THE TALLINN CHARTER: PRELIMINARY LESSONS LEARNT · 2013. 10. 10. · THE TALLINN CHARTER: EARLY LESSONS LEARNT Andorra, March 9-11, 2011 Moldova: expansion of coverage towards universality

THE TALLINN CHARTER: EARLY LESSONS LEARNT

Andorra, March 9-11, 2011

Andorra, 9-11 March 2011

THE TALLINN CHARTER:

PRELIMINARY LESSONS LEARNT

Dr. Hans Kluge

Director

Division of health systems and public health

WHO Europe



Overview of post Tallinn

Tallinn Ministerial

Conference on “Health Systems”

Copenhagen

Regional Follow-up

meeting

Andorra “European

Health Policy

Forum”

Draft Interim Report

RC 65

Final report

2008 2009

2011 March

2015

RC 61

Final Interim Report

2011 Sept

Oslo Meeting

on

“Health in Times of

Global Economic

. Crisis”

2010



The Tallinn Charter

• Beyond health care: effective

health systems promote both

health and wealth

• Investment in health is an

investment in future human

development

• Well-functioning health

systems are essential for any

society to improve health and

attain equity



Interim report on progress

Questionnaire respondents so far

Azerbaijan, Belgium, Belarus, Bulgaria, Croatia, Czech

Republic, Estonia, France, Hungary, Israel, Kyrgyzstan,

Latvia, Malta, Netherlands, Norway, Portugal, Serbia,

Slovakia, Switzerland, Turkey, Turkmenistan,

Uzbekistan

Working group members from

Belgium, Estonia, Italy, Kyrgyzstan, TFYR Macedonia,

Norway, Russian Federation, Slovenia, Turkey



Progress implementing the commitments of the Tallinn Charter (1)

• Much progress promoting or maintaining solidarity and equity

– Moving towards universal coverage

– Inclusion of the poor through better targeting of public resources

– More inclusive service delivery approaches (e.g. for the Roma inBulgaria, Czech R, Serbia and Slovakia)

• Increased or maintained pro-health and pro-poor investments

– Catalytic role of health ministries

– Comprehensive and prioritized multi-year programs

– Reinvestment of taxes on alcohol and tobacco (e.g. Latvia, Portugal)



Moldova: expansion of coverage towards universality

• Expanded PHC to all citizens

regardless of insurance

status

• Expanded coverage of

health insurance program

to the poor

• Coverage funded by pooled

general tax and payroll tax

in mandatory health

insurance scheme

46.8

69.4

24.4

65.5

45.6

76

63.7

90.7

0

10

20

30

40

50

60

70

80

90

100

Employees insured Non-working insured Self-insured Uninsured

Any kind of medical services Inpatient care

Insured pay less out-of-pocket



The Tallinn Commitments and the financial crisis

• Values of equity and solidarity were put to the test

• Across the board budget cuts affect health outcomes,

hurt the poor and vulnerable

• Poor and vulnerable needed to be protected from the

effects of budget cuts with additional measures

(health, social, economic)

• Searching for efficiency gains became even more

imperative (service delivery structure, financing

arrangements)




• Impressive progress in enhancing transparency and

accountability for health system performance

– Increasing use of evidence in policy development with many

innovations in knowledge translation (e.g. Kyrgyzstan, Tajikistan,

Moldova)

– Dynamic developments in health system performance

assessment (e.g. Belgium, Portugal, Armenia, Georgia,

Kyrgyzstan)

• Health systems are becoming more responsive to citizens

and patients



Belgium: multiple responses to Tallinn

• Reimbursement extended to all persons under a

fixed income limit (‘Maximum Billing’)

• A fund to finance redistribution of doctors to

medically-deprived areas

• Special attention given to mental health, end-of-life

care and care for patients with chronic conditions

• Cross-country learning – multiple joint action

activities at the EU level



Kyrgyzstan: another inspiring example in evidence-informed policy development

• Public-private partnership between the MOH and Health Policy Analysis Center (HPAC)

• MOH produces annual sector monitoring instrument

• HPAC produces policy analysis at the request of MOH

• These are fed into annual health system performance reviews

• WHO supported capacity and institution building




• Greater stakeholder engagement in policy

development and implementation

– Opportunities for participatory processes in policy

development through consultations

– Implementation increasingly in partnership with

stakeholders through partnerships, often public-

private

– Communication, information sharing, and regular

and easy to use feedback mechanisms



Portugal: focusing on inclusiveness and engagement of stakeholders

• Health system performance assessment leading to

development of new national health plan

• Innovation in the development of the national

strategy for the integration of the homeless

population

• Funding of NGOs for the prevention of accidents



Examples of cross-country learning activities

• Networks (SEEHN)

• Joint health system performance assessment Switzerland and Netherlands

• Twinning of health policy analysis units in Kyrgyzstan and Tajikistan

• Widely disseminated analytical work (studies, books, publications)

• Flagship courses on Health System Strengthening for Eurasian & Baltic countries

• Knowledge Experience Expertise Bank



Moving forward: From Tallinn to Health 2020

• Lessons learnt implementing the Tallinn Charter will

inform Health 2020

• Many synergies with Health 2020

– Underpinning values of solidarity and equity

– Holistic approach to health

– Central role of health systems

• Health 2020 will take forward the following key Tallinn

Charter concepts one great step further

– Rejuvenating public health

– Governance for health



Preliminary lessons learnt (1)

• The Tallinn Charter has led to a more vigorous policy dialogue on the importance to invest, reform, and preserve our health systems

• Remarkable efforts by Member States to reinforce their health systems towards meeting values of solidarity equity, and participation

• WHO Europe has been a key partner working hand-in-hand with Member States to enable health systems to contribute to good health, become more responsive and fair



Preliminary lessons learnt (2)

• Leadership, innovation, and openness have

been key success factors for moving forward

with the Tallinn agenda

• Limited resources and “tunnel vision” have

prevented gains in some cases

• Values and the policy objectives endorsed in

the Tallinn Charter are and can be put into

practice



Concluding remarks

The Tallinn Charter has

•• inspiredinspired countries to act on their values to improve health and wealth

•• affirmedaffirmed a value based approach to health system strengthening

•• encouragedencouraged health ministries to lead change for health improvement



-From Values

to Action -

Division of Health Systems

and Public HealthThank You.

Documents

THE TALLINN CHARTER: PRELIMINARY LESSONS LEARNT · 2013. 10. 10. · THE TALLINN CHARTER: EARLY LESSONS LEARNT Andorra, March 9-11, 2011 Moldova: expansion of coverage towards universality