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Tuesday, 22 January 2019 20:55

Developing an Agenda for Future Health Services Research in Malta

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Dr Gianpaolo Tomaselli1, Dr Natasha Azzopardi-Muscat1,2, Prof. Sandra Buttigieg2, Prof. Neville Calleja2, Dr Kenneth Grech1

  1. Department of Health Services Management, Faculty of Health Sciences, University of Malta
  2. Directorate for Health Information and Research Department for Policy in Health, Ministry for Health, Malta

Abstract

The Maltese health system is undergoing a period of change and transformation. This is partly in response to the changing socio-economic environment within the country. Planning and delivering adequate and appropriate health services necessitates that relevant local research on the health system takes place. In order to identify the top priorities for the Maltese health system, a National Round Table Consultation was organised by the Department of Health Services Management at the University of Malta and the Directorate for Health Information and Research on the 14 December 2017. This was conducted within the framework of the HORIZON 2020 EU project “Transfer of Organisational Innovations for Resilient, Effective, equitable, Accessible, Sustainable and Comprehensive Health Services and Systems (TO-REACH)”, setting a future research agenda for health systems in which 28 partners from 20 countries are participating.

45 stakeholders from academia, the public service, private sector and NGOs attended and participated in the round table meeting. Reports from interactive workshops were collated and compiled into an overall report. Document analysis using a structured health systems analysis framework was carried out.

There was broad consensus on several priorities and challenges that health systems are facing today at both national and European levels. Access to health services and universal health coverage were identified as key research priorities. Furthermore, it was felt that particular attention should be devoted to research on health workforce planning and on the effects of the implementation of new technologies within health systems (including digital health and social media). Research on hospital leadership and governance within the changing health system context was also identified as important. Local stakeholders believe that better collaboration and networking between countries would be beneficial for the sustainability of the national health sector. As a way forward, knowledge gaps should be bridged through the collection/collation of evidence gathered through research conducted within the Maltese health system, leading to a more solid, efficient, evidence-based and responsive national health system.

 

 

 

 

 

Background

Over the last decade, the Maltese health system has faced growing common challenges which include (among others) issues related to an aging population, as well as economic and financial pressures that motivate the pursuit of potential solutions for a more efficient, accessible, innovative and equitable healthcare. Although a strong political and public health leadership allowed Malta to make important improvements and advances to its health system over the last years, there are still problems that need to be addressed at the national level.  According to the Hit Report published by the European Observatory on Health Systems and Policies (2017),1 in Malta, there is the need to adapt the health system to an increasingly growing and diverse population, namely building capacity, allowing a more efficient distribution of scares resources, strengthening primary care and mental health, improving information systems, reducing access to medicine obstacles, and addressing challenges related to the sustainability of healthcare.2,3

To address the current challenges, there is a necessity for research evidence on our local health services, in order to identify and implement more effective and sustainable ways to organize, manage, finance, and deliver high quality care to persons living and working in Malta. For this purpose, a National Round Table Consultation meeting was held in Malta to obtain feedback from health stakeholders coming from different sectors and to identify most urgent challenges and priorities of the national health system, as well as gather suggestions to address the current issues.

Methodology

The Malta National Round Table Consultation on Health Services Research took place on 14 December 2017 at the Valletta Campus of the University of Malta. It was organised by the Department of Health Services Management within the University of Malta in collaboration with the Directorate for Health Information and Research within the Ministry for Health, as part of the HORIZON 2020 EU project “Transfer of Organisational innovations for Resilient, Effective, equitable, Accessible, Sustainable and Comprehensive Health Services and Systems (TO-REACH)”.

45 stakeholders from different backgrounds (namely academia, the public service, private sector and NGOs) participated and they were divided into three working groups and asked to propose and discuss a list for health services research priorities at both a national and EU level.

During the discussion, the following questions were addressed by participants: i) Which are the most important priorities for health systems research within Malta and which challenges will they help to address?; ii) What are the research priorities/projects for which we see added value in organising health systems research at a European level? iii) Which are the key criteria that need to be satisfied to ensure effective and appropriate transfer of innovation between health systems in different countries?

Reports from the interactive workshops were collected and compiled into an overall report. Document analysis using a structured health systems analysis framework4 was carried out. Data were further processed and analysed with the support of NVivo 11 Software.

 

Results

Table 1 illustrates the results from the discussion workshop on research priorities and challenges that need to be addressed by the Maltese health system at both national and European level. The initial results presented here arise from a thematic analysis of the discussions that took place within stakeholders from different sectors (academia, public sector, private sector, and NGOs).

Table 1 – Health systems priorities at national and European level

 

Broad priority topics

Sub-topics

Specific focus

Level concerned

Academia

Health integration and coordination

Health systems challenges

 

Sociodemographic challenges

 

Profile of burden of disease

·         Needs of future audience for: ageing population, migrants, DM screening, neurodegenerative diseases, diabetes and obesity

·         Integration of health and social care services; minimisation of fragmentation of care; improvement in efficiency and effectiveness of services

·         HR and clinical leadership development through capacity building

·         Person-centred care

·         Disinvestment agenda

National and EU

Health promotion and prevention

Health services gaps

·         Healthy lifestyle promotion

·         Health education

Research

Health services gaps

·         The practical use of University research

·         Multi-sectoral government approach and interdisciplinary research

·         Strategy for communicating research priorities without being overwhelming

·         Patient participation in research

IT, innovation and use of data

Health systems challenges

 

Health services gaps

·         Joint procurement of medicines/services/technologies

·         Digital health & social media

·         Misinformation

European integration

Health services gaps

·         European collaboration in research

Empowerment and health democracy

Health systems challenges

 

Sociodemographic challenges

·         Feminisation of the health service

·         Gender-issues

Public Sector

Health integration and coordination

Health systems challenges

 

Sociodemographic challenges

·         Obesity, including in children, population ageing, migrants, mental health, diabetes, sexual health, oncology, cardiovascular diseases

·         Decentralisation from secondary to primary care

·         Prioritising health requirements

·         KPIs for hospitals

·         Patient safety and quality of care

·         Disinvestment agenda

·         Primary care gaps

·         Inter-sectoral collaboration

National and EU

Health promotion and prevention

Health services gaps

·         Sexual health education (health promotion and prevention)

·         Employees wellbeing

·         Improving employees’ skills

·         Health prevention

Research

Health services gaps

·         Evidence-based practice

·         Citizen expectations and market research

·         Strategy for communicating research priorities

·         Interdisciplinary collaboration in academia

·         Knowledge transfer - private to public and vice-versa

IT, innovation and use of data

Health systems challenges

 

Health services gaps

·         Data availability and accessibility

·         New technologies

·         Joint procurement of medicines/services/technologies

·         Insufficient use of existing health data

European integration

Health services gaps

·         European Reference Networks

Empowerment and health democracy

Health systems challenges

 

Sociodemographic challenges

 

Profile of burden of disease

·         Bridging inequalities

·         Skills to meet needs and address gaps

·         Housing poverty

·         Needs of minority groups (migrants, men who have sex with men, etc.)

Private Sector

Health integration and coordination

Health systems challenges

 

Sociodemographic challenges

 

Health services gaps

·         Improving employees’ skills

·         Disinvestment agenda

·         Person-centred care

·         Delays of care

·         Duplication of services

·         Accountability

 

National and EU

Health promotion and prevention

Health services gaps

 

·         To prepare new parents for their new role

·         Personal wellbeing education

·         Mental and emotional health

·         Population ageing, diabetes, obesity, mental and emotional health

·         Social determinants of health

Research

Health services gaps

·         Training of healthcare staff - evidence-based research on training to render it effective and efficient

·         Knowledge transfer - private to public and vice-versa

·         Citizen expectations and market research

·         Cancer research

·         To create exchange possibility with foreign research groups

·         Strategy for communicating research priorities

·         The practical use of University research

·         Evaluation of research

IT, innovation and use of data

Health systems challenges

 

Health services gaps

·         Digital health

·         Data management

·         To create public-private network to share information solutions

Empowerment and health democracy

Sociodemographic challenges

 

Profile of burden of disease

·         Decrease health inequalities

·         Decrease barriers to accessibility

·         Person-centred care

·         Family wellbeing

NGOs

Healthcare pathway, integration and coordination

Health systems challenges

 

Sociodemographic challenges

 

Health services gaps

·         Availability of medicines and ability to include new medicines in publicly funded formularies

·         Mental health, patient safety, migration, poverty studies, tobacco consumption

·         Role of NGOs in Health systems challenges

·         Inter-sectoral collaboration

·         Improving employees’ skills

·         Health expenditure

·         Implementation science in healthcare

·         Capacity building

·         Quality of care

·         Prioritising health requirements

National

Communication and use of data

Health services gaps

·         Lack of data on medications usage

·         E-Health

 

Conclusion

The priorities listed in Table 1 suggest that easier access to funds, workforce mobility among health professionals, collaboration and networking between EU countries, and industry involvement in health research are the main expectations from a future programme of organised Health System Research both at national and EU level. Moreover, access to health services and healthcare coverage deserves particular importance specifically with regards to marginalised and minority groups of the population. The role of new technologies and digital health was perceived as a fundamental asset, which needs to be further developed in order to provide innovative solutions, considering the rapid and continuous technology advances.

The main challenges and priorities of the Maltese health system are related to health integration and coordination, intersectoral collaboration, health promotion and prevention, health education, research implementation, innovation, IT and digital health implementation, data management, European integration, empowerment, and health democracy.

The Maltese national health system, as well as other European health systems, should take into account the priority issues that emerged from this workshop so as to spearhead improvement of the health services sector. The aim is to attain more efficient, equitable, responsive and sustainable health systems, as well as to strengthen gaps and weaknesses within the service delivery.

About the TO-REACH project

The To-reach project is financed by the EU Horizon 2020 programme. The project’s multidisciplinary consortium includes 28 partners from 20 countries including EU member states, Norway, Canada, Israel and the US, and it covers research funders, policymakers and the research community. Its main goal is to prepare a joint European research programme aimed at producing research evidence supporting healthcare services and systems to become more resilient, effective, equitable, accessible, sustainable and comprehensive. Thus, To-reach is focused on setting out clearly what needs to be done in terms of the future Health Services and Systems Research agenda, with the objectives of: i) identifying common challenges and organizational needs across Europe; ii) proposing possible solutions to improve health systems performance; and iii) identifying the most effective ways to organize, manage, finance, and deliver high quality, sustainable, and equitable care to citizens.

Details of the To-reach initiative are available at https://to-reach.eu/ and https://twitter.com/toreachEU.

Acknowledgements

The authors would like to thank all people involved in the organisation of the National Round Table Consultation held on the 14 December 2017 and all participants. We also thank rapporteurs who have collected feedback from stakeholders presented in this paper.

References

  1. Azzopardi-Muscat N, Buttigieg S, Calleja N, Merkur S. Malta: Health system review. Health Systems in Transition 2017;19(1):1–137. Available from: http://www.euro.who.int/__data/assets/pdf_file/0009/332883/Malta-Hit.pdf?ua=1

 

  1. European Commission. 2018 European Semester: Assessment of progress on structural reforms, prevention and correction of macroeconomic imbalances, and results of in-depth reviews under Regulation (EU) No 1176/2011. Country report Malta 2018. Available from: https://ec.europa.eu/info/sites/info/files/2018-european-semester-country-report-malta-en.pdf

 

  1. European Commission. State of Health in the EU. Malta Country Health Profile 2017. Available from: https://ec.europa.eu/health/sites/health/files/state/docs/chp_malta_english.pdf

 

  1. World Health Organisation. Everybody’s business: Strengthening health systems to improve health outcomes. WHO’s framework for action. Geneva. 2007. Available from: http://www.who.int/healthsystems/strategy/everybodys_business.pdf

 

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