THE URGENT HEALTHCARE CHALLENGES

OF OUR TIME

by Georgi Stefanov

Chairman

Veliko Turnovo Municipal Council

In 1995, in Veliko Turnovo, was established the first in Bulgaria Public Coalition for Health, whose main goal is to support the development and implementation of the CINDY project of the World Health Organization (WHO).

The health analysis of the Bulgarian nation shows some extremely unfavorable trends in the last years, which require urgent and strong intervention of the national government and society as a whole.

On the background of constantly decreasing births, the death rate is going up; especially alarming is the increase of death cases among the younger age groups. More than four fifths of all death cases are a result of heart and blood vessel diseases, cancer, traumas and poisoning and chronic respiratory diseases. The same diseases, together with the diseases of the nervous system and the sensory organs, diseases of the skin and of the urino-genital system, form 75% of total disease cases in the country. Often they are also the main cause of acute disabilities.

The data about the physical development and ability of young people are also unfavorable, especially if compared to those of their counterparts in other European countries. A fact, proven by scientific theory and practice is that significant part of the problems related to human health (between 43 and 53 percent) are due to the lifestyle and most of all to unhealthy eating and other damaging habits in the behavior of the individuals, limited mobility, acute and chronic stress, etc.

The Municipality of Veliko Turnovo is one of the municipalities with considerably more unfavorable health indicators than the national averages.

In 1993, 57.1% of the death cases were caused by seroius damages of blood circulation organs, 14% were caused by malevolent tumors, and 5.5% and 3.4% were respectively due to traumas and incidents and to chronic respiratory diseases.

Child death rate is 17.5 per 1,000 births (in 1995) and is higher than the country s average. During the same year, the general sickness rate was 1,746.2 per 1,000 population, which is above the country s average of 1,239.3 per 1,000. The rate for blood vessel diseases was 132.3 per 1,000 compared to 74 per 1,000 nationwide. The rate for cancer cases (out of all registered cases) has increased from 1,936 per 100,000 in 1988 to 2,419.8 per 100,000 in 1995, compared to a national average of 2,119.6 per 100,000. There is an increase in the newly registered tuberculosis cases.

At the same time, the survey of the distribution of some major health risk factors conducted among the population aged 25 - 64 (1996), showed that 49.6% of the population of the municipality are smokers and that men smoke twice more often than women. Overweight are 21.6% of the surveyed men and 25.5% of the women. 27.4% of the surveyed men and 1% of the women abuse alcohol. Only 14% of the men and women do physical exercise every day. High blood pressure was registered in 42% of the surveyed men and 32% of the women. Most of the people suffering high blood pressure (up to 65.7%) are exposed to the effects of more than one risk factor.

MUNICIPAL POLICY AIMED AT GOOD HEALTH

Health policy is defined as the means, applied in order to achieve organized efforts in attracting and concentrating public interest over health problems, and above all, for disease prevention, rehabilitation and strengthening of health by applying scientific knowledge and appropriate technologies.

In the third year since its beginning, development and implementation, CINDY is more and more turning into an implicit unit of the overall social policy of the Municipality of Veliko Turnovo.

The general concern about the unfavorable condition of public health and the trend for its further deteriorating, caused the quick achievement of consensus among representatives of the municipal administration, healthcare experts (generators of the initiative) and representatives of the non-governmental organizations, to plan and implement large-scale program activities directed towards the following goals:

• eliminating the trend towards deterioration of public health in the municipality;
• creating prerequisites and conditions for improvement of the level of public health and an increase in the health capacity of the community and the individuals;
• impacting the decisive factors and causes of health risk, including the damaging factors of the environment, related to public health;
• forming a healthy behavior and lifestyle, excluding smoking, abuse of alcohol, use of drugs and oriented towards healthy eating, active motive regime, anti-stress and psycho-relaxing skills and techniques, etc.
• limiting the so called risk factors - overweight, high blood pressure, diabetes, increased cholesterol levels, etc.

These are the long-term strategic goals of the CINDY Program adopted by the Veliko Turnovo Municipal Council (Decision No. 442 of June 6, 1997).

What exactly is the CINDY Program? This is the English abbreviation of the name of the program: integrated intervention program for prophylactics of chronic non-infectious diseases. The program has the following specific characteristics:

1. CINDY s legislative base is the agreement signed between the national government of Bulgaria and WHO. It is substantial property of Municipality of Veliko Turnovo, which is a demonstration zone and represents Bulgaria before WHO s European Bureau and before the community of more than 23 countries participating in the implementation of this project.

2. Organizational structure and management.

The CINDY program is managed by the National Center for Health Studies (NCHS) and the Executive Director of the project for Bulgaria, Dr. Nikola Vasilevski. Organizational management is assigned to a Program Council consisting of 2 co-managers, a coordinator, the president of the Public Coalition for Health, and a representative of the municipal administration. The program s working bodies include: Council of Researchers, 5 working groups on the major risk factors and a Resources and Impact Group.

3. Preventive strategy and health policy of CINDY.

The program implements its socio-oriented interventions in two major directions: a) health promotion at general population level, and b) prophylactics addressed to certain risk (target) groups of the population. CINDY endorses the social responsibility for health, forms favorable infrastructure for promotion of health, strengthens and expands intersectoral cooperation and partnership for health. CINDY - Veliko Turnovo unifies the efforts of more than 30 representatives of the local and national government, economic, cultural, educational and non-governmental organizations.

4. Tools used by CINDY.

The main tools used by the program include:

• forming and training work teams assigned with the implementation of specific interventions under the program. These teams include medical and non-medical experts with enough practical experience, who are taught the techniques of health promotion and prophylactics;
• wide-scale information and educational campaign at population and at risk levels. In this respect, the press and the electronic media are of great help. As an example could be shown the volume of this activity in 1997 - 111 printed publications in the regional and national newspapers and 702 radio and TV broadcasts related closely to the problems targeted by CINDY;
• practical initiatives and projects aimed against the risk factors - opened a consulting room for giving up smoking; participation in the WHO-EURO game against smoking Stop and Win ; a month of prophylactic and control of high blood pressure; public debates with young people on the issues of drug addiction, stress, etc.;
• encouraging the creative behavioral factors of health - mass sports events, demonstration courses on healthy eating and healthy cooking for women, promotion of healthy foods and dishes, etc. Most of these initiatives take place within the traditional annual health holidays in Veliko Turnovo.
• encouraging, stimulating and expanding the production and trade with healthy foods.

5. Funding of CINDY.

Unlike some other projects, CINDY is not funded by the WHO. The program is funded by the following sources:

• The Health Strengthening National Fund at the Ministry of Health;
• the municipal budget;
• sponsorship and donations;
• international NGOs;
• other sources.

6. Information about CINDY.

The program publishes a newsletter which covers its development and its strategic intervention and promotion activities. CINDY also develops and maintains its own database.

7. Monitoring and evaluation of the effect and the end results of the implementation of CINDY.

For this purpose CINDY uses a standardized system applied in all countries from the WHO European region, participating in the program. Considering the long term of the project, the evaluation of its efficiency and effectiveness is checked every 5, 10, 15 and more years.

In the third year since its beginning, development and implementation, CINDY is more and more turning into an implicit unit of the overall social policy of Municipality of Veliko Turnovo.

Since the start of the CINDY program, work under the program has been done in cooperation with the Hygienic Inspection Institute, local government and healthcare institutions. Among the founders of the Public Coalition for Health in 1995 was the then mayor of the municipality, Mr. P. Georgiev. In June 1997, the Municipal Council adopted a mid-term CINDY program until 2010, and in the municipal budget for 1998 there are 4 million Bulgaria leva allocated for the program.