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Table 2 Administrative tiers, public health entities and system elements in Central and Eastern European countries

From: Reforming sanitary-epidemiological service in Central and Eastern Europe and the former Soviet Union: an exploratory study

country

administrative tiers

institutions

 

system

elements

 
   

financing

policy development

standard setting

management & administration

Albania [29]

Central

Ministry of Health (Public Health Department; Chief Sanitary Inspector)

x

x

 

x

  

Institute of Public Healtha

  

x

 
 

Regional (prefectures)

n/a

    
 

District

District Public Health Directoratesb

   

x

 

Local (municipality)

n/a

    

Bulgaria [30, 31]

Central

Ministry of Health (Principal State Health Inspector)c

x

x

 

x

  

National Centre for Public Health Protectiond

  

x

 
  

National Centre for Infectious and Parasitic Diseases

    
 

Regional

Regional Inspectorate of Public Health Protection and Inspection (RIPHPI)

   

x

 

Local (municipality)

n/a

    

Czech Republic [17, 32]

Central

Ministry of Health (Chief Public Health Officer; Department of Hygiene, Epidemiology and Microbiology)

x

x

 

x

  

National Institute of Public Healthe

  

x

 
 

Regional

Regional Public Health Authoritiesf

Institutes of Public Healthg

   

x

 

Local (municipality/community)

n/a

    

Estonia [25, 33, 34]

Central

Ministry of Social Affairs (Public Health Department)

x

x

x

x

  

Health Protection Inspectorate (HPI)

    
 

Regional

County office of the HPI

   

x

 

Local

Municipal officesh

x

  

x

Latvia [24]

Central

Ministry of Health (Public Health Department)

x

x

x

x

  

Public Health Agencyi

    
  

State Sanitary Inspectorate

    
 

Regional

Public Health Centerj

   

x

Lithuania [36–38]

Central

Ministry of Health

x

x

x

x

  

State Public Health Service

    
  

Center for Communicable Disease Prevention and Control (CCDPC)k

    
 

Regional (Apskritys)

County Public Health Center

   

x

 

Local (municipalities)

Local branches of County Public Health Centers

    

Hungary [35]

Central

Ministry of Health, Social and Family Affairs

x

X

  
  

National Public Health and Medical Officer Service (NPHMOS)l

  

x

x

 

Regionalm

n/a

    
 

County

County Office

   

x

 

Local (municipality)

Municipal Office

    

Poland [39]

Central

Ministry of Health

General Sanitary Inspectorate (Chief Sanitary Inspector)

x

x

x

x

  

National Institute of Hygienen

    
 

Regional (voivodship)

Sanitary Inspection station

x

  

x

 

District (powiat, county)

n/a

x

   
 

Local (gmina, commune)

n/a

x

   

Romania [18, 40]

Central

Ministry of Public Health (Department of Public Health)

x

  

x

  

Public Health Institutes at Universitieso

National Center for Disease Controlp

National Institute for Research and Development in Microbiology and Immunology "Cantacuzino"q

 

x

  
 

District (judet)

District Public Health Authorities (DPHA)

   

x

Slovakia [41]

Central

Ministry of Health

x

x

 

x

  

National Office of Public Health

  

x

 
 

Regional

Regional Offices of Public Healthr

   

x

 

Local (municipal)

n/a

    
  1. a The Institute of Public Health (IPH) is a national body, responsible to the Ministry of Health.
  2. b De-concentrated facilities of the Institute of Public Health
  3. c The Principal State Health Inspector within the Ministry of Health provides technical oversight of public health services within both the heath care sector and other ministries such as defense, interior, transport and justice. The public health network is centrally managed and consists of 28 RIPHPIs and some specialist national facilities.
  4. d Part of the Public Health Network, providing methodological support for health protection and disease control, environmental health, occupational health, and food and nutrition policy for regional inspectorates, regulatory bodies, and laboratories.
  5. e The National Institute of Public Health undertakes research, provides technical advice on hygiene, epidemiology, microbiology, occupational health, environmental health, and health promotion; drafts proposed legislation, and participates in under- and post-graduate training.
  6. f Regional Public Health Authorities are responsible for epidemiological surveillance, logistical support for immunization programmes, and health inspections.
  7. g Regional Public Health Institutes undertake laboratory analyses, including support for Regional Public Health Authorities, evaluate living and working conditions and quality of consumer and industrial products.
  8. h Municipalities are responsible to monitoring compliance with health protection legislation and coordinating disease preventive programmes.
  9. i The Public Health Agency was created from the National Environmental Health Centre (which was the redesignated Sanitary Epidemiological System from the Soviet period)
  10. j Public Health Centers are the regional offices of the Public Health Agency
  11. k The CCDPC is responsible for epidemiological surveillance of communicable diseases (with the exception of AIDS, HIV, STDs and tuberculosis).
  12. l The NPHMOS is under the auspices of the Office of the National Chief Medical Officer and is supported by two national bodies: the Fodor József National Centre of Public Hygiene, with five national institutes covering occupational health, chemical safety, nutritional health, radiation safety and environmental health; and the Johan Béla National Centre of Epidemiology.
  13. M Regions are groupings of counties. Their creation has been controversial and they currently have only limited functions. This may, however, change.
  14. n The National Institute of Hygiene oversees scientific monitoring of biological, chemical and physical hazards to health, as well as undertaking research and training in technical and scientific aspects of surveillance.
  15. O Four institutes in Bucharest, Cluj, Iasi, and Timisoara are autonomous bodies accountable to the Ministry of Health, providing technical support on public health and related topics to ministries and other national institutions with health responsibilities. The Bucharest Public Health Institute elaborates national standards and regulations, provides technical coordination, and implements four programmes within the National Programme on Community Health.
  16. p Since 2005 National Center for Disease Control has operated within the Institute of Public Health in Bucharest. Its task is to integrate parallel surveillance systems and coordinate the national communicable diseases network, monitor immunization, coordinate a national system of early warning and rapid response, and manage a public health information system.
  17. Q Along with teaching and research activities this provides technical support to public health authorities and conducts epidemiological surveillance.
  18. r The Regional Offices are the successors of the State Health Institutes, dating from 2004. They have divisions of hygiene, epidemiology and occupational medicine and are responsible for health promotion and health protection, disease prevention and monitoring of environmental impacts on health.
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BMC Public Health

ISSN: 1471-2458

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