EUROHEALTH

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Improving health information and health information systems
The EVIPNet country team, which worked
on the situation analysis described earlier,
a representative of the Ministry of Health
and the WHO Country Office decided
that the first EBP should focus on the
payment model for personal physicians
(general practitioners or paediatricians) † .
The EBP would help guide the Ministry
to implement the national health plan.
A team was formed to prepare this
specific EBP. The group consisted of
experts and practitioners, including a
family medicine specialist, the director of
a health care centre, a community nurse,
an expert from the providers’ association,
a representative from the HIIS, and the
EVIPNet country team. The process
involved several iterations before the draft
EBP was reviewed by both national and
international experts. The preparation of
the EBP was then presented and discussed
at the health system review policy dialogue
on primary care held in December 2015.
Lessons learned
Slovenia’s experience with both the
health systems review and developing a
KTP using the EVIPNet methodology
have been fundamental to equipping the
government with evidence-based and
inclusive decision-making processes that
are up-to-date, tailored and relevant to
the local context. Both the processes of
drafting the health system review reports
and the EVIPNet-guided EBP and policy
dialogues should continue to be employed
in the future.
The two approaches to EIP are
complementary. While both approaches
served to summarize and analyze available
evidence and information, the EBP to
be used for informing primary care
reform provides decision makers with
three detailed policy options to choose
from. The EIP processes used to inform
the health system review, on the other
hand, resulted, with a few exceptions,
in identifying the broader areas of
required action.
† Personal physicians are primary care providers
(particularly general practitioners) in the public health care
system, chosen by insured people (or their guardians) as their
first port of call for health related services. They also act as
gatekeepers to specialist and hospital care.
The credibility of any document that
synthesises evidence depends on the
consistency of the methods used to
combine and appraise the evidence,
considering locally specific circumstances
and the involvement of stakeholders. It is
clear that both the health system review
and the development of the EVIPNetinformed
KTP effectively involved a broad
range of stakeholders. For both processes
these were valuable opportunities to
acquire direct experience and unpublished
information (or tacit knowledge) that help
strengthen the scientific evidence. With
such a large group of interests around the
table it is possible to cross check scientific
evidence and minimize the monopoly of
one single set of interests or agendas. Both
processes required time and continuous
consultation to address all stakeholders,
interests and priorities. Both processes
also require continuously clarifying
roles and responsibilities among the
diverse groups of stakeholders to plan for
successful implementation.
Finally, an important lesson learned is that
a strong convening power, such as that
from the Ministry of Health, is necessary.
This was particularly evident in the case of
the health system review where important
backing from the Ministry of Health
was in place. As the focus shifts towards
implementation of the new national health
plan, the Ministry will need to sustain
and create additional capacities to ensure
the ongoing, systematic and targeted
use of evidence in policy-making. This
is a primary focus and strength of the
EVIPNet methodology.
Conclusion
The two approaches to EIP clearly
responded to different policy-making
needs and should be seen along a
continuum of EIP. Both approaches set
out to “synthesize, exchange and apply
knowledge by relevant stakeholders to
accelerate the benefits of global and local
innovation in strengthening health systems
and improving people’s health.” 4 The
Slovenian Ministry of Health is clearly
committed to engaging EIP processes for
health reforms. Without such government
support, evidence-based policy-making
initiatives would not attract the attention,
the expertise, or the involvement of
stakeholders that it needs to maintain
its integrity and strength. This political
support, however, must be matched with
ongoing, appropriate local capacity,
financial and non-financial resources
as well as systematic approaches.
References
1
WHO. Ljubljana charter on Reforming Health Care
in Europe. Copenhagen: WHO Regional Office for
Europe, 1996. Available at: http://www.euro.who.
int/__data/assets/pdf_file/0010/113302/E55363.
pdf?ua=1
2
MMC RTV SLO. European Commissioner
impressed by the preparations for healthcare reform.
21 March 2016. Available at: https://www.rtvslo.si/
zdravje/novice/evropski-komisar-navdusen-nadpripravami-na-zdravstveno-reformo/388793
3
Kolar Celar M. Speech by the Minister of Health
at the presentation of the analysis of the health care
system in Slovenia, Brdo pri Kranju, Slovenia on,
8 January 2016. Available at: http://www.mz.gov.si/
fileadmin/mz.gov.si/pageuploads/Analiza/8_1_2016/
Uvodni_nagovor_Milojka_Kolar_Celarc.pdf
4
WHO. EVIPNet Europe Strategic Plan. Copenhagen:
WHO Regional Office for Europe, 2015. Available
at: http://www.euro.who.int/__data/assets/pdf_
file/0009/291636/EVIPNet-Europe-strategic-plan-
2013-17-en.pdf
5
WHO. Slovenia holds workshop to optimize
evidence-based health policy-making. Copenhagen:
WHO Regional Office for Europe, 2015. Available at:
http://www.euro.who.int/en/countries/slovenia/
news/news/2015/02/slovenia-holds-workshop-tooptimize-evidence-based-health-policy-making
6
Petrič D, Žerdin M. Public network of primary care
providers in the Republic of Slovenia – General and
familiy medicine clinics and paediatric clinics at the
primary care level. Ljubljana: Ministry of Health, 2013.
Available at: http://www.mz.gov.si/fileadmin/mz.gov.
si/pageuploads/mreza_na_primarni__sekundarni_
in_terciarni_ravni/Mreza_za_ZS_13-11-2013-
lektorirano.pdf
7
WHO. EVIPNet Europe starter kit. Copenhagen:
WHO Regional Office for Europe; in press.
8
Ongolo-Zogo P, Lavis JN, Tomson G,
Sewankambo NK. Initiatives supporting evidence
informed health system policymaking in Cameroon
and Uganda: a comparative historical case study.
BMC health services research 2014;14(1):1.
Eurohealth — Vol.22 | No.2 | 2016