PHC Project Proposal within the BSR Programme

Primary Health Care Expert Group

Sixth Meeting
Oslo, Norway
September 30 - October 1st 2008

Reference PHC 6/6/1

Title Concept of PHC Project Proposal to BSR Programme
Submitted by ITA
Summary / Note This draft of the project concept is developed by consultant Carsten
Bayer from agency Sustainable Projects, contracted by Swedish
East Europe Commitee.
Requested action It will be discussed during the EG meeting and is expected that
Experts will be ready to propose potential partners of the project from
their countries and activities/results actual for their countries. These
activities should fit into the frame but can vary a lot. The scope of
activities of the project should reflect the specific interests of the
project partners and should not be an additional burden that the
partners have to do for the sake of the project only.

Project Proposal: Improvement of public health by promotion of

equitable distributed high quality primary health care systems
Background & Problem
In the Baltic Sea Region (BSR) large differences exist in health condition among
population groups. Large population groups enjoy good health, while
underprivileged ones suffer from high disease prevalence and premature
mortality. Contributing causes to these differences include social and economic
problems associated with high morbidity rates from cardiovascular diseases,
violence, alcohol and drug abuse and spread of infectious diseases such as TB
and HIV/AIDS.
Primary health care (PHC) is of special importance in addressing these health
problems. PHC is the level of care nearest to the community and with a
continuous relationship with all people. Strong primary care is the core element
of meeting community health care needs, preventing of communicable infectious
and non-infectious diseases and also for ensuring effective management of
health problems. Strong PHC helps to control the costs of the health system
through coordinating care and managing interfaces with other specialities.
Hence PHC takes responsibility for a needs-based allocation of scarce resources.
It can be used as an efficient tool for health promotion and disease prevention

PHC Project Proposal within the BSR Programme

and for more equitable allocation of overall health care resources to all
population groups.
While the importance of PHC is without controversy, the equitable availability of
high quality primary health care personnel and resources is a big challenge for all
BSR Countries. In urban centres the provision of PHC is often assured but in the
remote rural parts of the BSR countries PHC is often more difficult to master
from a human resource perspective.
BSR countries show a high diversity in the way health care in general and
primary health care in particular is organized. On the one hand the Nordic
countries (Denmark, Finland, Iceland, Norway, Sweden) have established general
practice oriented models of primary health care. On the other hand Poland,
Lithuania, Latvia, Estonia, Russia and Belarus are experiencing different stages of
primary care transition from the "Semashko system" of policlinics, in which
district paediatricians and internists work together with a number of specialists
as the first contact doctors, towards a more comprehensive and efficient model
of PHC based on family medicine.
Several BSR countries are experiencing unequal distribution of primary health
care resources, and not all population groups have access to qualified primary
health care professionals. The long traditions of the specialist - driven health care
systems also result in population groups with lower accessibility to qualified
primary health care becoming high users of secondary health care.
The unequal availability of quality primary health care services is related to a
number of problems, which include:
o
o

Political strategies for the establishment and development of a system of

equitably distributed and high quality PHC are frequently inadequate
Overall PHC resources (human & financial) are insufficient. Underlying reasons
for that include the small share of PHC in the overall health care financing,
and the little room that is given to PHC staff in the medical training system.
Geographical distribution of primary health care services in BSR is unequal.
One underlying reason for this is the absence of financial incentives within the
remuneration system for family doctors or nurses to work in more remote,
rural areas.
Quality of PHC services in BSR varies considerably. Underlying reasons for
that include that the PHC personnel (doctors & nurses) need to receive better
continuous medical education and the remuneration system does not reward
high quality in PHC activities enough.
Health systems often focus on doctors. However, in highly developed
countries the contributions, through teamwork and independent activities, of
nursing professionals including not only nurses but also rehabilitation
professionals, are indispensable for a high quality and cost effective health
system. Thus the professional training of nursing professionals must be
improved including preventive advice on life style issues & community-based
work.
The benefits of PHC are not sufficiently demonstrated/communicated to the
key stakeholders and the wider public.

PHC Project Proposal within the BSR Programme

Interreg BSR Programme 2007 - 2013

The Baltic Sea Region (BSR) Programme 2007-2013 has been designed under
the European Communitys territorial cooperation objective. It is built on the
experience of its two predecessor programmes supporting transnational
cooperation in the Baltic Sea region under the Community Initiatives INTERREG
IIC (1997-1999) and INTERREG III B Neighbourhood Programme (20002006).
The overarching strategic objective of the Baltic Sea Region Programme is to
strengthen the development towards a sustainable, competitive and territorially
integrated Baltic Sea region by connecting potentials over the borders. As part of
Europe, also the Baltic Sea region is expected to become a better place for its
citizens to invest, work and live. The programme will thus address the European
Unions Lisbon and Gothenburg strategies in order to boost knowledge based
socio-economic competitiveness of the Baltic Sea region and its further territorial
cohesion.
One of the four priorities of the BSR Programme aims at Ensuring co-operation
of metropolitan regions, cities and rural areas to share and make use of common
potentials that will enhance the BSR identity and attractiveness for citizens and
investors. The PHC project proposal can be submitted under this priority as
more specifically one of the planned results of priority 4 is To strengthen the
social conditions and impacts of regional and city development by implementing
joint actions in the field of public health to counteract major communicable
diseases and to address social and environmental factors of health problems.
Thus the PHC project fits very well to a specific niche of the overall BSR
programme, which in turn could provide funding for the necessary action towards
promoting an equitably distributed primary care system in the BSR.
The eligible area includes the whole territory of Denmark, Estonia, Finland,
Latvia, Lithuania, Poland and Sweden, and Northern parts of Germany as EU
member states. Also the neighbouring countries of Norway (whole country),
Russia (North-Western regions) and Belarus (whole country) belong to the
programme area.
Eligible beneficiaries comprise public authorities from national, regional and local
level as well as public equivalent bodies (such as research and training
institutions,
business
development
institutions
and
other
non-profit
organisations).
The contribution from the European Regional Development Fund (ERDF) amounts
to some 209 million EUR. Norway will make available 6 million EUR national
funding. Some 23 million EUR will be provided by the European Neighbourhood
and Partnership Instrument (ENPI) for the benefit of the eligible regions in Russia
and Belarus. The total of approx. 238 million EUR will cover:
o
o
o
o

up to 75 % of eligible project costs generated by partners from Denmark,

Germany, Sweden, Finland
up to 85 % of eligible project costs generated by partners from Estonia,
Latvia, Lithuania and Poland
up to 50 % of eligible project costs generated by partners from Norway
up to 90 % of eligible project costs generated by partners from Russia and
Belarus
3

PHC Project Proposal within the BSR Programme

The PHC project needs to present a single joint application to the programme,
which integrates the objectives of EU and Norwegian territorial cooperation as
well as actions supported by the European Neighbourhood and Partnership
Instrument.
The project duration is usually three years. Project partners are expected to cofinance activities with 10%, 15%, 25% or 50% of the budget (depending on their
country of origin). As staff costs (of permanent or temporary staff employed
anyway by the partner but working for the project) are eligible costs this cofinancing share does not need to be provided necessarily in cash (often the staff
costs takes a bigger share than 25% of the overall individual partner budget).
The PHC project proposal is planned to be submitted for funding within the
second call for project applications intended to open November 2008 and close
January / February 2009. The project activities would then start approximately in
the summer of 2009.

Project Objective and Project Results

The overall objective, which is in line with the BSR Programme and to which the
PHC project will contribute, is:
To improve public health by counteracting communicable diseases and
targeting health problems related to social factors
In order to contribute to the overall objective the project aims at achieving the
following specific objectives:
o
o
o
o

To promote equitable distribution of high quality PHC system

To balance patients preferences more towards primary health care
To better address health risks related to gender and social factors
To counteract communicable diseases through preventive
measures and evidence based clinical management

Specific results to be accomplished in the course of the project, which would lead
to the achievement of above-outlined specific objectives, include:
o

Framework for increasing PHC resources created

Mechanisms for equitable distribution of PHC system elaborated

Quality of PHC services improved

Knowledge and skills of PHC professionals in addressing health risks related to

social factors and counteracting communicable diseases improved

Expected outcomes and related activities

In order to tackle the problems identified above and to achieve the objectives
defined it is important to establish a network of equal partners, who can learn
from each others experiences on how to improve PHC services.
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PHC Project Proposal within the BSR Programme

Partnerships and pilot projects in this area could be very useful in finding the
balance between the needs of the patients and the communities and promote
effective working mechanisms in the primary care systems. Other appropriate
tools might comprise study tours or internships.
Payment schemes with incentives to increase health promotion and disease
prevention activities would be very relevant for most BSR countries. Sharing of
experiences in this field and lessons learned from mistakes would be appreciated
by the majority of health care decision makers of the BSR countries.
Special focus in the field of PHC human resources and professional training shall
be put on the role of nurses in clinical and preventive care. Here the project
intends to exchange and apply different audit measures (including ICT-based
tools), in order to ensure continued medical education and quality development
from a bottom-up perspective.
Expected outcomes of the project will be on the one hand on the operational
level by developing and piloting action plans and exchanging lessons learnt and
good practice solutions. These outcomes might include:
o
o
o
o

Further evidence for benefits of PHC generated, demonstrated &

communicated to key stakeholders and communities
Mechanisms for equitable distribution of high quality PHC system piloted and
evaluated
New payment schemes piloted and evaluated
PHC personnel trained in methods on lifestyle issues and in community based
work

On the other hand the project will include joint activities that lead to outcomes
such as strategies and conclusions for policy approaches. They might include:
o
o
o
o

Conclusions on financial incentives to PHC service personnel within medical

remuneration system, rewarding rural posting as well as quality achievements
Conclusions for policy making that support promoting equitably distributed
PHC services
Conclusions for balancing health care financing towards PHC
Conclusions for emphasizing education of PHC staff

All potential partners are invited to specify activities that fit into the frame
sketched above (Objectives-Results-Outcomes) and that are of relevance and
interest to them. As an example the following activities could be sub-summarized
under the outcome Conclusions for policy making that support promoting
equitably distributed PHC services
-

Situational analysis identifying distribution of PHC personnel within

BSR countries (outputs: country reports/studies)
Workshops exchanging results from country studies (outputs:
transnational workshops)
Assessment and comparison between the countries on the
interrelation between availability of PHC services and key indicators
for public health (outputs: thematic reviews)
Assistance to health care planners at national and regional levels to
develop appropriate strategies for equitable distribution of qualified

PHC Project Proposal within the BSR Programme

PHC personnel (outputs: regional strategies / preparation of pilot

projects)
Development of conclusions for further improvement of the policies
for equitable distribution of PHC (outputs: reports)
Meetings with key stakeholders of the health sector presenting and
introducing conclusions of the PHC project (outputs: dissemination
meetings)
Dissemination of results (outputs: conference, flyer, handbook etc.)

Project Partner Structure

Possible Project Partners suggested:
-

Russia:
Belarus:
Sweden:
Finland:
Lithuania:
Latvia:
Estonia:
Poland:
Norway: