69
order to build and sustain political buy-in and support and make reforms more sustainable. To that
effect, the MoH proceeded in three steps: (1) focus on “quick fixes” of the most important issues which
would yield visible results important to patients as well as the general population; (2) then implement
systematic reforms in order to improve performance; and (3) focus on long-term issues such as the
structure of the ministry in order to match new roles and responsibilities. Frequent field visits by a
multi-disciplinary field coordination team (FCT) that frequently included health directors from
different provinces helped communicating and overcoming challenges as well as building capacity and
acceptance for the reforms. Other measures for ensure buy-in and accountability were the
establishment of formal and informal feedback mechanisms such as regular monitoring reports and a
telephone hotline for patients, as well as passing responsibilities for following up on patient
complaints directly onto Deputy Provincial Health Directors and Deputy Hospital Directors.
One particular area in need of improvements is the quality of diagnostic and curative care, in hospitals
specifically. Furthermore, the primary healthcare services need to be strengthened to face the new
health challenges presented by the epidemiological transition. For this an increase in the number of
family physicians and nurses, the continued skills development of health staff, and improvements in
physical and technical resources within primary health care is needed. Considering the large share of
informal workers, demographic and epidemiolocal transitions, Turkey need to prepare for the
associated rise of OOP expenditure and related financial sustainability of the reforms. The family
medicine programme could play a role here: responsible for primary care, clinical guidelines
particularly for the prevention of long-term conditions can help reduce prevalence rates and
associated costs to patients and the health system. A standardized national health information system
provide nationwide infrastructure for the efficient sharing of electronic health records is still in
development. This one integrated HMIS system, based on harmonized and standardized data
descriptions, would be more efficient.