Foundation of Ministry (1920–1946) Continuity and organization of healthcare were a key focus in the
Seljuk-Ottoman medical tradition. Following the foundation of the
Grand National Assembly of Turkey, the Ministry of Health was established on 3 May 1920. The main goal of this initial period was to heal the wounds of the war and to build the legislation rather than developing a regular registration system. After the Republic was proclaimed, Dr.
Refik Saydam held the ministerial office until 1937. Saydam contributed to the design and development of healthcare services in Turkey. In 1923, healthcare services were delivered at governmental and municipal facilities. The country had 86 hospitals and 6.437 patient beds back then. During this period the Law on Practice of Medicine and Medical Sciences (1928) and the Law on Public Hygiene (1930) were adopted. These two and similar other laws are still in effect. The health policies during this era had four main pillars: • Plan, design and implement healthcare centrally, • Organize preventive care at central level and curative care at local administrations, • Raise the appeal of medical faculties to citizens to increase the number of health workers and enforce mandatory service for medical faculty graduates, • Launch programs to fight against communicable diseases like
malaria,
syphilis,
trachoma and
leprosy. Under these pillars, healthcare services were based on the "single-purpose care in broad geography - vertical organization" model. Legislation was developed to promote preventive care and local administrations were encouraged to open hospitals. The objective was to have a government physician in every district. Starting from densely populated settlements, diagnostic and treatment offices were opened in 150 district centers in 1924 and 20 more in 1936. The salaries of physicians providing preventive care were raised and they were forbidden to engage in private practice.
National Health Plan and Program (1946–1960) The "First 10-Year National Health Plan", the first written
health plan of Turkey, was adopted at the Supreme Health Council in 1946. The plan was announced by the Minister of Health Dr.
Behçet Uz in 1946. It took nearly one and a half year for the National Health Plan to become a draft bill. It was approved by the
Council of Ministers and at four different Parliamentary committees. However, the bill was not enacted because of the change of government. Although the National Health Plan and the National Health Program were not entirely implemented in the form of a law, the two documents deeply influenced the healthcare organization around the country. The basic approach was to centralize inpatient facilities that had been controlled by local administrations. The Plan aimed to expand healthcare to rural areas by establishing a 10-bed health center for every 40 villages. The care design of these facilities consisted of delivering preventive and curative services together. By design, each facility included two physicians, one health officer, one midwife, one visiting nurse and a village midwife and a health officer for every 10 villages. The number of the health centers was 8 in 1945, 181 in 1955 and 283 in 1960. The Maternal and Child Health Section was established at the Ministry of Health in 1952. A Maternal and Child Health Development Center was established in Ankara in 1953 with assistance from
UNICEF and
World Health Organization. In this period, pro-natalist policies were adopted due to high rate of child and infection related mortalities. Therefore, Turkey continued to increase the number of health centers, maternity facilities and infection prevention centers and strengthened its corps of health professionals. In 1954, the Minister of Health announced the "National Health Program and Health Bank Studies". Following on the First 10-Year National Health Plan, the Program provided the building blocks of healthcare planning and organization in Turkey. The National Health Plan split the country into seven health regions (i.e.
Ankara,
Balıkesir,
Erzurum,
Diyarbakır,
İzmir,
Samsun and
Seyhan). On the other hand, the National Health Program divided the country into 16 health regions. After
İstanbul and
Ankara universities, the medical faculty of
Ege University started admitting students in 1955 in order to strengthen the health workforce. The number of physicians, nurses and midwives increased more than 100% in 10 years. To address the challenges, the
World Bank has supported Turkey's Health Transformation Program since 2003 with two Adaptable Program Loans (APLs). The Bank also provided technical guidance, and shared the experiences of other countries. The Plan included the following targets under the title "Health for All": • Reorganize the administration and functions of the Ministry of Health, • Cover all citizens under
universal health care, • Merge all health facilities under a single body, • Grant administrative and financial autonomy to hospitals, • Introduce family medicine, • Attach special focus on maternal and child health, • Expand
preventive healthcare, • Promote private sector investment in healthcare, • Delegate powers to lower levels in all public institutions, • Address shortage of health professionals in priority development regions • Launch
digital transformation in health. The Program was developed and launched in early 2003 based on the earlier experiences including socialization and subsequent health reform efforts. Complaints about long waiting lists decreased. Patients stranded in hospitals for failing to pay the bills became a thing of the past as the main concern was the provision of social insurance and
universal health care. After addressing the emergency transportation issues, demands were now focused on qualified intensive care unit beds in sufficient numbers. The
60th government of Turkey added three more points to HTP which are the promotion of
healthy lifestyle, mobilizing stakeholders and multi-dimensional health responsibility for intersectoral collaboration and deliver cross-border health services which will for furthering Turkey's position internationally. In 2003, only 39.5% of the population was satisfied with health services, whereas by 2011 this proportion had increased to 75.9%. In the same period, the overall health workforce increased by 36 percent, growing from 295,000 to 460,000. == Organization ==