France

Health systems in transition France 125
for children up to the age of six years, with particular attention on families in
difficulty and run preventive health and social care interventions for children.
Health services are funded by SHI pursuant to partnership agreements with
the departmental PMIs. In 2012, the model agreement was expanded to include
home visits by midwives in the case of pathological pregnancies and coverage
of vaccinations provided by the PMIs to pregnant women and new mothers.
5.1.4 Health promotion and education programmes
INPES runs large-scale health education programmes and provides resources
for committees at the regional and departmental levels that carry out field
activities. The 2004 Public Health Act introduced objectives related to health
education and created regional public health plans that incorporate health
education activities.
5.1.5 National screening programmes
National screening programmes in France are centred upon cancer. The Ministry
in charge of Health decides which programmes will be implemented and shares
responsibility for implementation with the National Cancer Institute. The
2004 Public Health Act created 90 local structures, mainly at the departmental
level, to carry out mass screening programmes; 90% of these structures are
private non-profit-making associations, and around 50% are funded by general
councils, while the rest are funded directly by either the state or SHI. Tests and
related physician visits are funded by SHI. InVS is responsible for evaluating
these screening programmes.
Two mass national screening programmes have been deployed in France: one
for breast cancer and the other for colorectal cancer. Breast cancer screening
is targeted at all women aged between 50 and 74, who are invited by mail to
undergo a clinical examination and mammography every two years. Colorectal
cancer screening is aimed at all people aged between 50 and 74, who are invited
by mail every two years to go to their GP for free screening material, a faecal
occult blood test and explanations on the programme and on the process to use
the test. If people do not go to their GP in the next three months, they receive
a second letter of invitation. After two letters of invitation, the centre sends
them the test material at home expecting that people will do it and mail it back
for interpretation.
Organized screening programmes for cervical cancer have been piloted in
a number of departments. The 2014–2019 Cancer Plan called for a national
screening programme for cervical cancer for all women aged 25 to 65 years