12th World Public Health Congress

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REPUBLIC OF TURKEY MINISTRY OF HEALTH
12th World Public Health Congress
Prof. Dr. Recep AKDAG Minister of Health
April 27, 2009 ISTANBUL
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Health Policy Cycle
REPUBLIC OF TURKEY MINISTRY OF HEALTH
ETHICS
Evaluation
POLICY
Problem Identification and Diagnosis
Implementation
Policy Development
Political Decision-Making
Marc J. Roberts et. Al.
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The Control Knobs of Health Transformation
REPUBLIC OF TURKEY MINISTRY OF HEALTH
HEALTH CARE SYSTEM
FINANCING
TARGET POPULATION
HEALTH INDICATORS
EFFICIENT
PAYMENT
PROTECTING PUBLIC FROM FINANCIAL RISK
QUALITY
ORGANIZATION
PUBLIC SATISFACTION
REGULATION
ACCESSIBLE
BEHAVIOUR
PERFORMANCE GOALS
PERFORMANCE CRITERIA
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Marc J. Roberts et. Al.
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REPUBLIC OF TURKEY MINISTRY OF HEALTH
Performance Criteria
Budget Allocated for Preventive and Primary
Health Care Services in 2008 prices (billion TL)
In 2009, 3 ,98 billionTL is allocated for
preventive and primary health care services.
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REPUBLIC OF TURKEY MINISTRY OF HEALTH
Performance Criteria
Citizens of the Republic of Turkey can receive
preventive and primary health care services in
primary health care facilities across the
country with no requirement for a social
security paper.
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REPUBLIC OF TURKEY MINISTRY OF HEALTH
Performance Criteria
Vaccination Ratio in Turkey ()
The rubella, mumps and meningitis vaccinations
Pentavalan combined vaccine Conjugated
pneumococcus vaccine
22 years
6 years
1980
2008
2002
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REPUBLIC OF TURKEY MINISTRY OF HEALTH
Performance Criteria
Resource Allocated for Vaccination (million TL)
17 Times
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REPUBLIC OF TURKEY MINISTRY OF HEALTH
Performance Criteria
Iron-Like Turkey In order to prevent anemia,
which adversely effects health and mental
development of infants, we started to disseminate
free-of-charge iron drops in May 2004. We
provide 91 of our target population with this
opportunity and we aim to bring it above 95 .
Free-of-charge D Vit for Pregnants and
Infants In May 2005, we started to provide
free-of charge Vitamin D for infants skeletal
health up to 12 months. We provide 91 of our
target population with this opportunity and we
aim to bring it above 95 .

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Performance Criteria
REPUBLIC OF TURKEY MINISTRY OF HEALTH
An Innovation in the Republican History
National Medical Rescue Teams
National Medicel Rescue Teams serve in 81
provinces with 2.526 well-trained health care
personnel.
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Performance Criteria
REPUBLIC OF TURKEY MINISTRY OF HEALTH
Health Promotion
Tobacco Control

• In 2004, Turkey put a signature on the
  Convention on Tobacco Control, which was
  developed by the WHO, and prepared the National
  Tobacco Control Program in this framework.
• As required by the program, new arrangements were
  made for smoking and tobacco consumption
  accompanied by the amendments made to the Law on
  Tobacco Control and Protection From Tobacco
  Damages Numbered 4207.

Tobacco control actions in Turkey rewarded by
the World Health Organization
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Performance Criteria
REPUBLIC OF TURKEY MINISTRY OF HEALTH
Physical Activity in Tackling Obesity

• We have developed Turkey Program and National
  Action Plan for Tackling Obesity and we are
  about to launch the implementation.

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Performance Criteria
REPUBLIC OF TURKEY MINISTRY OF HEALTH
The importance of hand-washing should be
emphasized by all countries and should be put at
the top of the agenda in health promotion.
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REPUBLIC OF TURKEY MINISTRY OF HEALTH
Health Transformation Program in Turkey
How Much Progress Has Been Made Under the HTP in
the Last 6 Years?
1. Health Indicators
2. Protection from Financial Risk
3. Citizen Satisfaction
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REPUBLIC OF TURKEY MINISTRY OF HEALTH
Health Indicators
Maternal and Child Health
Source World Health Statistics 2008, DSÖ
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Health Indicators
REPUBLIC OF TURKEY MINISTRY OF HEALTH
Maternal and Neonatal Tetanus Elimination Program
A range of activities have been implemented and
as a result of this neonatal tetanus is
eliminated. It is considered to be a public
health success by WHO. A survey was conducted
jointly with WHO to assess the elimination of
neonatal tetanus in February 2009 in Sirnak city
and it is validated.
Number of Neonatal Tetanus Cases (All Live
births)
SourceWHO, Weekly Epidemiological Record, No17,
2009, 84, 141-148. http//www.who.int/wer
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Health Indicators
REPUBLIC OF TURKEY MINISTRY OF HEALTH
Ratio of Vitamin D Deficiency-Caused Rickets in
0-3 Aged Children (per 1000)
Prevalance of Anemia in 12-13 Month Infants
The proportion of iron deficiency, which was
approximately 30 before the Iron-Like Turkey
Program was reduced to 7.8 .
According to a survey conducted by Ataturk
University, the rickets - an D vit
deficiency-affiliated disease- was 61 per 1000
before but was decreased to 1 per 1000.
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REPUBLIC OF TURKEY MINISTRY OF HEALTH
Health Indicators
Number of Measles Cases
We are close to the elimination of measles.
In the previous decades, measles was
characterized with causing epidemics once in a
few years. There have been no reported cases of
indigenous measles in 2008.
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REPUBLIC OF TURKEY MINISTRY OF HEALTH
Health Indicators
Number of Malaria Cases Number of Malaria
Cases
We are close to the elimination of malaria.
18 years
6 years
1984
2008
2002
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Health Indicators
REPUBLIC OF TURKEY MINISTRY OF HEALTH
Number of Typhoid-Fever Cases
As a result of the serious activities we have
conducted, the number of tyhoid cases has
decreased by 1/100 when compared to the figures
in the year 2002.
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Financial Protection in Health Care Services
REPUBLIC OF TURKEY MINISTRY OF HEALTH
Percentage of households in poverty and
percentage driven into poverty by catastrophic
medical expenses
1,5
1,4
0,8
0,7
Source OECD Reviews of Health Systems, Turkey,
2008
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Satisfaction with Health Care Services
REPUBLIC OF TURKEY MINISTRY OF HEALTH
Level of Satisfaction with Health Care Services
in General () (TURKSTAT SATISFACTION SURVEY
2008)
Satisfied with Health Care Services in General
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Satisfaction with Health Care Services
REPUBLIC OF TURKEY MINISTRY OF HEALTH
EUROPEP Scale Satisfaction Survey in 81
Provinces(October 2008)

• EUROPEP questionnaire form, which aims to
  measure satisfaction level of patients with
  primary health care services, asks patients to
  answer 23 questions and makes assessment of
  physicians and offices, which they have visited
  very commonly in the last 6 months. The graphic
  demonstrates the average of the answers given to
  23 questions.
• EUROPEP scale is an internationally-respected
  scale, which has passed validity and realibility
  tests in 16 European countries.
• The scale was given to 8100 patients, consisting
  of 100 patients in each of 81 provinces across
  Turkey, who used primary health care services.

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OECD Reviews of Health Systems, Turkey
REPUBLIC OF TURKEY MINISTRY OF HEALTH
Page 14 in the Report The Health
Transformation Program in many ways reflects
good practice in the development and
implementation of a major health sector reform
including UHI coverage. Strong government
commitment and leadership along with major
financing reforms aided by strong economic growth
have been complemented by sequential delivery
system reforms.
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OECD Reviews of Health Systems, Turkey
REPUBLIC OF TURKEY MINISTRY OF HEALTH

• Page 14 in the Report
• Indeed, there may be much that other countries
  can earn from the recent health reforms in
  Turkey, especially in the use of
  performance-related pay to rise staff
  productivity.

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OECD Reviews of Health Systems, Turkey
REPUBLIC OF TURKEY MINISTRY OF HEALTH

• Page 124 in the Report
• Health system reform is a perpetual process.
  At this early stage in its implementation, Turkey
  appears to be one of the few middle-income
  countries to be implementing a bing-bang reform
  effectively.
• The HTP represents both an important
  improvement in Turkeys social welfare system and
  a good practice example for other countries
  struggling with the same issues.

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Primary Targets in the Upcoming Period
REPUBLIC OF TURKEY MINISTRY OF HEALTH
Alleviating risks for population health
Health Protection  
Health Promotion  
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All for Turkey in Better Health