MALTA. PHIRE Public Health Innovation and Research in Europe. Country Report. May 2012

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PHIRE Public Health Innovation and Research in Europe Country Report MALTA May 2012 EUPHA European Public Health Association P.O. Box 1568 3500 BN Utrecht The Netherlands

This report has been compiled by: Dr. Miriam Camilleri and Dr. Antonella Sammut Members of the Executive Committee of the Malta Association of Public Health Medicine This publication arises from the project PHIRE - Public Health Innovation and Research in Europe, Agreement Number 2009 12 14, which has received funding from the European Union, in the framework of the Health Programme. PHIRE is implemented from 1 September 2010 until 28 February 2013. PHIRE is coordinated by the European Public Health Association (EUPHA). Associated partners are: EHESP, School of Public Health (FR); Faculty of Public Health (FPH, UK); Institute of Hygiene (LIH, LT); Karolinska Institute (SE); Ministry of Health, the Elderly and Community Care (MHEC, MT); NIVEL Institute for health services research (NL); Slovak Public Health Association (SAVEZ, SK). PHIRE Public Health Innovation and Research in Europe 2

Contents Foreword... 4 1. PHIRE Innovation Projects... 5 2. Public Health Research System in Malta... 14 3. National and European Research... 18 4. Recommendations of workshop participants and conclusions... 19 References... 20 Appendix 1. Agenda of the Meeting... 21 Appendix 2. List of Participants... 22 Appendix 3. List of Distributed Documentation... 23 Appendix 4. Copies of Press Release... 24 PHIRE Public Health Innovation and Research in Europe 3

Foreword The PHIRE Country Report for Malta contains three main parts namely: the country health research analysis on the eight research innovation (tracer) projects identified by EUPHA (European Public Health Association) using data from Phase I of the project, a section describing the Country Public Health Research System and a third section on the interaction between National and European Research. The required information was obtained through a wide webbased consultation with local experts in the field of the eight tracer projects and also in the Education and Research Systems in Malta. In addition the authors undertook personal research to collect further information. A draft report was drawn up which was sent electronically to all invitees to the National Meeting for their feedback. A National Meeting was organised with representatives from the Ministry for Health, the Elderly and Community Care (MHEC), researchers and representatives from the Public Health Department of the University of Malta and the Malta Association of Public Health Medicine (MAPHM) to discuss the report. A documentation pack was presented to the participants. During the meeting all sections of the report, including each tracer project, were analysed in detail. Feedback from the web-based consultation was included in the section Information from Local Consultation. Further comments/recommendations for Malta as approved during the National Meeting have been boxed after each relevant section for ease of reference and entitled Additional Information, Comments and Recommendations for Malta. This format was preferred to that of including all comments at the end as such information would be more indicative and appropriate if placed after each relevant section. The agenda of the meeting and a list of annexes and a copy of the press release may be found at the end of this report. PHIRE Public Health Innovation and Research in Europe 4

1. PHIRE Innovation Projects Introduction In Phase I, EUPHA (European Public Health Association) Sections identified eight projects (tracer or innovation projects) initially funded by DG SANCO s Public Health Programme which started during 2003-2005 and were completed by 2006-2008. Information on the uptake and impact of these projects in the countries of the European Economic Area (EEA), i.e. 27 EU Member States, Iceland, rway and Switzerland, was obtained through a questionnaire on each project which was completed by identified country informants. National Public Health Associations also reported on national calls for public health research made in 2010 in their countries. Phase II involved the compilation of a brief Country Health Research Analysis by National Public Health Associations in the EEA countries using the data obtained in Phase I. A report on the eight Innovation Projects for Malta was made available to the Malta Association of Public Health Medicine (MAPHM) to discuss the findings, comment on impact, policy changes and lessons learnt and to provide any additional information or recommendations. After perusing this report which included a template questionnaire that had been used by EUPHA to collect information, it was difficult to interpret the presented findings for Malta because: The summary table illustrating Malta s participation in the projects and questionnaire, and dissemination of results did not provide sufficient material for analysis. The graphical representation of the findings from the questionnaire was limited to only some of the questions and was largely ambiguous, mainly because there was no clear indication of the magnitude of the values represented on the Y-axes. Data provided could not be validated since limited information was provided as to who had supplied EUPHA with information related to the projects. To overcome these limitations, we requested our regional contacts for the project to provide us with the names of: - Local participants in the tracer projects; - Questionnaire respondents and - Method of selection of Country Informants. We also consulted widely with several persons who in our opinion could have potentially participated in the original projects, have known experience in the field or might have knowledge about project implementation. We consulted with senior officials of the Ministry of Health and various public health directorates, University deans/heads of department in related faculties and relevant consultants/clinicians. PHIRE Public Health Innovation and Research in Europe 5

The regional contacts supplied us with the names of the participants for the Vaccine European New Integrated Collaboration Effort (VENICE) project and with the completed questionnaires for VENICE, Children, Obesity and associated avoidable chronic diseases (CHOB) and Healthy Ageing (HA) projects. Eventually we were supplied with names of Country Informants, including those who failed to respond to the questionnaire. Table 1 below outlines the method of selection of Country Informants by PHIRE. Table 1: Methods of selection of Country Informants Innovation project EUPHA Sections membership lists Additional names supplied by Project Leader PubMed abstracts of EUPHA conferences Snowball method VENICE Contacts from previous research projects Original participants CHOB EURO- URHIS I HA EAAD ENHIS CSAP EUCID VENICE - Vaccine European New Integrated Collaboration Effort; CHOB - Children, Obesity and associated avoidable chronic diseases; EURO-URHIS I European system of urban health indicators; HA - Healthy Ageing; EAAD-European Alliance Against Depression; ENHIS - Implementing Environmental and Health Information Systems in Europe; CSAP - Child Safety Action Plans Phase I; EUCID - European Core Indicators in Diabetes Mellitus The summary table illustrating Malta s participation in the tracer projects and questionnaire, and dissemination of results as provided in the PHIRE Report on Tracer Projects for Malta is presented in Table 2 below. Table 2: Malta s input in Tracer Projects Innovation project Project participation Results disseminated Questionnaire completed VENICE Yes Yes Yes CHOB Yes EURO-URHIS I Yes Yes PHIRE Public Health Innovation and Research in Europe 6

HA Yes EAAD ENHIS Yes CSAP Yes EUCID Additional Information, Comments and Recommendations for Malta - Graphical representation of the findings was not clear. It is suggested that results would be better represented in a table format with tick boxes. - The method of selection of Country Informants was not consistent across the projects, thus the validity of the results may be challenged. Concerns were expressed whether this inconsistency has influenced the responses given by other countries. - To our knowledge only one Country Informant per project was selected. Such a subjective form of data collection would have merited more than one Country Informant per project to reduce bias and increase validity. - It is suggested that Country Informants are chosen from EUPHA sections and validated by national Public Health Associations (where present). - The information given in the summary table (Table 2) can be validated except for the fact that for ENHIS and EUCID no Country Informant was approached to answer the questionnaire in the first place. We therefore recommend that PHIRE amend the table accordingly. VENICE Vaccine European New Integrated Collaboration Innovation Project Participation Results disseminated Questionnaire completed VENICE Vaccine European New Integrated Collaboration Effort Yes Yes Yes Findings from PHIRE Phase I: - The project had limited impact on Government policy/reforms and initiation of projects but no impact on Government knowledge/awareness and regulation/law changes. This may be attributed to the project not being given sufficient priority. - The local Advisory Committee for Immunisation Policy (ACIP) has facilitated the impact of the project. PHIRE Public Health Innovation and Research in Europe 7

- Results were disseminated via co-operation with other authorities; namely public health doctors and health care professionals working in the National Immunisation Service within the Ministry of Health. - Results of the project are still being disseminated to individuals who specifically ask for this information. Information from local participants: - The participants feel that the project provides a platform for the sharing of information about vaccination protocols amongst the member states and this helps the Advisory Committee for Immunisation Policy (ACIP) in making informed decisions. - Originally, the proposed time span of the project was that of three years. However once a network of public health professionals from all member states had been established, the project time was extended, and exchange of information is still ongoing. - Local participants answer requests for information from project leads or other persons directly involved in the project. - Participants however feel that time frames for response and submission of data are too short especially in view of the limited human resource capacity. Additional Information, Comments and Recommendations for Malta - Data collected should not remain limited to coverage rates of childhood mandatory vaccines but should be extended to include adult vaccine preventable disease in priority areas as determined from time to time by the European situation. - The EU could provide reference laboratories to assist small member states in conducting epidemiological research to evaluate the impact on vaccination. CHOB - Children, Obesity and associated avoidable chronic diseases Innovation Project Participation Results disseminated Questionnaire completed CHOB - Children, Obesity and associated avoidable chronic diseases Yes Findings from PHIRE Phase I: - The results were disseminated via channels that were not mentioned in the questionnaire. - The project had limited impact on Government project initiation. - There was no impact on Government policy/reforms, regulation/law changes and knowledge/awareness. - Impact was facilitated by an adequate infrastructure. - Impact was hampered by the lack of national and international networks and the lack of enthusiastic dedicated persons. PHIRE Public Health Innovation and Research in Europe 8

- There is no ongoing dissemination of results in Malta. Information from local consultation - Malta participates regularly in the Health Behaviour in School-Aged Children Survey (HBSC) and the European Children Obesity Study Initiatives (ECOSI) led by WHO. - Research has been conducted in this area and includes: Comparison of body mass index of a national cohort of Maltese children over a 3-year interval (Farrugia Sant Angelo & Grech 2011) Body mass index estimation in a school-entry aged cohort in Malta (Farrugia Sant Angelo & Grech 2011). Childhood obesity: a critical Maltese health issue (Grech V. 2007). - A National Strategy against Obesity for Malta entitled A Healthy Weight for Life was launched in February 2012 with dedicated funds from Programmes and Initiatives of the Ministry for Health budget ( 200,000 in 2011 and 160,000 in 2012). - A Strategy for the Prevention and Control of n-communicable Diseases in Malta launched in April 2010 also contained a section dedicated to Obesity prevention. Additional Information, Comments and Recommendations for Malta - To our knowledge, Malta did not participate in this project so the findings from PHIRE Phase I presented in the Tracer Report for Malta reflect the views of the country informant. This should be clarified in the PHIRE Tracer Report. - The Country Informant seems to be unaware of a number of developments in the area of child obesity. These developments may have been partly influenced by the outcomes of this project. - An Intersectoral Committee on Combating Obesity (ICCO) was set up following the Istanbul Charter in 2007. Its main objective is to develop an inter-ministerial strategy to combat both adult and childhood obesity. - The Ministry of Education in collaboration with Health Promotion Disease Prevention Directorate has formulated the Healthy Eating and Lifestyle Plan (HELP) to promote healthy eating and lifestyles within the school setting (https://education.gov.mt/mediacenter/docs/1_healty%20eating.pdf). - Fruit and vegetable scheme is available in local primary schools co-funded by the EU. EURO-URHIS I European system of urban health indicators Innovation Project Participation Results disseminated Questionnaire completed EURO-URHIS I European system of urban health indicators Yes Yes Findings from PHIRE Phase I: PHIRE Public Health Innovation and Research in Europe 9

- other findings were reported. Information from local consultation: - It is noted that the approached country informant failed to respond the questionnaire. - additional information was obtained. Additional Information, Comments and Recommendations for Malta - Project did not have major impact on Malta because locally there is no comparable rural setting found in other countries. HA Healthy Ageing Innovation Project Participation Results disseminated Questionnaire completed HA Healthy Ageing Yes Findings from PHIRE Phase I: - Dissemination of results was via national conferences, seminars and lectures to health authorities and via the mass media. - Healthy Ageing project had no impact on Government policy/reforms, project initiation, regulation/law changes or knowledge/awareness. - Factors hindering impact are lack of financial resources, lack of enthusiastic/dedicated persons and lack of national networks. - The respondent was not aware if results were still being disseminated. Information from local consultation - In 2011, the Ministry for Health, the Elderly and Community Care appointed a Commissioner for Older Persons whose responsibilities include the promotion and provision of opportunities for older persons, their participation in public life, and the support of best practices in treatment. - A national committee on Active Ageing was set up by the Ministry for Health, the Elderly and Community Care in conjunction with the European Year for Active Ageing (2012) in order to consult with stakeholders, including civil society organizations, and to identify key actions, initiatives and projects that will respond to the challenges of Europe s changing society. - A comprehensive active ageing strategy is currently being drafted as part fulfilment of the Council Recommendation on the National Reform Programme 2011 for Malta. PHIRE Public Health Innovation and Research in Europe 10

Additional Information, Comments and Recommendations for Malta - To our knowledge, Malta did not participate in this project and did not disseminate any results, so the findings from PHIRE Phase I presented in the tracer report for Malta reflect the views of the country informant. This should be clarified in the PHIRE Tracer Report. - Malta was first to raise the question of Ageing as a matter of international concern at the United Nations in 1968. A UN International Institute on Ageing (INIA) was founded in Malta in April 1988. - A conference was held in April 2012 to officially launch the Year for Active Ageing Programme and Solidarity between generations. - The elderly contribute in voluntary activities and also in the upbringing of their grand children. 24.5% of retired persons in Malta have done voluntary work (Eurostat 2012) - People of pensionable age were given the opportunity to continue working if they wished to do so, thus being able to contribute in a more direct way to society whilst being more financially independent. - A new draft Mental Health Act to repeal the one in force has been prepared. - Several initiatives in favour of the elderly have been in place even prior to the onset of the project, including the appointment of Parliamentary Secretary for the Elderly in 1987, several community services such as meals on wheels, handyman and telecare services and also the establishment of the University for the third age. EAAD European Alliance Against Depression Innovation Project Participation Results disseminated Questionnaire completed EAAD European Alliance Against Depression Findings from PHIRE Phase I: - other findings were reported. Information from local consultation: - The above information has been validated. - It is noted that the approached country informant failed to respond to the questionnaire. - In 2011, the Ministry for Health appointed a Commissioner for Mental Health. Additional Information, Comments and Recommendations for Malta - A new draft Mental Health Act to repeal the one in force has been prepared. PHIRE Public Health Innovation and Research in Europe 11

ENHIS Implementing Environmental and Health Information Systems in Europe Innovation Project Participation Results disseminated Questionnaire completed ENHIS Implementing Environmental and Health Information Systems in Europe Yes Findings from PHIRE Phase I: - other findings were reported. Information from local consultation: - country informant was approached to answer the questionnaire. - To our knowledge ENHIS is an ongoing process led by WHO. - New indicators will continue to be developed through Ministerial Conferences led by WHO. - Malta is committed to support ENHIS in the development of these indicators and their implementation. Additional Information, Comments and Recommendations for Malta - Country informant was approached to answer the questionnaire. We therefore recommend that PHIRE amend the table accordingly. - Malta should develop indicator-based analyses and reporting following the ENHIS method. CSAP Child Safety Action Plans, Phase I Innovation Project Participation Results disseminated Questionnaire completed CSAP Child Safety Action Plans, Phase I Yes Findings from PHIRE Phase I: - other findings were reported. Information from local consultation - Malta participated as an observer country in Phase I of the CSAP (2004-2007). - Malta participated in Phase II of the CSAP project (2007-2010). PHIRE Public Health Innovation and Research in Europe 12

- Malta developed Child Safety Report Cards and Country Profiles as part of the CSAP (Phase II). - Malta is also participating in TACTICS, a project that builds on the CSAP. - Results for Malta from CSAP are being compared to those from TACTICS. - The analysis will be presented to the Malta Commissioner for Children as evidence which may result in policy change. - It is noted that the approached country informant failed to respond to the questionnaire. Additional Information, Comments and Recommendations for Malta - One of the challenges of developing a Child Safety Action Plan is that there is no lead Ministry to spear head the various initiatives undertaken in the field of child safety by various ministries. EUCID - European Core Indicators in Diabetes Mellitus Innovation Project EUCID - European Core Indicators in Diabetes Mellitus Participation Results disseminated Questionnaire completed Findings from PHIRE Phase I: - other findings were reported. Information from local consultation - country informant was approached to answer the questionnaire. - Malta (University of Malta) is participating in the BIRO and EUBIROD projects. - These projects build upon previous projects including EUCID. Additional Information, Comments and Recommendations for Malta - country informant was approached to answer the questionnaire. We therefore recommend that PHIRE amend the table accordingly. - BIRO and EUROBIROD have developed a system of collecting, analysing and producing reports on diabetes data collected from different data systems. - These systems are used in the Primary Care and to a lesser extent in Hospital settings. - Data generated in these clinics feeds EUROBIROD. PHIRE Public Health Innovation and Research in Europe 13

2. Public Health Research System in Malta Figure 1: Collaboration between entities responsible for Public Health Research PUBLIC HEALTH RESEARCH ENTITIES National Government n Governmental Organisations Ministry of Education Ministry for Health, the Elderly & Community Care Discern Malta Council for Science and Technology Other Ministries National Statistics Office University Department of Health Information & Research Findings from PHIRE Phase I - The organogram illustrates the collaboration between different entities responsible for public health research in Malta. - An NGO namely Discern was added to the original oraganogram represented in STEPS (Strengthening Engagement in Public Health Research), since this information had been supplied under the section dedicated to independent organizations. - During 2010 there were no national calls for public health research in Malta. PHIRE Public Health Innovation and Research in Europe 14

- The National Research and Innovation Programme funded three projects in 2010, none of which were in the area of public health. - The Malta Council for Science and Technology has developed a National Strategy for Research and Innovation (2007-2010) entitled Building and sustaining the Research and Innovation Enabling Framework. - Programmes and calls Malta Government Scholarship Scheme (MGSS 2010) Strategic Educational Pathways Scholarships (STEPS). Commonwealth Scholarship and Fellowship Plan. Chevening Scholarships (British Council) Ad Hoc scholarships by Ministry for Education Information from Local Consultation In Malta there is no established Ministry of Science, however the Malta Council for Science and Technology (MCST) is the government body responsible for research policy, promoting scientific research, management of the local research funding programme and the national contact point organisation for the EU Research Framework Programme (FP). In addition the University of Malta within the Ministry of Education also undertakes research. The MCST, the Ministry for Health, the Ministry of Education, the University of Malta and other entities such as independent foundations are all autonomous and have distinct roles and responsibilities. Although some intersectoral collaboration does exist, this needs to be strengthened. The tendency is that every organisation/entity works on its own with limited results and with the risk of overlap. A concerted effort between the relevant stakeholders would encourage the pooling of resources leading to a more comprehensive approach and yielding better results. The participation of NGOs is still limited probably because of financial constraints. However, in 2010 SOS (Solidarity Overseas Service) Malta, one of the leading NGOs, held a national workshop Engaging Society in Public Health Research as part of the STEPS (Strengthening Engagement in Public Health Research) project of the EU Commission 7th Framework Programme. The Malta Health Network which is an umbrella organisation for patient organisations has also participated in Public Health Projects (Camilleri 2010). Also, other NGOs such as Jesuit Refugee Service (JRS), European Anti Poverty Network (Malta), Médecins Sans Frontières (MSF) take part in research. In Malta there is no commissioning within a national strategy set up. A policy is spear headed by the Government who is the main service provider. Government funds are allocated to the public health department which in turn is responsible to put the policy into action by formulating the necessary strategy. In the 2012 Government Financial Estimates the sum of 160,000 is allocated to the Strategy for Obesity Prevention and another 200,000 for the National Dementia Strategy which are fields related to the PHIRE Tracer Projects. Funds are also obtained through the participation in WHO initiatives and EU programmes. To our knowledge no public health research was commissioned in 2010. PHIRE Public Health Innovation and Research in Europe 15

Public Health Research is open to all persons interested in the field, including civil society. The information provided (Findings from PHIRE Phase I) is correct, however other Independent Organizations/Companies including NGOs conduct research which may be Public Health related especially in areas of social inequalities and social determinants of health. Academic research is also carried out by Maltese individuals following undergraduate/post graduate studies in foreign Universities/Institutions. Additional Information, Comments and Recommendations for Malta - It was suggested that the Organogram would be amended as shown in Figure 2 as research is also conducted by other NGOs (SOS Malta, MHN, JRS, EAPN, MSF) and other departments within the Ministry for Health, the Elderly and Community Care conduct research. - A centralised databank of research output should be set up. - Dissemination of project results should be channelled through the National Focal Point for Research Projects who in turn would send them to the secretary of the National Public Health Association (MAPHM). PHIRE Public Health Innovation and Research in Europe 16

Figure 2: Amended organogram depicting wider areas of public health research PUBLIC HEALTH RESEARCH ENTITIES National Government n Governmental Organisations Ministry of Education Ministry for Health, the Elderly, & Community Care Ex: Discern, SOS Malta, MHN, JRS, MSF, EAPN Research in other departments Other Ministries Malta Council for Science and Technology National Statistics Office University Department of Health Information and Research PHIRE Public Health Innovation and Research in Europe 17

3. National and European Research PHIRE Innovation Projects and National Research To our knowledge there are no National Research Programmes being conducted in the areas of the PHIRE Tracer Projects (other than those being conducted within European Projects). To our knowledge there is currently no national research being conducted (other than research being conducted within WHO initiatives and EU Projects). National and European Research The Ministry for Health, the Elderly and Community Care (MHEC) reiterates its position against EU financing of embryonic stem cell clone lines that are freshly produced by destroying human embryos or the use of embryonic stem cell clone lines because of reasons of commodification. The Ministry of Health communicates with the Office of the Prime Minister which spear heads the National consultation on the European Union s Horizon 2020 research programme. The main funding programmes (structural funds and Health for Growth programmes) that will supersede the Current Public Health Programme are still being discussed at EU level. MHEC scrutinizes the relevant EU documents and provides instruction notes and positions accordingly. Consultation is carried out through the EU affairs directorate. If the consultation requested is on a large scale it may be done through the Malta-EU Steering and Action Committee (MEUSAC). MHEC is presently engaged in the following research projects: - European Social Fund project involving research on Occupational Health and Safety partially financed by EU. - RESPIRA project co-funded by the Malta Italia project and the EU. - MHEC has been consulted and is currently involved in the preparation of a draft health research and innovation strategy. PHIRE Public Health Innovation and Research in Europe 18

4. Recommendations of workshop participants and conclusions The country health research analysis for Malta has presented an opportunity to assess the impact of the eight tracer projects on policy changes and the lessons learnt from such an experience. The shortcomings and difficulties encountered when undertaking the analysis were summarised after each relevant section. The main limitations of PHIRE work package 4 include the methodology used in choosing the Country Informant, the validation of the answers to the questionnaires and the inaccuracy in reporting whether such questionnaires were completed or otherwise. Recommendations mainly emanating from the national meeting were added at the end of each section. The analysis helped us review our public health research systems and identify areas which need to be further developed and improved. It highlighted the contribution to public health research by different research bodies and organisations, both governmental and non governmental. The report also indicated the interface between National and European research. Presentation of the PHIRE Phase II Country Health Research Analysis at the National Meeting has helped us to raise awareness on Public Health Research within our Ministry and appreciate the benefits of continuous exchange of information and results of research. This would translate into more effective and appropriate policies, strategies and actions to combat the ever increasing health challenges being presented by demographic changes and modern lifestyles in a scenario of global economic instability. PHIRE Public Health Innovation and Research in Europe 19

References Camilleri M. (2010). Reviewing Public Health Capacity in the EU - Assessment Tool for Public Health Capacity in the EU Member States Malta. Eurostat (2012). Active ageing and solidarity between generations. European Commission 2012 edition. Farrugia Sant Angelo V., Grech V., (2009). Body mass index estimation in a school-entry aged cohort in Malta. International Journal of Paediatric Obesity 4: 126_128. Farrugia Sant Angelo V., Grech V., (2011). Comparison of body mass index of a national cohort of Maltese children over a 3-year interval. Malta Medical Journal Volume 23 Issue 01. Financial Estimates 2012. Ministry of Finance, the Economy and Investment. Grech V. (2007). Childhood obesity: a critical Maltese health issue. Journal of the Malta College of Pharmacy Practice Issue 12. PHIRE Public Health Innovation and Research in Europe 20

Appendix 1. Agenda of the Meeting National Meeting as part of PHIRE Project 5 th April 2012 09:00 Welcome coffee 09:15 Welcome speech Dr Charmaine Gauci, MAPHM president 09:25 Introduction to PHIRE Dr Marvic Sammut & Dr Amanda Saliba, Regional Co-ordinators PHIRE 09:40 PHIRE Phase II Country Health Research Analysis - Methodology Dr Miriam Camilleri 09:55 PHIRE Phase II Country Health Research Analysis - Results Dr Antonella Sammut 10:20 Coffee Break 10:40 Discussion Moderator Dr Miriam Camilleri 12:00 Feedback from discussion 12:30 Concluding remarks Dr Charmaine Gauci, MAPHM president PHIRE Public Health Innovation and Research in Europe 21

Appendix 2. List of Participants Name Organisation Dr Charmaine Gauci Dr Neville Calleja Ms Mary Scicluna Dr Julian Mamo Director Health Promotion and Disease Prevention, Ministry for Health, the Elderly and Community Care; President, Malta Association of Public Health Medicine Director Health Information and Research, Ministry for Health, the Elderly and Community Care National Focal Point for Public Health Programme, Committee; Member on Public Health Programme, Ministry for Health, the Elderly and Community Care Head of Department of Public Health, University of Malta Dr Marvic Sammut PHIRE Regional Co-ordinator Dr Amanda Saliba PHIRE Regional Co-ordinator Dr Anthony Gatt Executive Secretary, Malta Association of Public Health Medicine Dr Miriam Gatt Dr Alexia Bezzina Dr Miriam Camilleri Dr Antonella Sammut Member Executive Committee, Malta Association of Public Health Medicine Associate Member Executive Committee, Malta Association of Public Health Medicine Country expert of the project Developing Public Health Capacity in the EU ; Member Executive Committee Malta Association of Public Health Medicine; Co-author PHIRE Malta Country Report, Member Executive Committee Malta Association of Public Health Medicine; Co-author PHIRE Malta Country Report PHIRE Public Health Innovation and Research in Europe 22

Appendix 3. List of Distributed Documentation Appendix 1 Appendix 2 Annex 1 Annex 2 Annex 3 Annex 4 Annex 5 Annex 6 Agenda List of Participants Background to PHIRE Malta s input in Tracer Projects Methods of Selection of Country Informants Results of selected questions from the web-based questionnaire Country Health Research System Points for Discussion PHIRE Public Health Innovation and Research in Europe 23

Appendix 4. Copies of Press Release Press Release by the Ministry for Health, the Elderly and Community Care in collaboration with the Malta Association of Public Health Medicine The Ministry for Health, the Elderly and Community Care is an associate partner in the Public Health and Research Innovation in Europe (PHIRE) project, an EU public health programme project, which aims to contribute to the improvement of public health research across the European Union. This project, which has been done in collaboration with the Malta Association of Public Health Medicine has two phases. Phase I of the project involved collection of information on eight tracer projects co-funded by the first European Public Health Programme and information on National Public Health Calls and Projects funded nationally. The project collected information from thirty EU/EEA countries. In Phase II, the Malta Association of Public Health Medicine looked at the impact of Phase I report. The topics encompassed Vaccination, Child Obesity, Child Safety, Healthy Ageing, Depression, Health Indicators and Health Information Systems. In addition the report analysed contribution to National and European public health research. This report was discussed at a National meeting with stakeholders from the Ministry for Health, the Elderly and Community Care, the Public Health Department of the University of Malta and the Malta Association of Public Health Medicine. The meeting also provided an opportunity to raise awareness on Public Health Research within our Ministry and appreciate the added value of information obtained through validated research. It was concluded that collaboration and sharing of knowledge would translate into more cost-effective and appropriate policies, strategies and actions to combat the ever increasing health challenges being presented by demographic changes and modern lifestyles, in a scenario of global economic instability. PHIRE Public Health Innovation and Research in Europe 24