HOME DELIVERY OF HEALTHCARE SERVICES SDG Targets 3.8 Executing Entity Ministry of Health Start & End Dates 2010-Ongoing Medical examination, analyses, treatment, care, monitoring and rehabilitation services, including social and psychological counselling services, are provided at own living spaces of individuals who are restricted to bed and/or home due to physical or mental conditions. In addition, patients’ relatives are trained on care. Such services ensure that patients receive quality services, reduce risk of infection, accelerate recovery, and increase the quality of life, satisfaction and comfort of both patients and families. The programme ensures sustainability of services in cooperation with the central and local governments. As of 2018 end, 1,600 service teams reached out 1.25 million patients. The target is to reach 1,800 service teams and 1.35 million patients in 2019. To guarantee access to healthcare services as a fundamental human right, Universal Health Insurance Scheme (GSS) was introduced in 2006. Universal Health Coverage implementation started in 2012 with the payments of the GSS premiums by the state for those who could not afford it. Major progress was made in the preventive and therapeutic healthcare services to refugees and migrants with the same quality and access conditions as Turkish nationals. In this regard, improvements are made for the provision of primary and secondary healthcare services, TACs are established and MHCs as well in the places densely populated by migrants. In 29 provinces, a total of 688 migrant health units opened in 178 MHCs which also employ foreign healthcare staff. “Regulation on Work Permits of Foreigners under Temporary Protection” and “Regulation Amending the Working Principles and Procedures for Foreign Professionals Employed in Private Healthcare Institutions” were issued to allow healthcare staff from the same nationalities as the refugees to work in these centres. The e-Pulse application, launched in 2015, is a personal medical record system that provides citizens with access to their medical histories through online and mobile devices. Through the e-Pulse system, medical professionals may access the medical records of patients, which helps increase the quality and rapidness of diagnosis and treatment processes, once authorization granted by the respective patient. Rational Medicinal Drug Use Action Plan, implemented in 2014-2017, aimed to raise awareness among healthcare staff and the public, to monitor the quality and the use of drugs and medical devices as well as the effectiveness of spending on them. One of the key objectives of the Action Plan was to reduce the use of antibiotics. During the implementation of the Action Plan, the daily dosage of antibiotic use per 1000 persons decreased from 40.5 in 2015 to 35.3 in 2017, respectively. The Health Institutes of Turkey was established in 2014 to strengthen and drive R&D activities in the field of health. Tasked with coordination of pricing, public procurement, public support funds, commercial and medical technology policies, data management and dialogue with the private sector, the Healthcare Industries Steering Committee was set up in 2015. In line with the holistic approach taken towards basic healthcare services, the Programme for Promoting Multi- Stakeholder Engagement in Health was launched in 2014. It adopted a multi-stakeholder approach to engage all relevant actors in healthcare. The first phase of the programme focused on preventive healthcare and services for improving well-being while the second phase was designed to mobilise therapeutic and rehabilitative healthcare services. Metropolitan Municipalities of Istanbul, Kahramanmaras and many other municipalities offer home-based healthcare services and elderly support programmes. In addition, Metropolitan Municipality of Istanbul provided 1,200,985 times home-based nursing care services until today. As part of healthcare funding, efforts are underway to increase the share of the private sector in the field of healthcare. As of 2017, 37% of all hospitals were privately owned; and the number of private hospitals rose from 47,143 in 2016 to 49,200 in 2017. Health-Disaster Coordination Centre (SAKOM) was established to mitigate and manage risks related to external factors associated with disasters on health. SAKOM made a major progress achieved in this field. National Medical Rescue Team (UMKE), composed of specialised volunteer medical professionals, offers emergency medical care and rescue services in times of extraordinary circumstances and natural disasters. The number of volunteer medical professionals and the quality of its medical teams specialising in different branches that makes UMKE one of the world’s leading medical rescue organisations. 62 TURKEY’s 2nd VNR 2019 SUSTAINABLE DEVELOPMENT GOALS “Strong Ground towards Common Goals”
NEXT STEPS: The following policies will be implemented in the upcoming years to achieve SDG 3: • Keeping up the valuable efforts undertaken in the field of maternal, child and adolescent health, • Scaling up training programmes aimed at improving reproductive health and raise awareness, • Combating communicable diseases and risk factors, increasing the number of partnerships with local administrations in this field, • Developing programmes and expanding services to promote preventive healthcare services and healthy lifestyles, • Increasing awareness, facilitating access to treatment and rehabilitation services, and scaling up social integration mechanisms in the context of combating drug addiction, • Developing projects to reduce the use of tobacco and tobacco products, • Improving the quality of healthcare service provision, scaling up services such as family practice, • Enhancing the physical infrastructure for healthcare services in terms of quality and quantity, • Generating data at international standards and quality to develop data and evidence-based healthcare policies, • Effectively maintaining the efforts in multiple sectors to combat non-communicable diseases, • Increasing the employment and qualifications of healthcare professions considering demand and supply, • Raising awareness among healthcare staff and the public on rational medicinal drug use, and reducing the use of antibiotics. 63 TURKEY’s 2nd VNR 2019 SUSTAINABLE DEVELOPMENT GOALS “Strong Ground towards Common Goals”
5.4. SDG 4. ENSURE INCLUSIVE AND EQUITABLE QUALITY EDUCATION AND PROMOTE LIFELONG LEARNING OPPORTUNITIES FOR ALL Turkey has in recent years made significant progress in access to education and increase in the quality of education via improved teachers’ qualifications. In the education system, a transformational programme is implemented to develop personalities and abilities of individuals through equal opportunities. Ensuring access to inclusive and quality education based on equal opportunities and lifelong learning facilities is one of the most important policies in achieving all SDGs, namely reducing poverty, qualified employment, and realising economic growth. POLICIES In addition to NDPs and strategic plans of relevant public institutions, key policy documents on SDG 4 include MoNE Strategy and Action Plan, Lifelong Learning Strategy, Vocational and Technical Education Strategy and Action Plan, Vision 2023, Teacher Strategy, and National Employment Strategy and Action Plan. The key components of the policy framework in line with SDG 4 are as follows: • Increasing the schooling rate at all levels of education, • Ensuring access to school and equal opportunities in education for all children, particularly for those with disabilities and girls, • Enhancing the quality in education, especially in the fields of teacher qualifications, educational environment, curricula, and institutional capacity, • Ensuring the integration of technology with education, • Expanding and implementing preschool education with a holistic approach, • Meeting physical infrastructure and teacher needs in preschool education, • Developing vocational education programmes of such quality and type as needed by the labour market, and adjust the content of secondary and higher education accordingly, • Focusing on applied training in raising skilled labour force, • Increasing skill-building and vocational activities, • Maintaining a quality-focused transformation process based on equal opportunities that strengthens the coherence with the labour market in the framework of lifelong learning approach, • Increasing lifelong learning opportunities for vulnerable segments, • Preventing early dropouts in education, reduce absenteeism, and ensure individuals out of education return to education, • Strengthening human and physical infrastructure to ensure that persons with disabilities in need of special education and gifted individuals receive education in suitable settings in line with inclusive education, • Increasing the share of private sector in education financing, • Ensuring continuous personal and professional development of teachers. LEGISLATION Our legislation includes regulations in place to ensure the right to access free and quality education based on equal opportunities. As per the Basic Law on National Education, each individual, regardless of gender, has equal right to access to quality education in educational institutions. Our legislation provides facilities including free boarding, scholarship, education fee and loan aids to students with financial limitations, to receive education up to the highest education levels. Our legislation also has regulations in place to ensure that individuals, who have significant differences in their individual and developmental characteristics and educational capacities from the expected level from their peers, have equal access to education with specifically trained personnel, as well as enhanced education programmes and methods in suitable settings. IMPORTANT DEVELOPMENTS AND IMPROVEMENT AREAS SDG 4 is assessed on three focus areas: i. Access to quality education; ii. Equal opportunities for education; and iii. Vocational education and lifelong learning. To ensure quality education, schooling rates were increased, human and physical infrastructure improved and the number of students per classroom reduced, the curriculum updated, special attention was given for in-service training of teachers, and funds increased for all levels of education. The number of students and net schooling rates were improved through the increased duration of compulsory education first to 8 years, then to 12 years between 2000-2016. Additionally, students were enabled to attend open education in secondary school. 64 TURKEY’s 2nd VNR 2019 SUSTAINABLE DEVELOPMENT GOALS “Strong Ground towards Common Goals”
As a result of the increase in access opportunities, the average education duration increased to 7.6 years while expected years of schooling increased to 17.7 years. With the impact of the efforts, practices and projects undertaken for purposes of the access to education, the net schooling rate which was 91% in primary education and 50.6% in secondary education in the academic year of 2002- 2003 was increased to 96.1% and 83.6% respectively in the academic year of 2017-2018. The access to higher education also increased and the net schooling rate in formal education for age 18-22 increased to 45.6% as of the academic year of 2017-2018. With 16 public and 4 foundation universities founded in 2018, the total number of universities increased to 207 and that of higher education students exceeded 8 million. Thus, it became the second country with the highest number of students in higher education in Europe. As a result of the efforts to expand early childhood education, there was significant progress in the access to preschool education. The net pre-schooling rate which was 11.7% for ages 4 and 5 in the academic year of 2002-2003 increased to 50.4% in the academic year of 2017-2018. The transition is in progress from double-shift instruction to full-day instruction to increase the quality in education. The rates of primary school, lower secondary school, and secondary school students who were in full-day instruction in 2013-2014 were 43%, 49%, and 76.5%, respectively and increased to 58.7%, 66.4%, and 93.2% respectively in 2017- 2018. With new classrooms commissioned recently, there has been significant improvement in terms of the quantity of learning settings. The number of students per classroom which was 39 in primary education and 27 in secondary education in the academic year of 2002-2003 decreased to 24 and 21 respectively in the academic year of 2017-2018. Steps were taken to increase the access and continuously improve the quality in all schools regardless of school type to reduce the quality difference between schools. The Education Vision 2023 involving a transition from quantity to quality in education was published. The Higher Education Quality Board was founded in 2018 as an administratively and financially autonomous body to internalise and expand the culture of quality across higher educational institutions. For purposes of improving the education processes, the number of teachers was increased, the Teacher Strategy and Teacher Competences Framework published, performance system efforts initiated, and education programmes updated at all levels in line with needs. All schools across the country have access to basic utilities including water, hygiene, electricity, internet etc. White Flag Certificate was institutionalised to encourage sanitation and hygiene at formal and non-formal educational institutions as well as to improve overall school health. The White Flag Certification was awarded to 5,943 schools in 2016, 10,810 schools in 2017 and 9,340 schools in 2018. In 2017, the System of Standards for Preschool and Primary Educational Institutions was formed to assess service offered in pre-schools and primary schools based on minimum specified criteria, collect data, and use findings in rehabilitative efforts. School administrators, teachers, parents and children assess the quality of educational services provided through this system. The education programmes were renewed to convey values including justice, peace, friendship, respect and love to students under relevant disciplines in 2016 by MoNE. Strengthening Democratic Culture in Primary Education project initiated in 2018 aims to incorporate a democratic school culture involving the universal fundamental values concerning students, school personnel and families as well as fundamental rights and freedoms into the education system, and to strengthen democratic culture practices across society. In September 2018, a cooperation protocol was signed between the Ministries of National Education, of Interior, and of Family, Labour and Social Services to enhance safety in schools and surroundings. “Come Out, Let’s Play” project launched in 2010 by MoNE in cooperation with NGOs. Within the framework of the project playgrounds at school premises were constructed that allowed children to improve their creativity and communication skills. During the implementation period of the project, that took place between 2010-2014, playgrounds were established in 500 schools located in 50 provinces. Starting from 2014, annual education financial support was allocated to students attending private schools for all levels of 65 TURKEY’s 2nd VNR 2019 SUSTAINABLE DEVELOPMENT GOALS “Strong Ground towards Common Goals”