National Population Health Strategy (Cure for All)

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The National Population Health Strategy (NPHS) 2009-2020 and its implementation plan 2009-2012 was passed by the Estonian Government on July 17, 2008 (Order No 325). It is a master document integrating any existing vertical development plan into a grand national public health policy document. The overall goal of the Strategy is to increase healthy life expectancy to 60 for men and 65 for women, and life expectancy to 75 for men and 64 for women by 2020.

Purpose of health policy or idea

The main purpose of the policy is to increase the duration of life lived healthy through reducing preterm mortality and reduced occurrence of illnesses. The Strategy has been divided into five thematic sections:

• Social inclusion and equal opportunities;
• Secure development of youth and children;
• Healthy life-, work- and study environment;
• Healthy lifestyle;
• Development of healthcare system.

Within these five thematic sections more specific priorities and specific aims are set.

NPHS is a composition of specific and so far independent development plans, strategies and vision documents. These development plans will continue to exist, to function and to be fulfilled - the NPHS does not cancel or change any, by default. All the component policy papers of the NPHS have their own management structure, funding and implementation plan.

From January 1st, 2009 when the NPHS will enter into force, the NPHS will also have a management structure. Moreover, this management structure/people foresees that they will have a strong say in the future financing of the vertical thematic development plans. Even though it does not appear whether the management of the NPHS is able to also allocate additional resources to these topics or only to reallocate in the framework set before the NPHS.

There is no indication in the NPHS that the management boards of the thematic sections of the NPHS and the vertical development plans it is composed of, will overlap or have the same people as members/participants. Also, the future development perspective of the NPHS is not defined in the document. The objective of the NPHS is to coordinate the work done in the whole country in the field of public health via one policy document, one simple management structure. The NPHS first hand has a direct effect on the thematic vertical development plan implementers. In more broad terms, it is the whole Estonian population which is targeted with the evoking of the NPHS.

Main points

Main objectives

Increase the duration of healthy life of Estonian people via preventing preterm mortality and illnesses.

Type of incentives

The NPHS incorporates all strategy documents in the country that deal with or affect human health in any way. It does not provide additional value in terms of defining new activities or increasing funding. In total it shows that more than 50% of Estonian annual national budget is spent on health activities in Estonia. Through NPHS the Ministry of Social Affairs increases its control over all thematic strategies both in terms of content and budget reallocation as this Ministry is fully responsible for the management of the NPHS. How or if the thematic strategies shall take into account the NPHS, is unclear.

Groups affected

All thematic strategies' management bodies and leadership. Altogether 24 different strategies are involved in the NPHS. Indirectly all people in Estonia are supposed to be affected.

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

It is a positive undertaking which could have involved more change, especially in the future management section of the document. Currently it leaves open the scope of control and influence of the managing structure to the thematic development plans existing implemented before and after the NPHS existance. There are no direct financial controls attached to the NPHS! It seems also to create dubbing management and reporting.  

It is a great undertaking which can lead to a good result if taken more seriously by the Ministry, i.e. reforming the implementation and financing structure as well.

Political and economic background

The Estonian NPHS 2009-2020 is a policy document integrating many thematic development plans and strategies affecting the health condition of the population. In different forms the document has been prepared since 1995 when government passed a health policy document. This was considered sufficient until 2006 when Government passed a proposal to draft a National Population Health Strategy 2008-2015.

Based on a vision document (National Population Health Policy - investment into health, adopted in 2006) the National Population Health Policy 2009-2020 was drafted and passed in Government on July 17, 2008. It will come into effect on January 01, 2009. The need for such a wide-based document has been argumented for with the need for more coordination between different strategies and their implmentation as well as with the need for more precise targeting and more optimal resource allocation. The main goal though, is the improvement of the population's health by providing common cross-sectoral policy document and management structure to implement it. The Ministry of Social Affairs seems to consider the NPHS as a "cure for all issues".

Complies with

EU regulations

There is no compulsory need to comply with any one particular regulation. It is rather a variety of international policy documents (14) which the Estonian NPHS complies with (pg 5).

Other

NPHS, in addition to the goal of improving the population's health, has to comply and deal with the health issues arising from the increased average age of the population and common change of values. More of a content-wise compliance than legal.

Change based on an overall national health policy statement

So far on the national level health goals were only stated in vision documents, which had no financial committments attached. The current National Population Health Policy 2009-2020 also includes at least a compendium of finances required to implement it.

Purpose and process analysis

Current Process Stages

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

Origins of health policy idea

Since the 1990-ies many health policy documents have been prepared in Estonia. On March 02, 1995 the first HP document was passed by the government as an official record. This visionary document focused mainly on different aspects of heath care, but not on human health in general as necessary. Thus there was an initiative to renew the policy document in 2002, but this process faded away.

In the summer of 2005 the management of the Ministry of Social Affairs decided to draft a new version of the national health policy document. It can be considered the start of the preparation of the current final version of NPHS 2009-2020, with a wide-based task force and later a 21-person managing committee established. During the preparation the Ministry cooperated with the Public Understanding Foundation for dissemination and organized a round of (6) dissemination events targeted at county governments, local governments, local stakeholders and local media. On October 12, 2006 the government agreed to establish a National Population Health Policy 2008-2015 and made the Ministry of Social Affairs responsible for the process. The Policy must have been drafted by 2007 November in cooperation with other ministries. The most solid grounds for the NPHS is the consitutional right of Estonians - "everyone has the right to the protection of health". 

On July 17, 2008 the National Population Health Policy 2009-2020 and its implementation plan 2009-2012 was passed by the Estonian Government. Starting from January 1, 2009 the Estonian NPHP will be in force.

Initiators of idea/main actors

• Regierung: The government mainly in the face of the Minister of Social Affairs is the driving force behind the preparation, passing and enforcement of the National Population Health Policy 2009-2020 and implementation plan 2012. The aim is control and development.

Approach of idea

The approach of the idea is described as:
renewed: It was first voiced in early 1990s, officially recognized by government in 1995; renewed in 2005-2006; redressed in 2006-2008 first time to a NPHP 2009-2020 passed as Government Order.

Stakeholder positions

Unexpectedly, the leaders of the vertical/thematic development plans and strategies now incorporated into the NPHS 2009-2020 have not voiced their opinions in the name of their original organizations in public. On the other hand, as the NPHS only copies the main attributes of the thematic documents into one large document and deals with the budget the same way, not allocating any extra finances, the leaders of the thematic development plans are not so much affected anyway.

In such a situation there is not much to oppose or to agree with: if the Ministry claims it is important to have one consolidated document, then let them do it. As a result, the Estonian NPHS is a consolidated version of the main parts of the existing thematic documents, put together and led by the Ministry of Social Affairs. The NPHS does not allocate any extra funding nor has the right to directly decrease any.

Actors and positions

Regierung
Minister of Social Affairs	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The National Population Health Strategy 2009-2020 has been passed by the Estonian Government. The preparation process was led by the Ministry of Social Affairs. The implementation will be monitored by them as well.

Legislative outcome

pending

Actors and influence

Regierung
Minister of Social Affairs	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The preparation process of the NPHS was led by Ministry of Social Affairs and all other ministries gave input to the prodess at various stages.  

The implementation of the NPHS. The document is targeting all levels of society: national and local government, organizations and individuals. All institutions at these levels shall be affected somehow. Even though the implementation will be remote from the Ministry of Social Affairs and during the preparation on NPHS only 6 major dissemination events were organized, the Strategy seems to make difference. The Ministry of Social Affairs has been taking and still is taking the Strategy seriously, linking all its initiatives to it.

Monitoring and evaluation

Thematic expert groups at the Ministry of Social Affairs will be formed to annually evaluate the implementation of the NPHS. The expert groups will be formed based on the same expert greoups that participated in the preparation of the NPHS.  

The Council of the NPHS will be formed of the scientists and organization (EU, WHO, etc.) representatives. The task is to evaluate the implementation of the NPHS against the stated goals impartially. It is also the task of the council to propose changes to the next years' activities.  

Government of the Republic will oversee the results from the managing committee and suggestions from the Council, annually.  

The managing committee is composed of representatives of different ministries, one representative of the local governments and one representative of the non-governmental organizations. It is the task of the managing committee to plan the next year's activities of the NPHS based on the results of the work of all other institutions.

Review mechanisms

Halbzeitevaluation, Abschlussevaluation (intern), Abschlussevaluation (extern)

Dimensions of evaluation

Struktur, Prozess, Ergebnis

Results of evaluation

The evaluation is done annually, in a 2-year and a 4-year cycle.

Annually - managing committee. 2-year cycle - + thematic expert groups, indicator renewal, activity report, government decision on past and future activities. 4-year cycle - + Council.

Expected outcome

The NPHS is still too new a document to assess the effectiveness as the main expected impact of the NPHS is the increase of average healthy age of Estonians. The acievement of such grand expected result dependsa on a multitude of issues other than stated in the policy document. As the document is a composition of many different development plans which still remain to be the implementation tools of the NPHS, the policy can hardly fail. The desirable effect could be that the coordination berween many existing development plans and institutions implementing them will improve, resulting in better impact or more efficient use of resources. The undesired impact is that the Ministry of Social Affairs will be able to manipulate with the thematic development plans so that the implementers will become unsatisfied and unable to do what they need to. As a start, the costs of implementation will increase as 1) the implementers of the thematic development plans will need to do one more reposrting cycle 2) there are many parallel additional managing and consultancy structures created with the NPHS.  

Possibly, once the NPHS becomes the sole strategy implemented centrally not via thematic development plans, it might lead to increased efficiency and better quality amounting to the probability of reaching the main goal: healthy people living longer.

Impact of this policy

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

The impact of the policy seems to add nothing to the already existing development plans/strategies implementation nor financing, ehich leaves the impact of this very document questionalble.

References

Sources of Information

• Ministry of Health
• Government of the Republic of Estonia

Author/s and/or contributors to this survey

Läänelaid, Siret and Ain Aaviksoo

Empfohlene Zitierweise für diesen Online-Artikel:

Läänelaid, Siret and Ain Aaviksoo. "National Population Health Strategy (Cure for All)". Health Policy Monitor, October 2008. Available at http://www.hpm.org/survey/ee/a12/3