7.2 Administration and governance
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Governance
Türkiye’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 Türkiye, “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 2024-2028 (Sağlık Bakanlığı Stratejik Planı 2024-2028), a fundamental document for Türkiye’s health policy, was prepared in a number of steps.
1. Preparation Process
A Strategy Development Board was established to carry out strategic planning activities. A Strategic Planning Team was formed to create the strategic plan preparation program and to carry out the strategic planning process in accordance with the preparation program. A Strategic Plan Core Team was formed to ensure the continuity of the strategic planning process and to actively carry out the work. The Strategic Plan Core Team was provided with strategic planning training. A strategic plan preparation program and timeline were prepared and put into practice together with the Strategic Planning Team. Activities were carried out in line with this preparation program and timeline.
2. Situation Analysis
The findings obtained as a result of the detailed studies carried out within the scope of the situation analysis were summarized as determinations and needs to be met, and a table of determinations and needs, which is the basis of the goals and objectives, was created.
3. Outlook on the Future
Drafts of the mission, vision and core values of the Ministry of Health were prepared by the relevant units and the draft studies were consolidated by the Strategic Planning Team. The consolidated draft mission, vision and core values were presented to the Strategy Development Board and finalized.
4. Strategy Development
Target card studies were carried out by the relevant units for the objectives, targets, strategies, performance indicators, costing and risk and control activities related to the target. The target cards were consolidated as a result of meetings held with the Strategic Planning Team and relevant personnel from the units. The consolidated scorecards were reviewed in separate meetings with our units and revised in line with the policies and measures set out in the 12th Development Plan. The target cards organized in accordance with the top policy documents were submitted to the Strategy Development Board and finalized.
5. Monitoring and Evaluation
At this stage, a general framework for monitoring and evaluation of the strategic plan is presented and the importance of monitoring and evaluation is emphasized.
6. Submission and Publication of the Strategic Plan
A draft strategic plan was created by compiling all the work done during the strategic planning process. The draft plan was submitted to the Strategy Development Board and finalized. The draft plan, which was finalized within the framework of the relevant legislation, was submitted to the Directorate of Strategy and Budget under the Presidency for evaluation with the approval of the Ministry. Updates were made to the draft plan according to the evaluation report of the Directorate of Strategy and Budget, and it was again submitted to the Strategy Development Board and announced to public by being published on the website of the Ministry of Health with the approval of the Ministry. It was also sent to the Directorate of Strategy and Budget and relevant institutions and organizations.
Cross-sectoral cooperation
The 12th Development Plan includes the following expression on cooperation between sectors and institutions:
- 2.3.3. Health - 706.3 The multi-stakeholder health responsibility model for improving health responsibility will be strengthened, and cooperation and coordination among sectors and institutions will be ensured.
Strategic Plan 2024-2028 of the Ministry of Health sets the following strategic goals for cooperation:
- Improvements in curricula and legislation will be carried out with the Ministry of National Education, local administrations and non-governmental organizations to raise awareness and educate children on healthy nutrition.
- In cooperation with the Ministry of Family and Social Services, efforts will be made to support the electricity and water bills of dialysis patients.
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.