EG on Primary Health Care
Third Meeting
Kraków, Poland
22 - 23 February, 2007
Title / Meeting MinutesList of annexes / Annex 1 – Report of Workshop with Attachments 1.1 and 1.2
Annex 2 – List of participants
Annex 3 – List of documents submitted to the meeting
Submitted by / Lead Partner Sweden
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. Mr. Zbigniew Król welcomed the participants to Kraków and also briefly presented Polish health situation.
2. Adoption of the Agenda
The Meeting adopted the provisional Agenda (doc. PHC 3/2/1).
3. Information about the outcome of the CSR 10 and PAC 3 events
The Secretariat provided short information about the outcome of the CSR 10 and PAC 3 events as well as a brief overview of the other recent developments in the NDPHS of relevance to the PHC Expert Group.
The new Northern Dimension (ND) Policy Framework Document and the Political Declaration on the Northern Dimension Policy agreed on in November 2006 between the EU, Russia, Norway and Iceland provided an important political background to the work of the Expert Group. The new Framework was of a permanent nature. Reference was made to the fact that the ND Partners had underlined the need for the cooperation reaching “tangible results”. The Expert Groups were important tools for reaching results and for implementing in practise what had been agreed on in the Framework documents. Also other actors of interest to the Expert Group were included for the implementation of the ND co-operation, such as regional actors, International Financing Institutions (IFIs), Non-governmental organizations (NGOs), and the Expert Group should make use of that. The principle of co-financing from all Partners was emphasized.
CSR 9 in Oslo in December had discussed the database and experts groups and the CSR had requested the Expert Groups to be fully engaged in the work. The next CSR meeting would be on 27-28 March. Future activities would be discussed and the Expert Group could consider what messages to convey to the CSR.
At the PAC meeting a discussion had been held about a vision for future activities and to take into account new ND environment. The Partnership should be both a coordinator and an initiator (minutes from the meeting can be read at the NDPHS website,
The next PAC was planned for November 2007 and the Expert Group would have an opportunity to bring up its concerns to high political level and develop proper input. The Secretariat proposed that Expert Groups develop thematic reports which recommendations to be included in final paper from the PAC.
A Work Plan for 2007 of the NDPHS had been endorsed by the PAC 3 in Oslo (doc. PHC 3/3/Info 3). Action line III.iii requested the Expert Groups to provide expert input to the preparation and implementation of joint activities carried out within the Partnership framework. Inter alia, if possible, the EGs should nominate Co-Lead Partners in their respective Groups. The Action Plan of the EG on Primary Health Care was attached to the Work Plan together with the Action Plans of the other EGs.
4. Workshop for the planning, setting objectives and other relevant elements for a comprehensive work plan. NDPHS Database and Project Pipeline
The report from the workshop is attached (Annex 1 with Attachments 1.1 and 1.2).
5. Agreement on priorities for the PHC Expert Group, based on the conclusions of the Workshop
Based on the discussions and conclusions in the workshop the PHC EG agreed on the strategy enclosed (Attachment 1.2), containing four working areas:
- Working Area 1: Framework for the PHC EG functions
- Working Area 2: Production of thematic reports and situations analysis
- Working Area 3: Support to planning, implementation and monitoring of projects, and
- Working Area 4: PHC EG contribution to database and project pipeline activities as crosscutting principles
As regards activities, the PHC EG agreed to give priority to Working Area 2, “Production of thematic reports, leading to suggestions for future activities”, in accordance with the strategy. Collection of information for and compilation of thematic reports would concern the following areas:
1. Collecting and aggregating information from PHC
2. Role of PHC in health promotion and disease prevention
3. Implications of demographic changes for PHC
4. Information sharing about remuneration systems for PHC and their implications.
It was preliminarily agreed to set up a sub reference group for each of the themes for the ITA to consult. Participants made preliminary choices of what reference group they wanted to take part:
1. Collecting and aggregating information: Leif Persson, Simo Kokko and Toralf Hasvold.
2. Health promotion etc.: Genovaite Palauskiene, Mary Collins.
3. Demographic changes: Mary Collins.
4. Information sharing on remuneration systems: -
In the first place Terms of Reference would have to be elaborated and agreed on for each theme.
It was noted that the priorities were relevant to all Partner countries. As regards data collection it was agreed that the group should try to collect information from all countries represented in the Expert Group.
6. Agreement on ITA(s)
Leif Persson, Sweden, informed the EG that Sweden had at its disposal around 100 000 € for 2007 that could be used for one or more ITAs, and that Sweden, as Lead Partner, was open to engaging one or more ITAs for working on the priorities of the EG. Unfortunately, it had so far not been possible to elaborate a final proposal.
The NDPHS Secretariat informed the meeting that the Expert Group would be able to use an additional 10.000 € for thematic reports related to the Database project.
The Expert Group agreed that in case it would have more than one person engaged, only one would have the position of ITA and the others could be “Task managers”, for more clarity as regards responsibilities.
As soon as the Chair had found an ITA and possibly Task Managers information would be sent to the EG for approval.
7. Next PHC EG meeting
It was agreed to hold the next meeting on 4 – 5 October 2007. Place of the meeting would be decided later.
8. Any other business
As a follow-up of the request by the NDPHS Secretariat in the workshop presentation of the database project the PHC EG agreed to nominate its Chair, Mr. Carl-Eric Thors, to represent the Expert Group in the Steering Group of the Database project. In addition, a future ITA should also take part in the Steering group.
On request of participants, Kerstin Ödman, Sweden, and the NDPHS Secretariat informed about the Partnership, especially its other Expert Groups (on HIV/AIDS, Prison Health and on Social Inclusion, Healthy Lifestyles and Work Ability (SIHLWA), as well as the Network on Trafficking of Human Beings and the CBSS Working Group on Co-operation on Children at Risk.
The NDPHS Secretariat furthermore informed about the development of a new website of the Partnership. One page would be set up for each of the four Expert Groups. The EG was invited to provide a text about itself and its activities. In a special section the EG was proposed to set up all its documents.
Attention was drawn to the fact that in 2008 the World Health Day would be devoted to Primary Health Care. The PHC EG could consider some activity to mark the importance of PHC.
9. Adoption of the PHC Meeting minutes
It was decided that the draft minutes be sent to participants at the latest on 23 March and that comments on the draft would be due, at the latest, on 30 March 2007. Revised minutes would then be distributed soon afterwards to be adopted per capsulam provided that no further comments were submitted. Furthermore it was agreed that a separate report on the Workshop should be elaborated.
10. Closing of the meeting
The Chair closed the meeting and thanked the Polish host for an excellently organized meeting.
EG on Primary Health Care
Third Meeting
Kraków, Poland
22 - 23 February, 2007
Reference / Annex 1Title / Report of Workshop with Attachments 1.1 and 1.2
Submitted by / Lead Partner Sweden
Summary / Note / Provides the report from the workshop, a work plan matrix and a strategy tree with priorities
Report from Workshop for the planning, setting objectives and other relevant elements for a comprehensive work plan. NDPHS Database and Project Pipeline
Ali Arsalo facilitated the workshop. Its aim was to elaborate a program with priorities for future initiatives, in accordance with the action plan for the Expert Group for 2007. As bases were used the Action Plan for the PHC Expert Group (doc. PHC 3/4/Info 1), the report of the Helsinki workshop in 2005 (docs. PHC 3/4/Info 2 and PHC/3/4/Info 2 Add.1). Furthermore, documents provided by the NDPHS Secretariat concerning the development of the NDPHS Database (PHC 3/4/Info 3 and PHC 3/4/Info 4) as well as the NDPHS Project Pipeline (doc. PHC 3/4/Info 5) were also used as bases for the workshop.
Ali Arsalo underlined the importance of having plans and project ideas in order to make financing bodies interested.
The workshop would be carried out according to a modified Logical Framework Approach (LFA). An example of the use of LFA was the elaboration of the Barents HIV strategy programme. In that case an expert had been appointed to visit all possible stakeholders to interview them on different problems that they considered to be important as regards HIV in the Barents region. Based on these interviews the expert elaborated a problem tree which was presented to a conference with the stakeholders. The problems were translated to objectives and activities. The conference participants had discussed the relevance of these and developed together a broader problem tree as well as broader objectives. The result had been presented to stakeholders again for finalisation. It resulted in a strategy tree with much information that could be shared by all involved. It contained elements to be implemented differently, for various needs in different places. It had taken one year to elaborate the strategy.
Ali Arsalo described the LFA as a process promoting a holistic way of thinking and acting, based on the analyses of problems and needs of the beneficiary and aimed at sustainable development. The key words describing the LFA principles were: identification of stakeholders, beneficiaries, participatory involvement, problem identification and analyses and orientation towards objectives.
The Expert Group first discussed whether it wanted to use the document from the Helsinki workshop as a basis for its priority discussion or whether it wanted to do totally new analyses. The Group agreed that the Helsinki document was a relevant basis for the discussions.
The Expert Group started by updating the information given in Attachment 2 of the Helsinki report, concerning identification of problems and development needs.
Estonia
Certain amendments had been made in the legislation but the main problems were the same. In certain cases salaries had been raised, at the same time PHC personnel had used the opportunities of the free labour market of the EU. There had been a drain to especially Finland, Sweden and the UK.
Finland
New legislation had contributed to improving access to primary health care, and the waiting periods had been shortened. However, the status was varying in the whole country. The whole primary health care system had been fragmented. Furthermore, the understanding of public health was varying, with many different interpretations.
Overweight and elderly care had come up on the political agenda.
Lithuania
The Ministry of Health now paid more attention to private PHC. There was better access to specialist care. All people could be sent to hospital during one or a couple of days for analysis and then back for further treatment. It was noted that these priorities were relevant to all Partner countries. As regards data collection it was agreed that the group should try to collect information from all countries represented in the Expert group. There is a need for better collaboration between PHC and social care. Training for nurses was planned for improving their understanding of public health.
The Ministry of Health was going to make a survey and ask patients about their views on the accessibility of health care. One idea was that all countries in the Expert Group could ask their patients the same question.
Norway
The general problem was that health problems change rapidly but systems were not adapted to this. One example was the elderly population. Elderly had problems of high age multi organ failure. They needed specialised high quality diagnostics, and the health system of today was not adapted to these needs. This also led to a mismatch of financing. Patients were neither treated at the right level nor at the right costs. There were two levels of medical work in Norway, the State and the Municipality PHC service working with public health matters.
To the list of problems should be added, concerning the ageing population, psychiatric care, diabetes. Furthermore, sick leaves was a big problem i Norway, related to muscle and skeleton problems, psychiatric problems. Every day 10% of the population were on sick leave.
Poland
Training had improved. There was a need to increase the number of doctors. TBC and HIV were still important problems in Poland.
Russia
Even if most of the problems listed still exist, a number of improvements had been made. Since 2006, the number of doctors had increased by 7 000. Salaries had also been improved, thus increasing the prestige of doctors. The Government, together with the WHO, was reviewing the health system. Even if access to the health services had been improved there were still important gaps between the rich and the poor and between regions. Primary health care needed to be developed for the whole population, including both medical and social aspects.
Sweden
Problems to be added were psychological problems, obesity, ageing population. A heavy work overload of the doctors was considered to threaten the Swedish primary health care system.
Marek Maciejowski, NDPHS Secretariat, described briefly the work on the Partnership Database and Project Pipeline. The EU Commission had granted financial support for this development. When finalized, the database and project pipeline would be the tools of both co-ordination and finding financing opportunities for projects. He underlined that the Expert Groups had a crucial role for the development of the database and that the CSR had requested all Expert Groups to become fully involved in the Database project. The different activities had been split up in 7 Work Packages, and the EGs needed to be involved in almost everyone in one way or the other. Reference was made to Doc. PHC 3/4/Info 5, showing point by point the need for participation by the Expert Groups. The PHC EG was invited to
- nominate a representative to the Project Steering Group
- assist in different ways to disseminate results (1 March 2007 – 31 December 2008),
- identify experts who can aid in the Database Development (1 January 2007 – 31 December 2007)
- assist in the work on Information on Specific Health Areas (1 January 2007 – 31 December 2008)
- be active in a number of ways in the field of Thematic Reports and Network Creation (1 March 2007 – 31 December 2008)
- support the development of the Project Pipeline (1 January – 31 December 2008).
The Chair reminded the EG that it had already included its contribution to the work on the database in its Action plan for 2007.
In order to facilitate the discussion on priorities the participants split into three working groups, led by Zbigniew Król, Paula Vainiomäki and Leif Persson respectively to discuss whether the Objective tree of the 2005 workshop was still valid and what changes needed to be done, as regards a) working areas and b) contents of working areas.
The result of the discussions is to be found in the Work Plan matrixes for the NDPHS PHC EG in Attachment 1.1.
The analysis made by the Expert Group resulted in a strategy setting priorities and some steps to start the implementation accounted for in Attachment 1.2.
1
Attachment 1.1
1. WORK PLAN matrix, including priorities for the NDPHS PHC EG 230207 (AS A WHOLE)
Working Area / Tasks and activities / Responsible / Reporting to whom / TimingPriority / Necessary resources / Region / Remarks & assumptions
Working Area 1
Framework for
PHC EG / 1.1. Functioning meeting procedures
1.2. Ensure horizontal
collaboration with other EGs
1.3. Recruitment and working arrangements of the ITA
1.4. Reporting to and
participation in NDPHS
1.5. Strengthening the role and visibility of the EG in PCH development between the ND Countries / 1.
1.
Contin. / Permanent group members are nominated
Qualified candidates are available
Working Area 2
Production of thematic reports and situation analysis / 2.1. Collection of information for and compilation of thematic reports about
2.1.1. Collecting and aggregating information from PHC
2.1.2. Role of PHC in health promotion and disease prevention
2.1.3. Implications of demographic changes for PHC
2.1.4. Information sharing about remuneration systems for PHC and their implications
2.2. Carrying out situation analysis
2.3. Policy analysis and reports
2.4. Dissemination of information / 2.
3. / ITA to draft
TORs and
budgets
Identification
of key
individuals
Working Area 3
Planning,
implementation and monitoring of projects / Project proposals to be
developed according to the
suggestions from thematic
reports / 3.
Working Area 4
PHC EG contribution to database and project pipeline activities / 4.1. Contribution to the development of the
database as a tool
4.2. Creation and use of the project pipeline “as a marketplace” or “project preparation platform” / Contin.
Contin.
2. Logical Framework based work plan matrix of the proposals of Groups 2+3 (Working Areas only)