Community Initiatives Support - Nelson Bays Primary Health

Community Initiatives Support - Application Form
Nelson Bays Primary Health (NBPH) promotes and supports quality community health services, with an emphasis
on keeping people healthy. “Be Well for all people” Piki te ora o nga tangata katoa
Aim of Community Initiatives Support
The Nelson Bays Primary Health (NBPH) Community Initiatives Support allows a partnership to be formed so both
NBPH and the applicant can support creative, innovative, health promotion initiatives that empower wellness for
the Nelson Bays community.
Rationale
The Community Initiatives Support is a process where a community provider has the opportunity to ask for help
to deliver a health promotion initiative. ‘Help’ may be financial or ‘in-kind’ (as listed on page 3 of the application
form).
Successful applications need to:
Explain their initiative and how it will impact on health & wellness of the intended audience.
Demonstrate support and involvement from its intended audience.
Explain how your initiative will reach high needs communities e.g. Maori, Pasifika or people who live in
low socio economic communities or who have low health literacy levels.
Show measurable outcomes with evidence of this through an evaluation.
Address a community need and show the evidence that this community need exists.
Preferred initiatives will contribute towards supporting current health targets on a local, regional or
national level.
The initiative being supported must have a focus on health and well-being within the community, and
support grass-roots activity; whether it’s an event, a programme, or a service.
The initiative needs to be sustainable and show how it will continue producing outcomes once money has
been spent.
The initiative must be implemented within 6 months of a successful application.
The applicant must explain how and what, they intend to feedback to NBPH after completion of the
initiative.
Key points to note:
You do not need to be an established organizational legal entity to apply.
If funding is required it is a one-off amount of up to $1,000 per annum, per organisation.
In addition to financial support, you can also access ‘in-kind’ support from NBPH such as; photocopying or
assistance with promoting your initiative. Simply refer to the application form and identify the nonfinancial
support you require.
The Alliance Governance Group (AGG), who makes the decisions on applications, will make their decision
based on the information contained within your application. More information is often better; and it is
recommended that you include supporting information (as an appendix). An application short on detail
may be declined as there is not enough information to form a decision.
You can choose to ‘present your application’ in-person at an AGG meeting. To do this, please contact the
Health Promotion Facilitator for support on this process.
October 2012

Process:
Applications will only be considered if all questions have been answered
Email (or post) completed application to Nelson Bays Primary Health (details below)
Your application will be considered by NBPH Alliance Governance Group (our community advisory group)
and you will be notified of their recommendations following their monthly meeting.
AGG meeting schedule for 2012:
Tuesday, 11 September
Tuesday, 16 October
Tuesday, 13 November
Meetings will recommence in January 2013 and will be held monthly.
To maximise your chance of success, please submit your application no later than 1-week prior to the meeting
date.
Further Information
A funding guideline is available which outlines exclusion criteria and the submission process of your application.
To access this guideline please contact:
Glenis Bell
Health Promotion Facilitator
Nelson Bays Primary Health
PO Box 1170
Nelson 7040
Email: glenis.bell@nbph.org.nz
Phone: (03) 539 1655 Fax: (03) 539 4958
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Nelson Bays Primary Health ‘in-kind’ support available
You are invited to access any relevant Nelson Bays Primary Health staff as below:
Allied Health Coordinator
ABC Smoke-free Facilitation
Community-based Dietitian
Diabetes Education and Awareness Coordinator
Falls Prevention Coordinator
Green Prescription Coordinator
Health Promotion Facilitator
Immunisation Facilitator
Maori Health or Kaiatawhai Whanau Ora Liaison
Pacific Fanau Liaison
Primary Mental Health Coordinator
Respiratory Nurse Educators
Strengthening Families Coordinator
Suicide Prevention Coordinator
Youth Health Coordinator
Phone (03) 539 1170 or email info@nbph.org.nz to make contact with the selected staff member
Health information
Support to access credible health resources or link you to the Nelson Bays Health Directory
www.nbph.org.nz/wp-content/uploads/2012/10/Health-Directory-Final-19052011.pdf
Newsletters
Support for the development of your membership newsletter e.g. provision of relevant articles
and/or photocopying of your newsletter (within certain limits)
Programme promotion
Support the promotion of your initiative such as:
- Link you to the Nelson Media Agency (if you qualify for their free assistance)
- Support the development of a flyer or brochure
- Provide a guide as to where to access free community advertising opportunities
- Include your information into our electronic BeWell newsletter (visit
www.nbph.org.nz/news-events/be-well-newsletters to view previous editions)
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Nelson Bays Primary Health
Community Initiatives Support – Application Form
Title of Initiative Organization responsible for initiative Today’s Date
Project leader and contact details
Name/s
Postal address:
Email address:
Phone:
Why do you want to do this initiative
What is the initiative/activity you require funding for and how do you know the need exists for this initiative (Include
evidence of the community need).
Please describe the main activity of the initiative
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Who is your target audience and how will you attract your intended audience to this initiative
Will your initiative help to reduce disparities in health
Disparities in health can be defined as differences in health status between different population groups. E.g. High needs
communities such as Māori, Pasifika, those who live in low socio economic communities or who have low health literacy
levels.
Initiative aim and outcomes
What do you want to achieve and how will you know you have achieved the intended outcome and will it contribute to
improved health status. Include additional information as an appendix if needed.
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Are your outcomes measurable
If your initiative is going to have a positive health impact, how will you know this E.g. what measurements will you use
How will you sustain your initiative
If funding is required, how will you continue this initiative once the funding has been used
What is the duration of the initiative
Start date, completion date or is it on-going
Request for Nelson Bays Primary Health non-financial or ‘in-kind’ support.
Referring to the list on page 3 of this application - what in-kind support do you require (if any)
Request for financial support. How much do you need and how will you spend it
Please give detail
Item
Amount
Please note: Include additional information as an appendix if needed.
Total cost of initiative
Amount applying for
Has your organisation received funding from Nelson Bays Primary Health previously
No Yes – please give details:
If yes, did you submit a feedback report
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Location and duration of the initiative delivery
Reporting back to Nelson Bays Primary Health (NBPH)
Accountability is one of the key ‘code of ethics’ when applying for and receiving funds. Your feedback report should include
the aspects highlighted in your application. Failure to report back will limit further opportunities for accessing NBPH funding.
Any further Information
Please feel free to attach any further information you wish to support of your application.
SIGNED by ) _______________________________
[FULL NAME OF SIGNATURE] ) _______________________________
TITLE ) _______________________________
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