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:
The last report for Montenegro highlighted several challenges for the upcoming period: achieving specific and tangible results in fight against corruption in health; strengthen efforts to implement the strategy for mental health and deinstitutionalisation of mental health patients; better healthcare for inmates. The report takes note of partial alignment with the EU framework in almost all health policy areas.
It is worth mentioning that Montenegro’s obligations stemming from Chapter 24 on fight against drugs greatly depend on the establishment of the Drug Office within the Ministry of Health.
The Europe 2020 strategy envisages promotion of good health as a crucial aspect of the economic growth agenda. More specifically, smart and inclusive growth refers to preserving 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 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 aging), 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 health of the fast-aging Europe; protection of citizens against health threats; support to 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 better quality of health for each citizen is put on an equal footing as the endeavours to preserve the health of the planet. In 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.
Strategy of WHO Regional Office for Europe
This policy is primarily created by the Ministry of Health (MH). The need to keep pace with the European and international developments led to 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, 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 eIDAS, as envisaged by the EU regulation. Montenegro’s orientation towards tourism as the key economic sector is reconfirmed by having health tourism policy developed by the Ministry of Sustainable Development and Tourism which aims to further strengthen the industry, with the support of the Government, and the Institute in Igalo to be the backbone of the system and remain state-owned.
The overarching strategic document Medium-term Government Work Programme 2018-2020 in its priority 5 includes health policy through creating conditions for accessible, quality, sustainable in the long run citizen-centred healthcare system with special focus on promotion and prevention, timely treatment, rehabilitation and care. The key indicators include the following: increase in the share of preventive examinations for cervical, breast and colorectal cancer by 5% in 2018; appropriation for fight against and prevention of HIV/AIDS of €360.000 annually; introduction of the electronic medical card; reducing waiting time for the first examination by a specialist to up to 30 days; continuous professional development for 700 doctors each year; specialisation provided for 180 doctors during the three years; reduction of drug consumption by 5% for each year and antibiotics consumption by 10% in 2018 and additional 5% in 2019.
The Health Policy by 2020 gives a general framework for healthcare development in Montenegro. In line with the World Health Declaration the following general health policy goals are discerned: longer life in good health; reducing the health gap, and insurance against financial risk. Some of the indicators underpinning the strategic documents include: bring regional and socio-economic discrepancies in health status and health protection down to under 10%; reduce infant mortality to up to 8 in 1000 births; reduce disability in children, youth and adolescents due to injuries by 50%; reduce low weight births by minimum 20%; reduce by minimum 50% smoking among youth, and teen pregnancies; increase the life expectancy of 65 years by 10%; improved mental health; elimination of measles; reduce mortality due to tuberculosis by the annual rate of 3%; immunisation rate of minimum 95%; reduce by 40% the rate of persons aged 65 suffering from cardiovascular disease, by 20% those suffering from malignant diseases, and by 30% the diabetes-induced complications; reduce mortality and disability caused by traffic accidents by 30% and injuries by 50%. Other measures refer to issues concerning alcohol, tobacco and drug abuse, promotion of healthy life styles, and reducing public exposure to physical, biological and chemical noxious substances from water, air and soil.
The Healthcare Development Strategy is consistent with the goals set in the Health Policy by 2020 and provides further details concerning the current situation, reviews the financial and legislative aspects of the health policy at all healthcare levels, and proposes changes, but also focuses on the required alignment with Montenegro’s international commitments and the Millennium Development Goals (MDGs) relevant at the time.
The priorities of the Master Plan for Healthcare Development 2015-2020 include reduced rates of chronic diseases (cardiovascular, malign, diabetes, mental health, etc.); prevention of contagious diseases with immunisation rate for children in each municipality of minimum 95% particularly focusing on increased coverage of at-risk populations (Roma); adoption of response mechanisms to health threats (outbreaks); particular attention is devoted to increasing quality of care for vulnerable and disadvantaged groups (women of reproductive age, infants, children and youth, elderly, persons with disabilities, socially deprived and marginalised persons, workers). The document assumes certain reform actions in the public healthcare system at all levels, and better quality of medical procedures and protocols.
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 the Europe 2020, but is also indirectly linked with the political priorities of the new European Commission until 2024. The Strategy refers to provision of 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.