Registration system of all plant species and genetic resources, especially those of field crops and horticultural crops as well as authorisation and supervision of private research organisations was established. In line with scientific and technological advances, the Biosafety Law incorporates a set of principles and procedures for addressing the risks associated with genetically modified organisms, products grown using modern biotechnology, operationalising a system of biosafety to ensure sustainability, inspecting and monitoring these activities. NEXT STEPS: The following policies will be implemented in the upcoming years to achieve SDG 2: • Increasing production and productivity to enhance self- sufficiency, enlarging enterprise sizes, • Increasing food aids for the target groups by reducing food waste and loss, • Supporting local employment of those living in rural areas to promote the continuity of agricultural production, • Increasing the efficiency of agricultural R&D services and supports, • Developing legislation to preserve genetic resources and biodiversity, • Employing agricultural production methods adapting to new technologies and changing climatic conditions, • Taking account of agricultural production cost-income balance in support payments, • Helping producers thriving in the sector and increasing their productivity through agricultural training and extension activities, • Facilitating organisation of small agricultural enterprises in particular to ensure more efficient production and better access to the market, • Meeting basic nutrition requirements of vulnerable segments, • Fostering the sustainability of agricultural labour force by supporting youth and women, • Enhancing coordination and cooperation on food-healthcare- nutrition policies, • Improving the infrastructure for agricultural statistics. 58 TURKEY’s 2nd VNR 2019 SUSTAINABLE DEVELOPMENT GOALS “Strong Ground towards Common Goals”
5.3. SDG 3. ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
In the framework of the Health
Transformation Programme
implemented in Turkey since the early
2000s, major changes and reforms
have been achieved in terms of physical
infrastructure, service quality, access
to services and financial support
in the field of healthcare. Through
these developments, there has been
substantial progress in all indicators
under each target, and SDG 3 stands out
as one of the goals on which Turkey has
made most progress.
POLICIES
In addition to NDPs and strategic plans of relevant public
institutions, key policy documents on SDG 3 include the Obesity
Prevention and Control Programme and National Action Plan,
National Cancer Control Programme, National Action Plan
on Mental Health, Rational Medicinal Drug Use Action Plan,
Turkish Pharmaceutical Sector Strategy and Action Plan,
National Tobacco Control Strategy and Action Plan, National
Anti-Drug Strategy and Action Plan, Non-Communicable
Diseases Multi-Stakeholder Action Plan, Healthy Ageing Action
Plan and Implementation Programme, Road Safety Strategy
and Action Plan, and Road Safety Implementation Policy
Document.
The key components of the policy framework in line with SDG 3
are as follows:
• Improving mental health,
• Protecting and improving maternal, child and adolescent
health,
• Improving reproductive health and awareness,
• Combating communicable diseases and risk factors,
• Promoting healthy lifestyles to prevent non-communicable
diseases,
• Strengthening preventive healthcare services,
• Increasing awareness, facilitating access to treatment
and rehabilitation services, scaling up social integration
mechanisms, in the context of combating drug addiction,
• Focusing the policies and practices particularly on children
and youth to reduce the use of tobacco and tobacco
products,
• Ensuring rational use of medicinal drugs,
• Increasing the quality of healthcare services,
• Ensuring accessible, quality, cost-effective and sustainable
provision of healthcare services,
• Enhancing the physical infrastructure for healthcare
services in terms of quality and quantity,
• Strengthening healthcare human resources and improving
their qualifications,
• Developing data and evidence-based healthcare policies,
and to this end, generating quality and standardised data
that would allow for international comparative studies.
LEGISLATION
The current legislation involves regulations aimed at
preventing health risks, and equal, accessible, quality, rapid
and efficient provision of healthcare services across the
country. In this context, preventive, protective, treatment
and rehabilitating mechanisms are addressed holistically to
improve health, with protective and preventive measures in
priority.
Further, the legislation includes restrictions, prohibitions and
sanctions regarding the production, transport, use and sale
of potentially addictive substances as part of the efforts to
combat substance abuse.
IMPORTANT DEVELOPMENTS AND IMPROVEMENT AREAS
SDG 3 is addressed under three main themes: i. Programmes
for preventive healthcare services and ii. Improving healthcare
service provision and infrastructure.
With regard to programs for preventive healthcare services
and promoting healthy lifestyles, comprehensive policies
are in place in Turkey in the fields of maternal-child health;
combating communicable and non-communicable diseases;
mental health; alcohol, tobacco and substance abuse; and
reproductive health.
59
TURKEY’s 2nd VNR 2019
SUSTAINABLE DEVELOPMENT GOALS
“Strong Ground towards Common Goals”
There are many ongoing projects including particularly those implemented under the Health Transformation Programme. A significant portion of these projects eventually became permanent components of the overall structure after being integrated as major reforms. Programmes for immunisation, antenatal care, reproductive health, school milk, nutrition- friendly school, cancer control and combating communicable and non-communicable diseases may be listed as examples of these projects. Through the improvements in neonatal screening-care programme implemented as part of antenatal and postnatal care services, neonatal mortality rate decreased to 5.8 per 1,000 live births, infant mortality rate to 9.2 per thousand, and under-5 mortality rate to 11.2 per thousand in 2017. Maternal mortality ratio is 14.6 per 100,000 live births. On all these targets, the global goal for 2030 has already been exceeded. Designed to reduce maternal and infant mortality rates, Mother-Friendly Hospital Programme and Guest Mother Project were launched to monitor pregnant and puerperant women, and ensure that all births take place at hospitals, and under safe conditions. Hospitals fulfilling 10 specific criteria are granted the title of “Mother-Friendly Hospital”. In addition, the Guest Mother Project involves hosting women going through a high-risk pregnancy in safe places. As of January 2019, 54 hospitals were named as “Mother-Friendly Hospital”. The Expanded Programme on Immunisation (EPI) is aimed at combating Pertussis, Diphtheria, Tetanus, Measles, Rubella, Mumps, Tuberculosis, Poliomyelitis, Hepatitis-B, Hepatitis-A, Pneumococcus, Chickenpox, Haemophilus influenzae type b (Hib), and preventing infant and child deaths and related disabilities caused by these diseases. All infants are given free vaccines in accordance with the immunisation schedule. The term “expanded” refers to administering vaccines to unvaccinated or partially vaccinated infants and children as soon as they are identified by also underlining the importance of homogenously disseminating this practice across the country. Significant efforts are undertaken jointly with local administrations to combat communicable diseases. As an example, Metropolitan Municipality of Mersin as well as District Municipalities of Besiktas, Konak, Nilüfer, Sisli and Çankaya have created voluntary testing and counselling centres. Non-communicable diseases (NCD) are becoming the main cause of death, as opposed to communicable diseases, not only in Turkey, but also globally. In Turkey, the share of NCDs in total disease burden was 69.7% in 2002, and rose to 82% in 2017. Activities aimed at reducing the risk factors of NCDs are undertaken as part of the Healthy Life and Activity Priority Transformation Programme. Work is undertaken to assess risks of cardio-vascular conditions, and monitor hypertension and diabetes at primary healthcare level in respect of NCD early diagnosis, treatment and process management. The Healthy Nutrition and Active Life Programme, Diabetics Programme and Reduction of Excessive Salt Consumption Programme are underway to promote healthy lifestyles, nutrition and active life habits, and to prevent obesity. Counselling services on healthy nutrition and obesity treatment are also provided at Healthy Life Centres and some Public Health Centres. In 2018, 235,000 persons received such counselling services. The Health Risk Screening Programme launched in 2018 involves personal health screening practices for specific age, sex and risk groups to prevent potential diseases before they arise. In this context, the Programme includes tests on blood pressure, blood sugar, cholesterol and fat levels, ECG (electrocardiogram), urinalysis as well as liver and kidney function tests. While there were 155 Cancer Early Diagnosis, Screening and Training Centres back in 2015, the number of these centres rose to 166 in 2017. Efforts are underway to further increase the number of these centres. Implemented since 2010 aiming to prevent malnutrition among children, the Nutrition-Friendly Schools Programme became permanent in 2016. Following the introduction of this programme, the sale of unhealthy foods in school canteens were prohibited. Community Mental Health Centres were opened for the first time in 2014 to ensure that psychological counselling services were available to patients with psychological disorders as part of primary healthcare services. Currently there are 163 centres operating across the country. A range of actions were taken to prevent drug and tobacco addiction, and reduce deaths and injuries from road traffic accidents. As a growing issue, drug addiction is not only a social problem but also a major health threat. In this context, the National Anti-Drug Urgent Action Plan was launched in 2015 to keep the society away from all forms of substance abuse, and then the National Anti-Drug Strategy and Action Plans were introduced for the period through 2023. 60 TURKEY’s 2nd VNR 2019 SUSTAINABLE DEVELOPMENT GOALS “Strong Ground towards Common Goals”
There are ongoing efforts to increase the number and enhance the quality of treatment centres where drug addicts are rehabilitated through medical and psychosocial interventions. There were 3 Addiction Treatment Centres for Children and Adolescents (ÇEMATEM) in 2014 and rose to 9 in 2019; 24 Residential Alcohol and Substance Addiction Treatment Centres (AMATEM) were functional in 2014, this number rose to 39 in 2018, with a total residential bed capacity increasing from 710 to 1,158. In addition to residential treatment centres, 66 outpatient centres also provide addiction treatment services. The project Anti-Addiction Training being implemented since 2014 undertakes education and instruction activities to raise awareness in the society particularly including students on tobacco, alcohol, substance and technology addictions. Local administrations are also involved in anti-drug efforts. For example, Metropolitan Municipality of Sakarya developed a Provincial Anti-Drug Action Plan, and provided training to 3,198 individuals. Municipality of Edirne is implementing an Anti-Drug Project in partnership with the Provincial Police Department. As part of the project “No to Drug Addition in Tuzla” led by the Municipality and District Governorate of Tuzla, and supported by non-governmental initiatives, voluntary awareness campaigns were undertaken and, 198 training programmes were organised where 311 volunteers trained 7,326 people. Turkey was one the first countries to sign the WHO Framework Convention on Tobacco Control in 2004. In this regard, through the legislation introduced in 2008, the number of places where consuming tobacco products were prohibited were increased and “all closed public spaces” were covered under the prohibition. Further, the National Tobacco Control Programme (2008-2012), National Tobacco Control Action Plan (2015-2018) and Tobacco Control Strategy and Action Plan (2018-2023) is under implementation. In addition, through a new legislative action, the standards on the packaging of tobacco products were revised, and a number of additional restrictions were imposed on the places of sale as well as domains of printed, visual and social media. The political will, notably the President of the Republic, central and local governments, NGOs and press are strongly committed to and engaged in combating tobacco. In addition to the preventive activities, Helpline 171 for Smokers offers support to tobacco users and free services are offered in clinics to help people to quit smoking. With its efforts, Turkey sets an example for the rest of the world. Despite all these achievements in the field of health, there is still room for improvement in preventing non-communicable diseases, provision of preventive healthcare services and addressing the health problems of growing elderly population in Turkey as in other countries. There are ongoing efforts to take measures to reduce loss of lives and property due to road accidents, a major socio-economic issue that needs addressing. In spite of the improvements in highway standards and the positive impact of the rapid progress in the construction of divided highways, mortality rate is higher than the average figure of developed countries. With regard to improving healthcare service provision and infrastructure, there have been major strides in the field of healthcare labour force, funding of investments and services, universal health coverage, and access to medicines. Through the positive outcomes achieved as part of the Health Transformation Programme, remarkable progress was made in terms of physical infrastructure and human resources. Although the number of hospital beds per ten thousand patients was 26.6 in 2015, this number rose to 27.9 in 2017. In addition, the share of quality beds in the total number of hospital beds was 67.7 in 2017, representing an increase from 59.7% in 2015. Through the surge in the number of physicians, nurses and other healthcare staff across the country, the number of medical professionals per person is now close to that of developed countries. Although total number of physicians and nurses/midwives per 100,000 people were 179 and 261 respectively in 2015, these figures rose to 186 and 272 in 2017. The number of primary healthcare institutions increased and the infrastructure of emergency services was substantially enhanced compared to 2015 when 21,696 Family Practice Units and 6,902 Family Health Centres existed which increased to 25,198 and 7,774 respectively. As of 2017, there was one family practitioner per 3,481 persons. However, the desired level in terms of average number of patients per family practitioner has yet to be achieved, and there is still need for a balanced distribution among provinces. 61 TURKEY’s 2nd VNR 2019 SUSTAINABLE DEVELOPMENT GOALS “Strong Ground towards Common Goals”