Skip to main content

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

Abstract

Objectives

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.

Methods

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).

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution.

References

  • Akdag R (2009) Progress report: Health Transformation Program in Turkey. In: Aydın S, Demirel H (eds) MoH Pub. No. 749, Ankara

  • 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):593–599

    PubMed  Article  Google Scholar 

  • 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)

  • 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 129–149

  • Beran D, Higuchi M (2013) Delivering diabetes care in the Philippines and Vietnam: policy and practice issues. Asia Pac J Public Health 25(1):92–101

    PubMed  Article  Google Scholar 

  • 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.12.104968:1–14

  • 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, Ankara

  • Gyberg V, Ryden L (2011) Policymakers’ perceptions of cardiovascular health in Europe. Eur J Cardiovasc Prev Rehabil 18(5):745–753

    PubMed  Article  Google Scholar 

  • 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

  • Mendis S, Chestnov O (2013) Policy reform to realize the commitments of the political declaration on noncommunicable diseases. Br Med Bull 105:7–27

    PubMed  Article  Google Scholar 

  • 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, Ankara

  • 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, Ankara

  • 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, Ankara

  • 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, Ankara

  • Nolte E, Knai C, McKee M (2008) Managing chronic conditions: experience in eight countries. European Observatory Studies Series No. 15, WHO, Copenhagen

  • 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

  • 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):P2498

  • 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

    PubMed Central  PubMed  Google Scholar 

  • Savas BS, Karahan O, Saka OR (2002) Health care systems in transition: Turkey, vol 4. European Observatory on Health Care Systems, Copenhagen

  • 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

  • Social Security Institution (2012) http://www.sgk.gov.tr/wps/portal/tr/kurumsal/istatistikler/sgk_istatistik_yilliklari. Accessed 28 May 2012

  • Sonmez M (2011) Paran kadar saglik (in Turkish). Yordam Publications, Istanbul

    Google Scholar 

  • Stuckler D, Siegel K (eds) (2011) Sick societies: responding to the global challenge of chronic diseases. Oxford University Press, NewYork

    Google Scholar 

  • Turkish Cardiology Association (2008) Ulusal kalp sagligi politikasi (in Turkish). Turkish Cardiology Association Publications, Istanbul

    Google Scholar 

  • 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, Istanbul

    Google Scholar 

  • Turkish Diabetes Foundation (2010) Diabetes 2020 vision and targets: solutions for diabetes in Turkey (in Turkish). Turkish MoH, WHO Europe, Int. Diabetes Fed Europe, Istanbul

    Google Scholar 

  • Turkish Statistical Institute (2014) TUIK Haber Bulteni (in Turkish) Sayı: 15974, 29 Ocak 2014. http://www.tuik.gov.tr/PreHaberBultenleri.do?id=15974. Accessed Feb 2014

  • 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, Ankara

  • 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 10:247

    PubMed Central  PubMed  Article  Google Scholar 

  • Walt G, Gilson L (1994) Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan 9:353–370

    CAS  PubMed  Article  Google Scholar 

  • Walt G, Shiffman J, Schneider H et al (2008) Doing health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan 23:308–317

    PubMed Central  PubMed  Article  Google Scholar 

  • World Bank (2012) World Development Indicators 2012. Washington DC

  • Yardim M, Cilingiroglu N, Yardim N (2014) Financial protection in health in Turkey: the effects of the Health Transformation Programme. Health Policy Plan 29:177–192

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bulent Kilic.

Additional information

This article is part of the supplement “The rising burden of non-communicable diseases in four Mediterranean countries and potential solutions”.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kilic, B., Kalaca, S., Unal, B. et al. Health policy analysis for prevention and control of cardiovascular diseases and diabetes mellitus in Turkey. Int J Public Health 60, 47–53 (2015). https://doi.org/10.1007/s00038-014-0557-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-014-0557-7

Keywords

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