Gaining health : analysis of policy development in European ...

Chapter 4
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The main functions of health policy formulation, coordination
and regulation are carried out by a number of institutions
under the direct control of the Minister of Health. 14
Beside these administrative functions, some of these institutions
provide health services themselves, including public
health services.
The National Public Health and Medical Officer Service
(NPHMOS) is one of the most important agencies of the
Ministry of Health. NPHMOS, headed by the Chief Public
Health Officer, is considered as the government-based
implementing agency for the NPHP. Its central organ is the
National Public Health Centre, which consists of national
health institutes. The Chief Public Health Officer is the
Director-General of the National Public Health Centre,
which controlled the local organs of NPHMOS through
county and city public health officers until a shift to regional
and district levels in 2006. NPHMOS institutes operate
in the counties and the capital on the basis of the former
sanitary-epidemiology stations. This means a homogeneous,
regimented, government-based authority with national
institutes and also county and city public health offices. In
fact, most prevention activities are developed in different
settings with outsourcing to NGOs.
Since the establishment of the two-tier local government
system 15 in 1990 (which replaced the former “council”
system), local authorities have become key actors in the
health sector. Although national policy determines the
broad framework for local policy, the Constitution guaran-
14
Act CLIV of 1997 on Health (1997/16) assigns responsibility for health
services to the National Assembly, the national Government, the Ministry
of Health, the National Public Health and Medical Officer Service and in
general the owners of health facilities, who since 1990 are mainly local
administrations.
15
Act LXV of 1990 defined the basic structure, rights and duties, sources
of funds and properties of local government. Municipal and county authorities
share responsibilities on the basis of the principle of subsidiarity.
This means that county authorities take over only those public services
that municipal authorities cannot undertake and are willing to transfer to
the county level.
tees the discretion of local government on local affairs, and
this cannot be overruled by the national authorities. The
local authorities are key partners in the different prevention
programmes.
Nevertheless, a lack of consensus can be seen about the
decentralization of the overall administrative system, including
the regional and district levels. A number of governmental
organizations, including NPHMOS, were reorganized in
2007 at regional and district level, replacing the old countyand
city-level system. However, because of the wider political
debate, the constitutional basis for such an important
change is still missing. In future we can expect a shift from
central decision-making bodies towards regions and districts
in the development and implementation of policies to
tackle NCD. The planned EU structural funds will be mainly
distributed according to a bidding system at regional and
district levels.
2.3. How things started
2.3.1. The first Health for All policy
Hungary has long experience in developing strategies
aimed at improving the health of the population. The first
CVD prevention programmes in cooperation with WHO,
pioneered by the National Institute of Cardiology, began in
the mid-1970s in the 17th district of Budapest and the city
of Pécs.
In December 1987, the Government announced by decree
a long-term programme on health promotion, a unique
experiment under socialist conditions in Europe. The programme
was to be implemented at the time that basic political
reforms were taking place. Changes that culminated in
the collapse of the regime marginalized this initiative, which
disappeared along with the old system by 1990. Hence this
programme cannot be evaluated properly.
The planning and initiation of the long-term health promotion
programme in Hungary was made possible by a num-
Case studies: policy development in countries for tackling noncommunicable diseases