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

The health of excluded and vulnerable groups is an explicit
component of the NPHP. The most important initiative is a
target health programme for the Roma population. Despite
some examples of good practice, health inequalities are
still a huge challenge for Hungarian policy development to
tackle NCD.
5.4. Sustaining policy implementation, monitoring
and revision
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.
5.5. Key conclusions
Hungarian policies to tackle NCD have existed for three
decades, with some degree elements of continuity. The
system is in place but is not necessarily sustainable owing to
uncertainty in the availability of resources. There are some
better developed sub-policies, such as those on tobacco
and nutrition, partly related to the EU integration process.
There are links between the public health strategy (as the
main umbrella policy), the risk-related sub-policies and the
topic-oriented larger programmes on, for example, CVD,
cancer and child health, but there is little consistency or a
clear coordination mechanism.
The NPHP has an uncertain sustainability owing to marginalization
of health policy, limited political commitment and
declining public funding. At the same time, however, there
is relative stability in institutional human resources and a
number of action areas. The investment of the EU structural
funds in the field of public health may create a new
situation in the medium term, with long-term challenges for
sustainability.
Equality is a key horizontal dimension of any programme
planning and evaluation in public health. There are specific
programmes matched to the needs of different marginalized
groups, such the Roma population and children from
poor families. However, inequality in health is still increasing
in Hungary and the equality aspect of the NPHP, despite
expressed concern, is not a success.
Examples of good practice appear mainly in communities
and settings at regional and local levels. There is a large
number of outstanding programmes, successful initiatives
and prime movers in the different settings, such as workplaces
and schools and at community level. There is also a
limited number of recent successful experiences in cooperation
with the private sector.
6. References
1. Highlights on health in Hungary, 2005. Copenhagen,
WHO Regional Office for Europe, 2006 (http://www.
euro.who.int/document/E88736.pdf, accessed 4 June
2009)..
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases