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

Chapter 6
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effectiveness of interventions. A strong focus on reviewing
and evaluating NCD policies, with the strengthening
of intervention and implementation research, would
greatly enhance knowledge on what works and what
does not, particularly in building partnerships for NCD
policy.
• Funding for evaluation. In the planning phase of policies
and programmes, an appropriate level of funding should
be guaranteed within public administration to fund monitoring
and evaluation. In addition, the research community
should be encouraged by designated funding to help
fill gaps on what does and what does not work.
• Sharing the knowledge of what works internationally. There
has been an expansion of “best practice” information
in recent years but this may not be easily accessible.
There is a need for new frames of reference for better
understanding and more developed methodologies of
adaptation to local needs.
• Transfer of knowledge within countries. Most countries
have examples of innovative action or pilot projects
at the subnational level, but this is not always widely
known or used. Stronger channels for sharing positive
and negative experiences and for discussing what went
right or wrong could help the dissemination of existing
good practices within countries. Successful practices and
pilots should be better integrated into the overall policy
development process.
• Capacity building in ministries of health. The capacity
of the ministry of health to meet the needs for NCD
policy development, and of public administration in
general, is rather weak in some countries. It could be
enhanced by training, in relation not only to tackling
NCD but also to innovative and flexible policy-making
and planning, modern public health approaches and the
skills for intersectoral cooperation.
• Ensuring the right care, at the right time, in the right place.
Access to prevention and health promotion services,
and to high-quality care and rehabilitation for NCD, and
the results of such care, present a challenge for achieving
equity in health. Review of the quality, appropriateness
and timeliness of care for NCD is needed to ensure that
effective interventions are given priority. Evidence-based
guidelines are available in some countries, and their
wider adoption and implementation could be facilitated
through performance monitoring, funding mechanisms
and incentive schemes.
• Addressing long-term needs. Those who suffer from
NCD, and their families, may live with the consequences
of these diseases for many years. The way in which
existing health and social services meet the long-term
needs of patients and carers can be assessed, with a
view to developing more integrated, patient-centred
care closer to home. It may be worth considering testing
and adapting innovations developed in certain countries.
Establishing a unifying framework
Many countries have a combination of broad policies for
health (and/or policies for health promotion and health
care), together with policies for specific NCD and/or their
risk factors. In no case, among the countries studied, does
there appear to be clear coordination or harmonization of
these various efforts. Even within broad health promotion
policies, individual NCD or health risks appear to be tackled
in a vertical way. The European NCD Strategy provides
the opportunity to establish a unifying action framework or
“umbrella” that draws together the individual components
towards a common goal.
• Understanding the situation. A comprehensive situation
analysis, both of the burden of NCD and the existing
policies, strategies and actions for tackling them, would
give a better understanding of the challenges and existing
gaps.
• Mapping a way forward. To support coordination among
partners, it is essential to clearly state and disseminate
widely:
--
the overall objectives for tackling NCD
--
the priorities between them
Pointers to the future