“Ministry of Finance needs to be a good listener” – Interview with Corina Pop, former Romanian State Secretary for Health

Corina Pop

Corina Pop (CP) served as Romanian State Secretary for Health from 2015 to October 2018. She coordinated the Project Implementation and Coordination Unit. At the EHFG plenary, she gave her perspective on “making the case for investment in health”. This interview is a follow-up on the heated plenary debate.

NP: During the plenary, you talked about the issue of ‘silo thinking’ and how to better understand the dialogue between health and finance decision-makers. We, as public health professionals, are sometimes in the position of having plans for a health project which we need to pitch to the finance ministry to convince them to allocate a budget for it. We would be interested to hear your take on such situations from the health perspective – how do you approach this challenge?

CP: First of all, I am a doctor, and I am not political. I am rather strictly a doctor in the position of the Ministry of Health. When I arrived at the MoH, one of the most important problems that I faced, and which is of particular interest to me, was that the doctors didn’t want to be involved in the projects. They are not interested in projects because running a project is very difficult. It is not like clinical or surgical medicine, or dentistry. It requires a type of work done by a civil servant. This means that you need to have a team, ideas, and you to spend a lot of time writing mails and talking about money and administration – this is why doctors do not want to be involved. I called everyone I know asking to help me run these projects because we had a reasonable amount of money at our disposal. For me, as a health system policy-maker, it means that you have to find both the resources and the beneficiaries. In order to promote your interests and projects, you need to convince not only the Ministry of Finance, but also the promoters who are the doctors, the managers of the hospitals etc. The promoters are especially interested in research and not in public health-related projects.

For example, I have an important project for Romania that I care about a lot. It is about health economics. As there is no specialist for health economics in Romania, I said ‘look we have to prepare a project: first, we need a curriculum and a methodology, then we need to find the professors, the teachers, the speakers, the experts, and finally we need to train and pilot the first 20-30 doctors or economists’. Even though I have written the guidelines and the programme, no one wants to run the project. And this is not only about the funding, it is also about the interest in public health.

BF: How do you think you could adjust this and make public health a more attractive specialty for doctors in Romania?

CP: It has to be specifically promoted during the undergraduate studies. What we need is for students to start learning about the importance of public health and health of the population as soon as they start studying medicine. It is important to talk about public health when talking about epidemiology in the first year. This way, the students have more options before they go the common way of choosing the surgical specialty which is associated with fame and lots of money. However, no one wants to talk about epidemiology, you know (laughs).

NP: Mr Hetemäki from Finland mentioned the issue of trust being a key factor for collaboration, which can only be based on a common understanding. Now adding that you also have to convince the promoters, how do you actually achieve this? 

CP: There are two dimensions. First, the evidence. Just saying ‘look I have a lot of evidence here, please give me the money’ is not enough to gain trust. Rather, you need to approach it by providing the evidence, i.e. number of saved women’s lives with cervical cancer. It is not like in a Disney cartoon in which you can achieve anything by repeating ‘please trust in me, trust in me’ (laughs). The second dimension is the team that will implement what you promise to do. However, I recently had a case of a very difficult and complex project in which the professionals were simply not able to promise to deliver a certain number of services. That is why the budgeting official said ‘OK, if you are not able to, you will not get the money’. It is very difficult to fight with the Ministry of Finance for trust. It is about the capacity-building and it is about the health workforce. That is why I said, ‘my wish for the Ministry of Finance is to be a good listener’, to have patience to explain that there is so much we can do, and this is not at all because we are unable. It is because health services are too complex. We have to be very patient and listen to the process. It should not be like in a marketplace: ‘how much do you want?’ ‘health spending is this much’, ‘which are the metrics?’, ‘OK, I won’t give any money’. This is impossible.

NP: Are there any tools to support you in convincing them?

CP: Yes, there are two partners you need. One of them is a very good journalist, always capable of presenting the problem. The second is the civil society, especially patient associations. Together with journalists and patient societies/associations, we can convince the Ministry of Finance. Not only with evidence, but with real life examples.

NP: I understand. We frequently hear the financial sustainability of healthcare systems being questioned due to challenges such as the aging population, unhealthy lifestyles and high prices of new medicines and technologies. In your view, what needs to be done to successfully address these challenges?

CP: The problems that require a lot of attention are related to innovation, ageing and costs of healthcare delivery. It should be taken case by case, though. Depending on the country, I can provide you with different answers. Regarding Romania, and the low-income countries, I have told you that it’s always about choosing between either prevention or treatment and diagnosis because all of these fall under the same budget. It is up to you to keep explaining the importance of keeping prevention high, because prevention will decrease the spending in the next 10 years. But the Ministry of Finance does not care about the next 10 years, especially if the elections are in 2 years. At the same time, you have to explain that it is impossible to spend only on prevention, because you have cases of cervical cancer that are happening right now, and need radiotherapy.

The problem is that they are not interested in prevention of lifestyle-associated diseases, because they do not understand the process from smoking and cancer to spending and expenditure. This is the process that we, as specialists, know all too well.

The budgeting officials are interested in taxing alcohol and smoking, but this money does not go to health. It means that you have to explain that we raise the taxes not only to gain more money, but also to prevent people form buying and consuming tobacco products, as well as to use that money to cure the already existing cancer. There needs to be a communication, one needs a lot of time to explain things that seem so trivial for us in public health.

BF: You were mentioning that these things are sometimes hard to explain. Do you think that the direct benefits that the health system has, such as contributing to people having longer lives and healthier lives, are measured enough in the current system? And do we communicate these benefits enough?

CP: Surely it is not communicated enough. And I think that everybody talks about aging, but everybody talks about what problems you have when you are elderly. No one talks about how beautiful it is to have your grandchildren and to be healthy at the same time. It means to explain that good health gives you the gift to be healthy when you are elderly. It means that you are healthy enough to help your family and community. We have to live well and have a high quality of life.

BF: This leads me on to the next question. Public health is actively working on well-being and safety of the entire population. Do you think that the entire health system takes this into account? Sometimes I feel we have a system that is geared around the financial aspect and doesn’t take into account the things which we cannot quantify.

CP: Yes, it’s interesting, we just discussed this one two hours ago. I think that the Sustainable Development Goals address exactly these ‘uncountable’ aspects. If we talk about any of the SDGs, none of them is only about numbers: they talk about quality, well-being, air, nutrition, communicable diseases, safety, patient safety, water, transport… So, yes, it’s exactly about the SDGs.

BF: So you see the SDGs as a useful tool to help you?

CP: Very useful, but they are not promoted enough by the policymakers. They understood they would need to take care about the SDGs, to fulfil the targets, but they don’t really care. If the policymakers were to read, but really read the SDGs, they would understand they are faced with a complete political programme, and a very beneficial one. It is so complete, it is so about people, it’s so social, at the same time addressing health, economy and inequalities.

BF: Is there any way that the SDGs have influenced or inspired you in the way you’re tackling certain health issues in Romania?

CP: Yes, we had a lot of meetings. We had a meeting with Zsuzsanna Jakab in July about SDGs, it was very important for Romania, because she has the power to bring the politicians to the same table.

NP: Who participated, only health policymakers?

CP: No, the president of the country, the directors of the whole university, the rectors of the universities.

BF: Did she help you to get other people on board?

CP: Yes, certainly, she has the power to do that. She’s wonderful in doing something to get all the policymakers on the same table, and without punishing any, she convinced them that was important to work for health.

This interview was conducted by the Young Gasteiners Beatrice Farrugia (BF) and Nataša Peric (NP).

Welcome HEIDI

Mr. Hubel, Coordinator of Healthy Ageing, Disability and Long-term Care

Mr. Hubel, Coordinator of Healthy Ageing, Disability and Long-term Care

Who is Heidi? Heidi is a little girl living in the Swiss mountains with her grandfather and her stories are told in one of the most famous children books but this is not a story about her. It’s about: Health in Europe Information and Data Interface.

On Wednesday the 6th October 2010 DG SANCO gave a workshop at the European Health Forum Gastein introducing HEIDI. The innovative European health information system was presented and sources which will feed into the system introduced. In an interactive discussion, participants could express their expectations and needs, provide feedback and recommendations for a successful system.

Workshop participants engaged in lively discussions on HEIDI.

Workshop participants engaged in lively discussions on HEIDI.

One and half years later, on the 3rd of May 2012 HEIDI was launched, presenting reliable and comparable data on health in the EU. It is a Wiki platform, enabling health experts to write reports and create texts that can be uploaded on the site and later on edited. This can be done individually, if you are registered as an editor, without the help of an administrator, allowing information to be shared and involving the whole health community across Europe.

Information on health status, determinants, systems and policies can be founded on the site and can be organised and searched for by year, country or by region. Searching for keywords or specific topics is also an option or browsing the glossary containing reports from e.g. the EMCDDA, IARC or WHO. As a user you are able to create your own reports by selecting articles and graphs and put them in one single document which can be saved or printed as a pdf, if you wish to have a hardcopy.

HEIDI is an innovative and interactive databank sharing information on the most up to date health context created by experts.

“More access to self-service terminals for all – Digital Agenda”

The elderly, people with disabilities, people who might face difficulties in understanding a language, or reading and those that simply just forgot their reading glasses often face difficulties in everyday life accessing self-service terminals such as public transport ticket vending machines or public information kiosks and cash dispensers.
In order to make the life of this target population more convenient, the APSIS4All project has been funded by the EU to improve the access to those services for people being limited in their capability. In total, 3.41 million Euros are provided by the European Commission to develop personalized interfaces. In September 2011, cash dispensers will be implemented in Barcelona, Spain, while half a year later ticket vending machines will be introduced in Paderborn, Germany. In both cases those innovations are trials which will run for four years.
Is that the beginning of an improved environment and will this defuse into all the countries of the European Union and hopefully beyond?

FP7- an overview and update

The seventh Framework Programme for research and technological development collects all research –related EU initiatives together and has the goal of growth, competitiveness and employment. There are 4 overall categories:
•    Cooperation which includes health (budget: €32 billion)
•    Ideas (budget €7.4 billion)
•    People (budget €4.7 billion)
•    Capacities(budget: € 4.2)

This programme will run from 2007-2013 and it is considered to respond to Europe’s employment needs and competitiveness. The biggest ever funding package for the Work Programme for 2012 is ~ 7 billion Euros. This is thought to create new jobs and growth in GDP in the future. One project funded through FP7 is INTERLINKS which we have followed carefully as we are member of the sounding board and attended the conference in May.


Cancer Research UK supporting online cancer information

The internet has experienced an information explosion on cancer and related issues. In 2006, ‘cancer’ was even the third-most searched-for word on Google News. As an increasing number of people search for cancer information online, social websites become more and more relevant as a source of information. However, finding accurate and reliable cancer information is crucial. Especially Wikipedia is a key player in this context.

This is why Cancer Research UK, the leading charity dedicated to beating cancer through research, has started efforts to improve the quality of cancer information available on Wikipedia. The organization’s primary goal is to save as many cancer patients as possible. First steps to clarify the huge amount of information available have been made with the help of the Wikimedia’s UK branch through advice and training. So far, the edits made by the Cancer Research team have been well received by the Wikipedia community.