Türkiye Kronik Hava Yolu Hastalıkları Önleme ve Kontrol Programı

Objectives

The 2018–2023 Türkiye Chronic Airway Diseases Prevention and Control Programme seeks to improve quality of life by preventing and controlling chronic airway diseases, particularly asthma and chronic obstructive pulmonary disease (COPD). It aims to reduce morbidity, mortality, disease burden and associated economic burden through integrated, community-based and cross-sectoral action that addresses clinical care, behavioural risks, environmental determinants and health inequalities.[1][2]

• Reduce exposure to tobacco smoke, indoor and outdoor air pollution, occupational hazards, allergens and other modifiable risk factors; promote physical activity, healthy nutrition and obesity prevention; and prevent respiratory infections.[2][3]
• Detect disease early, prevent progression and complications, and improve access to appropriate diagnosis, treatment, rehabilitation, home healthcare and follow-up for adults and children with chronic respiratory disease.[2][4]
• Increase public, patient, family, educational-institution and health-worker awareness of asthma, COPD, cystic fibrosis, childhood sleep apnoea and pulmonary rehabilitation.[5][3]
• Strengthen monitoring of disease burden and risk factors by measuring prevalence, incidence, morbidity and mortality; developing standardised data-collection methods; and calculating costs associated with medicines, emergency visits, hospitalisation and intensive-care admissions.[6][7]
• Promote equitable action on socioeconomic and environmental determinants through a Health in All Policies approach, including community empowerment, health literacy and patient involvement in care decisions.[1][8]
• Set specific improvement ambitions in selected areas, including annual five per cent reductions in tobacco use among people with asthma or COPD, annual five per cent increases in influenza and pneumococcal vaccination coverage, and a 25 per cent increase in relevant preliminary diagnoses recorded in primary care.[9][10]

Implementation

Implementation combines Ministry of Health leadership with a multisectoral GARD Türkiye structure, working groups, provincial boards, healthcare providers, public institutions, professional bodies and civil-society organisations. Delivery integrates population prevention, primary-care diagnosis and management, specialist referral, vaccination, rehabilitation, home care, public communication and environmental action.[1][11][12]

• Govern through a Deputy Minister responsible on behalf of the Minister, an Executive Board accountable to the Ministry of Health, a stakeholder General Assembly meeting every three years, target-specific working groups, provincial GARD boards and a secretariat within the General Directorate of Public Health, Department of Chronic Diseases and Elderly Health.[4][11][12]
• Coordinate action with ministries responsible for education, environment, labour, energy, agriculture, social services and urbanisation, alongside the Social Security Institution, municipalities, universities, professional associations and non-governmental organisations.[13][14][15]
• Update and disseminate primary-care guidelines for adult asthma, childhood asthma and COPD; train physicians and other health personnel through face-to-face and online learning; and record tobacco, biomass and occupational exposure in primary-care information systems.[16][17][18]
• Expand prevention through tobacco-control enforcement and cessation support, vaccination for eligible risk groups, indoor-air standards, clean-air action plans, industrial and workplace air-quality measures, cleaner energy and public education.[19][20][21][14]
• Develop pulmonary rehabilitation and respiratory home-health services through pilots, guidance, accreditation, certification, caregiver education, multidisciplinary teams, discharge criteria and equipment standards.[22][23][24]
• Improve access to respiratory technologies and reimbursement arrangements by updating indications for oxygen concentrators, non-invasive ventilation, home mechanical ventilation and tracheostomy-related devices, while using MEDULA and the Family Medicine Information System to record relevant patient and prescription information.[25][26][27]
• Monitor implementation through data-collection protocols, three-monthly process follow-up, annual country and working-group reports, provincial GARD board reports and a final action-plan evaluation report. Indicators include surveys, training outcomes, materials distributed, media and web reach, programme outputs, service use, hospital attendance and length of stay.[7][28][29]
• Assess service outcomes through changes in awareness, diagnosis, guideline adherence, tobacco use, vaccination, exacerbations, emergency and outpatient visits, hospital admissions, hospital days, rehabilitation and home-care uptake, and patient and family satisfaction.[9][30][22][23]

Monitoring & Evaluation

The 2018–2023 plan establishes a monitoring and evaluation function focused on chronic airway disease burden, risk factors, programme implementation, awareness and service outcomes. It combines routine data collection, surveys, administrative statistics, provincial reporting, working-group reports and annual assessment, although many actions lack fully specified baselines, surveillance definitions or independent evaluation methods.[1][2][6][7]

• Monitor prevalence, incidence, morbidity, mortality, disability-adjusted life years, risk-factor exposure, treatment use, emergency visits, hospital admissions and intensive-care admissions, alongside calculation of the economic burden of medicines and healthcare use.[6][7][31]
• Develop standard methods and data-collection protocols for reliable routine information, compile programme outputs, prepare annual country reports and publish a final action-plan evaluation report.[2][5][6][7]
• Collect progress indicators through working groups, which identify monitoring and scheduling measures, establish protocols, report annually to the General Assembly and operate with coordination from the Ministry of Health’s Department of Chronic Diseases and Elderly Health.[12]
• Review implementation through the Executive Board, which manages overall strategy and examines working-group proposals, and through a General Assembly that meets every three years to consider action plans, reports and activities.[4][11]
• Coordinate provincial implementation through boards chaired by provincial health directors or deputies, with provincial reports and local GARD Türkiye activities contributing to oversight and dissemination.[12][32]

The plan uses a mixture of outcome, output and process measures. High-level outcomes include reducing morbidity, mortality, disease burden and economic burden, improving quality of life, reducing hospital admissions and strengthening early detection, treatment adherence and rehabilitation.[1][2][33][34]

• Track awareness through baseline and follow-up surveys among the public, children, health workers and teachers; disseminate results to stakeholders, the public and the media; and use findings in GARD Türkiye objectives.[28][35][36][37]
• Measure communication outputs through numbers of printed materials, awareness events, media appearances, web-page visits, provincial-board reports and participation in training activities.[6][29][38][39]
• Assess training through pre-test and post-test results, attendance, distance-learning scores, field research, feedback reports and institutional statistics; one activity sets a 70% improvement in post-training scores, while paediatric respiratory training specifies an 85% improvement target.[18][40]
• Monitor primary-care practice through guideline publication and distribution, research in 2020 and 2023, and intended annual increases of 5% in COPD and childhood-asthma diagnoses and in guideline-consistent treatment adherence.[17]
• Record occupational, tobacco and biomass exposure at least annually in primary-care information systems and track tobacco-related brief interventions through Ministry of Health, Social Security Institution and central health-information statistics.[18]

Condition-specific monitoring includes asthma-control measures such as symptoms, reliever use, activity limitation, exacerbations, respiratory-function tests and validated questionnaires, with review every four weeks until control and then every three months.[41]COPD monitoring includes spirometry, symptoms, functional capacity, comorbidities, exacerbations, complications, health status and mortality.[42][43][44]

• Track smoking and vaccination among people with asthma and COPD through fieldwork, Ministry of Health and Family Medicine Information System statistics, aiming for annual five per cent reductions in tobacco use and annual five per cent increases in influenza and pneumococcal vaccination coverage.[9][30]
• Measure early detection through primary-care and hospital-system data, including a target to increase relevant preliminary childhood respiratory diagnoses by 25% compared with earlier records.[10][45]
• Monitor home healthcare and pulmonary rehabilitation through service-user numbers, accredited centres, trained or certified personnel, emergency and outpatient attendance, hospital admissions and length of stay.[22][46][23][47]
• Assess selected home-care models against targets for reduced emergency and outpatient use and hospital days, including specified 20% and 30% reductions, and targets for increased personnel and patient coverage.[46][48][23][49]
• Track air-quality actions through provincial reports, emissions measurements, clean-air action plans, national inventories, immission and emission monitoring, local GARD reporting and periodic online follow-up.[13][50][14][51]

National evidence sources include mortality statistics from the Turkish Statistical Institute, causes-of-death data coded under the International Classification of Diseases, 10th Revision, national disease-burden studies, chronic-disease surveys, Global Adult Tobacco Surveys and regional asthma and COPD studies.[52][53][54][55][56][57]Reported indicators require cautious interpretation because disease frequency and mortality measures can be affected by underdiagnosis, inconsistent terminology, variations in spirometry practice, awareness campaigns and differences in data quality.[58][59][60]

Formal accountability is strongest where responsibilities are allocated to the Deputy Minister, Executive Board, Ministry of Health, working groups and provincial boards.[4][11][12]However, the available material does not consistently specify numerical targets, reporting templates, data-quality assurance procedures, sanctions for non-performance, independent evaluation arrangements or a consolidated surveillance framework across all interventions.[2][5][3][6]

Costing & Financing

Financing detail is limited. The plan identifies reducing the economic burden of chronic airway diseases as an objective and calls for calculation of costs related to medicines, emergency care, hospitalisation and intensive-care admissions, but it does not provide a national respiratory-health budget, funding gap, financing schedule, allocation by activity or economic costing assumptions.[2][6][7]

• Mobilise human and financial resources through the Global Alliance against Chronic Respiratory Diseases framework to support national chronic airway disease programmes and prevention activities.[34][61]
• Use reimbursement arrangements for eligible influenza and pneumococcal vaccination, while the Ministry of Health purchases influenza vaccine for health personnel and provides it free of charge.[62]
• Update reimbursement indications and service arrangements for oxygen concentrators, non-invasive ventilation, home mechanical ventilation, nebulisers and tracheostomy-related equipment, with the Social Security Institution involved in relevant activities.[25][63][26]
• Recognise that COPD generates direct costs for diagnosis and treatment and indirect costs through disability, lost work, premature death and household expenditure; costs rise with disease severity.[64]
• Use tobacco taxation as an economic tobacco-control measure, with cigarette tax reported at 85.3% of pack price in 2018; cessation services and the ALO 171 advice line are reported as free to users, without stated funding sources or delivery costs.[65]

International burden figures are reported for contextual purposes rather than as a Türkiye-specific plan budget: respiratory diseases represented 6% of health-service budgets in European Union countries, COPD represented 56% of respiratory-disease costs, and COPD-related expenditure was reported as 38.6 billion Euro.[64]United States estimates for 2002 were 18 billion US dollars in direct COPD costs and 14.1 billion US dollars in indirect costs.[64]The material also notes comparatively high public health expenditure and broad reimbursement coverage for essential medicines in Türkiye, without quantifying respiratory-health allocations.[21][66]