The development of national health policy in Turkey

A written policy is an essential starting point for any administration. Objectives and targets should then be established and strategies to achieve these objectives should be developed. This general approach is also recognized in Turkey, but the policy formulation process is not linked to implementation. The administration does not feel obliged to work according to a plan. Another reason for not adhering to the policy could be that some of the policy principles and targets are too ideal and unrealistic. The targets and objectives are consciously set at an unachievable level to motivate the health workers, but this discourages the health administrators. Services are not evaluated routinely, and the data collected are not processed into usable information and are therefore not used in decision-making. Decisions are usually based on the previous experience of the individuals involved in the policy formulation process or on political will. The high turnover of administrators at the national and provincial levels of the Ministry of Health is another major barrier to adopting and implementing the health policy. If the core of administrators is not stable, a stable policy cannot be established. One of the obstacles to progress was the poor communication between the newly developed Project Coordination Unit and the well established general directorates of the Ministry of Health. Each directorate is autonomous: all deal with different issues. The Unit functions overlapped in many ways with those of the general directorates. This created an awkward situation for them, and sometimes they felt left out from decisions that affected them profoundly. The Unit reports to the undersecretary of state and the minister; therefore, the link with the general directorates was intended to be established through these offices, but sometimes this linkage failed, which resulted in duplication of decisions and activities. Instead of working together towards a common goal, which would strengthen their efforts, they usually work separately. The future is not easy to predict. Change is still needed, but the political environment and level of stability cannot be foreseen. The new Government is pursuing reform activities. The Grand National Assembly has not yet discussed the proposed legislation. New discussions will start at the Assembly, and the policy could be reformulated as a result. This may take some time, which will delay the process. One can hope that the achievements attained so far will be considered and built upon.