Cabina di Regia 22 Maggio 2008

1. Achieving broader health gains using Structural Funds for health related investments: the experience of the Italian Ministry of Health Venice, Italy, 25-26 February 2010 Sara Pavoncello Cabina di Regia 22 Maggio 2008

2. Agenda • Devolution scenario • Managing the projects in the previous Eu programming period 2000-2006; • The making of the new projects, EU programming period 2007-2013; • The organization of the Technical Unit of the Ministry of health; • Future challenges: where do we go from here.

3. Devolution scenario General overview ITALY 21 Regions Population: 59.131.287 • ITALIAN NATIONAL HEALTH SERVICE • 145 Local Health Units and 104 Hospital trusts • Total: 249 health facilities • HEALTH CARE EMPLOYED PEOPLE • 800.000 (health professionals, administrators etc.) • HEALTH CARE EXPENDITURE: • 2010: €104.614 millions • 2011: €106.934 millions Italian Health expenditure approx. : 8,7% GPD Average across OECD countries 8.9% USA 16.0%, France 11.0% • Life expectancy (2007) • Men 78,6 • Women 84,1

4. Managing the projects (programming period 2000-2006) ACTIVITIES CARRIED OUT UNDER THE ESF Under the European Social Fund (ESF € 470.000,00), several activities have been carried out by FORMEZ at different levels… …through the development of Training activities (aimed at programming, realizing, monitoring and evaluating policies and projects) addressed to regional staff; Training courses, addressed to Regional Epidemiology Observatories personnel, aimed at team building (professionals with different backgrounds); Research on social and health integration (setting up useful tools and instruments such as guidelines, identifying and implementing Best Practices) ESF MainObjectives • Strengthening programming knowledge and skills at Regional level (Regional Health Plan) • Supporting the development of Epidemiologic Observatories (Regional and Local levels) • Promoting social and health services integration (Local level)

5. Managing the projects (programming period 2000-2006)STRENGTHENING PROGRAMMING SKILLS AT REGIONAL LEVEL In particular, such initiatives have contributed in strengthening programming and evaluating health projects skills and competences, adopting a common approach to programming, sharing innovative experiences for social-health integration, as well as identifying relevant aspects to be taken into account Therefore, further steps need to focus on enhancing exchanges among Regions (to balance less experienced with more advanced regions), identifying and sharing best practices available, supporting formal and informal networks, investing in human resources development Pros & Cons • When Regions are less advanced local services happen to be more developed; • Developing of a “bottom up” approach to programming results more effective; • Significative results obtained through the integration of health and social services (Local Health Units and Municipalities) • Heterogeneity among Regions often implies lack of effective coordination mechanisms among different bodies involved (i.e. Health, Social, Enviroment depts); • Inadequate technical expertise and management skills and approach at regional level

6. Managing the projects (programming period 2000-2006)DEVELOPMENT OF EPIDEMIOLOGIC OBSERVATORIES A specific project, financed by the UE Regional Structural Funds, has been carried out to develop epidemiology observatories to strengthen the regional epidemiological capabilities …to implement regional health analysis methodologies supporting policy makers, developing integrated activities on environmental and health issues, through an institutional network of regional epidemiology observatories … Project Details Project Tasks • Assessing local needs and priorities • Identifying models, methodologies and best practices • Supporting the draft a regional plan of activities • Supporting the implementation of identified models and methods • Enabling sharing and know-how transfers • Helping to draft proposals to participate in European Programmes (VI framework Programme, European Action Plan on Public Health); • Creating networks of epidemiology observatories of Obj. 1 Regions through the implementation of a virtual community

7. Managing the projects (programming period 2000-2006)DEVELOPMENT OF EPIDEMIOLOGIC OBSERVATORIES The project has allowed to develop and put into practice methodologies and models to better assess population health status, within each specific area… …and support identifying the value of health as a prerequisite enabling territory development Pros & Cons • Increased regional epidemiologic skills (i.e. empowerment of epidemiological function, upgrading capacity building, internalization of competences); • Better program governance (more effective links and coordination between the Observatory and other organizations directly involved in the management of actions/measurements. • Project’s outputs show the need to keep on overcoming the identified regional gaps in a wider timing horizon • Investing on human resources development has not been considered a top priority due to local budget constraints

8. The making of the new projects (programming period 2007-2013) - THE ITALIAN NATIONAL STRATEGIC FRAMEWORK In Italy, the National strategic framework identifies goals and priorities to be achieved through the use of EU and National resources within a common strategy aimed at programming and integrating the different resources in one broad and coherent picture • EU resources: structural Funds • National resources: National funds addressed to southern Regions Resources

9. The making of the new projects (programming period 2007-2013) - THE ROLE OF THE ITALIAN MINISTRY OF HEALTH The Ministry of Health provides technical assistance to the Regions beneficiaries of EU cofinanced structural funds., in order to consistently develop and enact the regional operational programmes (ROPS) and initiatives • POAT: Operational support to Regions under Converge objective • ADI: Adequate standards in the area of integrated home care for elderly people Maininitiatives under way

10. The making of the new projects (programming period 2007-2013) Operational support to regions under converge objective (POAT) The project hasbeenfinalised and isnowwaitingtobeapproved by the Regions… …and it aims at strengthening governance and administrative skills and competences of the Regions (Calabria, Campania, Puglia, Sicilia) addressed by the Convergence Objective, in particular as regards health related projects relevant to socio economic development RegionsBeneficiaries Project Duration Project Activities • Strategic planning and programming to support regional activities and projects • Program management and technical support to adopt useful methodologies (i.e Health Impact Assessment); • Identification and sharing of eHealth best practices for a coherent development of ICT and National and Local information systems • Promotion and dissemination at National and international levels of good pratices improving access and quality of health services • 3 Years Project Resources • € 11 milions

11. The making of the new projects (programming period 2007-2013) National Technical Unit At National level, a specific technical unit, recently created within the Italian Ministry of Health is in charge for managing the project and acting as main point of reference …for Regions during the realization of the project, also with the ultimate goal of ensuring an integrated approach to EU program’s activities, providing a synergic framework with other activities funded by ordinary National resources, such as FAS • Composition • A selection of 13 people selected from various departments and with different professional background s(i.e. statistics, epidemiology, regulatory and administrative, etc). • MainAdvantages • Strengthening internal competences through Training courses (managing EU Fund projects), Team building and integration of different approaches and Peer collaboration

12. The making of the new projects (programming period 2007-2013)Adequate standards in the area of integrated home care Technical assistance initatives for achieving adequate standards in the area of home care for elderly in the Italian southern regions, stand within the National Strategic Framework (2007-2013), in particular with respect to innovative projects aimed at improving quality and coverage of essential services, defined as key elements for citizens’ well being and regional policy measures …

13. The making of the new projects (programming period 2007-2013) Adequate standards in the area of integrated home care In order to improve the existing area of integrated home care, the project objective is measured against a specific target through the application of a defined indicator • Target: Increasing the share of elderly beneficiaries of home care assistance within the Southern Regions from today’s 1,6% to 3,5% • Indicator: percentage of elderly beneficiaries of home care assistance out of total elderly population (65+ yrs) … % of elderly receiving home assistance out of the total elderly population (65Yrs+), 2005-2008 North Centre South & Islands Source: Istat based on Ministry of Health data

14. The making of the new projects (programming period 2007-2013) Adequate standards in the area of integrated home care The project is coordinated by 3 central government administrations (Ministry of Health, Ministry of Labour and Social Policy, Family Department of Council of Ministers’ Presidency) ...and it is finalised at supporting administrations of 8 southern Regions (Abruzzo, Basilicata, Calabria, Campania, Molise, Puglia, Sardinia, Sicilia) in the programming and realization of integrated home care for elderly as a result of the local integration of welfare, social and health services … Main Aims Regions Beneficiaries Project Duration • Multi-level governance (national, regional and local) and institutional cooperation aimed at: • Providing citizens with an integrated offer of healthcare and social services • Developing programming, monitoring and assessment skills and knowledge • 4 Years Project Resources • € 3 millions Project Steps • 1° Phase 2009-2010: € 1,5 millions • 2° Phase2011-2012: €1, 5 Millions

15. The making of the new projects (programming period 2007-2013) Adequate standards in the area of integrated home care The project actionsplannedfor the first phase are broken down into cross and vertical activities… Vertical Activities Cross Activities • Enhancing governance skills to plan and manage integrated home care for elderly (tools, methodologies, benchmarking among different regional experiences); • Sharing and disseminating an integrated common approach for services provision assessment • Supporting integration of social and health care components (identification of best practices, agreements between Municipalities and LHUs); • Sound information systems and homogeneous approach to data collection within a common methodological framework • Promoting activities planned in response to specific regions needs, such as: • Organisation guidelines for integrated home care; • Process and implementation design to better access to services with a one access point • Definition of multidimensional evalutation unit and professional roles associated; • Promotion of Laboratories and workshops on health and social integration; • Support the modernisation of information systems

16. The making of the new projects (programming period 2007-2013) Adequate standards in the area of integrated home care The project has allowed to develop and put into practice methodologies and models to better assess population health status, within each specific area… Pros & Cons • Multilevel integration at National level among the three different Ministries, at Regional level: social and health representatives working together, at local level: among different people working in the same area • Quality standards definition:through the use of standardized systems of controlling, monitoring and assessing • Improved governance skills for realizing integrated services. • Poor homogeneity in selecting and collecting data by information systems • Week integration between social and the health information systems

17. The making of the new projects (programming period 2007-2013) Adequate standards in the area of integrated home care -OrganisationalModel

18. The making of the new projects (programming period 2007-2013) Adequate standards in the area of integrated home care • Future Challengesahead • Health decentralization scenario: in consistence with a solidarity approach, efforts should be undertaken to reduce health inequalities; • Global strategy: programming and integrating the different resources (the regular national health budget with EU funds) in one broad and coherent picture; • Invest on reorganising health services in a territorial integrated dimension in the Southern Regions, improving efficiency and quality of the services’ performances; • Invest in prevention, involving citizens in the adoption of healthy life styles, promoting an health and social strategy for aged population. • Support in improving the regional information data bases to asses the impact on health care by adopting infrastructural policies through the development and use of analysis methodologies of available data • Create an extensive network of technical experts and stakeholders at EU, national and regional level on specific issues

19. Thanks foryourattention