7.2 Administration and governance
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- Turkey’s health policies dated before 1961 adopted vertical organization based on providing single-purpose services in a wide region. After 1961, a new approach based on the provision of multi-purpose services in a narrow area, in other words a horizontal organization structure, was adopted. And this integration was achieved by means of ‘health houses’ that are the primary health care institutions.
- The Law on the Socialization of Health Services (Sağlık Hizmetlerinin Sosyalleştirilmesi Hakkında Kanun) numbered 224, which was put into force after being published in the Official Gazette dated January 12, 1961 and numbered 10705 adopts an approach based on the provision of health services in an equal, continuous, integrated, graded, prioritized, participatory, team-work based, audited, and appropriate manner to address the respective needs of the population.
- According to the 56th article of the 1982 Constitution (1982 Anayasası) of the Republic of Turkey, “Everyone has the right to live in a healthy and balanced environment. The State shall regulate central planning and functioning of the health services to ensure that everyone leads a healthy life physically and mentally, and provide cooperation by saving and increasing productivity in human and material resources.”
- At the end of 2002, the state of the Turkish healthcare system made it necessary to undertake radical changes in many areas ranging from service delivery to financing, human resources and information systems. With this aim, the Health Transformation Program (Sağlıkta Dönüşüm Programı) was put into practice in 2003. The program was prepared by getting inspiration from past experiences, particularly related to the socialization of healthcare services, as well as from the recent studies on health reform, and from successful examples of health reform around the world. With this understanding, the hospitals of other public institutions, including those of the Social Security Institution (SSI) were transferred to the jurisdiction of the Ministry of Health. The coverage of Green Card Program for low-income groups was expanded and the green card holders’ ‘outpatient’ expenditures for healthcare services and pharmaceuticals began to be covered by the state.
The Strategic Plan of the Ministry of Health 2013-2017 (Sağlık Bakanlığı Stratejik Planı 2013-2017), a fundamental document for Turkey’s health policy, was prepared in a number of steps.
1. Establishment of the Strategic Planning Team
The Strategic Planning Team consisted of the Higher Board for Strategic Development, the Strategic Planning Executive Committee, the Strategic Planning Work Teams and the Strategic Planning Coordination Unit.
2. The Higher Board of Strategic Development
The Higher Board of Strategic Development was established in order to oversee and steer the strategic planning process and make critical decisions about the process. The Board was chaired by the Undersecretary and included the Deputy Undersecretaries and all the Heads of Departments in the Ministry of Health.
3. The Strategic Planning Executive Committee
The Executive Committee was established in order to guide, review, and finalize the activities of the Strategic planning teams. The Board was chaired by the Deputy Undersecretary and consisted of representatives at the level of Deputy General Directors/Department Heads of each unit, and the Head of the Strategic Development Department.
4. The Strategic Planning Working Teams
As one of the most important elements of strategic management approach is participation, it was ensured that all the stakeholders were involved in the strategic planning activities to the maximum extent possible. Strategic planning working teams were established in order to coordinate and consolidate the strategic planning activities. In addition to experts and managers from the Ministry of Health, experts from the Ministry of Development, WHO (World Health Organization), UNICEF, UNDP (United Nations Development Program) and the World Bank were also included in the teams.
5. The Strategic Planning Coordination Unit
Support services for strategic planning activities were provided by the Strategic Development Department. This Department was responsible for document management, training, collection of data, etc. for all the planning activities.
6. Literature Review for the Strategic Plan
National and international strategic plans and source books (Strategic Plan 2010-2015 of the Department of Health of the USA; Strategic Plan 2004-2014 (10-year plan) of the Ministry of Health of Canada; Ontario Strategic Plan 2010-2013; Department of Health Business Plan for 2011-2015 of the United Kingdom; Strategic Plan 2000 of the Ministry of Health of New Zealand; WHO 2008–2013 Medium Term Strategic Plan; and WHO Health 2020 European Policy Framework, etc.), scientific articles and the legislation on strategic planning were reviewed, and the approaches which were found to be useful in these documents were reflected to the Strategy Document drafted.
7. Strategic Plan Trainings
Training on the preparation of Strategic Plans were provided to the working teams in collaboration with WHO experts and strategic planning consultants.
8. Informational and Policy Dialogue Meetings
Informational meetings were held for the employees and the heads of units in the Ministry of Health in order to raise awareness of and increase participation in the strategic planning process. Policy dialog meetings were held in order to obtain feedback from stakeholders and their views were integrated into the process.
In the Strategic Plan of the Ministry of Health (Sağlık Bakanlığı Stratejik Planı), cooperation with the Ministry of National Education and the Council of Higher Education (CoHE) was foreseen, and the following strategic objectives were set:
- To establish a surveillance system to monitor the level of health literacy
- To increase the training, infrastructure and technological capacity for people to enable them to take more responsibility for their health
- To ensure inter-sectoral cooperation to promote health literacy
- To carry out joint activities with the Ministry of National Education in order to incorporate health literacy into the curricula of primary and secondary education
- To update the curricula for health and hygiene courses so that they can serve as a basis for developing health literacy
- To develop capacity-building programs for trainers and teachers of health literacy
- To raise student awareness on health development by cooperating with CoHE
- To establish bachelor's and master's degree programs in health development by cooperating with CoHE
In addition, a joint project namely mini 112 was launched with the Ministry of National Education in 2016. In the context of the project, a total of 1 million students have been reached in 4,197 schools. The objectives of this project included increasing the level of knowledge of primary school students about 112 Emergency Hotline; increasing their skills to utilize protective measures; enhancing their behavioral skills in extraordinary situations; reducing the unnecessary calls to the 112 Emergency Hotline; and increasing the level of knowledge about letting the ambulance pass in traffic.
The cooperation established between the Turkish Armed Forces and the Ministry of Health serves the purpose of supporting pre-marriage consultancy services in the context of increasing awareness on reproductive health and promoting healthy behaviors.
The Ministry of Health, the Social Security Institution (SSI), and trade unions are collaborating to improve and maintain occupational health and to increase awareness.
Inter-sectoral cooperation approach has been set as a stand-alone objective in the Strategy Document, the basic policy document of the Ministry of Health, and the goals and strategies related to this objective have been given in detail:
Objective: To establish policies and programs that ensure health equity and that influence social determinants of health within the framework of multi-sectoral cooperation.
• To identify the roles and responsibilities of the sectors to make health and health equity a common value among them
• To enhance the capacity for education, infrastructure and technology for the purpose of strengthening inter-sectoral cooperation
• To evaluate and follow-up the impact of multi-sectoral cooperation on health equity
• To conduct studies addressing social determinants of health and give feedback and impose legal sanctions when necessary