EG on Primary Health Care
Fifth Meeting
Vilnius, Lithuania
22-nd May, 2008
Title / Meeting MinutesList of annexes / Annex 1 – List of participants
Annex 2 – Final agenda of the meeting
Annex 3 – Policy paper
Annex 4 – The list of the proposed activities according to the rating order made during the workshop
Annex 5 – PowerPoint presentations
Submitted by / Task Manager Valentin Rusovich and ITAArnoldas Jurgutis
Summary / Note / These minutes provide a summary of the meeting, including information on decisions taken
1. Opening of the meeting and welcome
The meeting was opened by Mr. Carl-Eric Thors, the PHC EG Chair. Short introduction of the members of the EG was made.New members from Latvia (Ms Ineta Bumane and Ms Sanita Janka) were introduced.
2. Adoption of the Agenda
The Meeting adopted the provisional Agenda with minor amendments. Mr. Carl-Eric Thors, the PHC EG Chairproposed to discuss item 10 of the provisional agenda “Agreement on policy paper should be presented in the seminar on PHC situation in ND countries” before item 9 (Information on recent developments in NDPHS Database project).Participants of the meeting agreed on the proposed changes in the agenda (annex 2 ).
3. Information of the NDPHS Secretariat on the developments in the NDPHS since the last meeting.
Ms Toril Roscher-Nielsen, NDPHS CSR Chair,provided information on the issue.
Last November 2007 inVilnius there was a PAC meeting at the Ministerial level of the partnership where the working plan had been approved. The Ministers also decided to continue activities on the development of the Worker’s Health Declaration. (documents could be seen on the website). Norway took over the Chairof the Partnership from Lithuania and Russia started as co-chair of the Partnership.
During the CSR meeting in April 2008 the legal capacity of the NDPHS Secretariat was discussed and the process of new agreements with the partners of NDPHS is launched at the moment.
France decided to become an Associated Member of the partnership. CSR agreed to invite Belarus to participate in the expert groups of the ND partnership.
All working groups developed thematic reports according to the planning. Due to overlapping fields of the expert groups there was decided to plan the joint meeting of all expert groups of the partnership during the last days of September in Oslo.
4. Summary of the activities of the PHC EG since the last meeting in Stockholm in October 2008
Mr. Carl-Eric Thors, the PHC EG Chair, informed on the activities of the PHC EG.
Elaborating of the thematic report on PHC in the ND countries was the main activity since the last meeting in October 2007.
Another major activity included preparation of the seminar on the 23-d of May in Vilnius.
Carl Eric appreciated the input of the working group and ITA Arnoldas Jurgutis during preparation of the thematic report and the conference in Vilnius.
From the other activities of the EG: participation in the CSR meetings and Chairand ITA meeting in Brussels
There was also meeting in Tromso in January 2008 in the framework of the Barents region cooperation.Director of the East Europe Committee of Swedish Health Cre community Mr. Goran Carlsson clarified the intentions of the meeting in Tromso. There is a need for information sharing and harmonizing activities with Norwegianand Russian partners, to merge some projects started by the Norwegian and Swedish sides in cooperation with Russia within the framework of the Barents region partnership.
5. Presentation of the thematic report on PHC situation in ND Countries
ITA of PHC EG Mr.Arnodas Jurgutis presented the thematic report on PHC in the ND countries.
The report was developed by ITA Arnoldas Jurgutis and task managers Mr. Michail Dotsenko (Russia, St. Petersburg) and Mr. Valentin Rusovich (Belarus) with the input from EG members.
The report still needs updating from some countries members of the EG . Final report with updating information should be published in Autumn 2008.
Summarising key issues and recommendations from the report there was developed a policy paper (also translated in Russian) and fact sheets with the possible proposals for PHC improvements and the project based activities. During thismeeting of PHC EG members and the seminar on the 23 May the priority activities should be agreed. Proposals of the future activities for strengthening PHC in the Region, including proposals for development and implementing projects should be one of the most important further PHC EG working areas. Discussions on this issue already should start next day after the meeting during the Seminar on PHC Situation in ND Countries.
Another two reports are being planned for the future.The report “The role of PHC in health promotion and disease prevention” was not developed due to the situation that task manager Mary Collins is busy with her new position and she was not capable to participate in the work. It was decided that Valentin Rusovich (task manager from EGPHC) will take the coordination role for the development of this report.The report “Implications of demographic changes for the PHC in the ND countries” should to be developed in the future(PowerPoint presentation in the annex 5).
6. Funding opportunities for PHC EG activities
Mr. Carsten Bayer, expert in project development informed on the possibilities for funding of the projects in the ND region from the Baltic region EU funds. The program provides the amount of 208 mln euro for the period of 2008-2013 to be spend in the region of the countries of the Baltic Sea. Almost all proposals mentioned in the policy paper could be elaborated to the projects and could be eligible for granting. For instance, “Bridging the gap in the inequity of the PHC staff distribution in ND countries” listed number one would fit ideally the aims of the EU Baltic sea region program. The next deadline for call for proposals will be in January- Febrauary 2009. The mean project term is about 3 year (with possible extension to 5 year), the amount granted ranging from one to five mln euro. Co financing of 10% is required for partnerships projects with Russia and Belarus, 15% for Baltic Statesand 25% for old EU members. Co-financing could be organised in form of the personnel costs with no cash flows. Reimbursement of costs begins from the one-year period from the start of the project (PowerPoint presentation in the annex 5).
- Discussions on the recommendations for strengthening PHC in the NDP countries and on priority project based activities planned to be developed and implemented by PHC EG
Irina Slepushenko, EG member representing Russiastarted the discussion. Community oriented approach in the form of the primary health care doctors (pediatrician and therapeft) used to be seen as very progressive in the times of the Soviet Union. We positively see at the profession of GP but can not destroy in one instance the infrastructure of the pediatric and adult policlinics. In Russia at the moment there are 73000 community doctors (pediatricians and internists) and only 6000 GPs.
The regions of Russia could themselves decide on the most appropriate form of the PHC and the policy for implementing of the GP oriented model of PHC. Rural regions are most favorable places for introduction of the PHC model. Regardless of the PHC model we should emphasize the need to increase the responsibility of the community doctors for the health of the patients. A proposal was made to make the point of improving of the “health of healthy people” in the form of dispanserisation (general health check-ups) of the working population.
Mr. Arnoldas Jurgutis, ITA of EG The traditions of the Soviet health care system were putting all responsibility for health on the health system. Communities and the patients themselves should share responsibility for their health. SILWA group is dealing with these issues as an example – more responsibility of the employers for the employee’s health.
Ms. Paula Vainiomaki, EG member fromFinland, PHC has a big potential for the health promotion and addressing risk factors. PHC doctors and nurses see about 80% of the population during the year in Finland. Two priorities could be given from the Finnish perspective: dealing with the risk behavior (excessive drinking, low exercise, smoking) and improving payment schemes with more incentive reimburesement for the health promotion and prevention activities in the PHC.
Mr. Zbignew Krol, co-chair of EG, EG member representing PolandClarification of the role of the EG is needed. Is this merely advising role to the governments or is this more technical role in preparation of the project activities. Implementation of the projects is rather difficult and it is not clear who is going to implement this activities.
Concerning the list of characteristics of the PHC we could use WONCA documents on training of GPs, “five star family doctor etc.” as “the golden standard” on the PHC.
There is need of proper assessment of the PHC in the countries. For example in Poland there are still pediatricians that are working in the PHC in the minority but comparatively more GPs than in smaller countries. The size of the country makes difficult to compare the tempo of the reforms. The results are easy to achieve in the countries that are less populated.
Best reimbursement mechanisms are difficult to define due to different perspectives of the patients and GPs.
Ms. Toril Nielsen, Chair of CSR NDPHS Clarified the mission of the partnership as an overview of the situation in the ND countries to be able to give added value to assessment of the ND region. Elaboration of the golden standards, definitions is the prerequisite of the international organizations like WHO and others in the relevant field.
Mr. Pim de Graaf, representing WHO found the list of recommendations in the policy paper document highly relevant and sound. Some parts of the policy paper could be better structured. However there are too many recommendations. How to prioritize them is the question. It could be prioritized either per importance for all ND countries or per each country separately. Short list of priorities needed to be subsequently translated into the project implementation.
Mr. Marek Maciejowski, Head of the NDPHS Secretariat, emphasized limitation of time for the project(s) proposal development left till the end of the year.
Mr. Karsten Bayer advised to take into consideration the internationally relevant issues to be eligible for granting the project from the EU.
Mr. Pim de Graaf, WHO proposed to make priorities per country for the coming day discussion taken into consideration that time needed for the further possible endorsement of the project based activities at the relevant participants.
Mr. Zbignew Krol, Poland suggested to make per each country during the coming 2-3 weeks 3 priority areas from the list in the policy paper and submit to the secretariat after the conference.
Mr. Simo Kokko, Finland wondered what responsibility relates to the choice of the possible project: weather the commitment of the country (Finland) to implement the project or it means that the chosen project would be relevant for tackling the problems in the PHC in their own country.
Mr. Mikhail Dotsenko, Task Manager PHC EG considered improving of the training of PHC doctors as the main priority area in Russia.
Mr. Marek Maciejowski, Head of the NDPHS SecretariatUrged to make the choice of the priority activities during this session taken into consideration the lack of time left for the project proposal elaboration.
Questioners to fill in the priority actions per country were developed and given to the participants for the preliminary voting. Relevance of the selected topics should be checked during seminar next day after the PHC EG meeting. (Annex 3. Policy paper, Annex 4. List of the proposals in the policy paper according the ranking order for the relevance)
- Discussion on possible indicators to monitor changes in PHC in NDP region
Mr. Zbigniew Krol proposed that possible indicators to monitor changes in PHC in NDP will strongly depend on the priorities for the project activities and should be further discussed as soon as the priorities would be set regarding the concrete projects of the NDPHS. The proposal was accepted.
- Agreement on policy paper should be presented in the seminar on PHC situation in ND countries
Mr. Pim de Graaf (WHO) gave some general suggestion to improve the layout of the policy paper.The heading of the policy paper should be clarified for whom is this document developed. The paper misses the names who developed it and in which terms of references. In some places it should be better structured. The document is too big for the policy paper and need shortening.
Mr. Simo Kokko, Finlandfound difficult place to read the first part of the document on the policy issues to be sold in Europe. The proposal was either to delete or rewrite this part.
Mr. Goran Carlsson, Sweden explained the statements in the first part of the policy paper were mostly meant as the brain storming and that is why does not match the structure of the rest of the document. However new version should underline the importance of disease prevention and health promotion as the core elements of strong PHC system.
Ms Irina Slepushenko, Russia found the document too extended with the danger of trying to tackle too much issues in once. Data in the policy paper is outdated regarding poor facilities in the PHC. A lot improvements happened after implementing of the State national health project in Russia.
Mr. ZazaTsereteli, ITA of Prison Health Expert Group proposed priorities to be listed first. If the document contains outdated information there is still time left to add new one.
- Information on recent developments in NDPHS Database project
Mr. Marek Maciejowski, Head of the NDPHS Secretariat gave a brief introduction on the recent developments in NDPHS Database project. The website of the NDPHS Database project was recently updated. Information on the projects, partners, and possibilities for granting the projects are easily found on the website. Info sheets about the NDPHS activities are available in the hard copies and electronic versions on the website.
11.Next PHC EG Meeting
Next meeting of the PHC EG as it was announced was planned on the September 30 – October 12008 inOslo. One day it will be a joint meeting for all EG of the NDPHS.
12.Any other business
Issues regarding facilitating discussion during next day seminar “PHC development in the ND region” were tackled. Mr. Pim de Graaf and Mr. Goran Carlsson will facilitate the discussion during the seminar. The discussion should focus on the priority list.
Ms. Irina Slepushenko proposed to stick to one priority project per country during discussion tomorrow.
Mr. Arnoldas Jurgutis, ITA of the EGsummarized the next steps to be done by the members of the expert group.Upgrading information in the Annexes of the PHC report is needed from the country’s experts during coming 3 weeks.
The proposals from the countries are also needed regarding application of the scoring system by Barbara Starfield.
13.Adoption of the PHC 5 Meeting minutes
The procedure of adopting the minutes of the workshop will be as follows. Minutes should be send around for comments by the 9-th of June 2008. Comments are expected by the 16-th of June. On the 19-th of June minutes of the workshop are finally adopted and published on the website.
14.Closing of the meeting
Carl-Eric Thors, the PHC EG Chair closed the meetings and thanked everyone for the active participation.
Primary Health Care Expert Group
Fifth Meeting
Vilnius, Lithuania
22nd May 2008
Reference / Annex 1 to the MinutesTitle / List of participants
Summary / Note / This list includes participants who participated in the Meeting
PHC EG Chairman
Mr Carl-Eric Thors, M.D
Sannesgatan 1
SE-432 37 Varberg, Sweden
Phone: +46 708 15 63 29
E-mail:
Estonia
Mr Ursel Kedars
Ministry of Social and Health Affairs
Gonsiori 29
EE-150 27 Tallinn, Estonia
Phone: +372 6282135
Fax: +372 6992209
E-mail:
Finland
Mr Simo Kokko, M.D., Ph.D
Development manager
Stakes
P.O.Box 220
FIN-00531 Helsinki, Finland
Phone: +358 503 620 446 (mobile)
Fax: +358 9 396 72 417
E-mail:
Dr Paula Vainiomäki
Senior Clinical Teacher
University of Turku
Lemminkäisenk.1
20014 Turku
Finland
Phone:+358407010014
Fax: +35823338439
E-mail:
Latvia
Ms Ineta Bumane
Department of Analysis and Development, Deputy Director
Latvia Health Compulsory Insurance State Agency
Cesu street 31
LV-1012 Riga
Latvia
Phone:003717043760
Fax: 00371 7043701
E-mail:
Ms Sanita Janka
Head of the Department of Contracts,
Riga Territorial Deartment of Latvian HCISA
Cesu Street 31
LV-1012 Riga
Latvia
Phone:+3717201298
Fax: +371 7043701
E-mail:
Lithuania
Dr. Genovaite Paulauskiene
Chief Specialist Mother and Child’s Health Care Subdivision
Ministry of Health of the Republic of Lithuania
Vilniaus str. 33
LT-01506 Vilnius, Lithuania
Phone: +370 5 266 1473
Fax: +370 5 266 1402
E-mail:
Dr Virginija Ambrazeviciene
Chief Officer
Ministry of Health
Vilniaus 33
LT 01506 Vilnius
Lithuania
Phone: +370 266 47 19
Fax: +370 5 266 14 02
E-mail:
Poland
Dr. Zbigniew Król
Agency of Health Technology Assessment
Aleje Lotników 22
00950 Warsaw, Poland
Phone +48 22 5667200
Fax: +48 22566 72 00
E-mail:
Russian Federation
Dr. Irina Slepushenko
Chief of the unit
Ministry of Health and Social Development
Rakhmanovsky per. 3/25
127994 Moscow
Russian Federation
Phone:+7-495-692-42-17
Fax: +7-495-692-42-17
E-mail:
Sweden
Mr Göran Carlsson
Executive Director SEEC
East Europe Committee of the Swedish Health Care Community
Erstagatan 1F
SE-11628, Stockholm, Sweden
Phone: +46 8 4413350
Fax: +46 8 618 76 60
Norway
Ms Toril Roscher-Nielsen
Director General,
Ministry of Health and Care Services