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

Chapter 4
194
An attempt was made to streamline related activities of
various WHO projects such as CINDI, Healthy Cities,
Health Promoting Schools and Health Promoting Hospitals,
by “networking the networks”, with the intention of creating
a better balance in terms of health promotion, disease
prevention and health care actions.
2.1.2. Awareness building and the consultation process
The process of health policy development in Lithuania is
led mainly by experts from academia and research. What
is perhaps notable is that, although there are prominent,
undisputed leaders of this influential group, it is not an
exclusive club. As far as we can discern, attempts have been
made to involve groups in different parts of the country in
the background research, policy formulation and monitoring
processes. As seen in relation to the development of the
National Health Concept, the Medical Association also plays
a strong role.
One aspect that perhaps differs from other countries is the
heavy involvement of Parliament. This is not simply a question
of Parliament passing legislation or approving a document
at the end of a policy formulation process. Very soon
after gaining independence, Parliament devoted a whole day
to discussing the health challenges facing the country. Those
broad discussions were clearly a part of the more general
political process set in train by a country redefining its own
national identity.
Since then, an annual public health report (around 100
pages) is prepared by the National Board of Health (see
below). In late spring each year, a summary of this report
is presented to Parliament, which allocates 2.5 half hours
to its presentation and discussion. In November each year,
Parliament holds its one-day “Dialogue for health”, which
has become a Lithuanian tradition. The public gallery is
packed and the whole discussion broadcast on radio. Twice
a year, therefore, on a regular basis, Parliament discusses
public health. All reports are published and widely available,
creating pressure on the Ministry of Health regarding the
issues they cover.
There has been continued good collaboration between the
Parliamentary Health Committee, the Ministry of Health
and the academic community. Academics are respected
by all political parties and asked to provide information on
health issues. Their cross-party acceptance is said to be due
partly to the fact that many academics were active in the
liberation movement leading to reforms in the health sector,
thus gaining and retaining the respect of politicians.
The National Board of Health, set up in 1998, plays a strong
role in awareness building and its sessions are open to the
public. One third of its 15 members are experts in public
health, one third are nominated by the Association of Municipalities
and one third represent NGOs, although there
is apparently some concern among the NGOs as to the
weight given to their opinion. The President is not appointed
by the Government but elected by secret vote among
the members of the Board. Employees of the Board’s secretariat
are civil servants.
The Board is independent of the Ministry of Health and
reports each year directly to Parliament. Under the guidance
of its first President, Professor Vilius Grabauskas, this
report has taken a two-part form, the first part being a
standard general report including international comparisons
and the second part dealing with different topical issues.
In the first three years, for example, special issues included
the social determinants of health, the health of children and
young people, and harmonizing the health system with EU
requirements.
Partly through the work of this independent Board, strong
public pressure can be brought on the Ministry of Health.
For example, owing to such pressure the Ministry agreed
to examine the possibility of funding health promotion
services , such as certain screening processes, through the
Case studies: policy development in countries for tackling noncommunicable diseases