Ivan Erzen on establishing Slovenia's first comprehensive NPHI

Dr. Ivan Erzen

January 23, 2015

Dr. Ivan Erzen is currently chair-holding Professor of Public Health at the Medical Faculty in Maribor, and Director of the National Institute of Public Health in Slovenia. IANPHI spoke with him at the 2014 IANPHI Annual Meeting about the Institute's recent merger, and the successes and challenges of such a major change. Read the full interview below:

IANPHI: Could you outline the past 8 years (at NPHI) and the process that took place?

IE: In the beginning, there was a lot of talking, and searching for a suitable model for Slovenia, and it was apparent that the interest of regional institutes was mostly in the laboratory services, and their focus was on the laboratories’ accreditation and investment in new technology.  Because of this, we didn’t have enough time and resources for public health.

I was very keen to change this. Others believed that laboratory services were the only way to gain the money needed to invest in public health development.  However, I believe that for Slovenia, this wasn’t true. In fact, because there were so many laboratories, they were not economical anymore. Some of the resources we got from the Ministry for public health activities were put into the activities of the laboratories, Rather than to public health issues.  Previously, the nine laboratories competed among themselves, because Slovenia is a very small market, but now that we have one NPHI, the situation is different. They don’t need to compete any more, and they can organize the laboratory activities more effectively. So I think that in a few years, the people will get much more for their money that it was before. So this is a good solution.

IANPHI: How did the merger impact the implementation of PH programs in Slovenia?

IE: Before merging into one organization, we had very good experts and programs - very successful, very interesting programs - but we were developing 9 different programs to combat smoking, alcoholism and other issues because each of the nine organizations was creating its own, and this is a waste of resources.  It was fragmented; there was no national coordination, so the institutes were allowed to work like this.

So we had a few very good programs that were available only in certain parts of Slovenia and we didn’t address other PH issues that were emerging.  However, now we have the possibility to do this, with a total of over 400 staff, rather than trying to manage all of the national public health priorities from the smaller Ministry of Health staff.

IANPHI: How did merging into one institute affect the staff?

IE: It was challenging to transition all of these people from separate entities to working together, and through the process we found that the level of public health knowledge and expertise among the staff was quite varied. Some staff had studied public health in medical school and were extensively trained, whereas others lacked basic public health skills. Initially, we were concerned that people may not have positive responses to a standardized training and redefined roles now that we are all in one institute, but as I see it now, they are willing to change. They are very constructive and have prepared a national working plan for special fields, for example mental health, and we have established a group of experts, who are working now on this issue, and are developing everything from surveillance to program development in order to reduce the burden of different public health problems.

Previously, when ideas were developed, proposals were offered to the Ministry of Health, but now it’s decided that we are responsible for ensuring that those programs we propose will also be implemented, so we have to consider how to implement: do we have the infrastructure, do we have the people who will work in this field? It’s important to talk about the process. The process does not end with the proposal, but the process ends with the evaluation of the implemented program. So this is the whole process that we need to establish and that we should care about.

IANPHI: You spoke a little bit about some of the challenges of this transition and shifting over to the new institute, could you highlight what some of the greatest challenges to overcome have been, and how you’ve overcome those?

IE: We haven’t yet. The greatest challenge is the knowledge and expertise of the staff, because, as I’ve mentioned, there are a lot of differences. I thought that addressing this issue would go much faster, but it takes a lot of time. Our next challenge to tackle is to even out the levels of the skills and knowledge. This is our responsibility, because we are also engaged in education of future public health workers, and we haven’t been very successful in this field. The program is quite good, but the implementation of the program in reality is not so good. So, we will work in the immediate future especially on the education of our staff, so we will start with quite basic knowledge that they need to have. 

The other challenge which is also very important to address in the near future is communication. Communication in public health is a crucial tool. I feel that we haven’t put enough effort in this in the past, but we didn’t have all the possibilities that we have today, which enable us to communicate with different groups of the population. We didn’t have an approach to reaching certain groups, like people who don’t hear, or who don’t see, , so we want to develop communication plans that will cover all groups, using all of the tools that are available in modern technology. In order for the public to trust us, it is very important that we communicate in the right way so they understand us and feel that we can be trusted.  

These two things: communication and addressing the varied levels of knowledge of our staff, are the two greatest challenges we are working to overcome.

IANPHI: Thank you for your time, we look forward to seeing the continued progress and advancement of your institute.

IE: Thank you.

Dr. Ivan Erzen