Between October 1995 and December 1998 the pilot project 'Local Coordination of Health and Social Care' was conducted in 28 communities of the state of North Rhine-Westphalia. The project has been evaluated by two university research teams. The aim of the project was basically to establish new structures of health planning and coordination at the community level, in order to improve health reporting and health care as well as health promotion. To realize this aim round tables, working groups and project-offices were implemented in the communities. The evaluation was focused on the following question: What were the conditions (structures) and processes that influenced the project outcomes? Qualitative and quantitative methods were applied (interviews, standardised self-administered questionnaires, analyses of documents) to this end. Evaluation of structures showed that most communities succeeded in integrating relevant health policy actors into the newly created round tables and working groups. Working climate and achievements were evaluated favourably by most of the involved actors. All communities succeeded in developing and enacting recommendations for programmes, and about 40% of these programmes were implemented during the project. The probability of programme implementation was particularly high if the programme was based on reliable local data and if execution was effected only on the community level. The possibly beneficial effects on health care and welfare produced by the new programmes could not be assessed within the short project period. The paper concludes with a brief discussion of practical consequences for future health policy at community level.

In January 1998, the Public Health Service Act (OGDG) was put into force by North Rhine-Westphalia's state parliament as Article 3 of the Act on the Strengthening of the Efficiency of Districts, Cities and Municipalities. The objective of the Public Health Service Act is the performance of functions through the public health service in a way which corresponds to problems, ambitions and priorities at the local level. The effects of the Act have been documented over a period of 5 years. The authors describe the method of evaluation and the most important results. As well as describing traditional tasks, they focus in particular on process and structural data of the local health conferences. These have been introduced as a consequence of the Public Health Service Act in all 54 districts and self-administered cities in North Rhine-Westphalia. Another task which has become obligatory as a result of the Public Health Service Act is health reporting. Here, the authors report on the state of affairs with regard to implementation, major topics and differences in concept. Based on the state of development at the end of 2002, the authors describe present developments and prospects. They expect continuous need for support, particularly in the fields of health conferences and health reporting.

Health conferences are established structural elements in the field of health prevention and health-care in North Rhine-Westphalia. This applies to the state level (state health conferences) as well as to the municipal and city levels of government (local health conferences). After being tested in a pilot project in the period 1995-1998, the foundation of local conferences became obligatory in all municipalities when the public health service act of 1998 came into effect. The present article describes the relevant structures, developments and results.

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