Mapping the status of disease prevention and health promotion at primary health care level in Estonia

In Estonia, the burden of premature mortality from preventable diseases continues to be highthough the rates have been decreasing in recent years. Primary health care plays a central role inthe health system, providing a platform for the interface of health services with communities andfamilies and for intersectoral and interprofessional cooperation and health promotion. The study,Disease prevention and health promotion in primary care – needs and possibilities “, carried out inEstonia from November 2008 to June 2009, was initiated to identify the needs of primary healthcare (PHC) professionals – such as family doctors, family nurses, school nurses and occupationalhealth doctors – in their routine work in disease prevention and health promotion, and thepossibilities to strengthen their role in preventing noncommunicable diseases. The results show thelevel of readiness of the PHC professionals to practise health promotion and disease prevention inthe current settings. The study also determined aspects that could be improved to enhance diseaseprevention at the PHC level in Estonia. A number of recommendations have been made as anoutcome of the study.

Public health in Estonia 2008: an analysis of public health operations, services and activities

Since the end of the twentieth century, both public health as a discipline and public health services inEurope have faced unprecedented challenges. Estonian public health services (PHS) have undergoneextensive reform since 1990, as part of broader health sector reforms. Following European Unionaccession, the landscape of public health has been reshaped in many areas, most importantly through thenew National Health Plan 2009–2020, which sets out the basis of further improvements. This hascoincided with the evaluation of PHS undertaken by a team of the WHO Regional Office for Europe, at theinvitation of the Ministry of Social Affairs and its Public Health Department. The growing challenges to thehealth system in Estonia are mainly public health challenges: addressing the high incidence (which peakedin 2001) and prevalence of HIV, and addressing and reversing lifestyle and behavioural factors thatcontribute to ill health, such as tobacco use, alcohol consumption, low levels of physical activity andobesity.

Estonia: health system review

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Estonia has vigorously and quite successfully reformed its health system over the last decades. Whereas incremental changes are observed in the last five years,larger scale legislative reforms had been implemented since the early 1990s and at the beginning of this century. The current system is built on solidarity based health financing; a modern provider network based on family-medicine centred primary health care (PHC); modern hospital services and more attention for public health. This has resulted in a steadily increasing life expectancy and continuously high population satisfaction rates with access and quality. However, as in any health system, a number of challenges remain. They include reducing inequities in health status and health behaviour; improving control of and responding to the consequences of the high rates of HIV andrelated conditions; improving regulation of providers to ensure better public accountability; and sustaining health expenditures and human resources on a level that ensures timely access and high quality of care. The last challenge isparticularly important in the face of rising patient expectations and increased costs and volume of health care services. If solidarity and equity are to be maintained and guaranteed for the future, additional resources need to be found from public sources of revenue.

Health care systems in transition: Estonia

The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability).

Evaluation of primary health care reform in Estonia.

Estonia began to reform its health care system by reorganizing primary health care (PHC). Ten years ago, the health care system was inefficient, supply was biased towards institutional care, and PHC was almost non-existent in the western understanding: it was provided by different specialists in policlinics, and the financial basis of the system was in crisis. The reform had the following aims: to develop PHC by introducing family medicine, to guarantee the whole population access to family doctors' services, and to secure stable funding for these services. In 1998, a new phase in the reform was introduced through the creation of a new funding system for primary care services. The aim of this paper is to present a practically applicable set of indicators to evaluate PHC reform in terms of health economics criteria and then to apply these indicators in evaluation of the Estonian PHC reform.