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

ation in the long- and medium-term viability and sustainability
of different programme components.
Most professional organizations expressed their support at
the beginning, but later criticized the implementation when
they realized that their own objectives were not among the
few and decreasing number of well-resourced areas. Other
initiatives also suffered financial cutbacks.
In 2006, a Socialist–Liberal Government was re-elected and
introduced radical steps in health care reform. The focus of
the new Liberal leadership of the Ministry of Health centred
on reducing hospital capacities, introducing fees for copayment,
reforming the pharmaceutical market and reshaping
the health insurance system. In this very rapid process,
public health issues, including policy development to tackle
NCD, were marginalized. Policy implementation in the field
of NCD depends to a large degree on public spending, and
it suffered gravely as a consequence of the overall economic
situation in the country. The agencies dealing with NCD
prevention had to face severe staff reductions and diminishing
funding.
Currently, health policy-makers appear to be paying increased
attention to policy issues to tackle NCD. The policy
planning and coordinating capacity of the Ministry of Health
have been strengthened through the appointment of a
special Commissioner of Public Health. The Parliamentary
Health Committee often acts as watchdog for the implementation
of the NPHP, and a mid-term review is on its
agenda in 2008. In November 2007, a national conference
on CVD prevention was organized with the participation
of clinical institutions, PHC, civic and public health organizations.
The expected outstanding support of the EU structural
funds in the forthcoming years might be a stimulus for
new policy developments in this field.
2.5. Monitoring and evaluation
Annual progress in the NPHP has to be reported to Parliament,
which scrutinizes the activities and programmes in
detail. Compared to the previous situation, this represents
significant progress, stimulating not only the development
of a comprehensive monitoring and evaluation system on
NCD prevention but also calling, at least once a year, the
attention of policy-makers to health promotion and disease
prevention issues within the framework of parliamentary
debate. However, the report does not make a critical analysis
concerning implementation, the lack of resources or the
effectiveness of the programmes. In 2005/2006, a lack of
funding made impossible the preparation and publication of
a full printed public health report.
Each separate activity of the yearly public health action plan
is monitored in technical and financial terms, with special
consideration given to some horizontal elements, including
impact on equality. This monitoring system is insufficient to
evaluate the quality and effectiveness of the programmes.
Some specific monitoring and evaluation activities of the
National Institute for Health Development offer deeper
and more detailed evaluation results in some specific target
groups.
2.6. Policies to tackle NCD
In the Hungarian health policy, the status and the relationship
between different strategies related to the prevention
of NCD is not clearly systematized and consistent. From a
public health perspective, the broadest policy framework
is the NPHP. The different sub-policies tackling the issue of
risk factors are not always and explicitly integrated in the
overall public health strategy framework and independent
development of this type of policy can be observed mainly
in the case of tobacco and nutrition.
The most important sub-policies with clear identities are:
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Case studies: policy development in countries for tackling noncommunicable diseases