Primary Health Care Expert Group

Ninth Meeting

Helsinki, Finland

March 25 – 26th, 2010

Reference / PHC 9 Meeting Minutes
Title / Meeting minutes
Submitted by / Chair of PHC EG & ITA
Summary / Note / PHC 9th Meeting
  1. Opening of the meeting and welcome

The meeting was opened byPHC EG Chair Dr. Goran Carlsson, On behalf of hosts the participants have been welcomed to the meeting by Ministerial Adviser Mr Olli Kuukasjärvi. He shortly informed about new NDPHS strategy which planned to be approved during the upcoming CSR meeting in Moscow, April 19th-20th. The Chair invited all the participants of the Meeting to make a short introduction. The Chair, also members from Finland, Russia expressed their concern that Estonian members are not any more active in the PHC EG activities and have not been participating in the meetings since 6th Meeting in Kaliningrad. It was agreed that PHC EG Chair will communicate with Estonian Senior representative to the NDPHS to clarify possible reasons for that. PHC EG Chair thanked all the participants for the introduction also wishing fruitful discussions on the busy agenda of the meeting.

  1. Adoption of the Agenda

Dr. Goran Carlsson, Chair PHC EG have proposed to move agenda the item on election of new co-chair for the group to the second day, after item 13. The Chair also proposed to make the presentation from the new Russian NDPHS Chair country a separate agenda item.

The Meeting adopted the provisional Agenda with the amendments proposed (submitted as document PHC 8/2/1).

  1. Information from the NDPHS Secretariat on the developments in the NDPHS since the last meeting, including communication from the new Russian NDPHS chair

The Chair welcomed the new Senior Advisor at the NDPHS Secretariat, Ms Silvija Juscenko.

The NDPHS Secretariatprovided brief information on the following issues:

- the Partnership Annual Conference in Oslo, Norway, November 2009

  • the new NDPHS Strategy was adopted
  • NDPHS Declaration on Prison Health was adopted
  • Russia and Finland are the NDPHS Chair and Co-Chair, respectively, for 2010-2011

- the meeting of the working group on new Terms of Reference for Expert Groups and Task Groups (EGTOR) in Moscow on February 25, 2010

  • Expert Group and Task Group ToR templates were approved
  • The Expert Groups were invited to send their final proposed ToRs no later than 20 March 2010. Almost all Expert Groups have respected the deadline and after minor amendments made by the EGTOR Chair and the Secretariat the drafts were sent to the Expert Groups for a final revision by 29 March 2010.

- the meeting of the EG Chairs and ITAs in Moscow on February 25, 2010

  • The Russian Federation hopes to give a new impetus to the work of the NDPHS during its chairmanship. Russia informed that its priority will be the healthy lifestyles.
  • Chair Country disseminated a draft list of meetings foreseen for 2010

- the meeting of the past chair, the new chair and co-chair countries and the Secretariat in Moscow on February 26, 2010

  • Representatives of Norway, Russia, Finland and the Secretariat met to discuss the issues regarding next meetings of the CSR, PAC and PAC side-events

- the meeting of the chair, co-chair and Secretariat with WHO Euro

  • The Chair and the Co-Chair Countries and the Secretariat shall try to have a meeting with the new WHO EURO Regional Director Ms. Zsuzsanna Jakab. Issues to be addressed during the meeting include the involvement of the WHO in the activities of the NDPHS

- the role of NDPHS as Priority Area Coordinator for the health priority in the Baltic Sea Region Strategy

  • The fact that NDPHS has been proposed to contribute to the Strategy work exemplifies confidence and great expectations vis-à-vis it. It would help the NDPHS to increase its importance in the region and play a significant role in the regional cooperation in the Northern Dimension area as well as put the NDPHS in a better position to attract financing for its project-based activities. The role of the Priority Area Coordinator requires, inter alia, delivery of concrete results, implementation of the projects and involvement of multi-national stakeholders in the NDPHS’ activities.

-preparations for PAC and PAC side events for the years 2010 and 2011

  • The PAC side-event in 2010, as foreseen in the NDPHS Work Plan for 2010, should be dedicated to the EU BSR Strategy and the NDPHS role as a Lead Partner in the health sub-area. The meeting is planned to be organized in late October in Copenhagen and hosted by WHO/EUROThe idea of the Secretariat is to invite different donors.The Expert Groups can present their project ideas (mature ones) and possibly get some advice.
  • The PAC side-event in 2011 will, most probably, be dedicated to the Primary Health Care.
  1. Presentation of initiatives from the Russian NDPHS Chair country

The Russian PHC EG representative, Prof. Yulia Mikhailova, briefly presented plans of the new Russian CSR chair. The plans include initiative for extended collaboration between Member Countries and Organisations as well as several meetings in Russia, including the Ministerial PAC in the autumn of 2011. The theme of the side event is tentatively intended to be Primary Health Care.

  1. Summary of the activities of the PHC EG since the last meeting in Minsk, September 10-11th, 2009

PHC EG ITA,Dr Arnoldas Jurgutis, informed about the activities since the last PHC EG meeting in Minsk, in September 2009.

  • Immediately after the meeting in Minsk, September 16, the Joint Monitoring Committee of the Baltic Sea Region Programme announced that the ImPrim application had been approved. PHC EG Chair and ITA have visited Joint Technical Secretariat in Riga for contracting negotiations. PHC EG members from Partner countries have facilitated negotiations with Partner institutions and their respective Ministries for planning necessary own resources needed to contribute to the project activities.
  • As has been previously discussed, the Russian Kaliningrad project, initially an important part of the ImPrim application, was for formal reasons excluded from the ImPrim project. PHC EG Chair and PHC EG members from Russia have made efforts to source for external funding. Yulia Mikhailova (Russia) together with Tromso university have submitted project application to the Norwegian Funds, with objective to improve performance of primary health care professionals in Kaliningrad Region.
  • Denmark has made funds for health projects in Kaliningrad available through the Norwegian application procedure. Although no decision on this funding was yet available, it was hoped that funding for the Kaliningrad PHC project would be approved.
  • PHC EG Chair has actively participated in three NDPHS EG ToR meetings where have been elaborated draft versions of the Terms of Reference of EG
  • PHC EG Chair has proposed to CSR to form Task Group on Antibiotic Resistance, to initiate projects to address this very actual public health problem. Draft Terms of Reference of TG on AMR have been drafted by the Swedish MoH and the Swedish Institute for Infectious Disease Control in collaboration with PHC EG Chair.
  1. Report from Partnership Annual Conference side event on Prison health issues.

Arnoldas Jurgutis, ITA of PHC EGinformed that the side event of the Oslo Ministerial PAC was devoted to prison health issues and was attended by the Hon. Minister of Health of Norway and the Deputy Minister for Health of the Russian Federation. PHC EG contributed to this side event with presentation from Dr. Simo Kokko (Finland)on “Bridging the gap between the health services in prison and the civilian world - what could be the role of primary health care?” ITA also informed, that during the side event, presentation on Prison Health situation in Russia was made by PHC member prof. Yulia Mikhailova.The PHC EG members also contributed to the development of the Declaration on Principles of Cooperation between Prison Health and Public Health Services and Development of a Safer Society which was adopted during the event. The declaration and the presentations of this event can be viewed on the NDPHS website:

Mr Simo Koko (Finland)provided PHC EG members with a brief summary of his presentation. In his presentation he wanted to prove the necessity of close linkages of prison health and civilian health services and the main role of PHC in this linkage. Persons released from prison often went out to the society with multiple problems and they need integrated care.

Prof. Yulia Mikhailova (Russia) supported dr Kokko, also stressing on multiple problems people usually have when released from prison. She also informed that often released people in Russia do not have insurance and have very limited possibilities to get appropriate health care. Prof. Mikhailova proposed that PHC EG could initiate project to improve health care for this vulnerable society group and to improve cooperation and continuity with penitentiary health care system.

Dr Beate Lupton (Norway)stressed on existing different treatment standards in penitentiary health care systems when compared with civilian health care systems. The standards should be the same. To address existing gaps Norway several years ago introduced by law that primary health care providers in municipalities have also to take responsibility for prisoners if a prison is located in the area.

Dr Simo Kokko (Finland) said that the same initiative was taken in Finland that responsibility for prison health had been be moved to local municiapalities, but later local municipalities refused, because no sufficient funding had been provided from the government.

PHC EG Chair made summary remarks. He also thanked Dr Kokko and Prof. Mikhailova for their contribution to the PAC side event. PHC EG Meeting agreed that further communications with Prison Health Chair and ITA are needed for development of project proposals on how to improve care of people released from prison. PHC EG members also should communicate with senior representatives in their respective countries.

  1. NDPHS objectives and operational targets for the next four years.

PHC EG Chair informed that Partnership Annual Conference (PAC) in Oslo, Norway, in November 2009 adopted new goals and operational targets for the Partnership during the period 2010-2013. He presented the goals and welcomed PHC EG members to comment on the document.

Prof. Yulia Mikhailova (Russia) commented that Russia since Oslo declaration in 2003 until 2006 considered on how actively Russia should participate in the partnership, but since 2008 a number of positive decisions regarding active participation in the Partnership were taken.

Mr Olli Kuukasjärvi, MoH & SA of Finland,informed that Finland played active role in the Partnership since its very beginning in2003. There is strong enough commitment to the Partnership and Ministry of Foreign Affairs acts as coordinator of ND Partnership.

In response to the question raised by Dr Beate Lupton (Norway) regarding the legal enforcement tools in case of non-commitment to the NDPHS objectives by any of the PartnersMs Silvija Juscenko, Secretariat, explained that Partnership is political Framework with Political Commitment, but there are no legal tools to guarantee that all Partner countries give enough efforts e.g. to reach the Partnership strategic objectives.

Dr Beate Lupton, Norway, expressed her support to the Partnership and EG activities, that even without legal tools it makes some political pressure to Partner Countries calling to contribute to the objectives defined by the Partnership.

EG Members commented to the NDPHS Goals and operational targets. Mainly comments were addressed to Goal 5: Inequality in access to qualified primary health care in the ND area is reduced:

Prof. Yulia Mikhailova (Russia) informed that Operational target 5.1: Differences in the accessibility and quality of primary healthcare in the ND region are assessed and operational target 5.2: Mechanisms for promoting an equitably distributed and good quality primary care system, which corresponds to changing society health needs and increases the cost efficiency of the overall public health systems in the region, are defined are particularly actual for Russia. Some pilot studies indicated that there is very unequal accessibility to health care services by different population groups. It is very important to assess and develop appropriate strategies to address this issue.

The Meeting agreed that ImPrim will serve as good opportunity to reach operational target 5.1 and 5.2. in the Countries through Project Partners. Still PHC EG should continue with efforts to find funding sources for similar project activities in Russia.

The Meeting agreed that operational target 5.3 is not very relevant to PHC EG role and expertise. Additional resources of experts also should be found for operational target 5.4 on e-health technologies. Dr Beate Lupton (Norway) informed that Tromso university and prof. Toralf Hasvold works as one of the leaders in this area. The Meeting agreed that prof. Toralf Hasvold was very active with lot of valuable initiatives as PHC EG member and there could be found possibilities to get his contribution to the EG work on eHealth.

  1. Discussions on draftTerms of Referenceof the Primary Health Care Expert Groupand conclusions of the ToR for the EG

The PHC EG Chair presented the template for new Terms of Reference for the EGs and for Task Goups on new issues that had been agreed by EGTOR, an ad hoc working group. The PHC EG ToR had been adapted to the agreed format, and slight amendments have been proposed.

The Expert Group was invited to discuss the draft ToR and to discuss the conclusions and implications for the future work of the EG.

During the discussions it was agreed that the reference to the EG´s responsibilities as being on health systems development with a special focus on PHC were relevant and appropriately widened the scope of the EG.

A few minor amendments, without significance for the principles of the EG, were suggested and approved.

Since the EG template ToR, and hence the PHC EG ToR as well, are rather wide and unspecific, it was agreed that the EG Work Plan should specify, preferably for two years, the obligations and contributions of the EG towards the NDPHS Objectives and Operational Targets. A work plan for 2011 and 2012 should be drafted by the Chair, the Co-chair and the ITA and proposed for adoption at the next PHC EG meeting. During the drafting process, consultations with all PHC EG members should be held.

  1. Antimicrobial resistance –proposed ToR to CSR for a Task Group on this issue. Discussion on the role of the Primary Health Care EG in addressing this problem.

Draft Terms of Reference for a Task Group (TG)on Antimicrobial resistance had been elaborated and will be submitted to the next CSR session in Moscow April 19-20. The Chair informed that it was initially proposed that this TG should report through the PHC EG. However, the current draft ToR suggests that the TG reporting should be independent of any EG.

The Expert Group was invited to discuss all aspects of action related to the EG.

Prof Yulia Mikhailova (Russia)expressed the Russian satisfaction that the PHC EG initiated this TG, and the EG should keep active working with this important problem. The links to the PHC EG should remain strong.

Dr Simo Kokko informed that Finland was working with special projects targeted to primary health care doctors, to decrease prescription of antibiotics for humans. The problem with increasing resistance to Staphylococcus aueus, in important bacteria especially in hospital settings, was also emphasised. In addition, the contributions of veterinary services are very important.

Further support to this theme was expressed by Dr Paula Vainiomäki (Finland) and DrJacek Putz (Poland).

  1. ImPrim consortium – report from the kick-off Meeting and first activities planned for implementation by the partners

The kick-off meeting of theImPrim consortium took place as scheduled in Karlskrona, Blekinge county, Sweden, on February 22-23. All project partners, with one exception, participated in the meeting. The kick-off meeting focused on project planning, administration and reporting, and considerable time was allocated to Work Package planning.

A brief presentation of the Karlskrona kick-off meeting was given by the PHC EG ITA, and EG members contributed with additional aspects of the ImPrim project during the following discussion.

The project manager of the Finnish project from Turku, Dr Maika Kummel, gave a review of the nurse training activities associated with the Finnish project.

The problems associated with the drop-out of one project partner and possible replacements were discussed during the meeting.

  1. Workshop: Role of the nurse in primary health care. Experiences of immigrant doctors and nurses. Discussions on possibilities to strengthen the role of PHC nurse through ImPrim project activities.

This thematic workshop was linked to the PHC EG Meeting this workshop is organised by the Ministry of Health and Social Affairs of Finland and PHC EG of the NDPHS.