Elsevier

Health Policy

Volume 104, Issue 3, March 2012, Pages 215-221
Health Policy

Implementation of the Tallinn Charter in the WHO European region: Where is the evidence? a systematic comparison of online information before and after the end of the year of signature

https://doi.org/10.1016/j.healthpol.2011.11.015Get rights and content

Abstract

Background

The “Tallinn Charter: Health Systems, Health and Wealth” signed by 53 member states of the WHO European Region provides guidance for strengthening health systems.

Objectives

A systematic search was conducted to compare studies and actions related to the commitments of the Tallinn Charter.

Materials and methods

Target keywords were identified directly from the Charter. Structured web search was conducted on Pubmed/Google. Results for 2007–2010 were analyzed as frequencies before/after the end of the year of signature and classified by relevance and category of content.

Results

Searches for 2007–2010 extracted N = 717 papers in Medline and N = 634 links in Google using combined keywords. Additional N = 165 direct links to the Charter were found by Google for 2008–2010. An increase by 18% (scientific literature) and 10% (grey literature) was observed after 2008.

Discussion

The number of conceptual, methodological, analytical or system evaluation reports related to the themes of the Charter increased after 2008, while benchmarking and cross-country comparisons were less frequent. Opposite trends were observed for the grey literature.

Conclusions

The implementation of the Tallinn Charter is supported by more information available on the topic. The methodology used to perform a rapid search may be usefully repeated to monitor the process.

Introduction

The “Tallinn Charter: Health Systems, Health and Wealth” [1], endorsed at the 58th WHO Regional Committee for Europe (resolution EUR/RC58/R4 [2]), provides guidance and a strategic framework for strengthening health systems in the WHO European Region.

It stipulates that “health systems need to demonstrate good performance” and commits Member States (MS) to “promote transparency and be accountable for health system performance to achieve measurable results”. The Charter similarly commits WHO to “…provide cross-country coordination in implementation of the Charter, including the measurement of performance and the exchange of experiences…”.

Resolution EUR/RC58/R4 requested the Regional Director to report to the Regional Committee in 2011 with an “Interim Report” and again, with a “Final Report”, in 2015 on the support provided by WHO Europe and the progress accomplished by Member States in the framework of the follow-up to the WHO European Ministerial Conference on Health Systems held in Tallinn.

During the first post Tallinn Conference held in February 2009, MS requested WHO Europe to support their efforts to implement the Tallinn Charter. More recently, WHO RC Resolution EUR/RC60/R52 [3] endorsed the Regional Director's proposal to formulate a new European health policy (“Health 2020”), with a renewed focus on public health.

In October 2010, a meeting was convened in Copenhagen and a Working Group was nominated to support the preparation of such Interim Report. The main objective of this work was to highlight actions taken by MS in the implementation of Tallinn Charter, particularly for the central themes of performance measurement/evaluation, response to the crisis, and multi-sectoral action.

The first draft of the “Interim Report” has been presented at the 1st European Health Policy Forum, Andorra, 9–11 March 2011 [4].

To explore the level of dissemination and actions coherent with commitments of the Tallinn Charter, the Working Group agreed that a structured Web Search should have been conducted as part of its assignment. This report presents the main results obtained by such investigation.

Section snippets

Objectives

Scope of this work was to review the evidence of the implementation of the Tallinn Charter through:

  • a systematic search of online information aimed at highlighting studies and significant actions related to the commitments of the Tallinn Charter

  • a pre-post comparison of the results obtained before and after the end of the year of signature of the Charter (2008)

Keywords

The semantics of the Tallinn Charter is well specified in its preamble, including a series of declarations and official acts endorsed by

Results

The results obtained from our search are summarized in Table 1.

A brief description of the results related to each web search is provided in the following sections.

Discussion

The Tallinn Charter is a high level document directed mainly to National Governments of the European Region to implement actions aimed at improving health and wealth through strengthened health systems.

The document includes specific commitments to undertake rigorous monitoring of health systems in a broader framework that regards investing in health as a key strategy for the development of European society. Implementing such vision has become particularly hard with the start of the financial

Conclusions

A systematic online search of scientific papers and grey literature related to the major themes of the Tallinn Charter highlights an increasing presence of published reports since its signature.

Scientific papers include a higher production of conceptual, methodological and analytical papers, while more analytical work, system evaluations and cross-country comparisons emerge from the grey literature.

Among the dimensions identified by the WHO to evaluate health systems, “responsiveness” appears

Disclaimer

The views and opinions expressed in this paper reflect those of the individual authors and do not represent in any way the opinion of WHO or any of its affiliates.

Acknowledgments

The author thanks J. Kutzin (WHO Global Headquarters) and A. Guisset, M. Von Krauss and H. Kluge (WHO Europe), for their open and informal exchange of ideas on the implementation of the Tallinn Charter, which was of great help in the preparation of the present paper.

References (14)

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Member of the WHO Working Group for the Interim Report on the Implementation of the Tallinn Charter.

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