Capacity Building for Public Health and Health Promotion in Central and Eastern Europe Caroline Costongs Programme Manager EuroHealthNet

EuroHealthNet European network of national and regional agencies accountable for public health, health promotion and disease prevention Established in 1996 – office in Brussels Mission: to contribute to a healthier Europe with greater equity within and between countries Health Inequalities & socio-economic determinants –

Austria: Healthy Fund Austria Belgium FL: Flemish Institute for Health Promotion Belgium FR: ULB Bulgaria: National Centre of Public Health Protection Czech Republic: National Institute of Public Health Denmark: National Board of Health England: NICE Estonia: National Institute for Health Development Finland: Finnish Centre for Health Promotion France: INPES Germany: Federal Centre for Health Education (BZgA) Hungry: National Institute for Health Development Iceland: Public Health Institute of Iceland Ireland: Department of Health and Children Italy: Experimental Centre for Health Education Latvia: Health Promotion State Agency Lithuania: National Centre for Health Promotion and Education Malta: Health Promotion Department The Netherlands: NIGZ Poland: National Institute of Hygiene (PZH) Romania: Institute of Public Health Iasi Scotland: NHS Health Scotland Slovakia: Public Health Authority of the Slovak Republic Slovenia: National Institute of Public Health Slovenia, Regional Institute Murska Sobota Spain: Ministry of Health and Consumer Protection Spain, Canary Islands: University de la Laguna Sweden: National Institute of Public Health Switzerland: Health Promotion Switzerland Wales: Wales Centre for Health 33 Members in 25 countries

Capacity Building There is a need for structured exchanges on capacity building in public health and health promotion Aim of EC funded project ( ): To improve the capacity of EuroHealthNet agencies in CEE to respond effectively to the major health needs in their countries CEE region faced many changes: Political changes of 1989/91 Reforms of public services Accession to the EU which have had impact on the development of PH/HP. Czech R, Latvia, Slovenia, Estonia, Lithuania, Bulgaria, Romania, Poland, Slovakia, Hungary

Framework

Project Outputs Capacity Assessments & needs per country 3 Trainings, followed by trainings at the participating Institutes National Coalitions & capacity building plans Publication on capacity building for PH-HP in CEE in which we found some common trends and challenges.

Infrastructure and Organisational Development Development and implementation of health promotion policies require necessary organisational systems in place and functioning at national and regional level. HP is integrated in most national public health policies – but in some countries it receives little attention Frequent restructuring and changes in PH institutes can offer new opportunities, but also creates vulnerability and hampers sustainability In some countries there is a lack of clearly defined responsibilities between national and regional level Support for development of health promotion at regional level

Workforce development & Resources allocation The availability of qualified human resources and an investment of adequate financial resources in HP is essential Training in HP is available at universities. On-the-job learning and courses are given in most institutes. Some countries are developing an accreditation system for the profession. In SL only available for medical doctors – thereby limiting multi-disciplinary approaches to PH and HP The national available budget for HP is a small proportion of the national health budget (less then 1%). In some countries there is no earmarked budget for HP. Strategies are needed to diversify sources of funding – EU structural funds, taxes based, health insurance funds etc.

Leadership & Partnerships Ministry of Health and PH Institutes play a leading role – however the nr of HP leaders at this level is tiny. Political and institutional instability & consequent change of staff and potential leaders makes it difficult to ensure continuity and quality in HP. Important to identify leaders and establish partnerships at other sectors to enhance the capacity for health promotion. Lack of collaboration sometimes due to competition or to the limited understanding of HP in society. Clearly defined strategies and structures to optimise cooperation is still a challenge for most institutes. In particular there is a need to develop cross-governmental and cross-sectoral structures. European processes (like OMC, EU projects, structural funds) should be used to put health issues on the national and regional agenda and can be a catalyst for action

Lessons learned Time and timing… Development of national capacity plans following the 5 key areas of the Framework was evaluated positively Lack of capacity is also due to: dominance of medical perspectives, lack of available human resources at national, regional and local levels, changing institutional/political environments Sustainability of leadership should achieve more attention in capacity building initiatives. EU should further facilitate the development of capacity (infra- structure, workforce, resources etc) in CEE countries in order to see their EU health strategy and PH programmes implemented.