WORLD HEALTH ORGANIZATION
|World Health Organization |[pic] |Organisation Mondiale de la SantÉ |
|Regional Office for Europe | |Bureau R(gional de l'Europe |
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|Weltgesundheitsorganisation | |ВсемирнаЯ организациЯ здравоохранениЯ |
|Regionalbüro füR Europa | |Европейское региональное бюро |
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|Expert consultation | |
| |Updated: 20 February 2014 |
Essential Public Health Operations
(EPHO) and Services in Europe
Revised Version
EPHO 1: Surveillance of population health and well-being
Description of operation: Establishment and operation of surveillance systems to monitor the incidence and prevalence of diseases and of health information systems to measure morbidity and population health indexes. Other elements of this operation comprise community health diagnosis, data trend analysis, identification of gaps and inequalities in the health status of specific populations, identification of needs, and planning of data-oriented interventions.
1.1. Surveillance in the area of vital statistics
Surveillance in the area of civil registration should cover the following:
• existence of a complete vital registration system;
• existence of data on cause of death and adjustment for mortality and morbidity data; and
• evaluation and assessment of the quality and population coverage of collected data.
1.2. Surveillance of communicable diseases
Surveillance systems and disease registries should cover the following:
• existence of a legal framework for the reporting and surveillance of communicable diseases;
• existence of a list of notifiable diseases by relevant area (infectious, NCD, foodborne);
• existence of monitoring systems for microbiological and chemical contamination in the food
chain; and
• capacity to provide relevant data to international agencies (WHO, ECDC, EFSA, Eurostat etc.).
1.3. Surveillance of noncommunicable diseases
Surveillance systems and disease registries should cover the following:
• existence of a legal framework for the reporting and surveillance of communicable diseases;
• existence of a list of notifiable diseases by relevant area (infectious, NCD, foodborne);
• capacity to provide relevant data to international agencies (WHO, ECDC, EFSA, Eurostat etc.).
1.4. Surveillance of social and mental health
Surveillance systems and disease registries should cover the following:
• existence of Mental Health registry with sufficient confidentiality safeguards; and
• availability of indicators related to peer support networks or of any other type of operational social
• support and related activities.
1.5. Surveillance of maternal and child health
Surveillance systems and disease registries should cover the following:
• existence of a legal framework for data collection; and
• existence of information systems on provision of mother and child health services (process, outputs and outcomes evaluation).
1.6. Surveillance of environmental health
Surveillance systems and disease registries should cover the following:
• surveillance of data with integration of environmental factors with population health;
• existence of specific guidelines for the establishment of appropriate surveillance mechanisms for human and environmental hazards and diseases introduced into local communities;
1.7. Surveillance of occupational health
Surveillance systems and disease registries should cover the following:
• existence of surveillance systems to monitor workers’ health with the objective of accurately identifying and controlling occupational hazards. This includes:
o registry of exposure to major risks, occupational injuries and diseases; and
o capability of early detection and prompt reporting; and
• existence of special surveillance on asbestos-related diseases, silicosis, and other high priority occupational diseases following WHO recommendations and ILO conventions.
1.8. Surveillance of injuries and violence
Surveillance systems and disease registries should cover the following:
• existence of a national registry for Injury Surveillance (including domestic violence) from various sources: hospital information systems, emergency departments, death certificates, and accident reports;
1.9 Surveys of health status and health behaviors
Surveys of Health Status and Health Behaviour should cover the following:
• existing goals and definitions of population health items to study;
• existing definitions of subpopulations at risk, for example, people living in poverty, children, pregnant and lactating women, and Roma;
1.10 Mapping health inequalities
Surveillance systems health inequalities should include the following:
• A geographical component to health inequality data to allow the use of GIS to demonstrate the location of at risk populations and also to provide advocacy opportuities
1.11 Data integration and analysis (including community health diagnosis) in order to identify population needs and risk groups and monitor progress towards health-related objectives (in areas 1.1–1.8)
Data integration and analysis should cover the following:
• identification and establishment of agencies for evaluation and assessment of the quality of collected data;
• existence of protocols and standards for production, analysis and interpretation of data for comparison at national and international level;
• exchange of data within health registries and information sources among all national offices (including those outside the health sector), with sufficient safeguards for privacy and confidentiality;
• availability of software or ad-hoc computer programmes generating standardized analyses, tables and graphics;
• existence of hardware and infrastructure to support these activities;
• possibility of cross-sectional and trend analysis of data; and
• possibility of data disaggregation by socioeconomic markers, sex, ethnicity, levels of income, education and other relevant areas (e.g., in Occupational Health, disaggregation by industrial sector).
• Infrastructure for data analysis and integration of data and production of information.
EPHO 2: Preparedness and response to health hazards and emergencies
Description of operation: Monitoring, identifying and predicting priorities in biological, chemical and physical health risks in the workplace and the environment; risk assessment procedures and tools to measure environmental health risks; release of accessible information and issuance of public warnings; planning and activation of interventions aimed at minimizing health risks.
Preparedness for management of emergency events, including formulation of suitable action plans; development of systems for data collection and prevention and control of morbidity; and application of an integrative and cooperative approach with various authorities involved in management.
A. Monitoring and preparedness to health hazards
2.A.1. Chemical hazards
System and procedures for the identification of chemical and physical health hazards thorough analysis of surveillance data or epidemiological research.
System and procedures of control should include the following
• Surveillance networks of chemical and physical health hazards, including in the food chain (from farm to fork).
• Establishment of cause-effect correlations with outbreaks in the community.
• Encouragement of research for the development of new methodologies and oversight strategies.
2.A.2. Biological hazards (including Communicable diseases outbreaks)
System and procedures for the detection of outbreaks of communicable disease.
System and procedures of control should include the following:
• Procedures for GPs, nurses, physicians, etc. regarding the reporting of any unusual clusters or presentations of communicable diseases.
• The adequacy in practice of the reporting level.
• Whether outbreaks are detected in early or later stages.
• Whether risk communication is at place
2.A.3 Evaluate your system and procedures for outbreak investigation and cause identification.
System and procedures of control should include the following:
• How well the existence of an outbreak is established (refer to recent cases).
• Whether outbreak investigations are done by epidemiological teams?
• Whether case definition and case counts are applied?
• Whether risk communication is at place
• Establishment of cause-effect correlations with outbreaks in the community.
2.A.4 2.B.2 Arrangements and procedures for identifying possible hazardous exposures in the environment
• Capacity to critically assess potential impacts of uncertain environmental determinants, and to establish a dialogue with relevant sectors
• A multidisciplinary approach that integrates different skills and fields of knowledge to identify hazardous exposures.
2.A.5 2.B.9 Arrangements and procedures for monitoring progress towards implementation of the International Health Regulations (IHR)
• Evaluation of national laws regarding IHR.
• Interaction with different stakeholders (existing agreements, other mechanisms for interaction within integrated national system to implement IHR)
• Dissemination of knowledge to the health sector.
• Dissemination of knowledge to other ministries.
• Performing intersectoral table top exercises.
• Agreements with neighboring countries.
2B. 2C. Laboratory support for investigation of health threats (link with 1.11)
2.B.1 2.C.1 Readily accessible laboratories capable of supporting research into public health problems, hazards and emergencies
Laboratory Support should include the following:
• Existence of a network of readily accessible public health laboratories that are in line with National and International Standards.
• Existence of specific environmental labs monitoring air, water and soil quality as well as waste water and solid waste
• Collaboration with other laboratories (private, academic institutions) for both research and during crises.
• Communication between laboratories and epidemiological units.
• Integration of databases with the rest of SSII.
• Existing standards for lab control followed
2.B.2 2.C.2 Readily accessible laboratories capable of meeting routine diagnostic and surveillance needs
Laboratory Support should include the following::
• Existence of a network of readily accessible laboratories in line with national and international standards.
• Adaptation of the infrastructure to the volume of samples over time.
• Capacity to control and validate the results on national level
• Collaboration with other laboratories (private, academic institutions) for routine diagnostic and surveillance needs.
• Communication between laboratories and epidemiological units, including other sectors such as environment and veterinary fields.
• Integration of databases with the rest of SSII.
2.B.3 2.C.3 Ability to confirm that laboratories comply with regulations and standards through credentialing and licensing agencies
Laboratory Support should include the following:
• Existence of specific regulations on guidelines, protocols or standards to address the handling of laboratory samples, including procedures for collecting, transporting, receiving, storing, labelling, testing and reporting
• Availability of mechanisms to ensure the fulfilment of the above guidelines or standards for handling of laboratory samples (i.e. accreditation).
2.B.4 2.C.4 Ability to address the handling of laboratory samples through guidelines or protocols
Laboratory Support should include the following
• Existence of specific regulations on guidelines, protocols or standards to address the handling of laboratory samples
• Availability of mechanisms for inspecting the fulfilment of the above guidelines or standards for handling of laboratory samples.
2.B.5 2.C.5 Adequacy of the public health laboratory system and its capability to conduct rapid screening and high-volume testing for routine diagnostic and surveillance needs
Laboratory Support should include the following
• If no such laboratory exists, consider whether or how you aim to develop such a facility.
• Regulations concerning quality assessment of laboratories.
• Possibility of adapting to international standardisations: ISO 17000.
• Availability of PNT (standard work procedure).
• Mechanisms for certification and recertification.
• Performance of intra-laboratory and inter-laboratory reviews.
2.B.6 2.C.6 Capacity to produce timely and accurate laboratory results for diagnosis and research of public health threats
Laboratory Support should include the following
• Existence of the necessary laboratory infrastructure to produce results for diagnostic and investigative public health concerns.
• Availability of mechanisms for inspecting the fulfilment of the protocols to produce results for diagnostic and investigative public health concerns.
• If you do not have such ability, consider whether or how you aim to develop and maintain a new and appropriate facility.
C. D. Preparedness and response to PH emergencies
2.C.1 2.D.1 Ability to define and describe public health disasters and emergencies that might trigger implementation of an emergency response plan
Preparedness for management of emergency events should include the following
• Existence of specific preparedness guidelines for emergency response in the relevant areas:
o Natural Hazards (meteorological, geological and biological)
o Human-Caused Hazards: accidents (workplace, transportation or structural) and intentional acts (civil disturbance, strike, hostage incident, violence, terrorism, cyber-attack, arson)
o Technological Hazards (utility outage, loss of connectivity, application failure, fire, explosion, hazardous material spill or release, transportation interruption)
• Capacity to foresee the different factors that might trigger this type of emergency.
• Ability to anticipate the population at risk and its requirements.
• Systematic assessment of requirements and of the available means of action.
• Identification of underlying social problems that might be exacerbated during such incidents.
• Existence of information systems including intra-national and international warning networks.
2.C.2 2.D..2 Development of a plan that defines organizational responsibilities, establishes communication and information networks, and clearly outlines alert and evacuation protocols
Preparedness for management of emergency events should include the following
• The integration of planning for all the above potential emergency situations (in 2D1).
• Existence of a general plan, easily available and pragmatic, that defines organisational responsibilities, communication algorithms and information networks.
• What the basis is for elaborating the plan – i.e. whether it will be the previous analysis of the possible risk factors as well as of the requirements associated with these risk factors.
• Whether requirements for implementation are also developed alongside the plan/s.
• Whether emergency plans have been developed in collaboration with all other agents involved (not only medical/public health dimension, but also social, economic, occupational, environmental, and defence dimensions).
2.C.3 2.D.3 Periodic assessment of the capacity for rapid response, including testing of the emergency plan through tabletop exercises and large-scale drills
Preparedness for management of emergency events should include the following
• Systematic mechanisms for capacity response assessment.
• Table-top exercises and drills under ideal conditions to enable identification of processes or steps of the plan that need to be amended (refer to practical example).
• Periodic reports on results of the drills or practical exercises.
2.C.4 2.D.4 Development of written epidemiological case investigation protocols for immediate investigation
Points to consider in making your evaluations:
• Assessment of appropriateness of procedures for GPs, nurses, physicians, veterinarians etc. regarding:
I. The reporting of any unusual event or presentations of Communicable Diseases, including zoonotic.
II. Immediate investigation of relevant area (see 2.D.1).
• Assessment of the reporting level in the country.
2.C.5 2.D.5 Assessment of the effectiveness of evaluation of past incidents and identification of opportunities for improvement (see 6B6)
Points to be considered:
• How early/late the problems are usually detected.
• Existence of reports acknowledging aspects that should be improved in the future.
2.C.6 2.D.6 Maintenance of written protocols to implement a programme of source and contact tracing for communicable diseases or toxic exposures
Points to be considered:
• Whether there is an attempt to keep dynamic, written protocols accessible.
• Assessment of previous experiences regarding the availability and usefulness of the written reports.
2.C.7 2.D.7 Maintenance of a roster of personnel with the technical expertise to respond to all natural and man-made emergencies
Points to be considered:
• Explicit assessment of organisational aspects and existence of prepared professional teams.
• Log recording existing experts and professionals for different types of public health emergencies.
• Report acknowledging further needs of experts and professionals for different types of public health emergencies.
• Periodic updates to roster
2.C.8 2.D.8 Coordination with other sectors / Civil protection coordinated approach
Points to be considered:
• Explicit assessment of organisational aspects and existence of prepared professional teams.
• Log recording existing experts and professionals for different types of public health emergencies.
• Report acknowledging further needs of experts and professionals for different types of public health emergencies.
2.C.9 2.D.9. Implementation of the International Health Regulations (IHR) in the area of emergency planning
Points to be considered:
• How fully the IHR are currently implemented in the area of emergency planning.
• Whether there is a plan / programme for implementation and whether it is being implemented according to schedule.
• Evaluation of national laws regarding IHR.
• Performing intersectoral table top exercises.
• Agreements with neighbouring countries.
EPHO 3: Health protection, including environmental, occupational, food safety
Description of operation: Risk assessments and actions needed for environmental, occupational and food safety. Public health authorities supervise enforcement and control of activities with health implications.
This operation includes the institutional capacity to develop regulatory and enforcement mechanisms to protect public health and monitor compliance with accepted norms, as well as the capacity to generate new laws and regulations aimed at improving public health and promoting healthy environments.
3A. B. Environmental health and control of environmental health hazards
3.A.1 Legislative framework for environmental health protection
Points to consider in making your evaluations:
• Existence of an agency dedicated to environmental protection; competencies, authority and budget of that agency should also be considered
• Specific air quality regulations, including limits for carbon emissions by motor vehicles and factories
• Existence of water quality standards and regulations, with recent updated list of possible contaminants and their permissible level in drinking water
• Existence of standards for soil quality, with permissible levels of possible soil contaminants
• Legal/tax incentives to support sustainable energy sources
3.A.2 2.B.1 System with capacities, facilities and procedures for assessing actual or expected health impact due to environmental factors (link with 1.6)
• Existence of environmental epidemiology unit, or clear assignment of such tasks to dedicated PH staff, and environmental surveillance networks .
• The availability of professionals trained in methodology of environmental risk assessment procedures and models.
• Establishment of effective collaboration with environmental agencies, with access to environmental data
• Access to and use of modern methodology for dealing with environmental health determinants with population health regulations.
• Capacity to undertake rigorous risk assessment procedures.
• Interaction of multiply relevant parties exists
3.A.3 2.B.4 System and procedures for assessment of air quality (link with 1.6)
• Existence of a research group for integration of network data to find cause-effect correlation to the component of air pollution.
• Technical capacity in the area of environmental noise
3.A.4 2.B.5 System and procedures for assessment of water quality and robustness of clean water standards
• Environmental surveillance networks
• Compliance and enforcement of accepted standards (WHO Guidelines for Drinking-water Quality or other) to guarantee the quality and safety of plumbing materials used for drinking water
• Existence of surveillance system to monitor waste water storage and treatment
3.A.5 4.B.8 Activities and services directed at environmental health
Points to be considered:
• Existence of a list of activities or services directed at environmental health regardless of which authority or which ministry is the lead agency.
• Whether activities are multidisciplinary and intersectoral in nature.
• Whether services and activities are planned every year, or at least once every three years, according to a survey that deals with knowledge, attitudes and environment of the target populations.
• That the evaluation of activities and services is an integral part of the planning process.
• Whether feedback from the evaluation is implemented and is constructive for the following year’s planning.
3.B. Occupational safety (see 1.7)
3.B.1 3.A.1 Occupational Health Legislation
Points to consider in making your evaluations:
• Whether there is an explicit law on occupational safety / prevention of occupational risks (or a Prevention of Occupational Hazards Act).
• Inclusion of specific regulations to encourage safe work settings as part of the Law on the Prevention of occupational hazards.
• Legally established occupational health records (health check-ups that are tailored to the job post).
• Existence of regulations and a basic set of occupational health standards to make certain that all workplaces comply with minimum requirements for health and safety protection, ensuring an appropriate level of enforcement, strengthening workplace health inspection, and building up collaboration between the competent regulatory agencies according to specific national circumstances.
3.B.2 2.B.3 System and procedures for occupational health assessment and control (link with 1.7)
• Cooperation /interaction between ministries involved (Ministry of Health, Ministry of Labour, others).
• Existence of national approaches to prevention of occupational diseases and injuries which were developed according to countries’ priorities, and in concert with WHO’s global campaigns for elimination of asbestos-related diseases, and immunization of health-care workers against hepatitis B, and other actions addressing priority work-related health outcomes.
• Whether occupational health policies pay particular attention to high-risk sectors of economic activity, and to the underserved and vulnerable working populations, such as younger and older workers, persons with disabilities and migrant workers, taking account of gender aspects.
• Whether there is specific programmes established for the occupational health and safety of health-care workers.
• The performance of occupational risk assessment regarding exposures to risk factors (see below)
• The existence of workplace health promotion campaigns (see EPHO 4)
3.B.2 3.B.1. Technical capacity for risk assessment in the area of occupational health
Points to consider in making your evaluations:
▪ Arrangements to collect samples (surveillance network).
▪ Technically qualified personnel to carry out control tasks.
▪ Arrangements to access data on risk factors from existing reliable data flows.
▪ Access to existing studies on the matter (scientific evidence) as part of a developing knowledge base.
▪ Assessment and management of health risks at the workplace performed based on clear definition of essential interventions for prevention and control of mechanical, physical, chemical, biological and psychosocial risks in the working environment. Such measures include
• integrated management of chemicals at the workplace,
• elimination of second-hand tobacco smoke from all indoor workplaces,
• improved occupational safety, and
• health-impact assessment of new technologies,
• work processes and products at the design stage.
▪ Existence of institutional capacities built for primary prevention of occupational hazards, diseases and injuries, including
• strengthening of human, methodological and technological resources,
• training of workers and employers,
• introduction of healthy work practices and work organization, and of a health promoting culture at the workplace.
• Mechanisms established to stimulate the development of healthy workplaces, including consultation with, and participation of workers, and employers.
C. Food safety (see 1.2, 2.A.1, 2.B.7)
3.C. 1 Technical capacity for risk assessment in the area of food safety
Points to be considered:
• Assessment of public health impact of food safety hazards and risks based on prevalences of biological and chemical contaminants in the food chain;
• Existence of institutional capacities built for the monitoring, surveillance and reporting of contamination in the food chain and foodborne diseases;
• Technically qualified personnel to carry out defined tasks regarding science-based risk assessment;
• Accessible data on risk factors from existing reliable data flows (e.g. source attribution);
• Access to relevant scientific research as part of a developing knowledge base; and risk assessment exercises to formulate consistent policy recommendations.
3.C.2 2.B.7 System and procedures for food safety risk assessment (link with 2.A.1)
• Existence of mechanisms for food safety risk assessment.
• Functional separation of risk assessment and risk management.
• Performance of research on possible effects of industrial farming and cattle-raising (use of pesticides, antibiotics, toxic waste removal, etc.)
3.C.3 3.A.4 Food Safety Regulatory Framework
Points to consider in making your evaluations:
• Existence of an agency dedicated to food safety
• Specific regulations and circulars on food safety in various settings (wholesalers, retailers, restaurants, caterers, schools, etc.)
• Existence of science-based animal health and safety regulations for industrially produced fish and livestock
• Regulations covering proper food packaging and labeling
• Use of new pesticides is subject to approval by food safety authorities
• Existence of import/export standards
3.C.4 3.A. Health protection within the healthcare system
3.D Other health protection legislation, regulations and systems
3.D.1 3.A.6. System and procedures to ensure safety of pharmaceutical goods and medical devices
Points to consider in making your evaluations:
• Existence of national standards regulating quality and safety of medical products
3.D.2 3.A.7 Programmes on patient safety and quality of healthcare
Points to consider in making your evaluations:
• Existence of practice standards to guarantee patient safety in a clinical setting
• Existence of specific regulations to ensure the safe collection, transport, storage and use of blood, tissues and organs
• Established system for reporting and monitoring clinical error
• The existence of specific regulations on guidelines, protocols or standards to address the safety and quality assessment of Health Care Facilities and Programmes. (see 6E)
• The availability of mechanisms and capacities for inspecting the fulfilment of the above protocols or standards.
3.D.3 3.A.1 Legislation related to main behavioural determinants of health (see EPHO 4)
Points to consider in making your evaluations:
• The strength of anti-tobacco legislation (no smoking laws in public places, limitations on sales, advertising and marketing of tobacco products, tax burden associated with tobacco products)
• Limitations on marketing, purchase and consumption of alcohol
• Limitations on marketing of processed foods to young people
• Existence of tax incentives or disincentives on processed foods or drinks containing high amounts of transfats or refined sugar.
3.D.4 Road safety
Points to consider in making your evaluations:
• Robustness of road safety laws (helmet laws, speed limits, pedestrian protection, cycle lanes, etc.)
• Resources dedicated to enforcement (camaras and technical equipment, man hours)
• Existence of point-based or other system for rescission of driver’s license of safety offenses.
3.D.5 Injury prevention & public safety systems and controls (if not covered above)
Points to consider in making your evaluations:
● Sports and recreation safety (playgrounds, sports and recreation venues, equipment, medical assistance on hand for game injuries)
● Fall prevention measures (presence of hand rails and anti-slip materials on stairs and ramps, sidewalk safety laws, etc.).
● Gun safety laws
EPHO4: Health promotion including action to address social determinants and health inequity
Description of operation: Health promotion is the process of enabling people to increase control over their health and its determinants and thereby improve it. It addresses determinants of both communicable and noncommunicable diseases and includes the following activities:
• The promotion of changes in lifestyle, practices and environmental and social conditions to facilitate the development of a societal development among individuals and the community that promotes public health and reduces societal inequalities in health, across the social gradient. The promotion of changes in lifestyle, practices and environmental conditions to facilitate the development of a “culture of health” among individuals and the community
• educational and social communication activities, adapted to specific socioeconomic groups, aimed at promoting healthy lifestyles, behaviours and environments;
• Reorientation of health services to develop care models that encourage health promotion and ensure equal access to health care
• analysis to understand the root causes of health inequities, including factors such as social
exclusion, low income, and poor access to health and social services;
• design of interventions to address the socioeconomic determinants of health;
• Intersectoral partnerships for more effective health promotion activities
• Assessment of the impact of public policies on health and risk communication
The means of achieving this include conducting health promotion activities for the community at large or for populations at increased risk of negative health outcomes, in areas such as sexual health, mental health, health behaviour related to HIV, drug abuse control, tobacco control, alcohol control, physical activity, obesity prevention, nutrition, food safety, work-related health hazards, injury prevention, occupational and environmental health.
The broader role of health promotion includes advising policy-makers on health risks, health status and health needs, as well as designing strategies for different settings. It also includes taking account of the determinants of health, in particular the social or socioeconomic determinants that cause ill health.
Health inequities arise from the societal conditions in which people are born, grow, live, work and age, referred to as the social determinants of health. These include early years’ experiences, education, economic status, employment and decent work, housing and environment, and effective systems of preventing and treating ill health. Actions on these determinants of health, both for vulnerable groups and the entire population, are essential to create inclusive, equitable, economically productive and healthy societies.
The conceptual boundaries between “health promotion” and “disease prevention” are at times ambiguous and subject to debate. In the preparation of this document, choices were made on a pragmatic basis, and readers may find deviations from categorizations made elsewhere.
A. Building and strengthening resilience of communities
4.A.1. Organized community programs for health promotion
4.A.2. Development of intersectoral partnerships with civil society to utilize human capital and material resources available.
4.A.3. Identification of community resources that collaborate in promotional activities
B. Health promotion activities for the community at large or for populations at increased risk of negative health outcomes.
For all questions consider how tailored activities are to the whole population, taking account of issues such as poverty, ethnicity, gender, other socioeconomic factors and groups at particular risk.
4.B.1 Activities and services directed at healthy diet and nutrition, physical activity and obesity prevention and control
Points to consider:
• Integration of different promotion strategies around healthy nutrition and physical activity.
• Intersectoral approach and partnership/interaction of other ministries, NGOs, local government, and the private sector, including Ministry of Education regarding diet and physical activity in schools.
• Integration of dietary and physical activity advice into primary health care services.
• Integration of different promotion strategies around healthy nutrition and physical activity.
• Community participation in planning and implementation.
• The involvement of the food industry through agreements that favour improved diet, food labelling and supporting nutrition projects (see also 6A2iii).
• Developing promotional and healthy nutrition strategies for particular population groups.
• Elaboration of specific health education materials to different age groups and/or groups with particular ethnic or social characteristics.
• Continuous monitoring and evaluation of health promotion projects.
• Government support to networks of NGO for health promotion as an outreach activity
• The involvement of the food industry through agreements that favour improved diet, food labelling and supporting nutrition projects (see also 6A2iii)
4.B.2 Activities and services directed at tobacco control
Points to be considered:
• Existence of a legal framework (regulations against smoking in public places, availability to young people, media publicity, selling price, etc.).
• Enforcement of laws and regulations on smoking, for example in public places.
• Comprehensive plans for dealing with the problem ( economic, political, social, cultural, environmental, healthcare and ethical) in line with FCTC implementation
• Elaboration of specific health education materials to different age groups.
• Evaluation and assessment of the implementation of the programmes.
• Whether services address the whole population, taking account of issues such as poverty, ethnicity, gender, other socioeconomic factors and groups at particular risk.
4.B.3 Activities and services directed at alcohol control
Points to be considered:
• Existence of a legal framework regulating alcohol purchasing or consumption.
• Enforcement of such legal frameworks.
• Evaluation of the effectiveness of such frameworks in achieving public health aims.
• Existence of a list of activities or services directed towards alcohol control.
• Whether activities are multidisciplinary and intersectoral/interactive in nature.
• Whether services and activities are planned every year according to a survey that deals with knowledge, attitudes and environment of the target populations.
• Integration of the evaluation of activities and services in the planning process.
• Whether feedback from the evaluation is implemented and is constructive for the following year’s planning.
• Whether services address the whole population, taking account of issues such as poverty, ethnicity, gender, other socioeconomic factors and groups at particular risk.
4.B.4 Activities and services directed at prevention and control of drug abuse
Points to be considered:
• Existence of comprehensive plans for dealing with the problem: economic, political, social, educational, cultural, environmental, healthcare and ethical.
• Reinforcement of community participation, NGOs and community leaders.
• Suitable orientation of the healthcare services (which allow for the necessary support treatments and arrangements/deinstitutionalization/decentralization).
• Involvement of social services professionals.
• Evaluation and assessment of the implementation of programmes.
• Whether services address the whole population, taking account of issues such as poverty, ethnicity, gender, other socioeconomic factors and groups at particular risk.
4.B.5 Prevention of infectious diseases (e.g. HIV, tuberculosis) related to health behaviours
Points to be considered:
• Comprehensive plans for dealing with the relevant problem: economic, political, social, educational, cultural, environmental, healthcare and ethical.
• Involvement of different disciplines in an intersectoral /interactive approach.
• Elaboration of specific health education materials by considering the social characteristics of the group to which the messages are addressed.
• Upgrading community participation (development of community attitudes: family, education system).
• Emphasis on development of healthy (safe) attitudes and not only knowledge about them (development vs. knowledge).
• Building of culturally sensitive health promotion plans with emphasis on prevention.
• Evaluation and assessment of the implementation of programmes.
• Whether services address the whole population, taking account of issues such as poverty, ethnicity, gender, other socioeconomic factors and groups at particular risk.
4.B.6 Activities and services directed at sexual and reproductive health
Points to be considered:
• Existence of a list of activities or services directed at sexual health.
• Whether activities are multidisciplinary and intersectoral/interactive in nature.
• Whether services and activities are planned every year according to a survey that deals with knowledge, attitudes and environment of the target populations.
• That the evaluation of activities and services is an integral part of the planning process.
• Whether feedback from the evaluation is implemented and is constructive for the following year’s planning.
• Whether services address the whole population, taking account of issues such as poverty, ethnicity, gender, other socioeconomic factors and groups at particular risk.
• Whether Public Health and Primary Health Services are capable of dealing with family violence ¨
4.B.7 4.B.9 Mental health activities and services
Points to be considered:
• Existence of a list of activities or services directed at mental health.
• Whether the activities are multidisciplinary and intersectoral in nature.
• Whether the services and activities are planned every year according a survey that deals with knowledge, attitudes and environment of the target populations.
• Whether the evaluation of activities and services directed is an integral part of the planning.
• The feedback from the evaluation is implemented and is constructive feedback for the next year’s planning.
• Whether services address the whole population, taking account of issues such as poverty, ethnicity, gender, other socioeconomic factors and groups at particular risk.
• Community oriented services/decentralization, deinstitutionalization arrangements
4.B.8 4.B.10 Dental hygiene education and oral health activities and services
Points to be considered:
• Orientation of public health towards dental hygiene.
• Existence and promotion of educational programmes of dental hygiene from kindergarten and through school.
• Integration of strategies to promote dental hygiene with other related strategies, such as healthy nutrition.
• Continuous surveillance of dental health and monitoring and evaluation of various programmes related to dental hygiene education and its outcomes.
• Are services accessible and affordable by the whole population, taking account of issues such as poverty, ethnicity, gender, other socioeconomic factors and groups at particular risk?
C. Intersectoral and interdisciplinary approach
4.C.1 4.C.2 Effectiveness of advocacy for health-conducive policies, strategies, actions and interventions by the non-health governmental sectors through dialogue and intersectoral approaches.
Points to be considered:
• The existence of advocacy processes by a non- health governmental sectors.
• The views and the advice of the non- health governmental sectors are taken into account in the strategies, actions and intervention.
• The views and advices of the non- health governmental sectors have influenced the final strategies, action and interventions.
4.C.2 4.C.3 Application of health impact assessment to other sectoral or regional
policies and developmental plans.
Points to be considered:
• The notion and the concept of "health impact assessment" is known to the public health officials on the national and regional levels.
• Availability of professionals who can perform a health impact assessment on a regional level.
• The health impact assessment is taken into account while dealing with regional policies and developmental plans.
• The health impact assessment is an integral part of the developmental plans and regional policies done by a intersectoral teams.
4.C.3 4.C.4 Success or progress at interrelating information systems to ensure the
most efficient use of available data. (see 1.11)
Points to be considered:
• Availability of efficient information system based on sound data.
• The information system is undergone a continuous quality improvement.
• The information system provides each year a better use of available data.
• The availability of information system is influencing better quality of data and its most efficient use.
4.C.4 4.C.5 Intersectoral strategies and approaches in the following areas of public health: occupational health (health in the work place), environmental health, sexual health and mental health. (cross-reference relative areas)
Points to be considered:
• The intersectoral approach is part of the working culture on the national level.
• The strategies developed in each one of the above mentioned areas in public health are developed within an intersectoral framework.
• The implementation of national strategies is done in an intersectoral way.
• Existence of national policy framework for workers’ health are formulated taking account of the relevant international labour conventions and include: enactment of legislation; ¨
• establishment of mechanisms for intersectoral coordination of activities;
• funding and resource mobilization for protection and promotion of workers’ health;
• strengthening of the role and capacities of ministries of health;
• integration of objectives and actions for workers’ health into national health strategies.
• Whether national action plan on workers’ health is elaborated between relevant ministries, such as health and labour, and other major national stakeholders taking also into consideration the Promotional Framework for Occupational Safety and Health Convention, 2006. Such plans should include:
• national profiles;
• priorities for action; objectives and targets; actions;
• mechanisms for implementation; human and financial resources;
• monitoring, evaluation and updating; reporting and accountability.
4.C.5 4.C.6 Intersectoral strategies that specifically target the social determinants of
health, such as poverty, housing, work & unemployment, socio-economic exclusion (of groups or individuals), access to education, nutrition, drug use.
Points to be considered:
• The existence of specific targets in the national public health policy that are taking into account the social determinant of health.
• These specific targets are an outcome of intersectoral strategies.
• These intersectoral strategies are a basis for national and sub-national policies and programmes on regional and local levels.
D. Intersectorality Action
4.D.1 Policies, strategies and interventions aimed at making healthy choices easy
Points to be considered:
• Establishment of structures or mechanisms for policy development on the SDH and health equity.
• Existence of intersectoral policy and strategy to tackle the “causes of the causes”.
• Support comprehensive programmes of research and surveys to inform policy and action.
• Existence of a strategy led or advocated by the Ministry of Health to engage other sectors taking into account their contribution to health and equity; and impact of all policies on health
• Support all sectors in development of tools and capacities to address social determinants of health.
Existence of a periodic health in all policies review.
4.D.2 Structures, mechanisms and processes to enable intersectoral decision-making and action
Points to consider in making your evaluations:
• The interrelation and cooperation with appropriate interaction between the various authorities and administrations at different levels (which is essential to ensure that the existing regulations are applied, and that new regulations are created in order to face new challenges and requirements).
• The extent to which the government facilitates cooperation and communication/interaction mechanisms between administrations by establishing collaborative agreements, mixed committees, information systems of shared operations, shared legal regulations, joint protocols, etc.
• Executive support for intersectoral networks through political declarations and authority given to Ministry of Health
EPHO 5: Disease prevention, including early detection of illness
Description of operation: Disease prevention is aimed at both communicable and noncommunicable diseases and has specific actions largely delivered to the individual. The term is sometimes used to complement health promotion and health protection operations. Although there is a frequent overlap between the content and strategies, disease prevention is defined separately.
Primary prevention services include vaccination of children, adults and the elderly, as well as vaccination or post-exposure prophylaxis for people exposed to a communicable disease. Primary prevention activities also include the provision of information on behavioural and medical health risks, as well as consultation and measures to decrease them at the personal and community level; the maintenance of systems and procedures for involving primary health care and specialized care in disease prevention programmes; the production and purchasing of childhood and adult vaccines; the storage of stocks of vaccines where appropriate; and the production and purchasing of nutrition and food supplements
Secondary prevention includes activities such as evidence-based screening programmes for early detection of diseases; maternal and child health programmes, including screening and prevention of congenital malformations; the production and purchasing of chemoprophylactic agents; the production and purchasing of screening tests for the early detection of diseases, and capacity to meet current or potential needs.
Tertiary prevention includes to the rehabilitation of patients with an established disease to minimise residual disabilities and complications and maximise potential years of enjoyable life, thereby improving the quality of life even if the disease itself cannot be cured
Disease prevention in this context is considered to be action that usually emanates from the health sector, dealing with individuals and populations identified as exhibiting identifiable risk factors, often associated with different risk behaviours.
A. Primary Prevention
5.A.1 Vaccination programmes for the following groups
i) Children
ii) Adults
iii) The elderly
iv) Vaccination or post-exposure prophylaxis to persons exposed to a communicable disease
Points to consider in making your evaluations:
• Defining and providing accountable vaccination arrangements, including the necessary resources to ensure the efficiency of the programme.
• Adopting a consensus-built vaccination calendar in accordance with the international organisations’ recommendations (including the review and inclusion of new vaccinations in accordance with scientific/economic criteria).
• Vaccination register.
• Link with other SSII.
• Information programmes (including for parents and education professionals in the case of child vaccination) regarding the need to immunise the population as a main barrier against the transmission of diseases.
• Easy access to vaccination services for the vaccinations included in the vaccination calendar.
• Programmes run by professionals to inform about side effects.
• Training programmes for professionals.
5.A.2 Provision of information on behavioural and medical health risks
Points to be considered:
• Availability of information regarding behavioural health risks in our population.
• Explicit assessment of comprehensiveness of this available information.
• Consultation mechanisms to evaluate how to proceed to lower the risk.
• Usefulness/effectiveness of the available mechanisms.
• Existence of operational proposals for the future.
• Effectiveness of all measures to decrease health risks.
• Capacity of Public Health services and personnel to communicate
5.A.3 Systems and procedures for involving primary health care and specialized care in disease prevention programmes.
Points to be considered:
• Availability of information and protocols regarding the role of primary health care and specialized care in programmes on disease prevention.
• Explicit assessment of level of involvement
• Existence of operational proposals for the future.
• Financial incentives for the primary health care personnel to deliver individual preventive services
• Integration of dietary and physical activity advice into primary health care services.
5.A.4 Adequacy of production and purchasing capacity for childhood and adult vaccines, as well as for iron, vitamins and food supplements
Points to consider in making your evaluations:
• Availability of information regarding the capacity for the production and purchasing of products (i.e. respectively childhood & adult vaccines, and iron, vitamins and food supplements)
• Explicit assessment of further provision needs.
• Evaluation of the adequacy of reserves.
• Existence of operational proposals for the future.
B. Secondary Prevention
5.B.1 Evidence-based screening programmes for early detection of diseases, including screening and prevention of congenital malformations
Points to be considered:
• Legal framework.
• Network: defining and providing accountable structures.
• Application of international inclusion criteria of the potential target pathologies in screening programmes (consider the magnitude of the disease, the possibility of primary prevention, the natural history of the disease, efficient treatment in the sub-clinic phase, the parameters of the test, etc.).
• Structural and budgetary feasibility – and ability to deal with the detected cases quickly and effectively.
• Defining the target populations for the programmes.
• Arrangements set up to attend and receive cases for their diagnosis and treatment.
• Assessing the programmes.
• Adapting the screening programmes to the international organisations’ recommendations.
5.B.2 Adequacy of production and purchasing capacity for screening tests
Points to be considered:
• Coordinated framework.
• Network: defining and providing accountable structures.
• Applying international inclusion criteria of the potential target pathologies in screening.
• Structural and budgetary feasibility.
• Defining the target populations for the programmes.
• Arrangements set up to attend and receive cases for their diagnosis and treatment.
• Assessing the programmes.
• Adapting the screening programmes to the international organisations’ recommendations.
C. Tertiary Prevention
5.C.1. Existence of rehabilitation, survivorship and chronic pain management programs.
Points to be considered:
● Inclusion of rehabilitation within personalized patient care plans
● Existence of pain clinics
● Explicit pathways to link healthcare with psychosocial services
5.C.2 Capacity of establishment of patient support groups
Points to be considered:
● Designated resources for patient support groups
● Existence of materials (brochures, web pages) to support recovering patients
● Patient empowerment strategy
EPHO 6: Assuring governance for health
Description of operation: Policy development is a process that informs decision-making on issues related to public health. It is a strategic planning process that involves all the internal and external stakeholders and defines the vision, mission, measurable health goals and public health activities at national, regional and local levels. Moreover, in the past decade, it has become more important to assess the repercussions of international health developments on national health status.
Financing is concerned with the mobilization, accumulation and allocation of money to meet the population’s health needs, individually and collectively. The purpose of health financing is to make funding available, as well as to set the right financial incentives for providers, so as to ensure that all individuals have access to effective public health and personal health care
Quality assurance deals with developing standards for ensuring the quality of personal and community health services regarding disease prevention and health promotion, and evaluation of the services based on these standards. Evaluations should identify weaknesses in governance and operation, resource provision and service delivery. The conclusions of evaluations should feed back into policy and management, organization, and the provision of resources to improve service delivery.
A. Ensuring a whole of government and whole of society approach to health and well being
6.A.1. Structures and functions (for whole-government and whole-society approach)
Points to consider:
• Inclusion of priority health targets within broader (i.e., non-health) political agenda
• Intersectoral approach and partnership/interaction of other ministries, NGOs, local government, community leaders, academic centres and the private sector
• Continuous monitoring and evaluation of health promotion projects.
• Government support to networks of NGO for health promotion as an outreach activity
6.A.2. Capacity for intersectoral action for health and HiAP
Points to consider:
• Communication between ministries, including the existence of liaison staff, special protocols
• Existence of a strategy led by the Ministry of Health to engage with other sectors.
i) Ministry of Education regarding diet and physical activity in schools, as well as health education.
ii) Ministries of Transport, Environment and any other relevant Ministries regarding the built environment and transport in relation to health promotion.
iii) Ministries of Agriculture and Industry regarding the food industry and the promotion of healthier food products.
iv) Ministry of Labour regarding health promotion in the work place.
v) The involvement of the food industry through agreements that favour improved diet, food labelling and supporting nutrition projects.
vi) Developing promotional and healthy nutrition strategies for particular population groups.
vii) Elaboration of specific health education materials to different age groups and/or groups with particular ethnic or social characteristics.
viii) Continuous monitoring and evaluation of health promotion projects.
B. Health policy planning and implementation
6.B.1 Process of strategic planning in relation to public health services
Points to be considered:
• Existence of strategic planning process in relation of public health services.
• The process is performed on regular basis once a year/two years/ three years.
• The process is led by the PHS or by the ministry of Health or both.
• The process is performed and dictated by the PHS directorate.
• The process is attended by the headquarters and the districts.
• The process includes checking the vision, mission and the activities of the PHS.
6.B.2 Policy planning process at regional and local levels
Points to be considered:
• The national policy papers are taken into account in the sub-national public health policy planning.
• The process takes into account data or information on health status of the population on regional or local level.
• The views of stakeholders from different organisations including community leaders are taken into account in the process with or without their participation.
6.B.3 Appropriateness and effectiveness of public health policy (health impact assessment)
Points to be considered:
• Existence of a publication which sets up the national public health policy.
• Whether the national public health policy includes the activities of the PHS of the Ministry of health, and various activities concerning public health.
• Whether the national public health policy has been translated into programmes and activities.
• Amending the national public health policy regarding changing situation.
• Effectiveness of intersectoral collaboration/interaction.
6.B.4 System or programme for monitoring the implementation of policy and programmes in public health or related areas
Points to be considered:
• Existence of an evaluation process of the implementation of national public health policy, including quality review and performance assessment
• Setting of indicators, standards and benchmarks as integral parts of public health policies and programmes.
• Monitoring and evaluation of various policies and programmes are systematically performed.
• The results of the monitoring and evaluation are part of the feedback mechanism in the current and future public health policies and programmes.
6.B.5 Short-, medium- and long-term strategies to comply with a European Union community health services system
Points to be considered:
• Existence of systematic files identifying EU guidelines and standards.
• Attempt to systematically identify gaps between current situation in our country and the EU guidelines and standards.
• Existence of a written strategy to fill these gaps.
6.B.6 Appropriateness and effectiveness of how the repercussions of international health developments are taken into account in public health planning (e.g. preparing for avian and pandemic influenza, West Nile fever and severe acute respiratory syndrome (SARS)) (see 2D5)
Points to be considered:
• Availability of a national planning unit or ad-hoc committee, which evaluates or monitors the international developments and their implication on national health.
• The implementation of the health implication of the abrupt events of West Nile Fever or SARS on the public health planning.
• Availability of an intersectoral national public health plan to combat Avian Influenza or Pandemic influenza.
• The appropriateness of a national plan of a pandemic in case of a real outbreak occurred on country or sub- country level.
• Assessment of compatibility of plans with the international health developments
6.B.7 6.B.8 Appropriateness/effectiveness of any mechanisms or processes through which poverty, inequalities and the social determinants of health are taken into account in decision-making.
Points to be considered:
• Whether public health policy is integrated in a holistic national strategy that promotes social equity
• Whether local activists, NGOs and community leaders have the opportunity to offer input and feedback to policymakers in the area of health equity
• Whether public health policies place particular emphasis on maternal and early childhood nutrition and health
• Whether vulnerable groups are specifically targeted in public health policy
• The importance of human development indicators when setting national economic policy
6.B.8 6.B.9 Comprehensiveness and effectiveness of public health and other health-related policy decisions, through a multidisciplinary and multisectoral approach
Points to be considered:
• Whether there is multidisciplinary participation in the public health policy strategic process.
• Whether a multidisciplinary approach is taken into account in the public health policy strategic process, including at a regional and local level.
• Whether a multidisciplinary approach is felt in the final public health policy strategic document.
C. Regulation and control (see also relevant sections in EPHO3)
6.C.1. The creation of new laws and regulations aimed at protecting and improving health, and promoting healthy environments.
Points to be considered:
• The agility with which new health regulations can be implemented
• The support which health regulations have, in general, from the legislative branch of government, even when they conflict with purely economic interests
• The existence of a process to periodically revise and update existing legislations
6.C.2. Consumer protection as it relates to the health services
Points to be considered:
• The handling of medical malpractice suits (speed with which indemnification is awarded, fairness of compensation, system to hold clinician accountable in case of grievous offenses)
• Existence of system to report complaints in clinical settings
• Possibility for patients to receive a second opinion in their diagnosis or treatment
6.C.3. Carrying regulatory activities properly, consistently, fully, and in a timely manner
Points to be considered:
• The adequacy of resources dedicated to prevention and enforcement of health regulations
• The existence of a system to receive citizens’ complaints, and the timeliness with which these complaints are investigated
• The independence of regulatory bodies (lack of vested interests, and authority of regulatory bodies
D. Accreditation and licensing of service providers
6.D.1. Accreditation and quality control of health service providers. (see 3D2)
Points to be considered:
• The rigor and the speed with which accreditation of service providers is carried out
• Periodic revision of accreditation or licensing
• The adequacy of resources (in quantity and quality) dedicated to accreditation and licensing schemes
E. Evaluation of quality of individual and community public health services
6.E.1 Processes and mechanisms to define needs for personal and population health services from a public health perspective
Points to consider in making your evaluations:
• Data sources to define needs.
• Definition of the portfolio of services included in the system.
• Evidence of efficiency, effectiveness, etc., to incorporate new services
• Coordinating services in the overall process: from inclusion within the programme to cure
• Addressing services to cover the established prevention programmes
• The structures available must be capable of efficiently covering the population’s preventive needs
• Are services accessible?
• Are personal services affordable to all groups; is there a co-payment?
• What is the distribution of services (urban/rural, more/less affluent areas, regional disparities)?
• Are services used as intended and do they reach those targeted?
For preventive services in particular:
• Addressing services to cover the established prevention programmes
• The structures available must be capable of efficiently covering the population’s preventive needs
1. Preventive services, including disease prevention and health promotion services within the health system
2. Curative services
3. Rehabilitative services
4. Long term care/palliative care
6.E.2 Processes and mechanisms to identify the health service needs of populations that may encounter barriers to receiving health services (link with 6.B.8)
Points to be considered:
• The adequacy of your identification of the health service needs of immigrants, ethnic groups, and disadvantaged populations.
• Specific studies on these groups adapted to their characteristics.
• Alternative strategies to offer services that favour access.
• Collaboration with other social agents: NGOs, associations, social services, etc.
6.E.3 Comprehensiveness and effectiveness of procedures and practices designed to evaluate the delivery of personal and community public health services (link with 6.B.4)
1. Preventive services, including disease prevention and health promotion services within the health system.
2. Curative services
3. Rehabilitative services
4. Long term care/palliative care
Points to consider in making your evaluations:
• Assessments of coverage of accessible personal health services.
• Assessments of coverage of accessible community health services
• Existing databases, SSII.
• Studies on both the frequency of use and the use of the system.
• Health care indicators.
• Social care indicators.
• Socio-economic indicators.
6.E.4 Processes and mechanisms for conducting an analysis of participation in preventive services
Points to be considered:
• Adequacy of the analysis of the participation in preventive services of children and adolescents; adults; elderly.
• Adequacy of the gender-specific assessment of participation in preventive services.
• Developed SSII that enable the gathering of data about cover, access, specific programmes in process within these groups, statistics on the frequency of use.
6.E.5 Assessment and analysis regarding the integration of services in a coherent community health services system
Points to be considered:
• Existence of databases/records identifying duplications, fragmentations and lack of coherence when dealing with community health services.
• Availability of secondary analyses of published information on issues related to coherence and integration when dealing with community health services.
• Existence of surveys to professionals to identify their opinion on how to foster coherence and integration when dealing with community health services.
6.E.6 Adequacy of evaluation of the human resources structure and financial support to community health services (see EPHO8)
Points to be considered:
• Existence legal framework to support community health services system
• Existence of databases/records identifying specialised human resources dealing with community health services.
• Existence of accounting records and financial analyses identifying needs dealing with community health services.
6.E.7 Implementation, control and quality assurance actions on health systems that supply personal and community health services
Points to be considered:
• All the programmes must be assessed with the aim of analysing the amendments to be introduced.
• Description of the situation at the initial phases and the definition of the present-day situation: a comparative analysis.
• Access to the databases.
• Evaluate your implementation control and quality assurance actions on health systems that supply personal and community health services.
• Evaluate your application of evaluation findings to modify the strategic and operational plans of PHSS to improve services and programmes.Quality management of the health services offered.
• Management as far as processes, clinical guidelines, performance protocols, etc., are concerned.
• Research into services.
6.E.8 Health technology assessment centres or programmes
Points to be considered:
• Assessment of the implemented healthcare technologies.
• Study of the successful practices in other scopes.
EPHO 7: Assuring a competent public health workforce
Description of operation: Investment in and development of a public health workforce is an essential prerequisite for adequate delivery and implementation of public health services and activities. Human resources constitute the most important resource in delivering public health services. This operation includes the education, training, development and evaluation of the public health workforce, to efficiently address priority public health problems and to adequately evaluate public health activities.
Training does not stop at the university level. There is a need for continuous in-service training in economics, bioethics, management of human resources and leadership, in order to implement and improve the quality of public health services and to address new challenges in public health.
The licensing procedures of public health professionals establish the requirements of the future workforce concerning relevant public health training and experience.
The public health workforce includes public health practitioners, health professionals and other professionals with impact on health.
A. Human resources planning
7.A.1 Planning of human resources for public health
Points to be considered:
• Existence of national planning of public health human resources.
• Consideration of tools and methods used in such planning.
• Whether public health human resources planning has a long-term/anticipatory nature.
• Whether demographic changes are taken into account.
• Whether future health care needs have been taken into account.
• Whether effectiveness has been proven in practice during the last decade.
7.A.2 Effectiveness of human resources planning
Points to be considered:
• Whether decentralisation is an integral part of Human Resources planning.
• Whether there is a division of responsibilities between national and sub-national planning (in federal or decentralised countries).
• Whether there a division of responsibilities between the centre and districts in planning in non-federal countries.
• Whether appropriateness and effectiveness were proven in practice during the last decade.
• The balance/imbalance in the distribution of human resources.
• Whether the needs of different regions are taken into account.
7.A.3 Current provision of human resources for public health
Points to be considered:
• The multi-disciplinary approach in allocation of the potential work force.
• Allocation of the public health workforce according to shortage or surplus.
• Allocation of human resources according to population size and needs.
• Whether the distribution of human resources is evaluated at least once a year.
7.A.4. Migration of health professionals
B. Public health workforce standards
7.B.1 Mechanisms for maintaining public health workforce standards
Points to be considered:
• Projection of future health manpower needs in terms of quantity and quality.
• Ensuring that public health workers and managers meet an appropriate educational level.
• Whether appropriate standards have been established that permit the evaluation of quality of population-based and personal health services using data from all levels of the health system.
7.B.2 Mechanisms for evaluating the public health workforce, including continuous quality improvement, continuing education and training programmes
Points to be considered:
• Periodical assessment of teaching programmes.
• Existence of performance evaluation system or systems for continuing education courses to ensure that they contribute to developing human resources for public health.
• Existence of performance evaluation system or systems for continuous quality improvement.
• Whether results of the evaluation of continuing education and graduate training programmes are shared, and whether feedback from public health workers is obtained.
• Offering incentives and implementing plans that improve the quality of the country’s public health workforce.
7.B.3 Systems for improving teamwork abilities and communication skills
Points to be considered:
• Establishment of continuing education courses or in service training for improving teamwork abilities and communication skills.
• Continuous evaluation of the courses, and in-service training by feedback questionnaire of the participants.
• Existence of a mechanism on a national and/or sub-national level to evaluate the continuing education courses and in-service training.
7.B.4 System for supporting capacity development of intersectoral teams and professionals from across policy areas
Points to be considered:
• Whether the multidisciplinary character of the working environment, across different profiles, is an integral part of the culture of the public health system.
• Development of intersectoral teams and professionals in continuing educational courses or in-service training.
• Drawing lessons and evaluating the capacity of intersectoral teams after each public health event.
C. Education and accreditation
7.C.1 Structure of training in public health management
Points to be considered:
• Availability and quality of training in non-medical specialities related to health care.
• Adequacy of the training to the Public Health Services needs.
• The exposure to the public health issues in general and on country level in particular is part of the training in public health management.
7.C.2 undergraduate programmes in Medicine relevant to public health.
Points to be considered:
• Whether public Health is part of the curriculum in undergraduate programmes.
• Existence of introductory course in public health.
• Incorporation of public health issues (e.g. epidemiology and population approaches) within the curriculum of various courses.
7.C.3 undergraduate programmes in Pharmacy relevant to public health.
Points to be considered:
• The availability of pharmacists among the public health workforce.
• The availability of courses or integrative courses that include public health curricula.
7.C.4 undergraduate programmes in Veterinary Medicine relevant to public health.
Points to be considered:
• The availability of veterinarians among the public health workforce.
• The availability of courses or integrative courses that include public health curricula.
• Existence of experts in veterinary public health within veterinary schools.
• Cooperation or joint ventures between veterinary school/s and school/s of public health.
• Availability of post graduate courses or programmes for veterinary pubic health.
7.C.5 undergraduate programmes in Nursing relevant to public health.
Points to be considered:
• The availability of courses or integrative courses that include public health curricula.
• Existence of experts in public health nursing, in academic or non academic schools of nursing.
• Availability of post graduate courses or programmes for pubic health and community nursing.
7.C.6 undergraduate programmes in Dentistry relevant to public health.
Points to be considered:
• The availability of dentists among the public health workforce.
• The availability of courses or integrative courses that include public health curricula.
• Existence of experts in public health dentistry, within Dentistry schools.
• Cooperation or joint ventures between the school of dentistry and schools of public health.
7.C.7 undergraduate programmes in Social Work relevant to public health.
Points to be considered:
• The availability of social workers among the public health workforce.
• The availability of courses or integrative courses that include public health curricula.
7.C.3 Adequacy of schools of public health
Points to be considered:
• Availability of School/Schools of Public Health in the country.
• Availability of legal or national academic framework for evaluating the competences of such schools.
• Existence of collaborative agreements between the different academic authorities in this area, mainly universities, when such schools are non-university ones.
• Schools of Public Health fulfil the need for training the future workforce in public health.
• Mechanisms which facilitate the exchange of educational, occupational and research experiences within the same area of other European countries (grants, permits for placements, etc).
▪ Whether the disciplines of environmental health and occupational health are educated and trained according to the relevant international standards of accreditation
7.C.4. Bachelor of Public Health
Points to be considered:
• Availability of a Master of Public Health programme in the country.
• The design of this programme in relation to licensing or undertaking the professional and research work within public health.
• A continuous review and enhancement process of the programmes with a view to adapting them to current and future challenges of PHS.
• Adaptation to the unification criteria of European graduate studies
7.C.5 Master of Public Health programmes
Points to be considered:
• Availability of a Master of Public Health programme in the country.
• The design of this programme in relation to licensing or undertaking the professional and research work within public health.
• A continuous review and enhancement process of the programmes with a view to adapting them to current and future challenges of PHS.
• Adaptation to the unification criteria of European postgraduate studies.
7.C.6 Master of Health Services Administration and/or Policy, Leadership, or Management
Points to be considered:
• Availability of a Master of Public Health Public programme that provides studies in Public Health Services administration and/or Policy, Leadership, or Management.
• Adaptation of the programme to the needs of the PHS or the public health sector.
• The design of this programme in relation to undertaking professional work in public health management.
• Adaptation to the unification criteria of European postgraduate studies.
7. C.7 PhD of Public Health
Points to be considered:
• Availability of a PhD programme of Public Health
• Adaptation of the programme to the needs of the PHS or the public health sector.
• The design of this programme in relation to undertaking professional work in public health management.
• Adaptation to the unification criteria of European postgraduate studies.
7.C.8. Specialization on Public Health
Points to be considered:
• Availability of a Specialization on Public Health in the country.
• The design of this programme in relation to licensing or undertaking the professional and research work within public health.
• A continuous review and enhancement process of the programmes with a view to adapting them to current and future challenges of PHS.
• Adaptation to the unification criteria of European postgraduate studies.
7.C.9. CPD (Continuing professional development)
Points to be considered:
• Legal framework for professionals’ continuous education in health protection, promotion or disease prevention.
• Availability of programmes related to health protection, promotion or disease prevention.
• Defining and implementing continuous educational programmes for multi-disciplinary professionals working in PHS.
• The competence of these programmes to address the knowledge, skills and practices required of the professionals also in order to upgrade and to extend the various areas of action.
4.C.4. Effectiveness of evidence and know-how about broader determinants of health (SDH), and tools for acting upon evidence and trends incorporated into leadership training and development programmes.
Points to be considered:
• The approach of SDH is an integral part of the culture of the public health system (ministry of health and across other policy sectors) culture.
• That evidence-based SDH in public health thinking is considered for future public health programmes or interventions.
• Existence of relevant cross-government policy and leadership development strategies and programmes, concerning SDH.
• Evaluation of public health programmes and interventions regarding SDH among policy makers and politicians, as well as planners, and technical heads – across policy sectors, programmes and services.
ASPH sets out a list of competencies dealing with characteristics of leadership and the things which a good leader should consider (see below)
H. 1. Describe the attributes of leadership in public health.
H. 2. Describe alternative strategies for collaboration and partnership among organizations, focused on public health goals.
H. 3. Articulate an achievable mission set of core values, and vision.
H. 4. Engage in dialogue and learning from others to advance public health goals.
H. 5. Demonstrate team building, negotiation, and conflict management skills.
H. 6. Demonstrate transparency, integrity, and honesty in all actions.
H. 7. Use collaborative methods for achieving organizational and community health goals.
H. 8. Apply social justice and human rights principles when addressing community needs.
H. 9. Develop strategies to motivate others for collaborative problem solving, decision-making, and evaluation.
6.B.7 Role of public health operations within the ministry of health
• Should be considered in line with section 7 leadership in public health points
No mention of leadership as a characteristic of PH workforce.
Need something about how we can assess PH leadership capacity in the country
Suggest adding the following text to 7.C.9
• Define the desired attributes of leadership in public health and demonstrate how these are developed and rewarded in the current public health system
Or perhaps even add new section
7.C.14 Leadership in public health
Points to be considered:
• Describe the attributes of leadership and power in public health.
• Demonstrate the approach taken to developing public health leaders. Including articulation of an achievable mission set of core values, and vision.
7.C.12 Quality Control and Accreditation programmes at Undergraduate level.
Points to be considered:
• Established process of evaluation and accreditation of the undergraduate programmes.
• Evaluation of the undergraduate programmes by accreditation agencies to certify that they meet the minimum quality criteria required.
• Adaptation of the undergraduate programmes to the existing legal framework at both the national and European levels (the Bologna Process).
7.C.13 Quality Control and Accreditation programmes at Postgraduate level.
Points to be considered:
• Legal framework of certification required in accordance with pre-established criteria.
• The coordination and collaboration of training and accreditation programmes with educational institutions in order to develop a basic public health curriculum for various levels of public health.
• Periodic assessment of teaching programmes and continuing education courses to ensure that they contribute to developing human resources for public health.
D. Training of other actors with impact
7.D.1 Undergraduate programmes in other sectors with impact on health (economics, sociology, psychology)
• The availability of other sectors health (economics, sociology, psychology) among the public health workforce.
• The availability of courses or integrative courses that include public health curricula.
• Existence of experts in public health dentistry within Universities.
• Cooperation or joint ventures between the university and schools of public health.
7.D.2 Master programmes in other sectors with impact on health(economics, sociology, psychology)
• The availability of other sectors health (economics, sociology, psychology) among the public health workforce.
• The availability of courses or integrative courses that include public health curricula.
• The design of this programme in relation to licensing or undertaking the professional and research work within public health.
• Existence of experts in public health dentistry within Universities.
• Cooperation or joint ventures between the university and schools of public health.
EPHO 8: Assuring organizational structures and financing
Description of operation: Assuring sustainable organizational structures and financing means developing services that are efficient, integrated, have minimal environmental impact with maximal health gain, have sufficient funding for long term planning, in order to ensure health is protected and promoted today and in the future. A systems approach is needed to recognize the system level properties that result from dynamic interactions among human and social systems and how they affect the relationships among individuals, groups, organizations, communities, and environments.
In addition, financing is concerned with the mobilization, accumulation and allocation of resources to cover population health needs, individually and collectively. Comprehensive public financing should be the norm for proven cost-effective population-based services as well as personal services with broad effects beyond the person receiving the intervention. Health financing arrangements for public health shall set the right financial incentives for providers to ensure efficient service delivery and access to these services by all individuals. At the same time, appropriate incentives for the individuals should be put in place to ensure appropriate levels of utilization of public health services.
A. Ensure appropriate organizational structures to deliver EPHOs:
8.A.1. In the health system including: Primary health care, specialized health centres, hospitals, public health institutions and laboratory services
Points to be considered:
• Maximum distance to health centres (primary, specialized and hospitals)
• Range of services available in primary care centre (GP, pediatrics, nursing, community health, screening, disease prevention counseling services, etc.)
• Occupancy rate of hospitals
• Average waiting times for specialist services, both preventive and curative
• Average response time for lab results
• Designated responsibility(s), at national and local levels, for coordinating services
• Processes and mechanisms for working collaboratively across organizations and sectors
8.A.2. Services delivered outside the public healthcare system
Points to be considered:
• Defined list of public health services (e.g., by EPHO) that are delivered outside the public healthcare system, including through other governmental bodies, relevant NGOs, and private healthcare providers
• Designated responsibility(s), at national and local levels, for coordinating services
• Processes and mechanisms for working collaboratively across organizations and sectors
8.A.3 8.A.5. For education, training and research in PH
Points to be considered:
• Existence of a national school of public health, and/or departmental chairs of public health in public universities
• Budget dedicated to public health training and research
8.A.4 8.B.1. Systems approach to organizational structures that discharge the essential public health operations and services
Points to be considered:
• Characteristics of the public health system are explicitly defined (how different actors work together and interact)
• Contexts of gender, race, poverty, history, migration, and culture are considered in the design of interventions within public health systems
• Unintended consequences to changes in the system are identified
• Measurable (ideally SMART) indicators of the health system exist to monitor systems effects of the public health system. These should look at inputs, processes, outputs and outcomes.
• Strengths and weaknesses of applying the systems approach to public health problems are assessed.
8.A.5 8.C.1. Assessment and analysis regarding the effectiveness of public health structures
Points to be considered:
• Performance of independent assessments on the effectiveness of national public health structures
• Existence of structural, process and outcomes indicators in order to monitor implementation, roll-out and outcomes of programmes
B. E. Financing public health services
8.B.1 8.E.1 Alignment of financing mechanisms for public health services (including personal services with broad effects beyond the person receiving the intervention) with desired service delivery strategies
Points to be considered:
• Whether public health interventions receive budget lines in one or more areas of national health planning (public health within the healthcare system, for regulatory and enforcement agencies, other ministries, community and social care, etc.)
• How closely resource allocation is paired with service planning
• Ability to estimate how much of the national budget is spent on core public health interventions within and outside the health system
8.B.2 8.E.2 Decisions on public financing for services, taking into consideration the extent to which their benefits are distributed in the population
Points to be considered:
• The rigor of the prioritization process (how politicized the context of difficult funding decisions is, whether priorities are based on evidence and long-term needs)
• Whether future resource allocation is based on current use or estimated need
• Whether disaggregated health indicators are used to allocate more resources to populations with greater need
• Whether sufficient resources are used to retain health professionals working in underserved areas, through better pay or increased benefits
EPHO 9: Advocacy, communication and social mobilization for health
Description of operation: Communication for public health is aimed at improving the health literacy and status of individuals and populations. It is the art and technique of informing, influencing, and motivating individuals, institutions and public audiences about important health issues and determinants. Communication must also enhance capacities to access, understand and use information to reduce risk, prevent disease, promote health, navigate and utilize health services, advocate for health policies and enhance the well-being, quality of life and health of individuals within the community.
Health communication encompasses several areas including health journalism, entertainment, education, interpersonal communication, media advocacy, organizational communication, risk and crisis communication, social communication and social marketing. It can take many forms from mass multi-media and interactive communications (including mobile and internet) to traditional and culture-specific communication, encompassing different channels such as interpersonal communication, mass, organizational and small group media, radio, television, newspapers, blogs, message boards, podcasts, and video-sharing, mobile phone messaging and online tools and forums.
Suggest adding ‘tools’ above as this would imply key approaches such as twitter which simply saying online forums does not
Public health communication offers the public a way to counter the active promotion of hazardous products and lifestyles (e.g. tobacco). It is a two-way information exchange activity which requires listening, intelligence-gathering and learning about how people perceive and frame messages on health, so that information can be transmitted in more accessible and persuasive formats. Public health communication is also about transparency, so that the public can be aware of what is being said and done in their name.
9.1. Strategic and systematic nature of public health communication developed, with an understanding of the perceptions and needs of different audiences
Points to be considered:
• Whether public health authorities incorporate marketing techniques into health communication campaigns, including through public-private partnerships with marketing firms
• How many media are used to disseminate health communication (broadcast radio and television, websites, newspapers, pamphlets distributed in health and community centres, etc.)
• Elaboration of specific health education materials to different age groups and/or groups with particular ethnic or social characteristics.
• Whether a social (i.e., interactive) component is incorporated into health communication campaigns through social media tools and platforms
• Whether commercial competition in health messaging (either from hazardous industries like tobacco or alcohol, or from private commercial interests selling vitamin supplements, weight loss treatments, etc.) is taken into account and countered
9.2. Risk communication
Points to be considered:
• Use of the five-step approach to risk assessment
• Whether stakeholders’ perceptions on risks and trade-offs are taken into account in pre-testing of risk communication plans
• Whether citizens have access to interactive source for questions and clarifications on their doubts (website, hotline, coordination with primary care centres, etc.)
9.3 9.4. Advocacy for the development and implementation of healthy policies and environments across all government sectors (health in all policies) (see also 6.A.2)
Points to be considered:
• Whether health authorities engage the legislative branch of government on relevant laws, and engage policymakers on hot topics in order to take advantage of public support for particular issues
• Whether the health system is responsive to the concerns of other sectors (e.g., environment, economy, education, agriculture, community development) on cross-cutting issues
• Whether workshops are held to educate policymakers on public health issues
• Whether health authorities engage with mass media (e.g., through public interviews) to raise awareness and support for public health issues in the government (i.e., using public opinion as a lever to promote government action)
9.4 9.6. Public health communication evaluation
Points to be considered:
• Whether data is collected on public health communication (e.g., website visits, social media reach, audience share for broadcasts)
• Whether there is an evidence-based evaluation for health communication campaigns
9.5 9.7. Inter-country exchange of experiences and engagement with professional networks
Points to be considered:
• Existence of learning mechanisms from international and within-Region experiences, in order to maximize the use of effective practices
• Degree of participation in international and regional policy forums
• Public funding for national professionals who are active in European or regional health networks
9.6 9.9. Communication for policy options (see also 10.B.2)
Points to be considered:
• Whether research findings are translated into concise policy briefs, including different options for policymakers, considering criteria of effectiveness, cost-effectiveness, competing needs, disadvantages, corollary effects on the broader determinants of health, and needs for further data
• Whether real knowledge-brokering takes place, that is, whether policy needs are considered in decisions on research (agenda, funding), and whether research findings are presented in a way that can easily be translated to policy
9.7 1.12 Reporting and publication of data in multiple formats for diverse audiences (in areas 1.1–1.8)
Publication of data should cover the following:
• elaboration of periodic analyses and reports;
• data monitoring in various surveillance systems integrated and published periodically through various communications media; and
• appropriate use of the mainstream media (radio, TV, newspapers) and social media (Facebook, Twitter, etc.).
EPHO 10: Advancing Public Health research to inform policy and practice
Description of operation: Research is fundamental to informing policy development and service delivery. Research can take a number of forms: descriptive, analytical or experimental. Structure of research / descriptive, analytical and experimental
This operation includes:
• research to enlarge the knowledge base that supports evidence-based policy-making at all levels;
• development of new research methods, innovative technologies and solutions in public health;
• establishment of partnerships with research centres and academic institutions to conduct timely studies that support decision-making at all levels of public health.
A. Research data, information and capacity
10.A.1 10.1. Country’s capacity to develop PH research
Points to be considered:
• The availability of research institutes, universities, school of public health that have a capacity to conduct research in public health.
• Existence of priority agenda for research in public health based on population need and key actors in public.
• Availability of a mechanism that mobilises funding sources to encourage research in public health.
• Encouragement of schools of public health and research institutes to study health problems identified on the public health research agenda.
• Health research included as the priority in national research programmes and grant schemes, and fostering practical and participatory research.
• Updated assessment of burden of disease and its risk factors in the country for prioritization of public health research.
10.A.2 10.2 Adequacy of available resources (e.g. databases, information technology, human resources) to implement research
Points to be considered:
• Existence of database and information technology on a country and/or regional level.
• Integration of the existing SSII to create databases that are useful for epidemiological research and which concern public health systems.
• Facilitation of access to existing databases for both the professionals within the system and to researchers outside the system through collaborative agreements (e.g. with other research centres, universities).
• Availability of specific research training for professionals and thus develop the existing methodology in research.
10.A.3 10.4. Country’s evaluation of the development, implementation, and impact of public health (and public health service) research efforts
Points to be considered:
• The contemplation of the PHS system and tools in the design phase of the research.
• The development of programmes for assessment of public health research.
• The implementation of PHSS research in the system or in programmes designated for target populations.
• The evaluation of impact of public health research efforts.
10.A.4 10.B.1 Performance of research as part of the work culture of PHS.
Points to be considered:
• The existence of a work culture that enables the inclusion of research tasks in the usual work.
• Whether there is a collaborative agreement between the professionals working within the PHS system and researchers in the academic institutes or research centres to conduct research.
• Enabling environment for staff to identify new solutions to health problems in the community by providing the time and resources for staff to pilot test or conduct experiments to determine the feasibility of implementing new ideas.
10.A.5 10.B.2 Adequacy of the Ministry of Health’s proposing to research organisations
public health issues for inclusion in their research agenda. (see also 9.9)
Points to be considered:
• The existence of a bureau of chief scientist in the MoH on national or sub-national level (in a federal state).
• Defining the priority areas of public health research within the system as a basis to orientate future studies conducted by external agents (declaration of policy or budget allocation).
• Proposing by the MOH fields of research in public health to encourage research as an integrative part of the public health services.
10.A.6 10.B.3 Adequacy of the Ministry of Health’s researching and monitoring of best
practice information from other agencies and organizations. (see also 9.7)
Points to be considered:
• Monitoring by the MoH on best practices published by other agencies and organization within the country.
• Existence of the monitoring by the MoH on best practices published by other international agencies and organizations like EU, WHO.
• Establishing collaborative relationships to transmit information about public health practices at European and international levels.
• Adopting and implementing successful initiatives in other geographical locations with MoH adaptation to the specific situation in the country.
10.A.7 10.8. Capacity for the collection, analysis and dissemination of health information
Points to be considered:
• Availability of heath information collected by the public sector.
• Availability of regular and yearly health information in the national bureaux of statistics.
• The quality of the information collected analysed and disseminated by the public health sector.
• The health information collected by the public sector is used by the health and public health sector.
• Decisions are based largely on information produced by the information system.
• The health information collected by the public sector is in harmonization and coordination with that collected by the health sector.
10.A.8 10.9. Capacity to carry out research on the social determinants of health (and their influence on health) in order to shape and target policy
Points to be considered:
• Researching on poverty – including child poverty and poverty of the elderly.
• Researching on poverty on housing, work & unemployment, socio-economic exclusion – of groups or individuals.
• Researching on access to education, nutrition, drug use.
• Publishing and shifting resources from areas where there is good research and areas where it is lacking.
B. Dissemination of research findings
10.B.1 10.3. Planning for the dissemination of research findings to public health colleagues (e.g. publication in journals, websites)
Points to be considered:
• Setting up mechanism (organizations and structures) to diffuse research finding to decision-makers in public health.
• Promotion of exchange and transfer of results between the different research development settings (researchers working within the system, researchers working outside the system).
• Availability of a researcher networking that notify on publication published in journals and /or website.
• Setting up networks which favour the diffusion of results as well as the rapid implementation of the results obtained.
10.B.2 10.7. Active use of research evidence in designing and supporting policy in the field of public health (See also 9.9, Communication for policy options)
Points to be considered:
• Availability of research evidence for use in designing public health policy and/or:
• Availability of research evidence for use in supporting public health policy.
• Good practice in use of research evidence in creating public health policy.
• Inclusion in the health policy-making process of position papers that take into account the social determinants of health.
• Cost-benefit analyses are taken into account of in health policy making.
• Forming information from the data collected including possibilities for analyzing situation through the time
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