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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). Chapter 4 211 Case studies: policy development in countries for tackling noncommunicable diseases
Chapter 4 212 2. World development indicators 2006. Washington, DC, World Bank, 2006 (http://devdata.worldbank.org/ wdi2006/contents/home.htm, accessed 9 June 2009). 3. The Lithuanian health programme 1998–2010. Vilnius, Ministry of Health, 1998. 4. Health care systems in transition – Lithuania. Copenhagen, WHO Regional Office for Europe, 2000 (http:// www.euro.who.int/document/e69920.pdf, accessed 9 June 2009). 5. Morkuniene A, Murauskiene L. Health care system in Lithuania: short description, main indicators and distribution of health care costs by age groups. In: The economic effects of ageing and demographic uncertainty in Lithuania: a Phare ACE research project (http://www. etla.fi/lithuania/, accessed 9 June 2009). 6. Republic of Lithuania Law on the Health System. Vilnius, 1994 (www.wahlaw.edu/Forint/europe/lintuania.html, accessed 13 June 2007). 7. Report on health sector in Lithuania. Brussels, European Commission (http://ec.europa.eu/employment_social/ social_protection, accessed 10 October 2007). 8. Grabauskas V. Health policy development in Lithuania. In: Ritsatakis A et al., eds. Exploring health policy development in Europe. Copenhagen, WHO Regional Office for Europe, 2000 (WHO Regional Publications, European Series, No. 86). 9. The process of health policy development. Report of a Working Group on the development of subnational policies for health. Copenhagen, WHO Regional Office for Europe, 1992. 10. Ministry of Health. Lithuanian health report – 1990s. Kaunas, Medical Academy Press, 1993. 11. Lithuanian Health Programme 1998–2010. Vilnius, Ministry of Health, 1998. 12. Annual report 2002. Vilnius, Open Society Fund Lithuania, 2002. 13. Equity in health and health care in Lithuania. Copenhagen, WHO Regional Office for Europe, and Kaunas, University of Medicine & National Board of Health, 1998. 14. Implementation strategy of health care reform’s aims and objectives. Vilnius, Ministry of Health, 2006. 15. Health in the Baltic countries 2005, 14th ed. Kaunas, Ministry of Social Affairs of Estonia, Health Statistics and Medical Technologies State Agency of Latvia, Ministry of Health of Lithuania, 2006. 16. A strategy to prevent chronic disease in Europe. A focus on public health action: the CINDI Vision. Copenhagen, WHO Regional Office for Europe, 2004 (http://www. euro.who.int/document/e83057.pdf, accessed 9 June 2009). 17. Gaining health. The European strategy for the prevention and control of noncommunicable diseases. Copenhagen, WHO Regional Office for Europe, 2006 (http://www. euro.who.int/document/e89306.pdf, accessed 9 June 2009). 18. Programme of the Government of the Republc of Lithuania. Priorities of the Health Policy. Vilnius, Ministry of Health (www.sam.lt/en/main/veikla accessed 24 November 2007). 19. Policy development and implementation processes in the CINDI and CARMEN noncommunicable disease intervention programmes. A comparative study. Copenhagen, WHO Regional Office for Europe, 2004 (http://www. euro.who.int/document/e84998.pdf, accessed 10 June 2009). 20. Grabauskas V. The CINDI programme in Lithuania – its contribution to national health policy development. In: Harrington P, Ritsatakis A, eds. European Health Policy Conference: opportunities for the future. Vol. III. Implementing policies for health at country, regional and city levels. Copenhagen, WHO Regional Office for Europe, 1995. 21. WHO Framework Convention on Tobacco Control (WHO FCTC). Geneva, World Health Organization, 2003 (www.who.int/tobacco/framework/en/, accessed 10 June 2009). Case studies: policy development in countries for tackling noncommunicable diseases
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Gaining Health Analysis of policy d
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Abstract There is no greater threat
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Abbreviations The abbreviations sho
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vi Preface The WHO European Strateg
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Contributors Jill L. Farrington was
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Chapter 1 2 the European Region, sh
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Chapter 2 History and context of po
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tions and strategies to achieve the
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• Of the countries responding in
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Washington, D.C., US Government Pri
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Chapter 3 14 co-funded by the Publi
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Chapter 3 16 determine policy outco
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Chapter 3 18 • policies for older
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Chapter 3 20 developing methodologi
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Chapter 3 22 References 1. Gaining
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Appendix 1 Key informants interview
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Chapter 4 26 Albania Péter Makara
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Chapter 4 28 The strategy was final
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Chapter 4 30 for these organization
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Chapter 4 32 The directorates are a
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Chapter 4 34 etc. will continue to
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Chapter 4 36 thinking is still domi
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Chapter 4 38 Finland Anna Ritsataki
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Chapter 4 40 Both the state and the
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Chapter 4 42 2.1. Broad policy for
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Chapter 4 44 • the principle of u
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Chapter 4 46 Broad use is made of
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Chapter 4 48 MSAH prepares for appr
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Chapter 4 50 private donation. Ther
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Chapter 4 52 2.4.4. National demons
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Chapter 4 54 been the case at the E
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Chapter 4 56 materials or to check
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Chapter 4 58 The employer, in both
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Chapter 4 60 2.8. Broad intersector
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Chapter 4 62 was medically and econ
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Chapter 4 64 adequate, whereas that
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Chapter 4 66 planning philosophy an
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Chapter 4 68 any meaningful attack
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Chapter 4 70 In the overall improve
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Chapter 4 72 15. Strategies for soc
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62. International evaluation of the
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Chapter 4 76 The low cardiovascular
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Chapter 4 78 A characteristic featu
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Chapter 4 80 • cancer • CVD •
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Chapter 4 82 INPES carry out data c
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Chapter 4 84 the fight against canc
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Chapter 4 86 published in early 200
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Chapter 4 88 information was not su
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Chapter 4 90 intoxication, improves
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Chapter 4 92 research (see section
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Chapter 4 94 on public health repre
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Chapter 4 96 groups and the health
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Chapter 4 98 19. Chauliac M. Progra
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Chapter 4 100 recent years, Greece
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Chapter 4 102 the wake of political
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Chapter 4 104 telecommunications, h
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Chapter 4 106 2.3.3. Setting the ag
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Chapter 4 108 They were asked to se
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Chapter 4 110 been responsible for
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Chapter 4 112 companies. Neverthele
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Chapter 4 114 comparative analysis
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Chapter 4 116 an important effect o
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Chapter 4 118 2.8. Policies for spe
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Chapter 4 120 public health service
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Chapter 4 122 in defining inequalit
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Chapter 4 124 5.3. From awareness b
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Chapter 4 126 15. Draft Development
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Chapter 4 128 Hungary Péter Makara
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Chapter 4 130 The main functions of
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Chapter 4 132 management at an appr
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Chapter 4 134 The Public Health Pro
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Chapter 4 136 • tobacco control
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Chapter 4 138 • positive changes
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Chapter 4 140 Finally, a Platform f
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Chapter 4 142 • health care and g
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Chapter 4 144 to be sharp. The prop
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Chapter 4 146 able reasons, the Min
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Chapter 4 148 2. Kopp M, Réthelyi
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Chapter 4 150 1.3. The main feature
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Chapter 4 152 from outside the DoHC
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Chapter 4 154 to incorporate an exp
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Chapter 4 156 In 2004, there was an
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Chapter 4 158 ing socioeconomic var
Page 169 and 170: Chapter 4 160 The strategy is seen
Page 171 and 172: Chapter 4 162 2.5.2. Nutrition Some
Page 173 and 174: Chapter 4 164 The national lifestyl
Page 175 and 176: Chapter 4 166 A first policy for ol
Page 177 and 178: Chapter 4 168 In addition, many of
Page 179 and 180: Chapter 4 170 The strategy calls fo
Page 181 and 182: Chapter 4 172 tional policies. At t
Page 183 and 184: Chapter 4 174 the office of the Pri
Page 185 and 186: Chapter 4 176 28. Towards a tobacco
Page 187 and 188: Chapter 4 178 Kyrgyzstan Péter Mak
Page 189 and 190: Chapter 4 180 In the case of Kyrgyz
Page 191 and 192: Chapter 4 182 The active involvemen
Page 193 and 194: Chapter 4 184 disease prevention at
Page 195 and 196: Chapter 4 186 The existing, often f
Page 197 and 198: Chapter 4 188 ment. One part of the
Page 199 and 200: Chapter 4 190 fell rapidly from 199
Page 201 and 202: Chapter 4 192 the health field were
Page 203 and 204: Chapter 4 194 An attempt was made t
Page 205 and 206: Chapter 4 196 iour of schoolchildre
Page 207 and 208: Chapter 4 198 Lithuania reports reg
Page 209 and 210: Chapter 4 200 risk factors have bee
Page 211 and 212: Chapter 4 202 closer state control
Page 213 and 214: Chapter 4 204 of industrial disease
Page 215 and 216: Chapter 4 206 ensure that in the lo
Page 217 and 218: Chapter 4 208 in order to deal with
Page 219: Chapter 4 210 added weight of being
Page 224 and 225: Chapter 5 Reflections on experience
Page 226 and 227: whether lifestyles can be affected
Page 228 and 229: over the years. In these countries,
Page 230 and 231: In countries where the process has
Page 232 and 233: Policy formulation This section dis
Page 234 and 235: Capacity mapping The policy formula
Page 236 and 237: during policy formulation. Naturall
Page 238 and 239: civil servants have a degree of per
Page 240 and 241: It can be quite a challenge for the
Page 242 and 243: • the extent of the health proble
Page 244 and 245: example, improving health literacy
Page 246 and 247: The policy content The content of s
Page 248 and 249: With the possible exception of Finl
Page 250 and 251: tation, and an important investment
Page 252 and 253: We would add that more use needs to
Page 254 and 255: On the whole, “revised” policy
Page 256 and 257: arguments for applying an integrate
Page 258 and 259: the most appropriate prerequisites
Page 260: (http://www.euro.who.int/document/e
Page 263 and 264: Chapter 6 254 As premature deaths f
Page 265 and 266: Chapter 6 256 goods”, including f
Page 267 and 268: Chapter 6 258 be conflicting, and t
Page 269 and 270: Chapter 6 260 effectiveness of inte
Page 271 and 272:
Chapter 6 262 • Examining the cos
Page 273 and 274:
Chapter 6 264 ments/ev_060302_rd06_
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