turkey health transformation program c. implementation

448 Pages·2013·6.12 MB·English

“Dedicated to the most precious souls and memories of the health
care personnel who lost their lives in the Earthquake of Van and of
Dr. Ersin ARSLAN who was martyrised as a result of a nefarious
attack...”
Editor
Prof. Dr. Recep AKDAĞ
Written by
Dr. Yasin ERKOÇ
As the government, we believe that this country and nation
deserves the best of everything. We have strived to make
this ideal real for nine years. During this divine journey that
we set out in order to gain a place in the hearts and minds
of the nation, we rendered concrete services, created tangible
achievements and solutions to cure the problems of the people.
We put the Health Transformation Program into practice in
order to provide our citizens the quality health services they
deserve, we accomplished great things and made huge reforms.
As the poet beautifully said…
“It’s important to leave behind works;
Otherwise one does not exist, …”
Foreword
Tis evaluation report is a brief of the steps that we took in the last nine years in
health and it is also an example of success of not only the Turkish Governments but
also the Great Turkish Nation. We are proud of the fact that our achievements make
such a long list that can not be briefed at once and put into reports easily.
We have gained enormous experience thanks to the Health Transformation Program
and our goal is to share our experience at regional and global levels. Making such
progress, my country has become one of the global leaders in health.
Publishing this report, we do not only lay out the situation in the past and at present
in Turkey but also we share our experience with our neighbouring countries and
friendly and allied nations.
We take strength, excitement and energy from our nation and set sail for new
horizons. Our slogan is “Health for All”. Remembering and undertaking our
historical responsibility and consciousness for being as a leading country, we have
achieved the things that could not be imagined before. Our future is rooted in our
brilliant past.
We know that only dedicated and committed armies can win glorious victories which
owe their existence to a number of namesless heroes and heroines. On the occasion
of this report, I congratulate the compassionate and self-sacrifcing physicians,
nurses, health ofcers, technicians and all other health care personnel in Turkey and
I extend my sincere thanks to them on behalf of my nation.
Sincerely,
Recep Tayyip ERDOĞAN
Prime Minister
We have made signifcant progress in health since we assumed
ofce in 2002. We have accomplished great things with
the Health Transformation Program and we have made a
substantial transformation.
We improved our health indicators at a rare pace and level and
our success serves as a global example. We’ve shown with this
signifcant transformation that we can overcome any obstacle
and reach any objective.
We had no limits in service provision. On one hand we reached
the hamlets of Hakkari, highlands of Trabzon, villages of
Edirne, steppes of Yozgat and plains of Adana and on the other
hand we extended our helping hand to the earthquake victims
of Haiti, and tsunami victims in Indonesia and Japan.
Foreword
Also, we share with other countries the successful implementations made under the
Health Transformation Program which is highly appreciated in the international
arena. International organizations such as the World Health Organization and
the OECD state that other countries have a lot of lessons to learn from the health
reforms in Turkey and the Transformation in Turkey serves as a model for other
countries, too.
With its Health Transformation Program which is a unique model in the whole
world, Turkey has become one of the global health leaders that establish the global
health agenda. Turkey is not a country any more which has to keep up with the
global changes, instead, Turkey acts a leader for change based on the principle of
“serving the human”.
We know that we still have a long way to go. Yet, everybody should recognize that
the brilliant minds which have achieved such enormous transformation are capable
of making and will certainly make even bigger achievements. Besides, I am proud
to emphasize that our health care personnel, all of whom are the nameless heroes
and heroines in our health care system, is the main source of our self confdence and
commitment. On this occasion, I extend my most sincere thanks to all health care
personnel in Turkey who have recognized and adopted the spirit of transformation
in health and made devoted and intense eforts since the beginning of the process.
You are the pride and joy of our nation and I am so glad that I cowork with you…
With my best regards,
Prof. Dr. Recep AKDAĞ
Minister of Health
Te health policies that have been implemented in our country
throughout the history of the Republic have gone through some
basic periods of change. Dr. Refk Saydam period (1923), Dr.
Behçet Uz period (1946) and the start of socialisation in health
services pioneered by Prof. Dr. Nusret Fişek (1963) were the
important turning points. Health Transformation Program
(2003) was the last of these milestones.
On the other hand, the roles to be played by the governments to
ensure that the people lead a prosperous life economically and
socially were highlighted during the World Health Assembly in
1977, and then in 1978 during the Alma Ata Conference, the
foundations of the policy of ‘Health for All in the 21. Century’
were laid. In 1984, the ‘Health for All Strategy and Objectives
of the World Health Organisation European Region’ were
adopted.
Introduction
Putting such global policies and objectives into implementation, unfortunately, did not go beyond a
political wish for 20 years. Te “Health Transformation Program”, however, which we introduced in
2003 and have been implementing since that time, is a comprehensive program that considers all of
the previous actions and aims to produce the most proper solutions by encouraging participatory and
democratic processes. Te Transformation aims to organize, fund and provide health care services in
an efective, efcient and equitable manner. Reaching its goals, the Health Transformation Program
also takes into consideration the World Health Organization’s “Health for All in the 21st Century”
policy, the European Union’s “Accession Partnership Document” and other international knowledge
and experience.
Te Health Transformation Program has human being in its center. It is essential to protect individual’s
health together with community health. For this reason, “health care service that is accessible, qualifed
and sustainable for every one” is the underlying principle of this Program.
Te 9th Development Plan, which was drafted in compliance with the goals and objectives of the Health
Transformation Program in 2006, aims to facilitate access to health care services, increase service quality,
strengthen the Ministry of Health’s planning and supervision role, improve health information systems,
ensure rational drug and material use, and establish the Universal Health Insurance System. Most of
these objectives have been achieved so far since 2003 when the Health Transformation Program was
put into practice. Te universal health insurance, being one of the most components of the Program,
has facilitated access to health care services and increased service quality. Also a major pogress has been
made in health information systems, rational drug and material use and strengthening the Ministry
of Health’s planning and supervision role. Tis report presents detailed information on all of them
in its upcoming chapters. In this context, the Health Transformation Program is a complementary
part of the national policy. Tanks to the implementation of the Program, national health care services
have become more capable of responding to the rapidly changing and transforming health needs of the
future.
Te progress that we have made under the Health Transformation Program, which we developed as a
unique model to Turkey based on the previous and more recent health policy actions, has been brought
to the attention of the audience in some of the previous publications: “From Past to Present: Turkey
Health Transformstion Program, June 2007”, “Turkey Health Transformation Program Progress
Report, August 2008”, “Turkey Health Transformation Program Progress Report, September 2010”
and “Turkey Health Transformation Program Progress Report , June 2011”. Tis latest publication
presents an updated and reviewed version of these progress reports with new and more recent annexes.
Te data on Turkey covered in this book are calculated according
to the international defnitions and standards. As well as that
retrospective revisions are made accordingly.
All the fgures related with the facilities and personnel of the
public institutions and organisations that were taken over by
the Ministry of Health in 2005 are included in the data for
1994 and 2002 which were used for the comparisons in the
book.
‘Classfcation of Territorial Units for Statistics’ (NUTS) which
are used by the European Union countries are used in territorial
assessments.
The section titled ‘Anatomy of Health Transformation Program’
was prepared based on the sections of the Getting Health
Reform Right” by Marc Roberts.
Remarks
Table of Contents
FOREWORD ........................................................................................................................................... 3
PREFACE ................................................................................................................................................. 5
INTRODUCTION .................................................................................................................................. 7
REMARKS ............................................................................................................................................... 9
ASSESMENT REPORT EXECUTIVE SUMMARY ........................................................................... 17
GENERAL DEMOGRAPHIC INDICATORS ................................................................................... 33
OUR HEALTH POLICIES FROM THE PAST TO THE PRESENT ................................................ 43
Health Policies Between the Years 1920-1923 ......................................................................................................45
Health Policies Between the Years 1923-1946 ......................................................................................................45
Health Policies Between the Years 1946 - 1960 ....................................................................................................46
Health Policies Between the Years 1960-1980 ......................................................................................................49
Health Policies Between the Years 1980-2002 ......................................................................................................49
Health Transformation Program in Turkey 2003-2011 ......................................................................................51
ANATOMY OF THE HEALTH TRANSFORMATION PROGRAM ............................................... 53
A-DIAGNOSIS ...................................................................................................................................... 77
1. Financing ................................................................................................................................................................79
2. Payment ..................................................................................................................................................................81
3. Organization ..........................................................................................................................................................82
4. Regulation ..............................................................................................................................................................83
5. Behavior .................................................................................................................................................................85
B-POLICY DEVELOPMENT AND POLITICAL DECISION .............................................................. 87
C- IMPLEMENTATION ......................................................................................................................... 103
1. Primary and Preventive Health Care Services.................................................................................... 103
1. A New Era in Primary Health Care: Family Medicine ................................................................................. 106
2. Maternal and Child Health .............................................................................................................................. 117
A. Sexual Health and Reproductive Health Program .................................................................................. 117
B. Women are Getting Prepared for Pregnancy and Motherhood: Mothers Will Enjoy Teir Motherhood ..... 121
C. Safeguarding Our Future: Mothers and Children .................................................................................... 127
D. We are Overcoming the Obstacles through Newborn Screenings ......................................................... 131
E. Intensive Care of Newborns ........................................................................................................................ 133