1. SEECP Health Ministerial Meeting Achievements and challenges of strenghtening health system performance through addressing inequalities in health services in Croatia Achievements and challenges of strenghtening health system performance through addressing inequalities in health services in Croatia Chisinau, November 7, 2008 The Republic of Croatia Ministry of Health and Social Welfare The Republic of Croatia Ministry of Health and Social Welfare

2. 2 Basic documents proclaiming the right to health  Constitution of the Republic of Croatia  Health Care Act  Compulsory Health Insurance Act  Communicable Disease Control Act  Occupational Health and Safety Health Insurance Act

3. 3 Basic health rights Every citizen has health insurance Average number I.-XII.2006. Active workers 1.505.547 Active farmers 63.270 Pensioners1.015.823 Unemployed403.988 Other138.195 Family members 1.227.569 Refugees3.160 Total - Croatia 4.357.552 Structure of ensurees

4. 4 Basic health rights Every citizen has:  chosen family physician  chosen stomatologist  women – chosen gynecologist  preschool children – chosen pediatrician or family physician

5. 5 Basic health protection rights At population level:  epidemiological care – through the public health institutes network  preventive care of school children and youth - through the public health institutes network  prevention and treatment of occupational diseases and injuries (according to the Act)  health safety monitoring for foods, other object of common use and drinking water

6. 6 Compulsory Health Insurance Act and regulations based thereon include the rights to:  primary health care  emergency medical care  specialist health care  hospital health care  drugs administration  dental-prosthetic care and substitutes  orthopedic and other aids  health care abroad

7. 7 Plan and programme of health care measures resulting from Compulsory Health Insurance Act includes: Health care measures provided by:  primary health care  specialistic and hospital care  county public health institutes and Croatian National Institute of Public Health  transfusion medicine Health care measures for priority health problems (cardiovascular diseases, malignant diseases, mental disorders, injuries etc.)

8. 8 Monitoring the implementation of Plan and Programme Example: preventive examinations for age groupe 50+  GOAL Early detection of illnesses and risk factors  TARGET POPULATION I nsurees aged 50+ who had no clinical examination or dg procedure for a minimum of two years  METHODOLOGY General check-up and basic diagnostic procedures  INDICATOR % of persons in need covered by preventive examinations

9. NATIONAL PROGRAMMES

10. 10 National Breast Cancer Screening Programme  STARTED:  October 2006  TARGET POPULATION:  women aged 50-69 (covered 586,912 women ni Croatia)  GOAL:  to reduce breast cancer mortality by 25% within 5 years of the beginning of the programme and to increase the proportion of breast cancers detected in initial stage  SCREENING TEST:  mammography (double-reading)  SCREENING INTERVAL:  2 years  SCREEN-DETECTED CANCERS:  About 900 /October 2008/

11. 11 Colorectal Cancer Screening Programme  STARTED:  November 2007  TARGET POPULATION:  men and women aged 50-74 (about 1,200,000 Croatian citizens)  GOALS:  to reduce colorectal cancer mortality by 15% within 5 years of the beginning of the programme  SCREENING TEST:  Fecal occult blood testing (FOBT) followed by colonoscopy  SCREENING INTERVAL:  2 years  SCREEN-DETECTED CANCERS:  77 cancers, 421 polyps /October 2008/

12. 12 National Diabetes Programme  STARTED:  2008  TARGET POPULATION:  adults aged 50+ and younger with risk factors, pregnant women  diabetic patients  GOALS:  increase the number of new diagnosed cases at early stage  reduce the number of complications  SCREENING TEST:  Fasting plasma glucose; OGTT  SCREENING INTERVAL:  2 years / 1year  ESTIMATED PREVALENCE:  8,9% adults (18+)

13. 13 HIV/AIDS Prevention Programme 2005-2010.  Diagnostics and treatment of HIV positive person and AIDS patients free of charge, including HAART therapy  Educational programmes  Widening of voluntary counselling and HIV testing services (VCT) through the network of centers for voluntary, anonimous, free of charge testing  Second generation surveillance including not only surveillance of HIV prevalence and AIDS incidence and mortality but also other STDs and risk behaviour  Seroprevallence investigation in most at risk populations  Harm reduction and outreach programmes in population subgroups with risk behaviour

14. SPECIAL PROGRAMMES

15. 15. Prevention of overweight and obesity in childhood Co-operation project between Flanders, Croatia and Slovenia Flanders, Croatia and Slovenia “Implementation of a methodology for the development of evidence-based guidelines in school health care” Started in 2005 Phases: Developing guidelines applicable in daily practiceDeveloping guidelines applicable in daily practice Disemination of the guidelines to authorities and targetDisemination of the guidelines to authorities and target professional groups Implementation of the guidelines at the national levelImplementation of the guidelines at the national level

16. 16 Thank you for your attention !