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

Chapter 4
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the health field were influenced by the push for political
freedom. Following a considerable preparatory period, the
Lithuanian Medical Association (LMA) was re-established at
a national congress in 1989. Taking a role possibly unique in
Europe, delegates to the congress called on health professionals
to develop a new “National Health Concept” based
on the WHO Health for All principles. Following broad
consultation, this was to be presented to the lmA Congress
planned for September of the following year, and a
task force was established to carry this through.
In the mean time, in March 1990, the country declared
its independence and was internationally recognized in
September 1991. A Parliamentary Health Commission
was created and a new Department of Health Policy and
Strategy was established within the Ministry of Health for
the first time.
Following intensive national debate, the LMA enthusiastically
approved the draft National Health Concept at its seventh
congress. The Concept laid out basic principles that are still
valid and are constantly referred to and implemented today.
They included:
• the promotion of equality in health;
• intersectoral action for health promotion and disease
prevention; and
• strengthening PHC.
There then followed a process unique to Lithuania, and
doubtless influenced by the political situation of the time. It
was decided to achieve the highest possible commitment
to health at the national level by submitting the National
Health Concept for parliamentary approval. This process
was facilitated by the fact that one of the lmA task force
members, Dr J. Olekas, had become the first Minister of
Health and another member, elected to the new Parliament,
Dr V. Andriukaitis, was Chair of the Parliamentary
Health Subcommittee. Through their good offices, procedures
were established for presenting the National Health
Concept to Parliament in October 1991. On giving its
approval, Parliament requested the Ministry of Health to
coordinate action on the preparation of a national health
policy and programme.
WHO and Finland, where the first national Health for All
policy in Europe had recently been formulated, were asked
for assistance. Coincidently, the new Minister of Health had
attended a WHO meeting on health policy development at
the subnational level (9). There he was exposed to top-level
decision-makers from across Europe, presenting a broad
range of experience in targeting health gain, and apparently
asked his advisers why Lithuania had not yet taken this path.
At that point, the EU’s PHARE programme came into the
picture, requesting that in relation to proposed funding,
Lithuania should prepare a health policy framework. Lithuania
insisted this be in accordance with the WHO Health
for All approach. Acting as a PHARE consultant, WHO
supported the mobilization of over 40 Lithuanian experts
to prepare Lithuania’s first public health report, thereby
providing the evidence base for policy formulation (10).
The public health report was presented at the first National
Health Policy Conference in 1993. The Conference
was opened by the Prime Minister and attended by several
members of the Cabinet as well as members of Parliament
representing the Parliamentary Committees of Health,
Social Security and Labour, Economy and Finance, Education,
and Science and Culture. All major political parties,
administrators of national, regional and local health services,
academic and research institutions and NGOs having even
a marginal interest in health were represented. The then
Regional Director of the WHO Regional Office for Europe,
Dr Jo Asvall, spoke at a parliamentary session and presented
the conclusions of the Conference to the President of
the Republic. The strong political commitment was obvious,
as was the determination that this time there should be
Case studies: policy development in countries for tackling noncommunicable diseases