In 2019, it was estimated that the probability of a premature death between 30 to 70 years of age from the four target NCDs (cardiovascular disease, cancer, diabetes, chronic respiratory disease) in Hungary was 22.1% (vs. 16.3% European average).[1] In the biennial collaborative agreement between WHO and Hungary in 2018-2019, one of the key roles for WHO Country Office (WCO) Hungary was to provide high-level guidance on NCD policy and control. In 2019, WCO was involved in a pilot project to test out the collaboration between WCO, National Koranyi Institute of Pulmonology (NKIP), and local governments for NCD prevention at the community level.
Inspired from another partnership between the NKIP and local governments for providing specialised health care to the communities in the surrounding area of Buda region, WCO reached out to the Institute to see if WHO can partner with them to replicate a similar model, but for the goal of NCD prevention. WCO identified key opportunities to mobilize existing strengths and infrastructure in Hungary. For example, cardiologists at the Institute have not only been providing clinical care but simultaneously promoting heart health (and hence, NCD prevention) in consultations and post-treatment for outpatients. Plus, while the NKIP was not working extensively with local communities since its mandate is on tertiary care and national-level training and research, it was well-positioned to facilitate community engagement. When the WCO introduced the idea to the Ministry of Human Capacities (responsible, among other sectors, for health care services), it was extremely well-received and in line with their strategic planning for NCD prevention in subsequent years. WHO’s proposal and seed funding encouraged the MoH to seek further investments from within the government and NKIP and WHO’s involvement established credibility of the initiative amongst local populations. What started out as a small collaboration was gained more traction.
WCO then met with local government representatives from the Association of Buda-Region of Municipalities, a collective of small localities, NKIP, and the MoH. Once focal points were identified from each of the institutions, the WCO met with local representatives to conduct resource mapping at the ground level. Recognizing that a one-size-fits-all approach was not going to be effective nor efficient for these small towns with various local economies, WCO and the project team went so far as learning about the localities at the individual level, examining how many physical education teachers and counsellors there were, to assess human resources capacity for the implementation of the project in the towns. The project served to demonstrate that, from a clinical governance perspective, national health institutes can be the driving force of a public health program. These institutions can build on their reputation to involve important stakeholders to successfully implement public health programs. The project also demonstrated that commitment at the local level is crucial for building a network of different partner organizations, a process that needs patience, endurance, motivation, creativity, flexibility, courage and “out of the box” thinking.
The project brought to life a novel approach in Hungary as it promotes partnership-based health program, with involvement of local and central government, health providers and other local actors such as schools. The credibility that the Programme has built can serve for sustainable fundraising in the near future. Evidence-based interventions, managed efficiently and in a coordinated, inclusive way will provide the expected return of investment in the improvement of the health of the population.
Lessons from the Buda Region Health Program and impact on broader NCD prevention initiatives in Hungary
This project resulted in the following lessons that influenced other NCD initiatives, which will have long-term impacts on population health. Although the initial plan was to start with a national policy discussion that would dictate the directions of the projects, the opposite was implemented in practice. The pilot project involving 12 municipalities was completed first, in order to inform the larger, national conversations around policymaking for NCD prevention. This approach revealed two crucial factors that enabled the success of this project: 1) NKIP has a great reputation and is trusted by communities and 2) working with smaller towns and communities reduced potential conflicts that are common when working in much bigger locales. This strategy, starting small with the communities with the backing of trusted partners like the NKIP, will be an important reference model for NCD prevention in Hungary. In fact, it has already laid out the ground work and sparked the NCD prevention program called “Three Generations for Health,” which was recognised for its added value through the third prize of the European Union Health Award in March 2021. It has also informed the NCD prevention programmes targeted for mental health and healthy aging in the wake of the COVID-19 pandemic.
Throughout 2019-2020, WHO has taken a life-course and multisectoral approach, with an emphasis on building local relationships to support a sustainable development in the area of NCD prevention. These efforts are testament to the commitment and investment by the Hungarian government, national partners like NKIP, local governments, and WCO to prevent NCDs and undoubtedly contribute to WHO’s vision for another billion towards better health and well-being in 2019-2023.
Photo caption: Enhancing community participation to health prevention: the founding event of the Buda Region Health Program, May 2018.
Photo credit: Judit Pako
