HEALTH POLICY IN SUSTAINABLE DEVELOPMENT GOALS BY 2030
This policy is predominantly covered by the SDG 3 Ensure healthy lives and promote well-being for all at all ages. The pursuit of this goal aspires to push the global maternal mortality below 70 to 100.000 livebirths, eliminate preventable deaths in newborns and children under five years of age, end outbreaks and reduce premature mortality from non-communicable diseases, continue combating hepatitis, promote mental health and well-being, strengthen the prevention of substance abuse, place more emphasis on the issues of reproductive health and sexual healthcare, more universal access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all, reduce the number of deaths from hazardous chemicals, and deaths and injuries from road traffic accidents. SDG 3 covers also financing of the healthcare system, research and development concerning vaccines and drugs. Pertinent to health policy is also SDG2, particularly the efforts to combat malnutrition. SDG5 devoted to gender equality aspires to achieve universal access to sexual and reproductive health and reproductive rights (Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action). An important aspect that sustainable development goals strive to improve is the involvement of the healthcare system and its preparedness to climate change-induced consequences for human health, the importance of water, air and soil safety (sub-goals 1.5, 2.4, 6.1/2/3/4, 11.6/c, 13.1/2/3, 17.7).
HEALTH POLICY IN THE NATIONAL SUSTAINABLE DEVELOPMENT STRATEGY
The National Sustainable Development Strategy by 2030 sets improved health of citizens of all ages and reduced inequalities in health, with particular emphasis on children as one of its strategic goals (goal 1.2). This goal is elaborated through a number of measures aligned with the sustainable development goals (SDG3) and focusing on maternal and newborn health, promotion of healthy lifestyles, improved quality of healthcare. Some indicators in this area include: bring newborn mortality rate closer to the EU average (currently the EU average stands at 3.4 per 1000); share of healthy years of life increased to 55; the number of casualties in car accidents reduced by 50 percent; reduce the gap in GDP share for health compared to the EU average (EU – 10 percent, Montenegro – 5 percent); health spending as a share of budget and GDP, 12 percent and 9 percent, respectively; closing the gap in the number of doctors per 100.000 inhabitants compared to the EU average (CG 265.1 (2019); EU 340-350 (subject to the source of data). Apart from these targets, the NSDS also defines performance indicators in all areas of health policy, primarily relying on the indicators from sustainable development goals and well-established rates for measuring specific segments of health policy (suicide rate, disease-specific mortality rates, children mortality rate, rates for communicable, non-communicable, malign diseases, etc.)
Montenegro opened negotiation chapter 28 Consumer and health protection on 16 December 2014. Health protection is a part of this complex and comprehensive chapter and includes the following areas governed at the EU level: improved health by combatting communicable diseases, rare diseases and cancer; prevention of addiction from drugs, tobacco and alcohol and accidents caused through the use of alcohol, as well as the illnesses linked with environmental pollution, and the ability to act swiftly and in a coordinated fashion in case of general public health threats.
Two out of three final benchmarks in this chapter concern health:
Based on the innovative methodology of EU accession, health policy is located in Cluster 2 “Internal Market”.
The latest report of the European Commission for Montenegro (2021) highlighted several challenges for the coming period: completing the process of harmonizing national legislation with the EU acquis on health care, in particular on the rights of patients in cross-border healthcare and substances of human origin; the need to encourage the implementation of legislation to combat the harmful use of tobacco; issues related to patients’ rights in cross-border healthcare need to be addressed; The quality of access to health and services for vulnerable populations, including Roma and other minorities, the elderly, people with pre-existing mental health problems, people with disabilities and the population in rural or remote areas, should be further strengthened.
It is worth mentioning that Montenegro’s obligations stemming from Chapter 24 on the fight against drugs greatly depend on the establishment of the Drug Office within the Ministry of Health.
The Europe 2020 strategy envisages the promotion of good health as a crucial aspect of the economic growth agenda. More specifically, smart and inclusive growth refers to preserving a high level of health with a view of increased productivity and competitiveness, innovation towards creating sustainable healthcare systems, strong healthcare sector as a generator of a large number of jobs, increasing the number of people aged 65+, care for the elderly and increased finance for this section of the healthcare system with a view to a dignified life.
Among EU2020 seven flagship initiatives, four are relevant for public health: Innovation Union (innovation, sustainability and efficiency in the area of health; active and healthy ageing), A Digital Agenda for Europe (online access to health data; certification and promotion of e-Health services), An Agenda for New Skills and Jobs (employability and inclusiveness in the area of health) and European Platform against Poverty (financing healthcare services for the elderly; supporting community-based response to needs, such as social protection for the elderly; children’s health and global threats to health).
The EU Health Strategy was implemented over the period 2007-2013, but is fully compatible with the Europe 2020 Strategy. The objectives are focused on strengthening the health of fast-ageing Europe; protecting citizens against health threats; supporting increasing the pace of healthcare system development and uptake of new technologies (e-Health, biotechnology, and genomics).
The orientations of the EU E-Health Action Plan 2012-2020 include: achieving broader interoperability in e-Health services; support to research, development, innovation and competitiveness in e-Health; user-friendliness and distribution of e-Health services; and promotion of political dialogue and international cooperation in this area globally.
Among EU political criteria 2019-2024 the commitment to a better quality of health for each citizen is put on an equal footing as the endeavours to preserve the health of the planet. In the fight against poverty, the goal is for each child in the EU who is at risk of poverty or social exclusion to have access to healthcare; the roadmap for the adoption of Europe’s Beating Cancer Plan; fostering digitisation and the use of artificial intelligence in health.
In 2021, the EU strategic framework has been completed with several important documents. The EU Health Action Program (EU4Health Program 2021-2027) is dedicated to promoting healthy lifestyles, strengthening access to health care and prevention, and reducing health inequalities. The program includes activities in the field of infectious and non-communicable diseases.
The Pharmaceutical Strategy for Europe is based on 4 pillars: ensuring access to affordable medicines for patients; supporting the competitiveness, innovation and sustainability of the EU pharmaceutical industry and the development of high quality, safe, effective and green medicines; strengthening crisis preparedness and response mechanisms, diversified and secure supply chains, addressing drug shortages; and, ensuring a strong EU voice in the world, by promoting a high level of quality, efficiency and safety standards.
The covid-19 pandemic has brought changes in certain EU activities that can be considered important for the preparation of the strategic framework in Montenegro. Here you can consult the activities of HERA (EU Health Emergency and Preparedness and Response Authority), then the continuation of the action plan for the fight against cancer SAMIRA Action Plan.
Strategy of WHO Regional Office for Europe
The need to keep pace with the European and international developments led to a noticeable proliferation of strategic documents, some of which have a decade-long horizon. Thus, over the last several years, with the adoption of the legal and methodological framework for strategic planning in Montenegro, this line ministry has strived to specify the areas requiring the adoption of programmes as strategic documents for narrower and more specific areas of the health policy. The European Commission recognised certain progress in the area, in particular the inclusion and health insurance coverage for the Roma and Egyptian, a slight increase in appropriations for the public health, recognition in the national legislation of the European Health Insurance Card, the alignment of the national legislation with the EU Acquis, and the efforts to introduce e-health services. Montenegro is about to finish the process of introducing the so-called third-generation electronic card which would serve both as a personal ID and as a medical card, bearing all the information about the bearer and the qualified digital certificate and qualified electronic signature in line with e-IDAS, as envisaged by the EU regulation. Montenegro’s orientation towards tourism as the key economic sector is reconfirmed by having a health tourism policy developed by the Ministry of Economic Development which aims to further strengthen this area within tourism policy.
One of the priorities of the Government, which arises from the expose of the Prime Minister and which is one of the pillars of the Government’s Work Program for 2021, is Health and Healthy Environment. Within this priority, the key goal in 2021 is related to strengthening the control over the covid-19 pandemic and epidemiological protection of citizens through a strategic approach to immunization of the population. By implementing specific activities of prevention, control, coordination, diagnosis and integration, the focus is to strengthen the system for combating non-communicable diseases, the nutritional status of the population, low HIV prevalence and addiction.
The economic reform program 2021-2023 envisages the use of telemedicine in Montenegro through the establishment of an information system for telemedicine and the development of mobile health care – mHealth. In addition to the adoption of the normative framework and the implementation of the system, first through pilot projects, training will be organized for at least 150 health workers by 2023. It is planned that by 2023, 200 medical examinations will be performed via telemedicine.
The implementation of a large number of strategic documents in this area was completed in 2020. In 2021, final reporting on implementation, evaluation processes and preparation of new strategic documents is planned. It is important to point out that in 2021, the development of the document Health Policy of Montenegro will begin, which has the potential to become an umbrella strategy for health, whose priorities would derive directions and goals of strategic documents in individual areas of health policy.
The Strategy for the Protection and Improvement of Mental Health in Montenegro until 2023 envisages strengthening the capacity for prevention and treatment of mental illness, but also the promotion of mental health in order to prevent mental and behavioural disorders. A special part is dedicated to strengthening the mechanisms for respecting the human rights of persons with mental disorders, but also to improving information systems and registers and conducting research in the field of mental health with the aim of future planning based on data.
A specific part of health policy, in accordance with international obligations, is regulated through the Program for Adaptation of the Health System to Climate Change in Montenegro until 2022. The focus of this program is to create a national framework for strengthening capacity for adaptation and resilience to climate change risks. through the involvement of relevant actors in a participatory process to respond to the negative impact of climate change on human health. The implementation of this program should contribute to reducing vulnerability and improving adaptation measures, in order to reduce the negative effects of climate change on human health and increase the readiness of the entire health system to respond to challenges.
With a view to future developments of the healthcare system and keeping pace with the health policy developments within the EU, the adoption of the Strategy for Developing Integral Health Information System and E-Health Services is also significant. The Strategy mirrors the trends set in Europe 2020, but is also indirectly linked with the political priorities of the new European Commission until 2024. The Strategy refers to the provision of the necessary information to all stakeholders aspiring to better healthcare services and improved health of the population, planning the development of the system, its sustainability and orientations of the health policy, supported by a viable information system. Separate sections of the system increase the internal organisation quality, evaluation and performance appraisal of healthcare institutions, better planning, linkages with other sectors, support to research and development efforts.