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Model 1: Autonomous agency 

A number of countries have established health promotion foundations or a tobacco control fund as an independent statutory body outside of the government structure. These foundations are autonomous with flexible and independent management. An independent board governs the fund and controls decision-making on policies, programmes, and the allocations of funds.

These foundations are mandated by legislation, such as an Act of Parliament. This legislation establishes the funds accountability and transparency standards and processes. While the foundation operates independently, it works closely with the government by contributing to the development and implementation of the government’s priorities and directions for health promotion. 

The entity is likely to be relatively small and is not subject to all the necessary bureaucratic processes of government. They are more flexible, and can respond quickly and innovatively to emerging needs, threats or opportunities that will strengthen public health activities. The higher level of autonomy enables multiple collaborations across levels of government and civil society in various sectors such as health, education, cultural, arts, religion, sport, transport, and community. 

The funding source is guaranteed through the legislation to ensure a predictable flow of funds and protect the activities from any political changes. 

In some entities, members of parliament are appointed to boards of governance. This is sometimes considered a compromise approach. For example, in Thailand, the Prime Minister is the chair of the governing board of ThaiHealth and the Health Minister is the vice chair. In Australia, three of the major political parties are represented on the governing board in the Victorian Health Promotion Foundation. 

Generally, the government will maintain some control, for example by making appointments to the board and approving budgets. However, the foundations usually make independent decisions about health priorities and the allocation of their funds, and then report to the government. 

Advantages

  • Operate independently of government while supporting government priorities and directions for health promotion and contributing to government policy. 

  • Plan and implement long-term health promotion/tobacco control programmes with guaranteed funding. 

  • Utilize its independence to advocate to government in relation to health promotion policy 

  • Operate transparently without bureaucratic constraints. 

  • Gain support from all political parties because it is not aligned to any one political group. 

  • Mobilize public support for health promotion through prominent board members who have access to a range of high-level networks that can influence both the public and the government for health policy movement in the country. 

  • Cement a multi-sectoral collaboration across a range of government departments, non-governmental and community-based organizations.

  • Rapidly respond to research findings, threats, needs, or opportunities because of its independent management structure.

Disadvantage

In can be extremely difficult to set up a health promotion foundation with a dedicated, sustainable source of funding guided by legislation.

Case studies

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