Introducing the 20th Ljubljana Charter anniversary issue

Eurohealth — Vol.22 | No.2 | 2016 2 Editorial incorporating Euro Observer — Vol.22 | No.2 | 2016 INTRODUCING THE 20TH LJUBLJANA CHARTER ANNIVERSARY ISSUE By: Zsuzsanna Jakab, Milojka Kolar Celarc and Jevgeni Ossinovski Zsuzsanna Jakab is WHO Regional Director for Europe; Milojka Kolar Celarc is Minister of Health of the Republic of Slovenia; and Jevgeni Ossinovski is Minister of Health and Labour of the Republic of Estonia. Introduction We are delighted to offer our joint support to this publication, which looks at how Member States across the European Region are strengthening their health systems in line with the recently launched strategic document “Priorities for health systems strengthening in the WHO European Region 2015 – 2020: walking the talk on people centredness”. 1 The strategic document guides countries on how to implement the values outlined in two health systems charters – the Ljubljana Charter on Reforming Health Care in Europe 2 and The Tallinn Charter: Health Systems for Health and Wealth. 3 In 2012, the European health policy framework Health 2020 4 was adopted by the WHO Regional Committee. Health 2020 builds upon both charters, taking a human rights approach and emphasizing the importance of solidarity, equity and participation at the heart of national health policy development and decision making. The main goals of Health 2020 are the equitable improvement of health and well-being, and improvements in leadership and participatory governance for health. The strengthening of people-centred health systems and public health is one of its four policy priorities, alongside a life-course approach, tackling the burden of non-communicable and communicable diseases, and promoting resilient communities and supportive environments. It is in supporting the Health 2020 policy priority of strengthening people-centred health systems and public health that the charters have made the greatest contribution. Implementation of the charters has led to important advances in the WHO European Region, giving a better understanding on how to invest in health systems for the benefit of the overall development of societies and establishing a mandate to invest in policies that respond to the needs of vulnerable groups. The charters are relevant for all countries, promoting human rights and gender equality, where markets and economic interests may not. Together these documents remain of critical importance in guiding Ministers of Health towards the strengthening of health systems and public health, which lie at the heart of achieving our goals for population health. The charters The Ljubljana Charter on Reforming Health Care in Europe of 1996, whose 20th anniversary we are celebrating this year, was a milestone in thinking about health systems. The Ljubljana Charter brought a health systems perspective to health care reform, emphasizing the importance of smooth linkages between health system functions and health care performance. It focused on the positive role of health within the development of societies, and the importance of intersectorality. Universal access, it was argued, should be assured, alongside sustainable financing and continuously striving for quality. The achievement of these aims was supported with the establishment of the European Observatory for Health Systems and Policies. 5 The Ljubljana Charter emphasized the responsibility of governments exercising stewardship for the health system through legislation and governance, regulating health system performance and financing. A national health policy should be based on values, and aim to shape the performance of health care. Health systems should focus on the role of public health and primary health care, and integrate disease management, including health promotion, disease prevention, treatment and rehabilitation. The Charter also emphasized respect for citizens’ voice and choice; moving away from acute hospital care to primary health care, Editorial Eurohealth incorporating Euro Observer — Vol.22 | No.2 | 2016 3 community care, day care, home care and informal care; and the coming together of health and social care. The Tallinn Charter: Health Systems for Health and Wealth of 2008 built on these themes, with the added focus on health system-wide performance and accountability. The Tallinn Charter emphasizes that health systems should prioritize financial protection, consider the social determinants of health and actively influence other sectors with Health in All Policies. The Tallinn Charter also emphasizes that health systems should guide other sectors to address the social determinants of health. This approach to consider the multiple determinants of health in addressing public health was taken further in Health 2020, with its focus on governance for health across all determinants, and its emphasis on whole-of-government, whole-of-society and Health in All Policies approaches to improvements in health and well-being. Another focus of the Tallinn Charter is on financial accountability, and the fair and efficient use of resources. Vitally, individuals should not become poor due to ill-health. Overall system financing should meet needs, reduce barriers, protect against financial risk, and be fiscally responsible. Throughout, care delivery should be integrated and coordinated, delivering people-centred care and integrated disease-specific management programs. The importance of the charters There are many similarities between the Ljubljana and Tallinn charters, which have provided frameworks for progress, now supported by Health 2020. Both charters emphasize that governments have an ultimate responsibility to sustain universality in access to timely and affordable services of good quality. Such an approach also clearly links with the United Nations’ Sustainable Development Goals (SDGs). This issue of Eurohealth looks at Member State examples of health systems strengthening as outlined in the strategic document. In Estonia, the Tallinn Charter has provided a value-based foundation on which to build the health system in responses to a range of new and existing challenges for providing better health care, building on the themes of improving health system performance, and promoting transparency and accountability, particularly when these qualities were most needed due to the financial crisis. It also presented a forward-looking vision, covering issues such as health system responsiveness, patient-centeredness and the ability to respond to crises. The values of solidarity, equity and participation also paved the way to Universal Health Coverage (UHC). For both Estonia and Slovenia, the main values of the charters have been integrated into national health planning, focused on the equitable improvement of health and well-being and the further development of health care services. Based on these values Slovenia has recently launched a reform of its health system to assure patient- centredness. The reform aims to improve the integration of services, including public health and social services, along with strengthening primary health care. In Estonia, despite considerable overall budget cuts during the financial crisis, the health care budget was largely sustained as the charters helped to guide decision making to reduce the effects of the crisis. In both countries, reforms have been based on evidence and analysis, through wide stakeholder engagement and the involvement of other sectors. The charters have helped guide decisions about investment in the health sector and the use of resources – human, pharmaceutical and technological – particularly during the recent financial crisis. Investments have been made in expanding the health care services available through primary care as well as developing health care at the local level, improving cooperation with the social welfare system. Investments have also been made in the training and development of the health professional workforce, as well as improvements in compensation, working environments and staff morale. Across the European Region, Member States have been working towards implementing the main values of the charters, which have provided a high- level political mandate to invest in health systems across the Region and have secured health systems strengthening at the top of the agenda in both Member States and WHO. Now reinforced by Health 2020, many countries in the Region are developing and implementing policies informed by these goals. Now more work needs to be done, focusing particularly on the role of health systems in taking social determinants of health into account to reduce inequalities, achieving transformative change and improved health outcomes. This is the purpose of the strategic document Priorities for health systems strengthening in the WHO European Region 2015–2020: walking the talk on people-centredness. References 1 WHO Regional Office for Europe. Priorities for health systems strengthening in the WHO European Region 2015–2020: walking the talk on people centredness. Copenhagen: WHO, 2015. Available at: http://www.euro.who.int/en/about-us/governance/ regional-committee-for-europe/65th-session/ documentation/working-documents/eurrc6513- priorities-for-health-systems-strengthening-in-the- who-european-region-20152020-walking-the-talk- on-people-centredness 2 WHO Regional Office for Europe. Ljubljana charter on health care reform. Copenhagen: WHO, 1996. Available at: http://www.euro.who.int/__data/ assets/pdf_file/0010/113302/E55363.pdf 3 WHO Regional Office for Europe Tallinn Charter: Health systems for health and wealth. Copenhagen: WHO, 2008. Available at: http://www.euro.who. int/__data/assets/pdf_file/0008/88613/E91438. pdf?ua=1 4 WHO Regional Office for Europe Health 2020: a European policy framework supporting action across government and society for health and well-being. Copenhagen: WHO, 2013. Available at: http://www. euro.who.int/en/publications/abstracts/health-2020- a-european-policy-framework-supporting-action- across-government-and-society-for-health-and-well- being 5 European Observatory on Health Systems and Policies. Available at: http://www.euro.who.int/en/ about-us/partners/observatory