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

Chapter 4
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iour of schoolchildren. The “CINDI team” was active in the
development of the overall health policy and numerous
related health policy development activities.
As a new member of the EU, Lithuania is also examining
some of the implications and potential influence of EU
membership on health policy.
2.1.5. Finding solutions
The National Plan for Health is approved by Parliament.
The executive function is assigned to the Ministry of Health,
while monitoring and evaluation is the task of the National
Board of Health. The National Board of Health provides
strategic direction. A system of accreditation is in place
for public health services, as are “norms” for services and
activities. Such norms are agreed through collaboration
among the Ministry of Health, the Lithuanian Public Health
Association and professional organizations.
There is a combination of policies directed both at the
whole population and specifically at high-risk groups.
Business and industry, but particularly NGOs, are seen as
having an important role. Since the regaining of independence,
the voluntary sector has considerably expanded.
There are now over 400 registered NGOs that are
concerned in some way with health issues. Links have been
made to the EU-funded project organized by the European
Public Health Alliance for capacity building and the
networking of public health NGOs across Europe. Since
there is some concern among NGOs that their views are
not given sufficient visibility, many are coming together in
umbrella coalitions to strengthen their influence.
Lithuania also participates in the EU’s HIA project, within
whose framework a case study on the impact of transport
policy and air pollution on health has been developed.
Apart from this, the development of HIA is still rather
primitive. There is no legal or regulatory framework for HIA
yet, although the Ministry of Justice has decreed that legislation
should be checked for its possible health impact. Since
this is carried out by legal rather than health professionals,
however, it is said to lead to a simple recording of “no negative
impact foreseen.”
Although EU links may still be at an embryonic stage, it appears
that, as in the past, the door is wide open to sharing
experiences on an international level.
On a domestic and local level, the Health Economics
Centre, which is a private company, has initiated a project
funded by the Open Society, on “Public debates as a tool
to achieve sustainable health care development in Lithuania”.
Through this project, health-policy-related issues are
discussed, such as who wins and who loses through health
care reform, how family doctors should be paid, and whether
“unofficial payment” in the health care system should be
considered corruption. These discussions, involving health
care managers and providers, patients and politicians, are
intended to come up with suggestions that reflect more
fully the interests of the population.
2.1.6. Structures and processes for implementation
The National Board of Health is responsible for monitoring
the implementation of the Lithuanian Health Programme
and policies for disease prevention and alcohol and tobacco
control. The Parliamentary Health Committee also plays an
active part in scrutinizing progress.
The Board meets about once a month to discuss approved
programmes, making the medical community and the public
aware of implementation challenges. For example, a Board
task force examined all vertical programmes, concluding
that these were not as effective as expected and needed
better integration. A more integrated strategy for implementation
of the overall health plan was therefore agreed.
Case studies: policy development in countries for tackling noncommunicable diseases