Organization of

Health Services
in Turkey
DR. TUTOR MEMBER IŞIL IŞIK
NHS 401 PUBLIC HEALTH NURSING
Republican Era Health Services
(1920-1945 )
After the establishment of the Republic, the first Minister of Health, Dr.
The basic principle adopted by Refik Saydam in the development of
health services has been to give priority to preventive health services.
Dr. According to Refik Saydam, the important thing is to “protect the
condition of healthy individuals”, therapeutic services are the duty of
local governments (municipalities).
Another principle of Refik Saydam was to give importance to the fight
against “important diseases”.
For that period, organizations were established to deal with diseases
such as malaria, syphilis and leprosy.
Republican Era Health Services
(1920-1945 )
One of the biggest step of the health process was realized with the idea
of combining preventive and curative health services that after the
begining of First World War in our country and the establishment of
health centers where daily services are provided.
In 1929, the first Public Health Dispensary in Ankara Etimesgut was
established and this organization brought preventive health services to
rural areas, later (1943) this dispensary was expanded, and health
services in villages were carried out by assigning students of village
institutes as health officers.
Organization

In this period, the form of organization was stated as "vertical

organization" and it was concerned with a single disease (trachoma,
malaria, syphilis).
Dr. Refik Saydam was involved in the organization of health services in
this period (1920-1945). It adopted the units of “Government Doctor”
as its basis.
Republican Era Health Services
(1920-1945 )
Tuberculosis, syphilis and leprosy war departments are attached to the
Government Medical Office.
Duties of the Government Doctor:
Fight infectious diseases
Forensic medicine
Free examination of poor patients
General management jobs
1945-1960 Period
In this period, although the health service principles and organizational
style of the previous period (1920-1945) continued, there were some
positive and negative changes.
First of all, the health level of the society deteriorated, epidemics of
malaria, typhus, smallpox and tuberculosis were seen, tuberculosis was
tried to be controlled by establishing tuberculosis associations, but the
success in the cities could not be achieved in the rural areas.
With the establishment of the General Directorate of Tuberculosis
Control in 1960, more successful results began to be obtained.
Behçet Uz Period
The country is divided into 7 health zones.
10-bed "health centers" were established for 40 villages in each region,
In each health center, 2 physicians, 1 nurse, 1 midwife, 1 health officer
and,
A midwife (group midwifery) and a health officer were assigned to every
10 villages.
This period was a period in which the principle of providing preventive
health services and curative services together was adopted and
implemented (integrated service) and the establishment of health
centers in line with this view, "based on the population of the society to
be served" was carried out in numbers.
Behçet Uz Period
Accordingly, in these centers established for every 200 thousand
population, “mobile health” service was provided to the people of the
region.
While maternal and child health services were provided in government
offices and hospitals in the first year of the Republic in our country, it
started to function as a separate center after 1952 as a result of
agreements with the World Health Organization and UNICEF.
The first change between the years 1950-1960 was the transfer of the
treatment services left to the local governments (municipalities) to the
Ministry of Health, the nationalization of the municipal hospitals and, as
a result, the re-orientation of the services in the direction of preventive
services to curative services.
Socialization of Health Services
(1960-1978 Period)
In Turkey, basic health services started to be carried out within the
scope of the “Law on the Socialization of Health Services” adopted in
1961.
TSH is carried out in accordance with the "Directive on the Execution of
Services in Places where Health Care is Socialized" published in
accordance with this law.
Principles of Law No. 224
1. Equal Service: Health It is an innate human right. Therefore,
everyone will benefit equally from its services "in accordance with
social justice".
2.Continuous Service: One of the principles of Law No. 224, which
determines our national health policy, is to provide service to everyone,
everywhere and at all times.
3. Integrated Service: Until 1961, health services in Turkey were
organized in accordance with the “one-way service in the wide region”
model.
Socialized health services, on the other hand, brought the principle of
"multi-directional service in a narrow area". In other words, these
services are multi-purpose: All preventive and remedial services will be
provided by the same unit. This type of service is called "integrated"
(Unified) service.
Principles of Law No. 224
4. Service: Patients should first apply to health institutions that provide
first-level services, and those who are not diagnosed and treated there
should be referred to secondary-level hospitals. Thus, unnecessary
patient accumulation in hospitals will be prevented.
5. Priority Service: The law on the socialization of health services
adopts the principle of giving priority to protective services in general
and to groups at risk in particular. Mothers and children are the leading
risk groups in the country.
6. Participatory Service: It is a principle suggested by the Alma-Ata
Declaration to consult the public at all stages and at all stages of the
planning and implementation of health services, and to work with the
public.
7. Team Service: It is a fact that health services are teamwork.
Principles of Law No. 224
8. Supervision service: In the law, the concepts of supervision and in-
service training are considered together.
9. Appropriate Service: It has been adopted that the technology used in
the socialization of health services should be suitable for the conditions
of the country, and the wage system should be suitable for the people's
ability to pay.
10. Service by Population: In the socialized health services, the service
units and the scope of the service are planned according to the
population criterion, although the district criterion was used as a basis
in the previous systems.
Organization
In provinces, the Governor is the chief of all health services, and the
health director carries out the services on behalf of the Governor.
The principle that all individuals benefit from health services equally has
been adopted.
The curative and primary care services are carried out by the team.
Organization within the province was established as a two-step model.
Health Centers where home and outpatient treatment and preventive
services are provided .
The second level is the hospitals where the patients referred from the
health centers will be cared for.
Preventive Health Services:
These services are divided into two as personal and
environmental .
Personal preventive health services are aimed
directly at individuals.
Protective services for the environment
(environmental health services) are to protect the
health of people by destroying and correcting
harmful physical and chemical factors in our
environment or by preventing them from affecting
people.
Personal preventive health services;
These are the services carried out by members of health professions such
as physicians and nurses.

immunization
Regulating nutrition
Early diagnosis and treatment of diseases
maternal and child health services
Control of excessive fertility
drug protection
personal hygiene
health education
Personal preventive health services;
Immunization: With immunization, which is the most
effective way to protect against communicable
diseases, individuals can be protected against diseases,
and the majority of the population can be immunized
against a disease and the disease can be controlled.
Medication protection: In some diseases, it is possible
to protect people in danger with medication
(chemoprophylaxis). For example, INH is given to the
child of a mother with tuberculosis, sulphamide is
given to the sibling of a patient with meningococcal
meningitis.
 Personal preventive health services;
Early diagnosis: The contemporary health phenomenon
is in the direction that it is easy and successful to cure
diseases that are diagnosed in their early stages.

Good nutrition: The predisposing cause of many

diseases is inadequate and unbalanced nutrition. Today,
it has been determined that tuberculosis is more
common among malnourished people, infectious
diseases exhibit severe clinical pictures in malnourished
people, and those who die from measles are more
common in malnourished children.
 
Personal preventive health services;
Family planning: As it is known, women who give birth frequently and
the children born to these women are unhealthy. At the same time,
many women either become disabled or lose their lives while trying not
to become pregnant or have a miscarriage after their pregnancy. Getting
rid of these negative situations is possible with the widespread use of
family planning services.
Health education: It is the process of efforts made to inform people
about how they can protect their own health, how they can benefit
from health services, and to gain positive behaviors.
Personal hygiene: It is the event of protecting and maintaining one's
own health, providing care and a sense of well-being. At the same time,
it is the services of helping people acquire the necessary care habits
that will improve personal health.
Services carried out within the scope
of environmental health services;
Provision and control of water resources
Control of solid waste
Pest control
food sanitation
Control of air pollution
Control of noise pollution
Control of radiological pests
Work health
 Duties of health houses
MCH services (pregnant and
child follow-up)
Malaria eradication services
Patient monitoring and
education
Vaccination
AP services
Regulation and protection of
the environment
Health education services
First aid and emergency
treatment services
social assistance services
Detection and monitoring of
deaths, births and migrations.
Health Organization After
1980
In 1987, the Health Services Basic Law was enacted, but it could not be
put into practice.
The green card application was started in 1992.
Health Transformation Program
Basic Principles of the Health
Transformation Program
Human-centeredness: It is stated that the needs, wishes and
expectations of the individual who will benefit from the service will be
taken as a basis in the planning of the system and the provision of the
service, and the individual will be handled within the framework of the
concept of "family health".
Sustainability: It is envisaged that it will show a continuity by feeding
itself in harmony with the conditions and resources of Turkey.
Continuous quality improvement: It is aimed to constantly move
towards better, not seeing the point reached in the services offered as
sufficient.
Participation: During the development and implementation of the
system, it is aimed to create common platforms with a constructive
understanding by taking the opinions and suggestions of all relevant
parties.
Conciliation: It is aimed to meet at common points between different
parts of the sector by considering mutual interests, to provide unity in
standards and audit mechanisms and to comply with this.
Volunteering: It is aimed to ensure that all individuals who will take part
in the health system behave towards the determined goals, and that the
parties producing and receiving the service take part voluntarily in line
with encouraging measures, not forced.
Separation of Powers: It is the principle of separation of powers that
finance, plan, supervise and produce health services.
Decentralization: Organizing institutions according to the principle of
decentralization by making them administratively and financially
autonomous.
Competition in service: It is foreseen that health service provision will
be removed from the state monopoly and different service providers
will be in competition with each other in this field.
Health Transformation Project
Reorganization of the management structure of the Ministry of Health
Establishment of general health insurance
Restructuring of health service delivery
Strengthening basic health services and family medicine
Developing an autonomous management model for public inpatient
treatment institutions
Effective and gradual delivery chain
Health workforce equipped with knowledge and skills and working with
high motivation
Transition to the national health information system (e-health)
Basic principles of family
medicine
Continuity in service
Comprehensive service
Coordination in health services
public health
Preventive medicine
family integrity
Family doctor
The family, which is obliged to provide comprehensive and continuous
personal preventive health services and primary diagnosis, treatment
and rehabilitative health services to each person in a certain place,
regardless of age, gender and disease, providing mobile health services
to the extent necessary and working on a full-time basis. medical
specialist or specialist physician or physicians who have received the
training stipulated by the Ministry.
Duties of the Family Physician
Managing and supervising the family health unit, providing in-service
training
To cooperate with the district health administration in the health
planning of the region where it works.
To inform the public health center and the district health administration
of the situations concerning the community and environmental health
encountered during the practice of medicine.
To provide personal health promoting and protective services
Home visit on first registration
Diagnosis, treatment, rehabilitation services
Basic laboratory services
Registration and notification
First aid and emergency response
Duties of the Family Physician
To carry out examination and treatment by hospitalizing the patient within the
framework of the specialty training he received and the rotations he made
during this training,
To follow up people with chronic diseases as often as necessary,
To carry out health services for people with disabilities,
It is authorized and in charge of monitoring the prenatal, postnatal
puerperium and the baby together.
Family Health Staff
Nurses, midwives, health officers (community health) who serve
together with the family physician, who are contracted or assigned by
the Ministry

Duties
- Receiving and recording vital signs
- To administer the prescribed medications under the supervision of the family
physician
- Conducting wound care services
- To ensure that medical instruments, materials and devices are ready for service
- Assisting the family physician in first aid and emergency response services
- To ensure the coordination of outpatient services, referral, and the institution to
which the patients referred in the absence of a medical secretary are available.
- Taking and sending samples for laboratory examinations
- Mobile services, health education, MCHFP services

Temporary Family Health Staff

The family health worker who takes care of his place when the family health
worker is on leave
FAMILY HEALTH CENTER:
A health institution where family medicine services are provided by one or
more family physicians and family health personnel.

LOCAL HEALTH ADMINISTRATION: Provincial health directorate in provinces

and health group presidency in districts, which carries out health services and
administrative duties for public health and the environment, as well as
training, monitoring, evaluation, inspection and coordination activities.
COMMUNITY HEALTH CENTER: A health center that organizes the health
services of the people and the community living in its region, provides
preventive medicine services of the community, coordinates the primary
health care institutions among themselves and other institutions, and carries
out administrative services, health education and inspection activities.
PRIMARY HEALTH CARE: The health service provided at the first
point of purchase of the people from the health system,
including services for public health and personal protective,
diagnostic, treatment and rehabilitative health services.

SECOND STAGE HEALTH CARE: In cases where the diagnosis and

treatment of patients cannot be provided by primary health
care institutions, the health service provided by the health
institution to which they are referred.

THIRD STAGE HEALTH CARE: The health service provided in a higher

health institution where patients who are not included in the
scope of secondary health care services, require advanced
examination and treatment methods, and whose treatment is
special, are referred.