International Journal of Public Health

, Volume 60, Supplement 1, pp 47–53 | Cite as

Health policy analysis for prevention and control of cardiovascular diseases and diabetes mellitus in Turkey

  • Bulent KilicEmail author
  • Sibel Kalaca
  • Belgin Unal
  • Peter Phillimore
  • Shahaduz Zaman
Original Article



Current capacity of the Turkish health system is reviewed to evaluate and develop appropriate policies for cardiovascular diseases (CVD), diabetes mellitus (DM) and related risk factors.


This paper qualitatively evaluates existing policies; interviews with key informants (KIs); and rapid appraisal fieldwork in clinical settings about CVD–DM through the framework of Walt and Gilson (Health Policy Plan 9:353–370, 1994).


Document review shows that prevention and control of CVD–DM were strongly addressed in Turkey, yet no document mentioned country-wide early detection or screening programs. KIs indicated over-fragmented management of CVD–DM by the Ministry of Health (MoH). Coordination among the MoH, organizational structure at provincial level and civil society organizations are poor where mutual trust is a significant problem according to KIs. Clinical setting findings point to a complete lack of a referral structure and a lack of follow-up, compounding the absence of functioning health information systems for patient records.


Primary care services for CVD–DM require urgent attention, focusing particularly on the training of staff in public facilities, the integration of patient data, referrals and follow-up across all levels of the health system.


Cardiovascular diseases Diabetes mellitus Document analyses In-depth interviews Policies on noncommunicable diseases Qualitative study 


  1. Akdag R (2009) Progress report: Health Transformation Program in Turkey. In: Aydın S, Demirel H (eds) MoH Pub. No. 749, AnkaraGoogle Scholar
  2. Akgun S, Rao C, Yardim N et al (2007) Estimating mortality and causes of death in Turkey: methods, results and policy implications. Eur J Public Health 17(6):593–599PubMedCrossRefGoogle Scholar
  3. Atun R, Aydın S, Chakraborty S et al (2013) Universal health coverage in Turkey: enhancement of equity. Lancet 382(9886):65–99 (published online June 27, 2013)Google Scholar
  4. Basara BB, Guler C, Yentur Gk et al (2013) Health Statistics 2012. General Directorate of Health Researches, SB-SAG-2013/01, Ministry of Health of Turkey Publication No. 917 (in Turkish) ISBN: 978-975-590-471-9, Ankara, pp 129–149Google Scholar
  5. Beran D, Higuchi M (2013) Delivering diabetes care in the Philippines and Vietnam: policy and practice issues. Asia Pac J Public Health 25(1):92–101PubMedCrossRefGoogle Scholar
  6. Bowman S, Unwin N, Critchley J et al (2012) Use of evidence to support healthy public policy: a policy effectiveness–feasibility loop. Bull World Health Organ BLT.12.104968:1–14Google Scholar
  7. Erkoc Y, Yardim N (2011) Policies for tackling non-communicable diseases and risk factors in Turkey. Directorate General Primary Health Care, Ministry of Health of Turkey Publication No. 809, AnkaraGoogle Scholar
  8. Gyberg V, Ryden L (2011) Policymakers’ perceptions of cardiovascular health in Europe. Eur J Cardiovasc Prev Rehabil 18(5):745–753PubMedCrossRefGoogle Scholar
  9. Maziak W, Critchley J, Zaman S et al (2013) Mediterranean studies of cardiovascular disease and hyperglycaemia: analytical modelling of population socio-economic transitions (MedCHAMPS): rationale and methods. Int J Public Health 58:547–553. doi: 10.1007/s00038-012-0423-4
  10. Mendis S, Chestnov O (2013) Policy reform to realize the commitments of the political declaration on noncommunicable diseases. Br Med Bull 105:7–27PubMedCrossRefGoogle Scholar
  11. Ministry of Health of Turkey (2009) Prevention and control program for cardiovascular diseases: strategic plan and action plan for the risk factors. Directorate General Primary Health Care Services, Ministry of Health of Turkey Publication No. 743, AnkaraGoogle Scholar
  12. Ministry of Health of Turkey (2010a) Obesity prevention and control program of Turkey, 2010–2014 (in Turkish). Directorate General Primary Health Care, Ministry of Health of Turkey Publication No. 773, AnkaraGoogle Scholar
  13. Ministry of Health of Turkey (2010b) Turkish prevention and control of cardiovascular diseases program: strategic plan and activity plan for primary, secondary and tertiary prevention, 2011–2014 (in Turkish). Directorate General Primary Health Care, Ministry of Health of Turkey Publication No. 812, AnkaraGoogle Scholar
  14. Ministry of Health of Turkey (2011) Turkish prevention and control of diabetes mellitus program: activity plan, 2011–2014 (in Turkish). Directorate General Primary Health Care, Ministry of Health of Turkey Publication No. 816, AnkaraGoogle Scholar
  15. Nolte E, Knai C, McKee M (2008) Managing chronic conditions: experience in eight countries. European Observatory Studies Series No. 15, WHO, CopenhagenGoogle Scholar
  16. Phillimore P, Zaman S, Ahmad B, Global Public Health et al (2013) Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries. doi: 10.1080/17441692.2013.830756
  17. Satman I, Tutuncu Y, Gedik S et al (2011) Diabetes epidemic in Turkey: results of the second population-based survey of diabetes and risk characteristics in Turkey (TURDEP-II). Poster: A-11-2498. 47th EASD Annual Meeting, 12–16 Sept 2011, Lisbon. Diabetologia 54(Suppl. 1):P2498Google Scholar
  18. Satman I, Omer B, Tutuncu Y et al (2013) Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. doi: 10.1007/s10654-013-9771-5 PubMedCentralPubMedGoogle Scholar
  19. Savas BS, Karahan O, Saka OR (2002) Health care systems in transition: Turkey, vol 4. European Observatory on Health Care Systems, CopenhagenGoogle Scholar
  20. Serumaga B (2011) Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom:interrupted time series study. BMJ 342:d108. doi: 10.1136/bmj.d108
  21. Social Security Institution (2012) Accessed 28 May 2012
  22. Sonmez M (2011) Paran kadar saglik (in Turkish). Yordam Publications, IstanbulGoogle Scholar
  23. Stuckler D, Siegel K (eds) (2011) Sick societies: responding to the global challenge of chronic diseases. Oxford University Press, NewYorkGoogle Scholar
  24. Turkish Cardiology Association (2008) Ulusal kalp sagligi politikasi (in Turkish). Turkish Cardiology Association Publications, IstanbulGoogle Scholar
  25. Turkish Diabetes Foundation (2009) Diabetes 2020 vision and targets: the situation of diabetes in Turkey (in Turkish). Turkish MoH, WHO Europe, Int. Diabetes Fed Europe, IstanbulGoogle Scholar
  26. Turkish Diabetes Foundation (2010) Diabetes 2020 vision and targets: solutions for diabetes in Turkey (in Turkish). Turkish MoH, WHO Europe, Int. Diabetes Fed Europe, IstanbulGoogle Scholar
  27. Turkish Statistical Institute (2014) TUIK Haber Bulteni (in Turkish) Sayı: 15974, 29 Ocak 2014. Accessed Feb 2014
  28. Unuvar N, Mollahaliloglu S, Yardim N (2006) Turkey Burden of Disease Study 2004. Ministry of Health of Turkey, Refik Saydam School of Public Health Publication No. 701, AnkaraGoogle Scholar
  29. Van Herck P, De Smedt D, Annemans L et al (2010) Systematic review: effects, design choices, and context of pay-for-performance in health care. BMC Health Serv Res 10:247PubMedCentralPubMedCrossRefGoogle Scholar
  30. Walt G, Gilson L (1994) Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan 9:353–370PubMedCrossRefGoogle Scholar
  31. Walt G, Shiffman J, Schneider H et al (2008) Doing health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan 23:308–317PubMedCentralPubMedCrossRefGoogle Scholar
  32. World Bank (2012) World Development Indicators 2012. Washington DCGoogle Scholar
  33. Yardim M, Cilingiroglu N, Yardim N (2014) Financial protection in health in Turkey: the effects of the Health Transformation Programme. Health Policy Plan 29:177–192PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2014

Authors and Affiliations

  • Bulent Kilic
    • 1
    Email author
  • Sibel Kalaca
    • 2
  • Belgin Unal
    • 1
  • Peter Phillimore
    • 3
  • Shahaduz Zaman
    • 4
  1. 1.Department of Public Health, Medical FacultyDokuz Eylul UniversityIzmirTurkey
  2. 2.Department of Public Health, Medical FacultyMarmara UniversityIstanbulTurkey
  3. 3.Department of Sociology, Newcastle UniversityNewcastle upon TyneUK
  4. 4.Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK

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