National Health Programme

III. NATIONAL HEALTH PROGRAMME OBJECTIVES AND TARGETS

STRATEGIC TARGET

Improving the health status of the population and enhancing the related quality of life through:

  1. Creating conditions and developing personal motivation, knowledge and skills to choose healthy lifestyle and undertaking actions for improving own health and that of the others.

  2. Creating environments supportive to health, work and education.

  3. Reducing inequalities in health and access to health services.
National Health Programme

OPERATIONAL TARGETS

  1. Promoting physical activity among the general population.
  2. Promoting healthy diet and improving food quality.
  3. Reducing tobacco smoking.
  4. Reducing alcohol consumption, changing alcohol consumption patterns, and reducing alcohol abuse-related health damage.
  5. Reducing abuse of other psychoactive substances and drug abuse-related health damage.
  6. Improving efficiency of health education and health promotion programmes.
  7. Promoting mental health and preventing mental disorders.
  8. Reducing exposure to harmful factors in the living, working and educational environment and mitigating their health effects.
  9. Improving sanitation throughout the country.
  10. Reducing the incidence of accidents, and traffic accidents in particular.
  11. Improving efficiency and effectiveness of emergency services in life threatening conditions.
  12. Improving access to and efficiency of primary health care.
  13. Preventing premature births, low birth weight and reducing related health effects.
  14. Improving early diagnosis and active care of persons at risk of ischaemic heart disease.
  15. Improving early diagnosis and treatment of breast and cervical cancers.
  16. Providing better opportunities for people with disabilities and developing their capacities to lead active lives.
  17. Improving prevention of communicable diseases.
  18. Improving prevention of dental caries and periodontal disease in children, adolescents and pregnant women.



National Health Programme

TARGET 1

Promoting physical activity among the general population

Expected outcome by 2005

Rationale of the target

The contribution of physical fitness and appropriate physical activity to physical, mental and social health and wellbeing of people in all age groups has become widely acknowledged. Physical activity:

Physical activity is not popular in Polish society. It is estimated that only 30% of children and young people, and 10% of adults practice various forms of physical activity which satisfy basic physiological needs of the body.

Expected health gain

Tasks designed to achieve the target

To achieve this target it is required:

  1. to ensure weekly 5 hrs of physical exercises in all types of primary and secondary schools;
  2. to organise gym halls in, at least, 75% of schools;
  3. to introduce new, more attractive programmes of physical exercises, creating opportunities for individual initiatives, helping to acquire the habit of practicing physical activities throughout the adulthood, promoting not only sport but also ideas of health and culture and to train teachers how to implement those programmes;
  4. to modify physical education curricula in order to equip teachers with necessary skills to perfom new roles effectively and to act as animators of lifestyles conducive to health;
  5. to encourage local self-governments, nongovernmental organizations and different institutions to create opportunities to promote physical activity in different social groups;
  6. to introduce attractive forms of motivating people to eisure physical activities.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved: Ministry of National Education, State Sport and Tourism Administration, Ministry of Health and Social Welfare, Ministry of National Defense, Central Statistical Office.



National Health Programme

TARGET 2

Promoting healthy diet and improving food quality

Expected outcome by 2005 Rationale of the target

There is strong interrelationship between healthy diets and food quality and the normal physical and mental development, nourishment, health, wellbeing and life span.
Overnutrition, undernutrition and unbalanced nutrition as well as food of bad quality in terms of healthy standard value can all lead to health problems such as ischaemic heart disease, arterial hypertension, atherosclerosis, certain neoplasms, diabetes type II, osteoporosis, endemic goitre, obesity, certain diseases of the alimentary tract, iron deficiency anaemia etc. These diseases are responsible for lowered biological, economic and intelectual potential of the population. Methods for improving human health which involve proper nutrition and better food quality are well known and their efficiency has been already evidenced in many countries.

Expected health gain

Tasks designed to achieve the target

To achieve this target it is required:

  1. to promote education of people in the area of healthy diet, especially at schools under the comprehensive national health education programme;
  2. to supply the national market with good food of standard nutritive value;
  3. to verify or establish new legislation, harmonised with requirements of the European Union, that will provide for the promotion of healthy eating patterns and the development of healthy food production, processing and marketing;
  4. to promote and encourage further breast feeding of newborns;
  5. to implement, in cooperation with local self-governments and parents, the system of providing meals at schools;
  6. to impose the treatment of table salt with iodine, promote its proper distribution and encourage people to use only iodized salt;
  7. to organise the dietetary counselling for healthy and sick persons under the public health care system;
  8. to promote administration of folic acid to women at reproductive age in order to prevent congenital defect of neural tube in newborns;
  9. to reorganise the system of food and nutrition safety control putting special emphasis on better coordination;
  10. to provide food and nutrition support for social groups with the lowest income and particularly difficult living conditions;
  11. to promote the production of certified food from ecological farms and develop education in ecological issues addressed to decision-makers, producers and consumers.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (Food and Nutrition Institute, National Institute of Hygiene, Mother and Child Institute), Ministry of National Education, Ministry of Economy, Ministry of National Defence, Ministry of Environmental Protection, Natural Rersources and Forestry, Ministry of Labour and Social Policy, Ministry of Agriculture and Food Economy, Central Statistical Office.



National Health Programme

TARGET 3

Reducing tobacco smoking

Expected outcome by 2005 Rationale of the target

In better off countries tobacco smoke is a major environmental pollutant affecting the health of active and passive smokers. The adverse health effect of smoking in terms of both physical and mental condition has been already well documented. The nicotine-related smoking addiction can be reduced by developing and implementing well designed preventive programmes addressed mainly to children and young people in order to prevent their first contact with smoking.

Expected health gain

Tasks designed to achieve the target

To achieve this target it is required:

  1. to enforce the provisions of the Health Care Law, especially those included in the section on the effects of tobacco smoking;
  2. to reduce smoking among teachers and health service workers and to promote nonsmokers among candidates for employment in schools and health facilities;
  3. to strengthen anti-smoking campaigns among students of all types of schools;
  4. to make provisions for smoke-free institutions and public places;
  5. to impose strong controls on cigarette advertising;
  6. to maintain relatively high prices of tobacco products;
  7. to reduce systematically the content of harmful substances in tobacco and smoke of cigarettes available on the Polish market;
  8. to encourage the authorities, local self-governments and nongovernmental organizations to participate in anti-smoking campaigns;
  9. to establish networks of antinicotine counselling services to help existing smokers to stop smoking and to encourage them to overcome their addiction to tobacco. They should operate, at least, in bigger cities, especially in those where medical schools are located.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (Cencer Centre, National Institute of Hygiene, National Centre for Health System Management, Mother and Child Institute), Ministry of National Education, Ministry of National Defence, Central Statistical Office, General Headquarters of Police.



National Health Programme

TARGET 4

Reducing alcohol consumption, changing alcohol consumption patterns, and reducing alcohol abuse-related health damage

Expected outcome by 2005

Rationale of the target

It is estimated that in 1995 the substantial, mean, annual alcohol intake accounted for 7-9 litres of pure alcohol per capita. A rapid increase in alcohol consumption observed during the years 1989- 92 has been recently supressed. Nevertheless, the problems like heavier drinking among young people and women, the prevalence of spirits in the alcohol consumption pattern (spirits - 57%; wine - 15%; beer - 28%), alcohol intoxication among drivers, alcohol consumption by patients under treatment and during recovery, and violence in alcoholic families still exist.
The estimated number of alcohol addicts reaches 800-900 thousand persons, including 139 thousand of those registered in alcohol treatment out- and in-patient facilities. The efficiency of withdrawal therapy among these patients is still low and the majority of them continue to drink.
The extent of alcohol-related health damage could be reduced even with the same level of global alcohol intake in Poland by improving the axcess to out- and in-patient treatment among alcohol abusers and strengthening its efficiency as well as by promoting modern diagnostic methods in primary health care centres and in other health facilities and by immediate intervention in the case of alcohol abusing patients.

Expected health gain and social improvements

A reduction in alcohol-related health damage and the extent of social problems, including:

Tasks designed to achieve the target

The priorities and relevant tasks are identified in the National Programme for Alcohol Prevention and Solving Alcohol Problems adopted by the Council of Ministers on 13 August 1996. The national strategy aimes at:

  1. limiting access to alcohol and controlling the alcohol market;
  2. promoting administrative, fiscal and educational mechanisms in order to change the alcohol consumption pattern;
  3. imposing efficient mechanisms of legal and social control of alcohol-related pathologies;
  4. promoting educational programmes addressed to young people and risk groups;
  5. improving the efficacy of and access to therapeutical programmes for alcohol abusers and their families.
  6. training of different professional groups in the area of alcohol problems;
  7. supporting and promoting activities of self-help groups and sobriety associations.
The National Agency for Solving Alcohol Problems acting under the Ministry of Health and Social Welfare is responsible for supervision and coordination of the implementation and funding of individual tasks committed by the Ministry.
According to the provisions of the amended Law on Upbringing in Sobriety and Counteracting Alcoholism adopted by Parliament on 4 July 1996, the state administration is committed to ensure 1% of incomes from the excise tax, and the Agency is responsible for allocating these funds for individual tasks identified in the National Programme. Moreover, communities are responsible for promoting preventive activities and solving own alcohol problems, and they are authorised to obtain additional funds coming from annual payments for alcohol licences issued within the community area.

Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (National Agency for Solving Alcohol Problems, Institute of Psychiatry and Neurology), Ministry of National Education, Ministry of National Defence, Road Traffic Departament, General Headquarters of Police, Central Statistical Office.



National Health Programme

TARGET 5

Reducing abuse of other psychoactive substances and drug abuse-related health damage

Expected outcome by 2005

Rationale of the target

In Poland it is difficult to estimate a real number of drug addicts. At present, the number of only opiate addicts is accounted for 25-30 throusand of persons. Recently, the amount of illicit psychoactive substances such as amphetamine, cocaine, hallucinogens, cannabis-type drugs has rapidly increased on the Polish market. The same applies to opiate, volatile solvents and multiple drugs. The increase in consumption of illicit drugs has been observed especially among younger people who are not as yet addicted but are exposed to risk of intravenous use of drugs.
Since the efficacy of drug addict treatment is rather limited throughout the world, and the risk of acute health damage (mental disorders) is growing profoundly, treatment and rehabilation programmes are supported and promoted.

Expected health gain

A reduction in drug-related health damage, including lower incidence of:

Tasks designed to achieve the target

To achieve this target is it required:

  1. to establish drug policy aimed at managing psychoactive substances and harmonising legislation with current and changing needs;
  2. to promote reliable information on psychoactive substances in all types of schools within the general health education programmes, and develop social and personal skills to protect young people against temptation to reach for drugs;
  3. to encourage preventive programmes in mass media and other special programmes designed for high risk groups, and to train personnel how to implement these programmes;
  4. to reduce supply of psychoactive substances through legislative mechanisms, and greater involvement of the police and customs personnel;
  5. to train health service workers, teachers, policemen and penitentiary personnel etc. in early identification of drug-related problems, and to develop skills essential in working with persons experiencing such problems and providing addicts with comprehensive, professional assistance;
  6. to train primary health care medical personnel in the safe application of psychoactive drugs which may induce addiction;
  7. to implement programmes of effective detoxication, treatment and rehabilitation of drug abusers and addicts, as well as programmes reducing health damage such as metadon programmes, needle and syringe exchange programme, and promote sexual education (use of condoms).
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (Institute of Psychiatry and Neurology), Ministry of National Education, Ministry of Internal Affairs and Administration, Ministry of Justice, General Headquarters of Police.



National Health Programme

TARGET 6

Improving efficiency of health education and health promotion programmes

Expected outcome by 2005

Rationale of the target

Raising health awarness and health competence both in professional groups and in the whole society is now crucial to shaping and promoting healthy lifestyle. This can be achieved mainly by developing more effective health education in society, especially among children and young people. Despite the fact that health promotion is recognised as good investment, in Poland there has not as yet been developed a comprehensive health education programme compulsory at schools. There is also an urgent need for health education programmes focusing on the elimination of risk factors responsible for chronic diseases and promoting lifestyles conducive to health addressed to the whole population.
In order to stimulate initiatives and effective actions for health promotion it is necessary:

Expected health gain Tasks designed to achieve the target

To achieve this target it is required:

  1. to establish and implement a comprehensive health education programme at primary and secondary schools (the program should tackle such issues as drug addiction prevention, HIV/AIDS and sexual education) and develop mechanisms supporting its implementation (system of under- and postgraduate education of teachers, methodology counselling, production of teaching and audio-visual materials for students and teachers;
  2. to intesify promotion of healthy lifestyles in mass media, stressing the need for developing people's skills and highlighting their options so that they can exercise more control over their health and cope with major health hazards;
  3. strengthen the infrastructure for health promotion and improve the system of allocation of funds needed for implementation of health education programmes and projects at the local, regional and national levels;
  4. to implement the system of under- and postgraduate education for health services workers and other professional groups in the field of health promotion (journalists, self-government workers, teachers, politicians, members of non-governmental organizations);
  5. to stimulate and support health promotion projects and activities based on the settings approach (healthy cities, healthy communities, healthy homes, health-promoting schools and workplaces);
  6. to develop healthy lifestyle counselling focusing on family problems, psychological aspects, healthy diet, smoking cessation and reducing alcohol abuse;
  7. to support local self-governments and nongovernmental organizations in their activities for health education and health promotion.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (research institutes, sanitary and epidemiological stations), Ministry of National Education, Ministry of National Defence, Ministry of Environmental Protection, Natural Resources and Forestry, Polish Television and Radio, The Social Insurance Institution.



National Health Programme

TARGET 7

Promoting mental health and preventing mental disorders

Expected outcome by 2005

Rationale of the target

In Poland 15-25% of persons suffer from mental disorders and 10-20% of children and adolescents at the school age need mental health and psychological care: psychogenic disorders or conditions in which psychogenic factors play important role are most frequent. During the recent years a systematic increase in the number of persons seeking help of psychiatrists and psychologists or general practitioners because of neurotic disorders has been observed. The incidence of depressions and psychosomatic disorders, and the number of problems related to abuse of alcohol or other psychoactive substances are also growing. This increase can be attributed mostly to present conditions of life, and especially to rapid political, economic and social changes that increase people's vulnerability to mental distress.
Mental health promotion encompasses primarely:

Expected health gain Task designed to achieve the target

To achieve this target it is required:

  1. to impose effective legal and economic measures, and ensure the provision of comprehensive support and assistance in the family crisis in order to restore its normal functioning;
  2. to foster local initiatives in organising leisure time activities for the community groups as an alternative to their paticipation in activities of different subcultures;
  3. to provide training in mental health protection and promotion for people involved in bringing up, care, education, social reintegration and treatment of children and young people, as well as in management and organisation of work and recreation;
  4. to assist parents in acquiring knowledge of the mental development and relevant needs of the child, and in developing their skills to stimulate and support this development, to acquint children with the role of the family and principles of its functioning, to shape creative personalities and healthy life styles;
  5. to develop, within school comprehensive health education programme, personal and social skills (responsibility for own health, communication with other people, solving own problems and conflicts, coping with stress and outside pressure etc.), create conditions and atmosphere supportive to mental health and foster school movements promoting mental health;
  6. to provide community- and institutionally-based support to families in difficult financial and emotional situation;
  7. to ensure access to counselling and professional assistance for:
  8. to support the development of self-help groups and nongovernmental organizations in their activities for mental health promotion.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (Institute of Psychiatry and Neurology, Mother and Child Institute), Ministry of National Education, Ministry of National Defence.



National Health Programme

TARGET 8

Reducing exposure to harmful factors in the living, working and educational environment and mitigating their health effects

Expected outcome by 2005 Rationale of the target

Although the state of the environment has been gradually improved in Poland, the situation is still far from being satisfactory and actions aimed at further improvement should be intensified.
Indoor air pollution (at workplaces, homes), outdoor air pollution, pollution of drinking water and surface waters, soil and food are responsible for many health problems like reproduction disorders, neurological, immunological, renal and behavioural disorders. They also increase the risk of chronic diseases, diseases of the respiratory and digestive systems, neoplasms and also congenital malformations.
Over the last 25 years the incidence of occupational diseases has shown a growing tendency. The following seven categories of diseases contribute most to this increase: hearing impairment, chronic disease of the voice organ, infectious and invasive diseases, pneumoconioses, skin diseases, vibration syndrome, poisoning. These diseases make about 85% of the total incidence of occupational diseases.

Expected halth gain

In relation to 1995:

Tasks designed to achieve the target

To achieve this target it is required:

  1. to develop the governmental strategy "Environment and Health" based on the guidelines laid down by the WHO Regional Office for Europe and incorporated in the Helsinki Declaration, signed by Poland in 1994;
  2. to continue the implementation of the strategic governmental programme "Safety and Human Health Protection in the Working Environment";
  3. to elaborate and implement programmes of preventing health effects of exposure to the environmental harmful factors;
  4. to develop new and improve the existing information systems for monitoring the environmental health hazards and their effects;
  5. to eliminate or update technologies contributing to the pollution of working and communal environment;
  6. to introduce ecological heating systems in urban areas with levels of sulphur dioxide and suspended dust exceeding MAC values;
  7. to impose effective measures to eliminate lead containing petrol from the market and to reduce the number of old cars without catalysts; to promote ecological fuels and rail transport;
  8. to improve legislative mechanisms in the building industry towards the reduction of health hazards related to technologies used, and the promotion of ecological building materials;
  9. to restructure the agricultural production in areas with soils overpolluted by toxic substances;
  10. to accelerate the construction of water supply and purification systems and sewages in rural areas;
  11. to impose effective technologies of water treatment in the systems supplied from surface water reservoirs in order to prevent the process of secondary water micropollution;
  12. to mitigate the effects of wrong localisation of various objects by constructing acoustic screens and applying other protective measures;
  13. to develop and implement integrated programmes of ecological and health education addressed to decision-makers, self-governments, producers and consumers;
  14. to improve the systems of early detection of health and environmental hazards induced by ionizing and nonionizing radiation;
  15. to elaborate and introduce local programmes aimed at reducing the volume of wastes and promoting their utilization, and to introduce central programmes of ecologically safe treatment of toxic wastes; to put special emphasis on dangerous wastes, including biologically contaminated wastes from health service facilities, wastes left after actions taken to mitigate outcomes of chemical accidents; to limit combustion of wastes and apply it only if it proves to be the most safe for the human health and the environment way of the waste neutralization;
  16. to establish the efficient system for control of activities undertaken by individual institutions to protect human health against adverse effects of physical, chemical, biological and social environment.
Monitoring and evaluation of outcomes

Environmental factors:

Health indicators: Sectors involved:
Ministry of Health and Social Welfare (State Sanitary Inspection, The Nofer Institute of Environmental Health, National Institute of Hygiene, Mother and Child Institute, Institute of Tuberculosis and Lung Disease, Institute of Rural Medicine, Food and Nutrition Institute), Ministry of National Education, Ministry of Economy (Central Institute of Mining), Ministry of National Defence, Ministry of Environmental Protection, Natural Resources and Forestry, Ministry of Labour and Social Policy, Ministry of Interior Affairs and Administration, Ministry of Transport and Maritime Economy, Central Statistical Office, The National Atomic Energy Agency (Central Laboratorium of Radiological Protection, Institute of Chemistry and Atomic Technique, Institute of Atomic Physics), The Polish Committee for Standardization.



National Health Programme

TARGET 9

Improving sanitation throughout the country

Expected outcome by 2005 Rationale of the target

Sanitation throughout the country, and especially of public services (schools, offices, health service facilities, catering facilities, railway stations etc.) departs considerably from the standard recommended by the European Community. However, certain improvements have been made recently. This situation contributes among others to the incidence of food poisoning and viral hepatitis A. In addition, it limits the efficacy of health education.
The sanitation can be improved if the access to means and instruments for maintaining hygiene, removal of wastes etc. becomes easier and is associated with advancements in health education.This should involve concerted actions of all sectors.

Expected health gain

Tasks designed to achieve the target

To achieve this target it is required:

  1. to provide conditions and support further development of the market with cleansers, detergents and articles of personal hygiene at prices acceptable for mass buyers;
  2. to introduce legal and technological norms of the removal, storage and utilization of wastes, harmonised with the norms of the European Union;
  3. to provide sufficient number of public lavatories in urban areas and to control their technical and sanitary condition;
  4. to improve the system of waste neutralisation;
  5. to improve sanitation at health service and educational facilities so that they could serve as examples to be followed by other public services;
  6. to tighten the sanitation criteria for public services and to increase sanctions towards persons responsible for sanitation at the all country levels who fail to perform their duties.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (State Sanitary Inspection, National Institute of Hygiene), Ministry of National Defence, Ministry of Interior Affairs and Administration.



National Health Programme

TARGET 10

Reducing the incidence of accidents, and traffic accidents in particular

Expected outcome by 2005 Rationale of the target

In Poland traffic accidents are one of major causes of death in the category of injury and poisoning, and the major cause of death among young people. The year 1995 brought about 6.900 deaths and 70.226 injuried in traffic accidents. In Poland traffic accidents are characterised by profoundly high mortality: 12 deaths per 100 traffic accidents, whereas in the European Community member States this rate accounts for 3.5. In high industrialised countries much success has been achieved in combating road accidents due to effective implementation of preventive programmes and well developed systems providing first aid for those injuried in traffic accidents.
Despite recent improvement, the scale of occupational accidents is still very large. The annual number of persons involved is higher than 100 thousand, including 600 deaths.

Tasks designed to achieve the target

To achieve this target it is required:

  1. to reduce the number of causalties of road accidents caused by excessive speed, mainly through:
  2. to reduce the number of causalties of road accidents caused by unexperienced drivers, mainly through:
  3. to reduce the number of causalties of traffic accidents caused by drunk road users, mainly through:
  4. to reduce the number of causalties of traffic accidents involving unprotected road users, mainly through:
  5. to reduce adverse effects of accidents, mainly through:
  6. to reduce the number of causalties at cross-walks in small towns, mainly through:
  7. to reduce the number of causalties at places of high risk of accidents, mainly through:
  8. to update teaching methods in the area of labour safety and hygiene, and information about occupational hazards;
  9. to impose on employers safe and hygienic conditions at workplaces;
  10. to promote legislative and information mechanisms contributing to the reduction of accident risks;
  11. to establish a national agency for accident prevention.
Monitoring and evaluation of outcomes

Indicators:

Evaluation of the scale of human and material losses and the incidence of traffic and occupational accidents with particular emphasis put on:

Sectors involved:
General Headquarters of Police, National Council for Road Traffic Safety, Ministry of Health and Social Welfare (Mother and Child Institute, Institutes of Occupational Medicine, National Institute of Hygiene, National Centre for Health System Management), Ministry of National Defence, Ministry of Transport and Maritime Economy, Central Statistical Office.



National Health Programme

TARGET 11

Improving efficiency and effectiveness of emergency service in life threatening conditions

Expected outcome by 2005 Rationale of the target

The number of accidents involving casualties, including deaths at the place of accident continues to increase; still high numbers of deaths occurring shortly after the onset of acute episodes of cardiovascular diseases and an increasing number of sudden deaths from unknown causes before arrival of the first aid are registered.

Expected health gain

Tasks designed to achieve the target

To achieve this target it is required:

  1. to reduce waiting time for emergency service in life threatening conditions to 15 min;
  2. to reduce the number of deaths during the first hour after an accident;
  3. to reduce time elapse between an acute episode and rendering of medical aid in the case of diseases of the circulatory system;
  4. to draft the law on life-saving procedures;
  5. to implement a uniform programme of first aid education at primary schools;
  6. to incorporate medical first aid into responsibilities of fire brigades, the police and ship salvaging units;
  7. to update the regulations and equipment of sanitary aviation;
  8. to unify the organisation, equipment, training and regulations of public emergency services throught the country;
  9. to establish and implement regulations of the functioning of public health care facilities and state administration bodies in cases of calamities and accidents;
  10. to establish the telematic system of cardiological supervision.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Road Traffic Department of the General Headquarters of Police, Ministry of Health and Social Welfare (National Institute of Cardiology, National Institute of Hygiene, National Centre for Health System Management), Ministry of Posts and Telecommunication, Ministry of National Defence, Ministry of Transport and Maritime Economy.



National Health Programme

TARGET 12

Improving acess to and efficiency of primary health care

Expected outcome by 2005 Rationale of the target

High standard and easy access to primary health care services are prerequisites for reducing social and regional inequalities in the medical care. Well organised primary care ensures prevention, and facilitates treatment of diseases in their earlier, frequently reversible stage. This is the field of practice where the patient usually makes his first contact with the physician and where health supportive attitudes can be promoted.

Expected health gain

Tasks designed to achieve the target

To achieve this target it is required:

  1. to promote the concept of family health physicians;
  2. to expand the network of well equipped primary health care centres;
  3. to shift the responsibility for primary health care management to local self-governments;
  4. to promote contracting of health services;
  5. to educate about 2.500 physicians in the field of family medicine within the resident system and about 1.200 physicians with longer experience at short-term intensive courses;
  6. to advance qualifications of nurses and midwives employed in primary health care;
  7. to alter the system of primary health care financing and to replace the service provision-based system by insurance system.
Monitoring and evaluate outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (Institute of Rural Medicine, Mother and Child Institute, National Centre for Health System Management), Central Statistical Office.



National Health Programme

TARGET 13

Preventing premature births, low birth weight and reducing related health effects

Expected outcome by 2005 Rationale of the target

Despite significant decreasing tendency observed in Poland, infant mortality rates are still twice as high as in Western Europe. Prematurity and low birth weight are major contributors to high infant mortality. In 1995 infant mortality rate accounted for 13.6 per 1.000 live births, and the percentage of newborns with low birth weight (below 2.500 g) reached the value of 6.7% (in Western Europe it ranges between 4 and 6%). In Poland death risk in newborns with low birth weight is twofold when compared to developed European countries.

Expected health gain

Tasks designed to achieve the target

To achieve this target it is required:

  1. to improve diagnostic measures and treatment of infections of the genitourinary system in pregnant women;
  2. to reduce smoking among pregnant women to the level below 10%;
  3. to improve nourishment among pregnant women living in poverty;
  4. to reduce by 20%, in relation to 1995, the number of pregnancies among women aged under 18 and above 35 years;
  5. to promote pre-pregnancy care of women and improve diagnostics and active care of pregnant women at risk of premature delivery;
  6. to promote the reference system in regard to premature delivery (transport of the mother) and improve the quality of care of premature infants.
Monitoring and valuation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (Mother and Child Institute), Central Statistical Office.



National Health Programme

TARGET 14

Improving early diagnosis and active care of persons at risk of ischaemic heart disease

Expected outcome by 2005 Rationale of the target

Poland belongs to only a few European countries where "epidemic" of ischaemic heart disease - the most life threatening disease of the circulatory system - has not as yet been effectively controlled. Persons under 65 years of age are at greatest risk. In most countries this disease is still a major cause of death.

Expected health gain

Tasks designed to achieve the target

To achieve this task it is required:

  1. to improve detection of arterial hypertension already at the stage of primary health care. The frequency of newly detected cases of hypertension should increase with the pace of at least 2% per year;
  2. to promote nonpharmacological treatment and early therapy of hypertension in out-patient facilities;
  3. to promote broader evaluation of blood fat level and in the case of its increase undertake appropriate dietetic and pharmacological therapy;
  4. to expand the scope of basic analytical methods in district laboratories in order to include the analysis of fat levels.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (National Institute of Cardiology, Food and Nutrition Institute, National Institute of Hygiene, National Centre for Health System Management), Ministry of National Defence.



National Health Programme

TARGET 15

Improving early diagnosis and treatment of breast and cervical cancers

Expected outcome by 2005 Rationale of the target

Breast cancer is the most dangerous neoplasm which still spreads among women in Poland. The incidence of malignant neoplasm of cervix uteri is lower than that of breast. The effective treatment of both cancers depends, to the great extent, on their early detection.

Tasks designed to achieve the target

To achieve this target it is required:

  1. to increase women's awarness concerning the need for regular tests and to develop their skills to perform them in order to facilitate early detection of breast cancer and diseases leading to its occurrence;
  2. to increase the frequency of detection of preinvasive breast cancer by 2% annually;
  3. to increase the frequency of cytological tests of cervical smears among women under 60 years of age. The annual increase should account for at least 2%;
  4. to establish units for performing screening tests for breast cancer at branches of the National Institute of Oncology and in most other microregions and to provide them with necessary diagnostic equipment;
  5. to promote cytological tests among women aged 18-60.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (Cancer Centre and Institute of Oncology, National Institute of Hygiene, Mother and Child Institute), Central Statistical Office.



National Health Programme

TARGET 16

Providing better opportunities for people with disabilities and developing their capacities to lead active lives

Expected outcome by 2005 Rationale of the target

According to estimated figures there are about 4.8 million people with disabilities, including about 300 thousand children and adolescents. Diseases of the circulatory system, nontraumatic diseases of the musculoskeletal system (including osteoporosis), consequences of injury and poisoning, chronic respiratory diseases, impairments and dysfunctions of locomotor system, and mental disorders in children and adolescents are major causes of disability.
Living conditions of people with disabilities are difficult and the quality of their lives is far from satisfactory. They are denied the opportunities of complete successful treatment and rehabilitation, and they suffer restricted educational opportunities. The supply of orthopaedic equipment and technical aids is not sufficient. Because of limited mobility the disabled encounter a great number of barriers in transport, public services and buildings. All these contribute to the fact that in Poland, in comparison to other countries, less people with disabilities, especially young people, are able to participate in productive life, and very often they do not return to normal life, suffering psychic and social discomfort. Such a sitituation increases an economic burden for the whole society.

Expected health gain

Tasks designed to achieve the target

To achieve this target it is required:

  1. to remove urbanistic, architectural and transport barriers in places of habitation and work, in public services and means of public transportation in order to improve mobility of people with disabilities;
  2. to facilitate and encourage the production of orthopaedic equipment and other technical aids to provide the disabled with the opporunities for normal functioning; to change the rules of setting limits of funds for purchasing orthopaedic equipment and technical aids by providing for in the Budget Law (in the state budget and that allocated to regional governors) a certain quota of financial means to be used for this purpose;
  3. to improve and advance education of people with disabilities, including:
  4. to assist the disabled in getting employment by establishing workplaces with sheltered employment and adjusting to their needs workposts in regular workplaces;
  5. to develop positive social policy supportive to families taking care of their disabled members in order to alleviate their burdens (especially in the case of severe disability) and to provide the disabled with the opportunity for staying with the family instead of living in a welfare home;
  6. to promote positive attitudes in society towards people with disabilities (understanding problems of the disabled, tolerance, creation and promotion of different forms of integration);
  7. to encourage social movements and support local self-governments and nongovernmental organisations in their activities for better quality of life enjoyed by people with disabilities, their greater activity in the working environment and social integration;
  8. to reform the system of disability certification, putting more emphasis on social, economic and occupationl situation of the disabled and their rehabilitation before granting them a disability pension;
  9. to improve the rehabilitation system for the disabled, including:
  10. to modify the system of education designed for the rehabilitation personnel towards a comprehensive model (medical, psychological, occupational and social rehabilitation).
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare, (Mother and Child Institute), Ministry of National Education, Ministry of Internal Affairs and Administration, Ministry of Posts and Telecommunications, Ministry of National Defence, Ministry of Transport and Maritime Economy, Ministry of Labour and Social Policy (Institute of Labour and Social Policy), The Social Insurance Institution, Social Agriculture Insurance Service, Central Statistical Office.



National Health Programme

TARGET 17

Improving prevention of communicable diseases

Expected outcome by 2005 Rationale of the target

Mortality from and morbidity of communicable diseases decreased considerable after the war, nevertheles, the rates are still higher in Poland than in more developed countries. Tuberculosis still remains a major cause of deaths caused by communicable diseases. Diseases transmitted by the skin damage create a severe problem. Among them viral hepatitis B takes the first place. Infant communicable diseases controlled by vaccinations have not as yet been eradicated.

Expected health gain

Tasks designed to achieve the target

To achieve this target it is required:

  1. to introduce combined vaccine for measles, mumps and rubella;
  2. to cover all risk groups with vaccanation for viral hepatitis B;
  3. to increase the efficacy of detection and treatment of tuberculosis to the level of 90% through close cooperation with primary health care in the area of disease detection and treatment (training of family physicians and pediatricians); to improve the efficacy of TB vaccinations through:
  4. to prevent blood transmitted infections through expanding the national information system of blood services in order to facilitate, among others, the identification and registration of persons whose blood should not be collected for therapeutical purpose; to implement the existing "Programme of AIDS Prevention and Control" which encompasses education of the whole population and risk groups and identification of infection sources;
  5. to prevent the spread of food infection and poisoning through:
  6. to promote ecological technologies of sterilisation of medical instruments and food conservation, including techniques which involve ionizing radiation;
  7. to increase awarness of possible import of communicable diseases, that do not occur in Poland, among people who travel abroad, employing health education programmes;
  8. to make vaccination for diphteria compulsory among the adult population, especially among risk groups living close to endemic areas.
Monitoring and evaluation of outcome

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (National Institute of Hygiene, State Sanitary Inspection, Institute of Tuberculosis and Lung Diseases, Mother and Child Institute).



National Health Programme

TARGET 18

Improving prevention of dental caries and periodontal disease

Expected outcome by 2005 Rationale of the target

In Poland dental caries, very frequent in the whole population, is considered as a social problem closely related to healthy-damaging behaviours. During the years 1987-95 no decreasing tedency in the incidence of dental caries could be observed (only a 0.1 reduction was noted in children aged 12, whereas during 1970-87 it was equal to almost 2). The worsening condition of parodontium is also found in children aged 12 and young people aged 18. These negative changes result from the fact that the planned dental care of children and young people had to be terminated because of financial constrains and other difficulties.
Dental caries and periodontal disease can be prevented. In many countries due to consistent policy the frequency and severity of these two dental problems have fallen dramatically, and certain groups of children are free from dental caries, and part of adults above 30 years of age have no decayed, missing or filled teeth and have own detintition to the end of their days. Pregnant women, children aged 1 - 7 and young people belong to most vulnerable groups and must be covered by an intensive preventive programmes.

Expected health gain

Tasks designed to achieve the target

In order to achieve this it is required:

  1. to promote more effective health education in the area of oral cavity health addressed especially to:
  2. to introduce teeth brushing after each meal in the daily programme of activities in nurseries, kindergardens, health resorts, children's homes, recreation centres for children, and during summer or winter holiday camps;
  3. to promote topical fluorid application in children of all types of schools, if there are no local contraindications in the place of residence;
  4. to promote administration of fluoride tabletes in children between the age of 6 months and 10 years in areas with trace amounts of fluor in drinking water if there are no contraindications;
  5. to continue, in children aged 6-8 with high risk of early development of dental caries, preventive sealing of oclusal surfaces of first molars and varnish application on smooth surfaces;
  6. to use locally antibacterial and anticaries effect of chlorhexidine in the form of gel or teeth laquer in pregnant women and children with high risk of dental caries.
Monitoring and evaluation of outcomes

Indicators:

Sectors involved:
Ministry of Health and Social Welfare (medical schools, Mother and Child Institute), Ministry of National Education, Central Statistical Office.



National Health Programme