Strengthening Capacity for Public Health Policy Im

University of Matej Bel, Faculty of Economics, Banska, Bystrica, Slovakia: Strengthening Capacity for Public Health Policy Implementation and Management at the Regional Self-Government Level

The project has been focused on strengthening capacities and building co-operational network in the area of public health at regional level of self-government as well as improvements in public health management and economics. The main goal of the project is therefore to strengthen the system of capacity and network building at the regional self-governmental level among different institutions entering the area of public health and health management. One of outcome of the project was the preparation of the methodological manual helping regional health policy makers to understand the implementation and management of public health policies, as well as emerging tasks and responsibilities on various levels.

The time-table for the project has been set for 12 months starting January 2005 and ending December 2005.

Accepting above mentioned tasks and goals, the main objectives of the project as written in proposal and accepted by the NISPAcee are following:

1. To analyze theoretically modern methods and techniques of implementation and management of public health policies on the regional level through strengthening capacity and creating co-operational networks of institutions.

2. To examine the current public health policies management practices used in Slovakia at the regional self-governmental level and highlight the most important weaknesses of these practices. The focus will be put on identified internal reserves, current and potential level of capacities and created network of institutions participating in the area of regional public health policy development, implementation and management.

3. Based on the comparison of different approaches and methods of public health policy implementation and management to prepare the manual supporting creation of stable network of institutions operating in the area of public health and health care provision. The manual will be focused on different economic and managerial aspects in participating public organizations, with specific focus on conditions of regional self-governmental subjects dealing with public health policies in Slovakia. The manual will be later used by these (and other) regional government departments for training of respective civil servants, and could be used also on other levels in Slovakia and other CEE countries. As the main focus group are health departments at regional self-government offices, management of various types of health care providers owned by regional governments, representatives of self-governing associations as well as university students of participating educational institutions.

4. To help ensure that adequate numbers of highly trained individuals are available to carry out public health policy at the regional self-governmental level in order to improve quality of health care, improve the status of public health care system at the regional level, and enhance access to public health services and provide mentorship to help trainees to implement modern methods and techniques of implementation and management of public health policies at the regional level.

Final Results and Findings

Objective 1

The system of public health policy implementation and management at regional self-governmental level in Slovakia is very far from meeting modern public health policy standards and practices as applied in the developed western countries. In Slovakia as well as in other CEE countries the public health sector and its regional policies are only emerging and will be strongly influenced by ongoing health care reform touching all levels. Having strong capacity and built networks could have helped to successfully manage these processes and reached the settled goals on regional level.

Activity 1: Analyses of the public health policy implementation and management background (theoretical and practical sides):

a. Theoretical analyses of the modern methods of public health policy implementation and management

b. Analyses of experiences and key issues in the area of public health in Slovak republic on different levels of government

- Study of the relevant professional literature focused on the modern methods of public health policy implementation and management

- Consultations with experts in this problematic

- Monitoring of experiences of various institutions in the area of public health policy implementation and management at regional self–governmental level and monitoring the situation with the use of manuals

The project team in this stage has performed the theoretical analyses focused on the modern public health policy implementation and management tools and techniques, which have radically changed many practices and approaches in public health during the last period. Project team, based on the analysis of modern countries approaches toward the health care policy creation, implementation and management has chosen 4 countries and their systems for further research and manual creation.

Project team has performed several consultations with colleagues from foreign institutions involved in the area of health care policy and systems. Based on the debate results, the project team has agreed to focus in further research on 4 key determinants of health policy. Determinants will be used to give policy exactness and direction of behavior for all involved players.

The situation of the Slovak healthcare system is to be placed next to the four systems and compared on the basis of the selected 4 key determinants:

1. money,

2. people,

3. research and technology (the utilization of research in health policy making),

4. healthcare system.

The four systems are best represented by the countries:

1. United States of America,

2. United Kingdom,

3. Sweden,

4. Netherlands.

On the basis of the health care policy in these four countries an advice about further developments in Slovakia will be the result in further stages of the project.

objective 2

To perform the analysis of reality, needs and methods of public management in the area of public health policy implementation and management used at the regional self-governmental level in Slovakia. We would like to monitor all used methods in these types of organizations of public sector and analyze the character of main problems caused by use of these old methods. There will be used methods of comparison, description, method of analyze and synthesis as well as historical method.

Based on the research results and performed workshop involving important actors in the area of public health policy building and implementation (health care providers, interest groups, health insurance companies, national level state regulators, self-governing authorities, educational and research institutions), the findings show that the health policy at the regional level in Slovakia does not exist. All the actors have agreed that such a document could be helpful in showing directions and making decisions, but there is no formal (nor informal) linkage or working net of cooperating institutions in this area as well as there is no official document containing binding rules and procedures for the actors.

Activity 2: Monitoring the system of health care system and public health policy implementation and management under the health care reform attempts in Slovak republic

a. Analyses of the state and identification of needs of the researched problematic at the regional self-governmental level in Slovakia

b. Comparison of theoretical background and practical needs of participating subjects

- Study of internal materials on the system of public health policies and manuals concerning processes, procedures at the regional self-governmental level in the chosen regional self-governmental units and owned health care providers and other participating bodies.

- Consultations with the departments of the chosen regional self-governmental units on the topic of the researched problematic.

- Monitoring of the ongoing training courses for the employees in the area of public health policy implementation and management at the regional self-governmental level and other institutions involved in public health policy

Project team has arranged several working meeting with the regional self-governing body officials, which have led into first informal agreement of cooperation in this area and later into formal partnership and close cooperation for further research in this area.

In the middle of June 2005, project team has organized professional workshop for selected players in the area of public health and policy. The workshop was facilitated by the professional facilitator and took place at the neutral academic place at the Economics faculty of Matej Bel University in Banská Bystrica. Invitation and programme of the workshop are in the form of attachment to this report. All representatives have agreed to form working group that would be for assistance for the project team in this project and further researches in the area of health care policy formulation and implementation.

Workshop outcomes have set the further direction for the research and work. The participants have clarified their position within the public health policy creation, implementation and management as well as their contributions for such document.

The workshop outcomes lead into next phase, which are the consultations with the departments of the regional self-governmental body on the topic emerged during the workshop within the researched problematic as well as preparation of draft documents including the indicators for public health policy formulation, which will be presented on the next workshop planned for late October 2005. Following month is focused on the monitoring of the ongoing training courses for the employees in the area of public health policy implementation and management at the regional self-governmental level and other institutions involved in public health policy building. This issue will be addressed in late October and early November 2005. Participating actors will be offered for special training courses based on the professional workshops thematically focused on the issues emerged during the project and specified as the most problematic area in the public health policy.

Objective 3

Project objective No. 3 was to implement relevant knowledge, gathered information and obtained results and research outcomes into the manual, which should help to the regional self-governmental bodies to strengthen capacities, create networks of partners and prepare themselves for overtaking responsibility for public health policies, their implementation and management on regional and local level in Slovakia. Some parts of this material can be used in others CEE countries going through the process of liberalization and health sector reform. The manual focuses on health policy theoretical background, research methods, descriptive methods, recommendations, research finding and suggested managerial methods that could lead into building stable network of regional health policy actors working cooperatively and able to share information.

Activity 3: Preparation of manual which would lead to the strengthening of capacity and cooperation in the area of public health policy implementation and management

Identification of the main problems in the public health policy and health care system and the proposal of their solution – creation of methodological processes and procedures of pubic health policy implementation and management at the regional self-governmental level.

- Based on the modern methodology of public health and health care policy implementation and management, we intend to analyze the state in this area and identify the needs and main problems of public health policy management at regional self-government level in Slovakia.

- Methodological preparation of the procedures of public health and health care policy management at the regional self-governmental level, which will be technically prepared in the form of manual for the purpose of the regional self-governmental entities and owned health care providers.

The last part of the manual is focused on appropriate managerial methodology of creating the regional health policy by setting up communication platform as well as creating acceptable strategic scorecard including relevant measurements and indicators helping to analyze and manage the relations among particular health policy actors (health insurance companies, Ministry of Health, Health Surveillance Authority, Regional Public Health Offices, inpatient and outpatient health care providers, chambers, municipalities and regional self-government bodies).

Prepared manual as well as main results of the whole research and project findings are prepared for critical evaluation and questioning on various international conferences, workshops and seminars.

During the realization phase of activity 3, the project team performed following tasks and activities:

1. Analysis of current status of Banska Bystrica region (demographic, socio-graphic, economic characteristics; technical, social and health care infrastructure in the region) according to the request of regional self-government office;

2. Comparative analysis of 4 indicators on international level;

3. SWOT analysis of 4 indicators on national and regional level in Slovakia and Banska Bystrica region;

4. Analysis of potential conflict within the scope, authority and responsibilities of individual actors involved in the health sector and regional health policy creation and implementation based on the requests and recommendations of regional self-government authorities, health insurance companies and providers, which participated on realized meetings and workshops;

5. Suggested managerial approach has been suggested on the basis of Balanced Scorecard, which has been discussed with colleges from abroad research and university institutions (The Netherlands and USA). For this purpose, the international student exchange has been arranged between the Matej Bel University and University of Twente, The Netherlands.

6. Suggested Balanced Scorecard approach has shown potential constraint in the area of communication and therefore the regional health policy communication platform has been suggested for creation as a first step towards building the regional health policy.

7. The project has helped to strengthen the natural position of Regional Self-government Office in the attempt to create and manage the regional health policy by several meetings of relevant actors, which agreed to participate and provide necessary information, material and technical resources to build up acceptable regional health policy.

8. The project and organized workshops and meetings have clarified the position of educational university institution and research centers in the process of health policy creation. All involved actors have agreed to cooperate with research centers and university in the area of primary research and analysis by providing information databases and access to the internal material concerning health care and health policy in the region.

9. Direct result of the research was the participation of university researchers in the primary research oriented on the analysis of preferences of citizen within the region in the area of quality and accessibility to various outpatient health services and suggested improvements in the services and network management. The first results are expected to be available in the middle of April, 2006.

10. Dissemination of project and research results will be administered through continuing meetings and workshops with regional health policy actors as well as through participation on national and international conferences and seminars concerning health policy on regional level. The following selected conference and seminars participations of the project team have been arranged:

a) International seminar in Brno, Czech Republic, January 2006. Key topic of the seminar is the “Management of territorial self-government” (focus on the usage of tools and measures of budgetary revenue increase and expenses decrease);

b) 5^th International Conference in Athens, Greece, June 2006. Key topic of the conference is “Health Economics, Management and Policy” (project team research article and conference contribution is oriented on Regional Health Policy and Health Care Reform in Slovakia – analysis and suggested approach).

Objective 4

Through the Department of Public Economics at the Faculty of Economics University of Matej Bel, Banská Bystrica in cooperation with CENTER FOR HEALTH POLICY AND STRATEGIES located in Banska Bystrica the advanced multidisciplinary training focused on modern public health policy implementation and management tools and techniques in context new legislation and economic conditions in Slovakia has been provided. The program has provided training and presentation of prepared manual to a select group of public health professionals in the organization, financing, and delivery of public health services involved in the regional health policy and health care.

Objective 4 has been realized in following sessions:

1. training (1^st workshop oriented on basic principles of health policy, presentation of capacities of individual actors and looking for the potential contribution of individual actors)

2. training (2^nd workshop) – realized workshop, November 4^th – 5^th (training has been focused on using the guide in the practice in health policy realization in regions, understanding the suggested approach, looking for the model of communication platform existence and functioning; setting the agenda for further meetings)

3. presentation of study and analysis of region;

4. defining the priorities for further research and tasks of participants on the research focuses on preferences of citizens on quality-accessibility decision.

Proposed time-table has been fully respected and there were no delays in the project realization – objective 3 and 4.

Regarding the proposed budget for the project, there have been no unexpected problems or over-the-limit requests. The only request has been made for the usage of unused international costs to be available for participation on the forthcoming conference in Athens, Greecein June 2006 with the aim to disseminate the project results and evaluate reached outcomes with high-class professionals and researchers in the area of health economics, management and policy. More information about the conference and its standard can be found on the address: www.atiner.gr.

Conclusion

The project team has realized all planned activities and during the whole project was strongly focused to deliver the outcomes set in the proposal as well as to successfully create and maintain for the future the cooperating network of partners in the area of public health on the Banska Bystrica regional level.

Planned activities 3 and 4 were performed according to the proposal and no threats have occurred in the organizational or financial sense that could negatively affect the project results. Small issues did have occurred among participating institutions and players, who have had relatively high expectations on the outcomes of this project regarding deep primary research within the region that could not have been realized during the remaining 4 months. This request was addressed and we have started to perform defined research with our internal faculty sources. We must add that the whole process has been slightly slowed due to ongoing regional level elections process that took place in November.

But the positive side of the whole project is the exploited potential for our institution to be the leading partner in this area on the local level and we have successfully started to build working network of professional, educational and regulatory institutions participating in the area of public health policy formulation, creation, implementation and management in the Banska Bystrica level, which can be demonstrated by the communication platform, participation in ongoing researches and access to the information and databases of participating partners for the purpose of further researches and analysis according to the needs of partners.