The “EfshariBari in the City” Initiative for Promoting Active and Healthy Living in Local Authorities 2022: An Evaluation Study


Health promotion is an approach that focuses on preserving and improving health. It includes preventing non-communicable chronic diseases through intervention programs addressing malleable factors by changing individual behaviors, policies, and the environment, as well as strengthening the community. The “EfshariBari in the City” initiative (hereafter, the initiative) has been active since 2018 in order to promote active and healthy living and meet local authorities’ obligations for improving public health. In 2023, the Ministry of Health commissioned the Myers-JDC-Brookdale Institute to conduct an evaluation study of the initiative in order to assess its activities and its contribution to promoting a healthy and active lifestyle.


  1. Examine the intervention programs implemented as part of the initiative and assess implementation barriers and facilitators.
  2. Examine the initiative’s contributions as perceived by the health coordinators[1] responsible for its implementation in participating local authorities.


A cross-sectional mixed-methods study that included:

  1. An online cross-sectional survey designed to identify the main areas of the intervention programs and their contents. The survey was sent to 57 health coordinators in local authorities who had taken part in the initiative in 2022; 37 responded.
  2. Semi-structured in-depth interviews of 30 health coordinators designed to gain in-depth understanding of the activities carried out in the local authorities and assess implementation barriers and facilitators.

The survey data were analyzed using SPSS and the in-depth interviews were analyzed using ATLAS.ti, based on thematic content analysis.


All health coordinators who completed the survey form (37) reported on activities among senior citizens; 29 reported on making environmental changes to encourage physical exercise; and 21 reported on activities in schools.

The in-depth interviews indicated diverse activities, mainly in schools and among senior citizens. The intervention programs included workshops and lectures on health promotion, as well as training for professionals to ensure long-term impact. The interviewees suggested it was difficult to make environmental changes to encourage physical exercise due to the relatively limited budget provided by the initiative. The health coordinators argued that the initiative contributes to the local authorities’ commitment to promoting public health.

Barriers to implementing the intervention programs included: delays in the initiative’s schedule, including both delays in issuing the public appeal for supporting local authorities in implementing intervention programs, and delays in approving the budget; the small budget; the lack of a health department in some of the local authorities; and the attempt to simultaneously implement multiple intervention programs in several domains and several population groups.


  • Adjust the schedules of the initiative activities to the local authority’s budget year and activities, from publishing the public appeal to the implementation of the various programs.
  • Publish the public appeal once every two or three years, to enable the planning and execution of complex intervention programs that require time and a secure budget.
  • Invest resources in documenting the intervention programs and creating general evaluation indicators for the initiative.
  • Allow the local authorities greater flexibility in prioritizing programs and resources based on each authority’s needs.
  • Promote mutual learning among health coordinators in various local authorities and pool their resources, including sharing insights and joint purchasing of required tools and services.

[1] The health coordinators’ responsibilities include the management and promotion of a healthy lifestyle in the relevant local authority.

Citing suggestion: Abdel-Rahman, N., Brosh, T., Levy, N., Loren, O., & Baron Epel, O. (2024). The “EfshariBari in the City” Initiative for Promoting Active and Healthy Living in Local Authorities 2022: An Evaluation Study. RR-995-24. Myers-JDC-Brookdale Institute. (Hebrew)