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Cancer strategy in Estonia

Country: 
Estland
Partner Institute: 
PRAXIS Center for Policy Studies, Tallinn
Survey no: 
(11)2008
Author(s): 
Aaviksoo, Ain and Gerli Paat
Health Policy Issues: 
Public Health, Prävention
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein ja ja nein nein

Abstract

On May 10, 2007 a National Cancer Strategy was approved by the Regulation of the Ministry of Social Affairs. The current version of the strategy was prepared in co-operation with oncologists. First attempts to consolidate activities aimed at improving prevention and treatment of cancer date back to 1998. Reduction of cancer incidents and mortality as well as increase in the survival and the quality of life for cancer patients are the defined goals of the current strategy.

Purpose of health policy or idea

 Since 1998 the Ministry of Social Affairs has been preparing a national program to combat one of the biggest health problems - cancer. In 2007 the strategy was finally approved and financing from the state budget was decided on. One of the main features of the approved strategy is the combination of treatment and prevention.  

The Estonian cancer strategy involves all areas of cancer protection: prevention, early detection, screening, healing and supportive care, and corresponding scientific researches. Elimination or reduction of known risk factors (especially smoking and other factors of living or work environment) could significantly reduce the share of cases. The number of malignant tumours that could not be prevented may be reduced by early detection (screening programs) and more effective treatment. 

Main points

Main objectives

 There are two main objectives of the strategy:

  • Reduce cancer incidents and lower the mortality rates by 5% per year starting from 2015.
  • Increase the survival of the cancer patients, improve their quality of life and reduce the mortality by 10% starting from 2015.

Type of incentives


 

Groups affected

A range of professionals including cancer patients and their carers, health professions concerned with cancer care, hospitals and home care providers, researchers.

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell recht traditionell innovativ
Kontroversität unumstritten neutral kontrovers
Strukturelle Wirkung marginal recht marginal fundamental
Medienpräsenz sehr gering recht hoch sehr hoch
Übertragbarkeit sehr systemabhängig recht systemabhängig systemneutral


 

Political and economic background

Estonia needs a well-reasoned national cancer strategy because previous limited measures have not brought the expected results in reducing cancer incidences and mortality or in increasing the survival rate for cancer patients. Health care administrators and stakeholders have acknowledged this. In order to achieve the best results there should be concerted measures involving different areas of cancer protection.

During the last decade the problems with health care quality are ever more under discussion and the term quality of care has recently become a buzz word. Characteristical to Estonia's healthcare system is a decentralised provision network and the strong single purchaser EHIF (Estonian Health Insurance Fund). Strong economic grouth between 2000-2006 brought upon an increase in public health expenditure; the proportional increase between 2000 and 2006 was about 50%.

The Ministry of Social Affairs is currently preparing the Population Health Strategy for 2008-2020, which is seen as an overarching strategy and policy for the health system. It aims to guide further improvements by requiring public health and health care services as well as health in all policies to work together with other sectors. In addition, measurable targets are available in specific health sector strategies such as the HIV/AIDS strategy and the strategy for prevention of cardio-vascular diseases.

These health strategies involve measuring achievements and reporting health sector activities as well as intersectoral aspects to stakeholders with the aim of improving both accountability and transparency. For instance, there are a number of activities related to the cancer strategy (e.g. measures to lessen smoking) in the National Strategy for Prevention of Cardiovascular Diseases (CVD) for 2005-2020.

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein ja ja nein nein

Origins of health policy idea

Experts from the Estonian Oncology Centre already started working out the Cancer Strategy (Cancer Program) in 1998. The government approved this program but due to an unbalanced focus on treatment (eg. purchase of expensive hospital equipment, like linear accelerators) the strategy was never implemented in reality.

In the meantime, the heart strategy was completed. In 2005 the cancer program was brought back to life and renamed as cancer strategy. This time the initiative was given to the Society of Estonian Oncologists. Later on the Ministry of Social Affairs took the matter in their hands. Although the financing challenges remained, there were still some opportunities for starting to implement the cancer program already before 2005.

For instance, the Estonian Cancer Screening Foundation started to manage and coordinate cancer screenings conducted in Estonia. Screenings for breast cancer began in 2002. The screenings are conducted all over Estonia. In districts where there is no mammography office, the screenings are conducted with mobile mammography. Screening for cervical cancer began in 2003. Furthermore, there is now an opportunity for the cancer patients to receive help and support in the form of home care medicine.

Initiators of idea/main actors

  • Regierung: Hesitations due to strong clinical influence 
  • Leistungserbringer
  • Kostenträger

Stakeholder positions

All the stakeholders (Ministry of Social Affairs, Estonian Health Insurance Fund, National Institution of Health Development, Cancer Registry, Estonian Oncologists Club, Estonian Health Insurance Fund etc) find the strategy necessary, but they have expressed their concern that the clinical treatment is less valued in the strategy compared to prevention and public health interventions.

Actors and positions

Description of actors and their positions
Regierung
The Minister of Social Affairs sehr unterstützendsehr unterstützend stark dagegen
National Institute for Health Developmentsehr unterstützendunterstützend stark dagegen
Leistungserbringer
Society of Estonian Oncologists sehr unterstützendsehr unterstützend stark dagegen
Estonian Cancer Society sehr unterstützendsehr unterstützend stark dagegen
Kostenträger
Health Insurance Fund sehr unterstützendunterstützend stark dagegen

Influences in policy making and legislation


 

Actors and influence

Description of actors and their influence

Regierung
The Minister of Social Affairs sehr großsehr groß kein
National Institute for Health Developmentsehr großneutral kein
Leistungserbringer
Society of Estonian Oncologists sehr großgroß kein
Estonian Cancer Society sehr großneutral kein
Kostenträger
Health Insurance Fund sehr großgroß kein
Estonian Cancer Society Society of Estonian Oncologists The Minister of Social Affairs National Institute for Health DevelopmentHealth Insurance Fund 

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The Ministry of Social Affairs is responsible for coordination and achieving the goals of the national cancer strategy. The serving unit of the strategy is the department of public health at the Ministry of Social Affairs and the executive unit is the National Institution for Health Development. The executive unit has to carry out the activities designated in action plan in order to achieve the objectives of the strategy and to work out and present an annual analytical report on the cancer strategy to the social minister by February 1st.

For organizing the cancer treatment the committee of cancer treatment quality is established. It has to coordinate the working out of the instructions for diagnostic and treatment; monitor treatment queues, -quality and -arrangement; as well as for rehabilitation and palliative care and to make relevant suggestions to the social minister.

Main measures:

  • Reduced consumption of tobacco products
  • Reduced consumption of alcohol
  • Promoting healthful and safe food choices
  • Guaranteeing healthier physical environment
  • Increasing the population's conciuosness about cancer risks connected with environmental influences, especially avoidable factors (including the effects of ultraviolet-radiation and infections)
  • To introduce quality diagnostic methods and provide the availability.
  • To provide quality multimodal (including all the treatment methods) cancer treatment in optimal range.
  • Guaranteeing rehabilitation and palliative care services by competent service providers.

Monitoring and evaluation

The effectiveness of the strategy is assessed by effectiveness indicators.The effectiveness indicators are in place but there is no formal evaluation plan. Current practice has been that routine monitoring is carried out by the Ministry of Social Affairs and the National Institute for Health Development. Occasional external evaluations are carried out by local or international (WHO) expert teams. However, the current indicators are defined rather broadly and in a long-term perspective, which makes measuring of the effect complicated.

The department of health information and analysis at the Ministry of Social Affairs, the department of epidemiology and biostatistics at National Institute of Health Development and the Cancer Registry are responsible for the assessment of the strategy. The central role in the assessment of the strategy's effectiveness has the database of Cancer Registry. The goal of the Cancer Registry is to guarantee the processing of data of all cancer cases in Estonia which forms the basis for general cancer statistics in the Republic of Estonia and also for analysis of cancer incidence rates and survival of cancer patients, for studying the causes of cancer, for giving prognoses of trends, for developing health care and directing health policy, for planning cancer protection measures and for assessing their effectiveness based on internationally accepted criteria.

Results of evaluation

There are no results for the first year. The work has started in all the fields of medicine, yet there are minor problems in the co-operation between the doctors and other parties.

Expected outcome

This is a long term process and may not show the results for a couple of years, nor is it easy to measure the success with the indicators pointed out in the strategy.

Impact of this policy

Qualität kaum Einfluss relativ starker Einfluss starker Einfluss
Gerechtigkeit System weniger gerecht neutral System gerechter
Kosteneffizienz sehr gering neutral sehr hoch

The strategy is necessary and important in bringing together different actors. Nothing fundamental will happen, but action becomes more targeted, planning is easier and most probably population health will benefit from the strategy. Recently several public health programmes have been approved and implemention started. National and regional networks of individuals and organisations have started to form and such national programmes will provide improved capabilities for planning and cooperation. The cancer strategy is different for its strong component of medical interventions (both screening programmes and improvement of treatment capacity and organisation). Even though some tensions and distrust between clinicians and the public health community is felt, the opportunity to work together towards the same goal can imrpove their relationship, if leadership and governance of the programme are of good quality.

References

Sources of Information

National cancer strategy 2007 - 2015. Available at www.sm.ee/eng/pages/index.html.

Author/s and/or contributors to this survey

Aaviksoo, Ain and Gerli Paat


 

Empfohlene Zitierweise für diesen Online-Artikel:

Aaviksoo, Ain and Gerli Paat. "Cancer strategy in Estonia". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/ee/a11/3