Community action--challenges and constraints--implementing evidence-based approaches within a context of reorienting services.

Community action on alcohol use-related projects face significant challenges in focusing efforts where they are most likely to be effective--on environmental strategies for optimum impact and sustainable institutional change. Reorienting and enhancing the efforts of existing services is a crucial issue for all countries with limited resources. This paper evaluates the use of a public health partnerships model to reorient resources and enhance cross sector collaboration to reduce alcohol consumption-related harm in a large New Zealand city from 2001-2004. The evaluation assessed changes in the management practices of participating health provider organisations, the reorientation of activities and the redeployment of provider resources, in light of evaluation evidence from collaborative initiatives undertaken by key stakeholder organisations. Despite the considerable challenges inherent in reorienting existing health sector resource and encouraging more evidence-based practice, this evaluation found encouraging signs of positive systemic changes, both within the health sector and with external stakeholders, in the redirection of priorities and resources. The focus on collaborative environmental strategies has also contributed to some limited, but promising structural changes to reduce harm in the licensed alcohol availability, accessibility and promotion environment.