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

5.4. Sustaining policy implementation, monitoring
and revision
The means for monitoring and evaluating epidemiological
trends are considered from the initial stages of policymaking.
Less attention has been given to a more qualitative
analysis, including the process of policy development, or
the effectiveness of specific interventions. Interestingly, the
monitoring and evaluation process is said to have caused
some disillusionment, as it has become clear that certain
parts of the health programme are not being implemented
as planned.
The sound evidence base already achieved, the provisions
for ongoing and regular surveillance of health status and behaviour,
and the transparent processes in place for reporting
back and making information accessible should ensure
that NCD remain on the policy agenda in Lithuania, with or
without the present key movers. Lithuania is in the fortunate
position, therefore, of being able to further fine-tune
the knowledge base for NCD policy development, including
for example:
• a sharper focus on possible inequalities, including gender
differences and the particular issues facing the rural
population in relation to access to health promotion and
NCD services;
• further development of the methodology for HIA and
the creation of a legal or regulatory framework for its
implementation;
• evaluation of the effectiveness of interventions to tackle
NCD;
• assessment of the accessibility of information at local
level and for lay people;
• methods for improved participation in policy development;
and
• evaluation of the operation of structures for intersectoral
action.
Numerous NGOs are being created and are attempting to
strengthen their impact on NCD policy through joint action.
An evaluation of the channels of communication open
to NGOs and their capacities for effective action could
perhaps strengthen the voice of civil society. Given the high
level of education of the population, the use of modern
communications technology holds considerable potential.
For NCD policy development to become a reality, three
policy streams need to converge: awareness of the problem;
a facilitating policy environment; and the means for
policy development. In the case of Lithuania, all three are
strongly evident.
In summary, five main factors seem to have dominated the
process:
• political changes creating a facilitating environment;
• the decisive and persistent role of key experts and
politicians;
• the unique role of Parliament and the degree of crossparty
collaboration;
• long and continued participation in international networks,
particularly the CINDI project, and the support
when needed of WHO and other international organizations;
and
• the availability of a sound evidence base at the beginning
of the process and its continued improvement, with
regular surveys, formal public health reports and a transparent
monitoring process linked to quantified targets.
6. References
1. Highlights on Health in Lithuania 2005. Copenhagen,
WHO Regional Office for Europe, 2006 (http://www.
euro.who.int/document/e88740.pdf, accessed 9 June
2009).
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Case studies: policy development in countries for tackling noncommunicable diseases