Change in the geographic distribution of human resources for health in Turkey, 2002-2016

Introduction: Turkey, which suffers from both undersupply of physicians, nurses and midwives and imbalanced distribution of healthcare personnel, has been developing and implementing various policies to solve these problems. The Ministry of Health launched the Health Transformation Program in 2003 for effective, efficient and fair provision of healthcare services for all people. This study aimed to take a closer look at the impact of policies implemented to reduce the imbalance of the distribution of human resources for health for the past 15 years in Turkey. Methods: Data for the distributional imbalance obtained from Ministry of Health registries was analysed by using Lorenz curves and Gini coefficient for the years 2002, 2005, 2008, 2012 and 2016. Results: Geographical imbalances for healthcare professions decreased distinguishably during the 15 years. Gini coefficient was 0.33 for specialist distribution in 2002, and decreased gradually to 0.26 in 2008 and finally 0.21 in 2016. Similarly, Gini coefficients were 0.18, 0.20 and 0.25 for general practitioners, nurses and midwives, respectively, in 2002. In 2012, Gini coefficients for the same professionals were calculated as 0.09, 0.11 and 0.19, respectively. Conclusion: The findings indicate that the policies targeting the distribution of healthcare personnel in Turkey have yielded positive results. Yet it is evident that these results are not due to a single action. It is essential to improve existing implementations, identify the instruments and factors that satisfy and motivate healthcare personnel, and continue developing and implementing comprehensive policies

AMOUNT OF MEDICAL WASTE COLLECTED BY METROPOLITAN UNICIPALITIES: DATA ON 2004 AND FIRST SIX MONTHS 2005; METHODS OF COLLECTING, AMASSING AND DISPOSAL MEDICAL WASTE IN 81 PROVINCES

Tehlikeli bulaşıcı hastalıkların artması, tek kullanımlık malzemelerin kullanımını artırmıştır. Dünya Sağlık Örgütü tarafından 2000 yılında kontamine şırıngalarla 21 milyon Hepatit B (tüm yeni enfeksiyonların %32'si), 2 milyon Hepatit C (tüm yeni enfeksiyonların %40'ı), en az 260.000 HIV enfeksiyonu (tüm yeni enfeksiyonların %5'i) oluştuğu tahmin edilmiştir. Amaç: Büyükşehir Belediyeleri tarafından toplanan 2003-2004 yılları ve 2005 yılı ilk altı ayı tıbbi atık miktarlarının bulunması, 81 ilin tıbbi atık toplama, biriktirme ve imha yöntemlerinin tespit edilmesi ile bu konuda yapılacak çalışmalara katkı sağlanması amaçlanmıştır. Yöntem: Büyükşehir belediyeleri ilgili dairelerinden 2003, 2004 yılları ve 2005 yılı ilk altı ayı tıbbi atık miktarları, Temel Sağlik Hizmetleri Genel Müdürlüğü (TSHGM) Çevre Sağlığı Açık Alan biriminden 81 ilin 2004 yılı toplama, biriktirme ve imha yöntemleri verileri alınmıştır. Bulgular: Yıllık tıbbi atık miktarı 82.803 ton tahmin edilmiştir. Çalışmada yer alan şehirlerde yatak başına tıbbi atık miktarı 0,36 ile 1,80 kg; kişi başına yıllık tıbbi atık miktarı 0,42 ile 1,86 kg arasında değişmektedir. Tıbbi atık toplama yöntemlerine bakıldığında 44 (% 54,3) ilde belediye çöp aracı ile (evsel atıklardan ayrı), 27 ilde (%33,3) özel tıbbi atık taşıma aracı ile toplanmaktadır. 33 il (%40,7) belediyesi çöp alanında, 32'si (%39,5) şehir dışındaki çöp alanında biriktirmekte, sadece 5'i (%6,2) özel tıbbi atık toplama alanında, 2'si (%2,5) özel şirket ve özel yakma tesisinde biriktirilmektedir. 40'ı (%49,4) gömme (12'si kireçlenerek), 22'si (%27,2) yakma methodu ile imha edilmektedir. Sonuç: Tıbbi atıkların imhası güç ve maliyetlidir. Üretim aşamasında azaltılması, üretim miktarlarının ölçülmesi önemlidir. Kesin değerlerin bilinebilmesi için sağlık kuruluşları ve belediyelerin tıbbi atıkları ayrı ayrı toplamaları gerekmektedir. Bu konuda yayınlanan yönetmelik ve genelgelerin ilgili kurumlar tarafından takiplerinin yapılması önem taşımaktadır. The increase in the prevalence of dangerous and communicable diseases gave rise to the use of disposable medical supplies all over the world. According to the estimations made by the WHO, 21 million cases of Hepatitis B (32 % of all infections) , 2 million cases of Hepatitis C (40 % of all infections), and minimum 260.000 cases of HIV infection (5 % of all new-borne infections) occurred due to syringes / injections. Objectives: To identify the amount of medical waste collected by the Metropolitan Municipalities in 2003-2004 term and the first half of 2005; to contribute to contribute to the future studies by identifying the medical waste collecting, storing and destroying methods used in 81 provinces across Turkey. Methods: Data on the amount of medical waste materials in 2003, 2004 and the first half of 2005 was received from the Metropolitan Municipalities and data on collecting, storing and destroying methods in 81 provinces was received from the Environmental Health Open Space Unit of Directorate General of Primary Health Care Services. Results: The estimated amount of medical waste materials per year was 82.803 tons. In the provinces subject to the above-mentioned study, the amount per hospital bed was 0.36 - 1.80 kg, the amount per person was 0.42 - 1.86 kg. As for the methods of collecting medical waste, in 44 provinces (54.3 %) medical was collected by the Municipality's dustcarts (apart from the household waste products) and in 27 provinces (33.3 %) with specially designed medical waste carts. In 33 of 81 provinces across Turkey (40.7 %) waste products were stored in the Municipality's dust field and in 32 (39.5 %) in a dust site far from the city center whereas just in 5 (6.2 %) of them it was kept in specially built medical waste collecting facilities and 2 (2.5 %) in private company-owned special burning centers. In 40 provinces medical waste materials (49.4 %) was preferably destroyed by burying (in provinces they are limed before burying) and in 22 (27.2 %) burning . Conclusion: Medical waste production should be reduced. Disposal is difficult and costly. Production amount should be known. Health care facilities and municipalities are supposed to collect medical waste materials separately in order to identify the exact amount. To this end, it is essential for relevant public agencies and authorities to follow-up and comply with the regulations and circulars issued

Knowledge, attitudes and practices regarding COVID-19 among the Turkish and Malaysian general populations during lockdown: A cross-sectional online survey

AbstractBackground: COVID-19 is public health threat across the globe. The aim of the study is to assess the knowledge, attitudes and practices of the Turkish and Malaysian general populations regarding COVID-19 during the lockdown. Methods and materials: A cross-sectional quick survey was conducted online on 01-07 April 2020. Data were collected from samples of the general public in both Turkey and Malaysia. Results: A total of 1,320 people from the two countries participated in the study. In Turkey, only gender and education were demonstrated to have an association with overall knowledge (p˂0.001), while in Malaysia it was shown that age and marital status (p˂0.001) were statistically significant. In Turkey, those who had a good attitude towards COVID-19 were mostly male, married and postgraduates; in Malaysia, females, married those who had completed a middle-school education, and postgraduates demonstrated a good attitude towards COVID-19. In Turkey, 55.3% of study participants wore masks and 90.9% avoided crowded places; in Malaysia, 87.1% wore masks and 93.4% avoided crowded places. Conclusions: Participants had good knowledge about COVID-19, however they also showed misconceptions about COVID-19, especially in relation to its transmission. Participants’ confidence was high and they believe that their country can win the battle against the COVID-19 virus. [Ethiop. J. Health Dev. 2020; 34(4):243-252] Key words: COVID-19; knowledge, attitudes and practices; Turkish community; Malaysian community; pandemi

Principal health reforms

Health care reform has been given the utmost importance on Turkey’s policy agenda since the late 1980s. In 1989, the SPO’s Master Plan Study (SPO, 1990), which was developed through a World Bank loan, introduced new concepts to the Turkish health care system. The Plan suggested splitting the functions of purchasing and provision, developing an internal market, implementing general health insurance, formulating a family medicine system at the primary health care level and giving autonomy to state hospitals. From 1990 to 1993, intensive efforts were undertaken to reshape the health care system in a way that reflected global trends and approaches. The World Bank had an important role in developing this process. The National Health Policy (Ministry of Health, 1993) presented the first comprehensive analysis of priority health care policies and also set out future strategies. However, a decade of political and economic instability (1993–2003) led to reform proposals that remained as blueprints with no concrete steps for implementation

Executive summary

Turkey is located in the northern hemisphere and bridges Europe and Asia. The bordering countries are Greece, Bulgaria, Georgia, Armenia, the Islamic Republic of Iran, the Syrian Arab Republic and Iraq. The country has a population of 73 million, 26% being under 14 years of age in 2010. Turkey is a parliamentary democracy with a clear separation of executive, legislative and judicial powers. The 1982 Constitution describes Turkey as a democratic, secular and social state governed by the rule of law. The Turkish Grand National Assembly (Türkiye Büyük Millet Meclisi), or parliament, is the legislative body acting on behalf of the nation. The President, elected by the people, and the Council of Ministers (Cabinet) headed by the Prime Minister, exercise executive power. Independent courts handle judicial power. Administratively, Turkey is divided into 81 provinces headed by provincial governors appointed by the central government. Provincial governors are the representatives of all ministers at the provincial level. All ministries, including the Ministry of Health, have their own local organizations in the provinces and the heads of these organizations are responsible to the provincial governor

Conclusions

Turkey has achieved considerable health status improvements since the 1980s in major health status indicators. However, although infant mortality, child mortality and maternal mortality rates have decreased, and life expectancy at birth has increased over time, the indicators are still not compatible with the current development level of the country. In addition, regional inequalities constitute a challenge for the years ahead. Improved access to health care services in recent years has contributed positively to the improvements in health status; however, for further improvements, developments in the country’s socioeconomic level are also required

Provision of services

The Constitution gives the Ministry of Health the responsibility to protect and improve public health in Turkey. However, certain aspects of public health require intersectoral collaboration. As will be discussed below, the Ministry of Health leads the process in areas where this collaboration is needed. The Ministry of Health undertakes this responsibility both through its centralized departments and through the provincial health directorates. Prior to the full implementation of the family practitioner scheme nationwide (at the end of 2010), health posts and health centres in rural areas undertook the majority of disease prevention, health education and other public health-related measures. Now, these activities are carried out by population health centres. Centrally, both the General Directorate of Primary Health Care Services and the General Directorate of Maternal and Child Health and Family Planning are responsible for public health. In addition to these, the departments for malaria control, cancer control and tuberculosis control in the Ministry of Health and the Refik Saydam Hygiene Centre Presidency also undertake public health measures

Physical and human resources

The Ministry of Health’s General Directorate of Curative Services is responsible for licensing health care institutions and major medical technologies in Turkey. The Directorate also is in charge of establishing health care institutions of the Ministry of Health and increasing their capacity; licensing private and public sector facilities (except those affiliated with the Ministry of National Defence); and carrying out authorizations and certification proceedings for imported medical devices (Decree No. 181, Article 10, 1983)