

This monitoring will include:

documentation of the range and number of non-government organisations, government departments and individuals involved in implementing the National Asthma Strategy;

• compilation of information about the nature and extent of activity relating directly and indirectly to the Implementation Plan;
   
• quantification of contributions to the National Asthma Strategy, including time, materials and money;
   
• study of the collaborative approach to managing and implementing the strategy, in particular the roles played by lead and collaborating agencies; and
   
• observation of the relationships developed across the spectrum of asthma activity.

Evidence of the impact of the Implementation Plan may be partly identified through the 2003 national epidemiological survey.

Economic Appraisal

The economic cost of asthma in Australia has been established already and this plan calls for its continued monitoring. To date, however, there has been a lack of economic evaluation of specific inputs and outcomes relating to asthma.

It will be important to ascertain whether or not the Implementation Plan and its content have been 'good value'. It may be technically impossible to isolate Implementation Plan activity from other influences and therefore calculate the benefit. However, it will be possible to conduct cost-related research on tracking Implementation Plan resources and activity together with the broader impacts on people with asthma, on health professionals and on health sector resources.

Content Updated 1999