country profile turkey 2006

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DEVELOPMENT OF PUBLIC HEALTH RESEARCH COUNTRY PROFILE REPORT TURKEY Professor Hikmet PEKCAN MD, MPH Turkish Public Health Association Ankara/Turkey 2006 hikmetp@hacetepe.edu.tr

TURKEY: 

TURKEY

GENERAL INFORMATION  : 

GENERAL INFORMATION   Foundation (date): October 29, 1923 System of Government: Republic Capital: Ankara Surface Area: 780 576 km2  

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Government   Turkey is a republic with a unicameral parliament of 550 members. The Head of State is President Ahmet Necdet Sezer. Justice and Development Party was elected in November 3, 2002 The new cabinet headed by Prime Minister Recep Tayyip ERDOGAN.  

Demographic Indicators: 

Demographic Indicators Total Population- 1997 (estimate - million): 62.8 2000 (census - million): 67.8 Rural: 35% Urban: 65% 2005 (estimate – million): 72.3 Natural population growth rate (%)(2005) 1.26 Age distribution (%) 2005 0-14 years: 28.4 15-64 years: 65.7 >65 years: 5.9

POPULATION PYRAMID TURKEY, 2000 : 

POPULATION PYRAMID TURKEY, 2000

Gross National Product (GNP) per capita: 

Gross National Product (GNP) per capita In 1998 3160 $ (World Bank Atlas Method) 6594 $ (Purchasing power parity method) In 2003 3390 $ (real growth rate 5.9 %) In 2004 4112 $ (real growth rate: 10%; increased by 21.4 %) In 2005 4128 $ (increased by 5 %) Real GDP according to purchasing power parity per capita (2004): 7213 $

Economic Indicators: 

Economic Indicators Total health expenditure In consolidate budget (2000): 63.0 % In GNP (2000): 6.6 %

Vital Statistics : 

Vital Statistics Crude birth rate (per 1000 live births) (1998): 23.4 Number of live births, per 1000 population(2002): 21.3 Annual intercensal increase % (1990-97): 15.1 Total fertility rate (2003) 2.2 Urban: 2.1 Rural: 2.7 West: 1.9 East: 3.7 Life expectancy at birth for both sexes (years) 70.8 Male 66.9 Female 71.5

Mortality Rates: 

Mortality Rates Infant mortality rate (per 1000 live births-2003): 29 Urban: 23 Rural: 39 West: 22 East: 41 Under-five mortality rate(per 1000 live births): 37 Maternal mortality rate (per 100 000 live births) (1998): 49 Crude mortality rate (per 1000 live births-2000): 6.7

Vaccinations : 

Vaccinations Children 12-23 months fully immunized: 54.2% BCG: 88% DPT1: 89% DPT2: 76% DPT3: 64% Polio1: 95% Polio2: 83% Polio3: 69% Measles:71%

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Acute poliomyelitis incidence (per 100 000): 0.0 Tuberculosis incidence (per 100 000 all forms-2004): 32.0 Syphilis incidence (per 100 000-2002): 4 496 cases reported between 1990-2002: 4.9 AIDS incidence per 100 000-2004): 551 cases reported between 1985 and 2004: 0.8

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Human development index (HDI-2002) Ranks 88 in 2003 HDR 0.75 Percent of regular daily smoking adults (2000): 65.0 Pure alcohol consumption per litre per person per year (1996): 0.9 Average enrgy per person per day (1999-2001): 3360 kcal

Public Health Structure in Turkey: 

Public Health Structure in Turkey Placement of Public Health in the National Health Policy (main public health law/legislation).

The Constitution of The Republic of Turkey: 

The Constitution of The Republic of Turkey Article 5.- The fundamental aims and duties of the State are; to safeguard the independence and integrity of the Turkish Nation, the indivisibility of the country, the Republic and democracy; to ensure the welfare, peace, and happiness of the individual and society; to strive for the removal of political, social and economic obstacles which restrict the fundamental rights and freedoms of the individual in a manner incompatible with the principles of justice and of the social State governed by the rule of law; and to provide the conditions required for the development of the individual’s material and spiritual existence.

The Constitution of The Republic of Turkey: 

The Constitution of The Republic of Turkey Article 10.- All individuals are equal without any discrimination before the law, irrespective of language, race, color, sex, political opinion, philosophical belief, religion and sect, or any such considerations. No privilege shall be granted to any individual, family, group or class. State organs and administrative authorities shall act in compliance with the principle of equality before the law in all their proceedings.

The Constitution of The Republic of Turkey: 

The Constitution of The Republic of Turkey Article 12.- Everyone possesses inherent fundamental rights and freedoms which are inviolable and inalienable. The fundamental rights and freedoms also comprise the duties and responsibilities of the individual to the society, his/her family, and other individuals.

The Constitution of The Republic of Turkey: 

The Constitution of The Republic of Turkey Article 13.- Fundamental rights and freedoms may be restricted by law, in conformity with the letter and spirit of the Constitution, with the aim of safeguarding the indivisible integrity of the State with its territory and nation, national sovereignty, the Republic, national security, public order, general peace, the public interest, public morals and public health, and also for specific reasons set forth in the relevant Articles of the Constitution. General and specific grounds for restrictions of fundamental rights and freedoms shall not conflict with the requirements of the democratic order of society and shall not be imposed for any purpose other than those for which they are prescribed. The general grounds for restriction set forth in this article shall apply for all fundamental rights and freedoms.

The Constitution of The Republic of Turkey: 

The Constitution of The Republic of Turkey Article 17.- Everyone has the right to life and the right to protect and develop his material and spiritual entity. The physical integrity of the individual shall not be violated except under medical necessity and in cases prescribed by law; and shall not be subjected to scientific or medical experiments without his/her consent. No one shall be subjected to torture or ill-treatment; no one shall be subjected to penalties or treatment incompatible with human dignity..

The Constitution of The Republic of Turkey: 

The Constitution of The Republic of Turkey Article 19.- Everyone has the right to liberty and security of person. …of measures taken in conformity with the relevant legal provision for the treatment, education or correction in institutions of a person of unsound mind, an alcoholic or drug addict or vagrant or a person spreading contagious diseases, when such persons constitute a danger to the public…

The Constitution of The Republic of Turkey: 

The Constitution of The Republic of Turkey Article 41.- The family is the foundation of Turkish society. The State shall take the necessary measures and establish the necessary organization to ensure the peace and welfare of the family, especially the protection of the mother and children and for family planning education and application.

The Constitution of The Republic of Turkey : 

The Constitution of The Republic of Turkey Article 56.- Everyone has the right to live in a healthy, balanced environment. It is the duty of the State and citizens to improve the natural environment, and to prevent environmental pollution. To ensure that everyone leads their lives in conditions of physical and mental health and to secure cooperation in terms of human and material resources through economy and increased productivity, the State shall regulate central planning and functioning of the health services. The State shall fulfill this task by utilizing and supervising the health and social assistance institutions, in both the public and private sectors. In order to establish widespread health services general health insurance may be introduced bay law.

EQUITY FOR HEALTH CARE: 

EQUITY FOR HEALTH CARE

Fertility, birth interval, use of contraceptive methods and induced abortion by residence Turkey Demographic and Health Survey- 2003 : 

Fertility, birth interval, use of contraceptive methods and induced abortion by residence Turkey Demographic and Health Survey- 2003

Antenatal care, place of delivery and assistance during delivery by residence, Turkey Demographic and Health Survey 2003: 

Antenatal care, place of delivery and assistance during delivery by residence, Turkey Demographic and Health Survey 2003

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Turkey

CAUSES OF MATERNAL MORTALITY: 

CAUSES OF MATERNAL MORTALITY Haemorrhage Toxemia Infections

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General Directorate of Mother and Child Health/Family Planning

Major causes of mortality (under 5 years): 

Major causes of mortality (under 5 years) Birth trauma and other perinatal causes: 48.4 % Acute respiratory infections: 12.3 % Coronary hearth diseases: 7.4 % Meningococcal infections: 6.7 % Diarrheal diseases: 6.0 % Others: 19.3 %

Nutritional status of children by residence, Turkey Demographic and Health Survey 2003: 

Nutritional status of children by residence, Turkey Demographic and Health Survey 2003

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%25 known %75 known total hypertension cases

Education level according to residence Turkey Demographic and Health Survey 2003: 

Education level according to residence Turkey Demographic and Health Survey 2003

Percent distribution of some housing characteristics, according to residence, Turkey Demographic and Health Survey 2003: 

Percent distribution of some housing characteristics, according to residence, Turkey Demographic and Health Survey 2003

Number of Hospitals, Beds and Beds For 10.000 Population by Regions, Turkey 2003 : 

Number of Hospitals, Beds and Beds For 10.000 Population by Regions, Turkey 2003

Health centers with no physician and health houses with no midwife (2003): 

Health centers with no physician and health houses with no midwife (2003)

   The structure of public health management and services (national, regional local): 

    The structure of public health management and services (national, regional local) The Ministry of Health is the officially responsible from developing and implementing health policies in Turkey. The Ministry provides the primary care of charge at the health centers and health houses throughout the country. Secondary and tertiary curative services are paid by the individuals out of pocket or through insurance organizations. Besides the Ministry of Health, the Social Insurance Organization, universities, armed forces, some other public organizations and private sector provide health services.

Health Centers/Health House: 

Health Centers/Health House Health centers serve a population of 5000-10000 in rural and 10000-50000 in urban areas. Health care teams in health centers are composed of staff like general practitioners, dentists, nurses, midwives, sanitarians and other relevant personnel. In each health house, which is the most peripheral units of the health care network, a midwife serves.

Administrative Units: 

Administrative Units The main administrative units in Turkey are provinces (81 provinces). Provincial governors (Vali) represent each ministry, including health, in their province. ”Provincial health directors” on behalf of provincial governors direct health services. Provinces are further divided into districts and districts are divided into villages. In the country, there are 81 provinces, 849 districts and 36 699 villages.

Municipalities: 

Municipalities Municipalities are founded in the localities with more than a population of 2000. Their main responsibility regarding health is environmental health services such as safe water, waste disposal and food control.

 The current main issues of public health: 

 The current main issues of public health Strategic/ long-term objectives in public health until 2020; Turkey has National Health Policy 21 which has main objective; to improve health statistics of Turkey, to increase life expectancy, to improve quality of life and To eliminate the differences of health levels between regions and social groups.

For the achievement of these main goals, long term objectives are :: 

to control, eliminate and eradicate important infectious diseases in Turkey to increase the quality of life by reducing the frequency of important non-infectious diseases such as disability, disability for work and early death. to reduce deaths and injuries caused by accidents, violence and disasters and provide continuity . For the achievement of these main goals, long term objectives are :

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to provide healthy start and continuity to the life to newborns, babies and preschool children. to reduce health problems related to sexual life at least 50 %. to decrease the use of addictive substances such as tobacco, alcohol, volatile, and psychoactive drugs to minimum level. to decrease the factors effecting health in negative way like malnutrition and inadequate physical activity to minimum level.

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to increase the health quality of youth, elderly and handicapped persons and to provide more active role in society. to improve psycho-social goodness statue of society and provide special care for mentally ill patients. to provide more health living conditions at home, school, at work and every place we live. to provide “reachable, acceptable and usable” qualified health service to society, to enlarge health network via eliminating social and regional differences, and to reach sustainability.

Current Priorities and Immediate Objectives of Public Health: 

 To achieve our long term objectives, our current and immediate objectives are: to provide basic health education to society, to eliminate extreme poverty and starvation, to improve maternity and child health, to decrease child mortality rate, to struggle with AIDS/HIV, malaria and other diseases, Current Priorities and Immediate Objectives of Public Health

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to maintain sustainability of environmental and natural resources, to improve global collaboration for development, to encourage gender equality and to improve social role of women in society, eradication of infectious diseases.

Public health research as a strategic issue within the national policy on science and research,: 

Public health research as a strategic issue within the national policy on science and research, Total research and development expenditures on health is 10 % of total research and development expenditures in Turkey. On health issues research and development (R&D) studies are done by universities, public and commercial sector.

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Main topics of R&D studies are biotechnology and genetic researches. The other studies are diagnosis and treatment of cancer and circulatory diseases, eradication of infectious and parasitic diseases (epidemiology, microbiology), pharmacology, maternal and child health, family planning, environmental protection methods, surgical and clinical techniques and their equipment improvement, artificial tissue and organ development, natural organ and tissue transplantation.

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Although R&D studies on health are recommended and supported in Turkish development plans and annual investment programs, R&D studies on health are not enough.

Organization of public health research (institutional structure for planning, priority setting, funding, implementation, communication): 

Organization of public health research (institutional structure for planning, priority setting, funding, implementation, communication) On health issues research and development studies are done by the following associations and institutions;

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Ministry of Health (MoH) MoH is the main public health policy maker of Turkey. Organized and serves in basis of public health approach and health priorities of the country. Serve as a main health provider of the Turkish Republic. According to its role MoH conducted important public health researches to determine the health problems, service needs or to evaluate the success of interventions. Population and Health Research, 2003 and National Health Burden Study were the latest and most important population based public health studies. MoH conducts an intervention to prevent iron deficiency, vitamin D deficiency among Turkish children in 2005. Projects can be funded by partners or only by the economical sources of MoH. Programmes such as prevention of iodine deficiency disorders, prevention and promotion of breastfeeding, baby-friendly hospitals etc are also on progress.

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Refik Saydam Hygiene Center Presidency School of Public Health (RSHCPSPH) RSHCPSPH is the branch of MoH and serves as a research center. This institution has been conducted number of studies in collaboration with national and international partners. Health revision project studies are conducted by RSHCPSPH.

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Medical faculties The number of Medical Faculties are more than forty in Turkey. Public health departments of medical faculties conduct public health researches in collaboration with national and international partners and supporters. WHO, UNICEF, UNDP etc are the international partners of medical faculties. Collaborating centers of WHO serves as focal research points in medical faculties too.

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Hospitals Hospitals are organized to serve secondary and tertiary health services in Turkey. They conduct blood and blood products circulation system project and emergency department organization networks projects in Turkey.

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Hospital Management High School(HMHS) HMHS was one of the main partners of Health Burden Study of Turkey.

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Voluntary organizations (associations, societies and foundations) In previous two decades the number of voluntary organizations has been increased. These organizations are in communication with international donors. They conduct number of studies related with health problems of Turkey. European Union Reproductive Health Program formed a new platform for voluntary organizations to conduct public health researches on reproductive health.

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Pharmacy Companies National Disability Study of Turkey and Hepatitis B Prevalence Study were conducted by pharmacy companies in Turkey.

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Research Institutions TUBITAK (The Scientific and Technical Research Council of Turkey) In these associations and institutions, medical faculties, Ministry of Health, hospitals, TUBITAK and Refik Saydam Hygiene Center Presidency School of Public Health are the most active ones.

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 TUBITAK; Generally supports researches of academic institutions. One of the latest public health research supported by TUBITAK is “A Study in Provincial Center of Van to Determine the Socio-demographic Characteristics, Life Quality and Health Status of the Urban Population”

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Funding of the studies are; provided by State Planning of Organization (DPT) and Turkish Treasury via internal and external sources. Today in Turkey on health issues after hospitals and medical faculties, research center is Refik Saydam Hygiene Center Presidency School of Public Health.

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There was no center for R&D studies and for coordination of studies on. R&D studies on health were held separately and uncoordinated so that more than one institute can work on same topic at the same time and this cause loss of time and money. The reasons for these are; there is no administrative structure and not using the available arrangements. To handle with this situation, it decided to centralize in one center at Refik Saydam Hygiene Center Presidency School of Public Health. The administrative and institutional structure and studies are still under construction for this School of Public Health.

Main areas of public health research during last two-three years or current planning period.: 

Main areas of public health research during last two-three years or current planning period. Turkish Population and Health Research Research of Determination of Maternal Deaths and Causes National Health Financial Records Research National Disease Burden and Cost Efficiency Research Work Load Indicators in Personnel Need Methodology Improvement of Management Capacity Study

  Collaboration with international projects: 

  Collaboration with international projects International Reproduction Health Education Center (UN Population Fund) Computer Based Management and Support Systems Project (UNOPS) United Nations Population Fund Third Countries Program (2001-2005) Projects by Ministry of Health under UN Third Countries Program; Developing Strategy for Adolescent Reproduction Health Information and Service Requirements Strengthen Management of Reproduction Health, etc.

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On International Family Health Visual – Auditory Program (With JICA- Japanese International Cooperation Agency) Integrated Management of Childhood Illness Program (IMCI) with WHO Strengthening of Family Planning Education, Family Planning and Consultancy Programs after Delivery and Abortion, Contraceptive Logistics and Management Information System Improvement Project (USAID)

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Healthy Cities Project (WHO) European Network of Health Promoting Schools (WHO Regional Office for Europe, Council of Europe, European Commission)

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The role of EU public health networks for supporting new developments in public health research – evaluation and recommendations. Cancer Scanning and Education Centers Project is supported by EU MEDA Program. There are also project with MATRA Program of EU.

Key Health Challenges : 

Key Health Challenges · Periodical provision of reliable public health indicators · Maternal and Child Health Non-communicable diseases (mainly CVDs and cancer) Communicable diseases (mainly vaccine preventable) Health care reforms, including health policy development · Prevention of road and domestic accidents

Sources: 

Sources State Statistics Institution web site www.die.gov.tr MoH- Turkey Health Report (February 2004) 2005 Annual Programme of 8th Five Year Development Plan MoH, UNFPA, HUIPS Hospital Research 1997 HUIPS (2004): Turkey Demographic and Health Survey 2005 Annual Programme of 8th Five Year Development Plan WHO Report 2004 Geneva. (WHO/HTM/TB/2004.331) www.saglik.gov.tr MoH www.saglik.gov.tr http://hdr.undp.org/statistics/data/cty/cty_f_TUR.html http://hdr.undp.org/statistics/data/cty/cty_f_TUR.html