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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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)
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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 CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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)
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
Progress implementing the commitments of the Tallinn Charter (2)
• 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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
Progress implementing the commitments of the Tallinn Charter (3)
• 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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
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
THE TALLINN CHARTER: EARLY LESSONS LEARNT
Andorra, March 9-11, 2011
-From Values
to Action -
Division of Health Systems
and Public HealthThank You.